From our archives: False Hopes

FALSE HOPES - Why America's Quest for Perfect Health Is a Recipe for Failure by Daniel Callahan, Simon & Schuster, New York, 1998. 330 pp,$24, ISBN 0-684-81109-X

Daniel Callahan, cofounder of the Hastings Center and the Director of its International Programs, takes on the entire medical establishment--doctors, nurses, hospital administrators, medical researchers, and pharmaceutical and medical technology companies--all of whom he believes are united in a relentless pursuit of unlimited medical progress, stopping at nothing short of the conquest of all disease and the indefinite extension of life spans (see last month's review of Schwartz' Life Without Disease - The Pursuit of Medical Utopia). 

The Hastings Center is an avant-garde institution where any idea can be explored (see "Duty to Die" in the HHK column in this issue of the Journal). Callahan, as the president of the Hastings Center from 1969 to 1996, must be taken seriously. In the preface, he presents his political leanings, aligning himself with the Clintons in their quest for healthcare reform. He bemoans the fact that no plan made it through Congress--not one bill, not a single reform. Callahan is even more appalled that at the next presidential election, both candidates all but ignored the issue.

Initially, the reason he takes this stance is not clear. However, he soon points out that the universal, if poorly financed and often corrupt, healthcare systems in China, Southeast Asia, and in much of Latin America, are turning to the marketplace and accepting privatization as their new gospel. He finds it most unsettling that the popular, well managed, equitable health care systems of Western Europe have begun to unravel in the post WW II welfare state. These systems, beset with rising costs, are high on the budgetary hit lists of political leaders who are looking to the marketplace to reduce public benefits, thus securing their own future.

Callahan realizes that if everyone is having a problem, and all are looking for answers, there must be an underlying basic issue. Almost all healthcare reform efforts assume that the solution lies in better organization and financing. Callahan then observes that no matter how much money is spent and no matter what the health gains may be, they never seem to be enough. Conventional solutions do not address the real problem. No matter how much progress, they always seem insufficient to meet the "needs" of the day.

The most cherished and celebrated aims, commitments, and values of modern medicine are beginning to give us trouble. But challenging these ideas, Callahan reflects, is not new. Rene Dubois in his 1954 book Mirage of Health questioned the then imminently anticipated total conquest of disease and stated this would not happen, not soon, not ever. In the 1970s, theologian Ivan Illich, British physician John Powles, American physician Rick Carlson, and British professor of social medicine, Thomas McKeown, each showed in a systematic way that there is no clear correlation between population health and medical care. Carson boldly predicted the diminishing impact of physicians and hospitals on health by the year 2000.

Callahan emphasizes that "A serious transformation will require taking money away from the acute-care sector, including research into the cure of many lethal diseases, and using it instead on prevention research and massive educational efforts designed to change health-related behavior." Callahan asserts that sustainable medicine will do the following: give priority to preventing and treating diseases that afflict the many rather than finding cures for diseases that effect the few, improve the quality of life for the elderly rather than extend life indefinitely, and focus on primary care and public health measures that benefit society as a whole rather than satisfying the health needs of individuals.

Callahan as an ethicist explores topics and issues on which to base future dialogue as well as change the direction of the debate. But he doesn't give us the final answer. He does point out that many Americans are bypassing traditional physicians and hospitals and are going to alternative medicine practitioners whom they pay from their own pockets. According to some estimates, these visits exceed those to traditional practitioners. This demonstrates that patients will pay for what they perceive as valuable.

However, Callahan's prejudices outlined in the preface, may prevent an objective extension of the excellent ground work he has developed. He might also have mentioned that the current debates in Britain and Europe include proposals for a significant transfer of costs from the national health systems to the individual through major co-payment plans, not only for office visits, but also for hospital stays in some instances. That may not be politically correct, but it would be a giant step toward what is economically correct for our patients.

Del Meyer, MD

This review is found at www.delmeyer.net/bkrv1098.htm.

