The docs tackle your queries about postmodern medicine:
Q: I hear about many medical breakthroughs. What illnesses might be conquered in the next three to five years?
A: Two areas of medicine will probably see major changes soon. First up: vaccines, which in widespread use virtually wiped out polio and smallpox by 1980. We’re constantly working on new vaccine technology, and it wouldn’t be surprising if malaria, dengue fever and many other viral illnesses are vaccine-preventable within five years. Beyond that, scientists are working on vaccines to protect against illnesses that aren’t traditionally thought of as virally induced, such as breast and prostate cancer and even addiction.
Second: diseases we already can prevent, but don’t. You can decrease your risk for heart disease, stroke, cancer and mental dysfunction significantly—some studies suggest by up to 80 or 90 percent—by making a few changes. You should: Eat a diet with less than 4 ounces of red meat per week, five servings of fruits and vegetables per day, only whole grains and no added sugars or syrups; do at least 30 minutes of physical activity daily (walking counts!); have a body mass index (BMI) under 25; avoid all tobacco products; and drink alcohol in moderation (less than two drinks for men and one for women per day).
On The Daily Show last year, host Jon Stewart had a wonderful segment describing how Congress will do anything or pass any law to prevent even one American from getting Ebola but wouldn’t enact any ban on sugary food or virtually any cause of heart disease. The truth is, when you consider the most common illness-related causes of mortality, much of our fate rests in our own hands. Focus on the actions you can take to live healthier, and you’ll play an important role in eradicating diseases—no lab coat required.
Q: I keep hearing about “superbugs” and antibiotic resistance. Will this problem be solved or is it only going to worsen?
A: You’re right to be concerned. Many in medicine fear drug-resistant bugs—and biological terrorists using them—more than anything else. Why has this resistance mess occurred? Well, the superbug epidemic was not caused by people stopping short on their seven-day course of sinus infection drugs (although we don’t condone that!).
More than 80 percent of the antibiotics sold in the U.S. are given to livestock and poultry, not humans. The drugs usually are used as a preventive measure, not for sick animals, but to enable efficient, cheap mass production. And the drugs don’t just stay in the animal; they run off into our water supplies and our environment. The Food and Drug Administration is phasing in a policy that bans routine non-illness use of antibiotics for livestock and poultry farming. One key way you can fight superbug development now is to buy poultry and livestock products with: a “USDA Organic” seal, labeling of “no antibiotics added” or “no antibiotics administered” that’s accompnied by a “USDA Process Verified” shield, or private certification by entities such as Global Animal Partnership or Whole Foods.
Scientists are working on alternatives to antibiotics, but the going is slow. There are interesting studies about using probiotics, or healthy bacteria, to fight and prevent infections. We’re also seeing promising research about using liposomes to treat bacterial infections. (Liposomes are molecules made up of lipids that mimic the appearance of host cell membranes, so when bacteria come in and release toxins, they attack the liposomes instead of your cells.) We’re not sure when drugs like these might reach the market, but we’ll stay tuned.
Q: What’s your opinion of websites and apps that offer e-consultations with doctors and nurses?
A: Although you shouldn’t rely on e-consults for all of your medical needs, they can help solve some important health quandaries. First and foremost, they’re a highly efficient way to get a second opinion—an underrated step in ensuring you’re receiving the best and most appropriate care. Get this: A second opinion changes diagnosis or treatment a whopping 30 percent of the time, according to research. Telemedicine can give you access to specialists for a second opinion on anything that may involve an invasive procedure or taking a drug for longer than three weeks. In addition, e-consults are great for people who need nutrition coaching with registered dietitians but for some reason can’t meet with one regularly in person; they’re also helpful for homebound patients or those who live far from specialists.
To reduce red-tape headaches, it’s smart to use a telemedicine program that’s either based in your state or that’s affiliated with a large health- care organization—one big enough to employ experts with licenses to practice medicine across state lines. The rules are a little complicated, so ask questions and do research to determine who is able to treat you. At the Cleveland Clinic, our MyConsult program is available to anyone in all 50 states and in many foreign countries; similar programs exist at other organizations.
Q: I’ve been thinking about getting a DNA analysis to learn about my risk for various diseases. Who is a good candidate for these tests and why?
A: Only a few years ago, you had to be wealthy to afford the cost of knowing your genome. Nowadays, DNA kits can be ordered online for less than the price of a new iPhone. Unfortunately, the FDA limits your ability to receive genetic health information without seeing a specialist. Currently, DNA kit companies such as 23andMe offer only ancestry-related DNA reports. They will send you raw genetic data, but you’ll need to take that data to a genetic specialist to make sense of it. So how do you determine whether that’s a good idea? If you have a family history of a certain disease, it can be helpful to have a genetic specialist assess your risk for that disease.
It’s important to think about the two outcomes of these screenings. You’ll learn either that you don’t carry Uncle Joe’s risky genes and get peace of mind, or that you do carry them and may be able to do something about it. You can change your gene expression—at least for certain diseases—by eating well and exercising often. So will you? Many of us won’t: Research on men found that even those who had just suffered heart attacks altered their heart-risk behaviors for only two weeks afterward. So think carefully about whether learning you’re at a higher risk for a certain illness will spark you into action or if it will only add stress to all of your other risk factors.