Who's To Blame?

Kevin MD is a respected web site and e-newsletter with a collection of interesting points of view, many from the physician community perspective. 

They had this post, from an internist and public policy wonk named Steven Schimpff, MD. In an interesting article about rationing and whether we need it, he argues the same points that many have argued before -- too much unnecessary testing when patient history and deduction would do (he doesn't address the issue of our litigious society and what happens when tests aren't done and outcomes are negative), too much unnecessary treatment at end of life when palliative care would do, and too much prescribing when lifestyle changes would do. 

Fine. 

It's this sentence, however, that pissed me off.

"As a society, we eat a non-nutritious diet and far too  much of it, we are sedentary, we are chronically stressed and 20% still smoke. The results are complex chronic illnesses like diabetes, heart disease, cancer, and stroke."

It's a lazy sentence that paints a way-too-wide brush. The results of such "bad" behavior aren't these illnesses. It may be a RISE in incidence of these diseases -- certainly there's a link between smoking and certain cancers, and some evidence points to links between obesity and some cancers, too. 

But there's also genetics at play. There are genetic links to some cancers, to heart disease and I believe diabetes (but don't quote me on that last bit... I'm not a doctor.) There's also a generation of chemicals and other environmental factors that have been permeating society that many would argue are part of the cause.

Cancer patients and survivors already spend enough time thinking, "What could I have done to prevent this cancer?"  We don't need someone pointing a finger at our behavior, too. I'll own up to being stressed - but I'm far from sedentary, have never eaten all that bad, and don't smoke. Sometimes bad things just happen.