It's time to put prevention back into preventive healthcare

This OpEd from Dr. Klodas appeared in the Minneapolis StarTribune this week.

This week the U.S. Preventive Services Task Force (USPSTF) — the same body that tells us when to get a colonoscopy, get immunized or have our cholesterol checked — weighed in on preventing heart disease, advising doctors on who should take statin medications (like Lipitor and Crestor).

Nearly 40 million American adults already take statins, at a cost of $17 billion per year. This new guideline is poised to expand these numbers dramatically.



The recommendations also signal a fundamental shift in preventive care: Pills are now the first resort, not the last. So long as you have a risk factor for heart disease, are between 40 and 75 years of age, and meet a risk calculation threshold (which most people do) — congratulations, here’s your prescription, for the rest of your life.

Sure, side effects are possible, but don’t worry about those, just take the pill.

Physicians like me are already pushing back. Dr. Rita Redberg from the University of California, San Francisco, points out that the absolute risk reduction from expanded statin use is small, and risk of side effects (like muscle aches and brain fog) is not inconsequential.

Most importantly, the recommendations do nothing to address the major root causes of heart disease: poor diet and inactivity. Voluminous data (ignored by the task force) support effective lifestyle alternatives. For example, Dr. Dean Ornish’s Lifestyle Program has been shown to go beyond prevention and actually undo heart disease. Dr. Joel Fuhrman’s Eat to Live plan has been shown to reverse diabetes. And Step One Foods’ food substitution approach has been shown to improve cholesterol profiles in as little as 30 days.

All of these programs are nutrition-based, not pill-based. They don’t come with side effects. They come with side benefits like weight loss and lower blood pressure.

The task force missed the mark. Instead of creating guidelines around who should take pills, as a preventive task force, they should have focused on strategies to prevent the need for medications in the first place. Lifestyle change is the real solution to reducing the incidence of heart disease, controlling health care costs, and helping patients feel better. Pills should be the last resort.