You recently responded to a motion by Ms Corinne Ellemeet by saying: “There is no such thing as lifestyle medicine”. Well, we can tell you that you’ve been misinformed, and we’d like to put that right.
Let’s start with the Van Dale dictionary’s definition of ‘medicine’: the science that identifies the cause and nature of diseases and indicates the appropriate medications (= curative substance, medicine). And let’s apply that definition to lifestyle-related diseases, using type 2 diabetes as a prototype. We have identified the most important cause of this disease – which is lifestyle. Solid scientific evidence has now pinpointed the best medicine for this disease – lifestyle modification is by far and away the most effective cure. In fact, lifestyle is the sole medicine for type 2 diabetes, as it is the only way to cure this disease completely. All other medicines – i.e. pills and insulin – reduce blood glucose levels, but do nothing to resolve the underlying problems. So they are not a cure.
Interaction between genes and lifestyle
To put it even more succinctly: pharmaceutical preparations do not comply with the definition of a medicine. So, in this case, lifestyle has to be seen as medicine rather than prevention. Incidentally, almost all chronic, non-communicable diseases (which affect 8.5 million people in the Netherlands) are the result of interactions between our genes and our lifestyle. We can’t modify our genes, but we can do something about our lifestyle.
“Lifestyle is the sole medicine for type 2 diabetes, as it is the only way to cure this disease completely”
No place for lifestyle medicine
Perhaps you meant, “No use is being made of lifestyle medicine”. That would be a more accurate statement. Lifestyle medicine has no place in the everyday reality of Dutch healthcare. There are historical reasons for this. We tend to wait until people get sick, and then expect doctors to solve the problem with a pill or an operation. That healthcare model worked just fine – a hundred years ago. Then, our biggest problems were infectious diseases and accidents.
Healthcare model no longer fit for purpose
Today, most diseases are very different in nature. They tend to be complex, systemic disorders that are often triggered by unhealthy lifestyles. The old model is no longer fit for purpose. Doctors have no time for lifestyle coaching, nor is there an effective reimbursement scheme, because the effects of laws and regulations are compartmentalized into ‘care’ and ‘prevention’. As a result, insurers refuse to formally reimburse the costs of lifestyle medicine under the Healthcare Insurance Act, local authorities are unable to comply with their duties under the Social Support Act (Wmo) and everyone points the finger at ‘the system’, i.e. at you. At the end of the day, it is the people with type 2 diabetes who pay the price.
“I hope you won’t let the business community tell us how to run our healthcare system”
One thirteenth of the cost
You know, you are about the same age as we are. If we three were to develop type 2 diabetes today – and the figures show that, even at our age, this is not unrealistic – then the total cost of treating us for the rest of our lives would be about 130,000 euros each. In our case, a lifestyle medicine programme would cost around 10,000 euros, or just 1/13th of that amount! To say nothing of the personal and social benefits of being less severely ill or, indeed, entirely healthy. Hardly a difficult choice, right? Where there are winners, there are, of course, losers. We would not need nearly as many pills, and the loss of potential patients would impact the health service financially. But I hope you won’t let the business community tell us how to run our healthcare system.
Lifestyle medicine: there really is such a thing! Of course, we don’t yet have supporting evidence for every single lifestyle-related disease. Nor will lifestyle medicine cure every single patient. So, if we are to develop effective lifestyle medicine, in the broadest possible sense, we will need an effective research agenda. Together with counterparts in the Netherlands, we’d be happy to get involved in this. But research alone is not enough.
“Substantial modifications will be needed if the healthcare system is to tackle diseases that can be cured by lifestyle changes From care to cure. And from the consulting room to the living room”
From care to cure
Substantial modifications will be needed if the healthcare system is to tackle diseases that can be cured by lifestyle changes. From care to cure. And from the consulting room to the living room. We need a system that enables members of the public/patients to take control of their own health, 365 days a year. You are responsible for the system. You have it in your power to facilitate the use of lifestyle medicine in the Netherlands. The ball is in your court!
Ben van Ommen (Principal Scientist at TNO)
Hanno Pijl (Professor of Diabetes at Leiden University Medical Centre – LUMC)
- Healthy Living