To read more reviews, go to www.delmeyer.net/PhysicianPatientBookshelf.htm.

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DIETS STILL DON'T WORK  

DIETS STILL DON'T WORK  by Bob Schwartz, PhD, Breakthru Publishing, Houston, Texas, 202 pp, $9.95 © 1990, by Robert M. Schwartz, ISBN: 0-942540-04-2. Review by Del Meyer, MD

The Really Bad News

Dr. Bob Schwartz summarizes a lot of his first book, Diets Don't Work, (some thought this was a joke book) written in 1982 (with several subsequent editions), in the first chapter of the present book. He owned twenty-six health clubs in the west and southwest during his thirties. He had been on a hundred different diets during that ten-year period and was successful every time at reaching his weight-loss goal. But his weight always returned once he stopped dieting. He had lost more than 2000 pounds during that decade but ended up weighing more.

One day as he was looking through the monthly weight and measurement files in his health clubs, he ran across an old record of one of his members who had been dieting and exercising for 20 years. Comparing her present day records with those of 20 years earlier, he discovered that her present day weight and measurements were bigger than when she had first started dieting and exercising. An idea began to form in his head.

Some people go to a health club to gain weight. What would happen if he were to put underweight people on the same diet that overweight people were on to lose weight? Would they also gain weight?

The program was a hit. He found many volunteers and they all gained weight.

Why?

Doctor Schwartz discovered two basic reasons for this phenomenon. One is that diets lower your metabolism, or the rate at which your body burns food. When the amount of food that your body has been receiving drops drastically, your body figures that the planet has temporarily run out of food and your metabolism slows down in order to compensate. The problem is that when you go back to normal eating, your metabolism does not seem to pop right back up to where it started. It moves up very cautiously. Some people have dieted so often that they can actually starve and not lose any weight at all.

The other reason why diets don't work, however, seems to be the more important. He discovered that ANYTHING THAT HUMAN BEINGS ARE DEPRIVED OF, THEY BECOME OBSESSIVE ABOUT. Diets are supposed to have you think less about food, but just the reverse happens. We begin to think about food all of the time. We even have dreams about eating.

Part Two of his first book, Diets Don't Work, is on "Dismantling the Dysfunctional Diet Mentality." After this book was published, Schwartz received countless letters from readers who were thrilled that they were losing weight without dieting. They were most grateful, however, because they had finally lost their obsession about food. They were amazed that this longtime problem had vanished.

The Secret of Naturally Thin People

Dr. Schwartz then started studying in greater depth the naturally thin people who had never had a weight problem. He found that some of them had a high metabolic rate. But they were young and he knew their metabolism would eventually slow down at which time they would probably have a weight problem.

Surprisingly he found that as these naturally thin people grew older and their metabolism slowed down, their eating slowed down. How did they do it?

He would ask these naturally thin people questions that every fat person knows the answers to, such as, "How many calories are in (whatever food they were eating)?" To Schwartz' amazement, they had no clue. He finally saw the light. Only fat people knew about calories.

How did the naturally thin people avoid putting more food in their bodies than needed? That would be the secret to weight loss and keeping it off. The naturally thin people had different eating habits. Some ate well-balanced meals while others ate mostly fast foods. Some exercised regularly, but some did not exercise at all. Some ate three meals a day, some ate one, and some ate six times a day. What was the secret?

The Results of Schwartz' Research

1.          For almost everyone, being thin is a natural state.

2.          It can be as easy and as natural to lose weight as it is to gain it.

3.          Naturally thin people do four simple things that fat people don't, and they never diet. (See below)

4.          People gain and keep weight for specific reasons and there are specific ways to get and keep weight off.

5.          It's not weight that's the real problem - it's the mentality behind it. Get rid of the mentality, and the weight comes off by itself, as quickly and as naturally as it was put on.

How Thin People Think and Eat: The Real Secret

Schwartz recognizes the ultimate secret sounds deceptively simple, but don't be fooled. It may be the most difficult challenge you've ever faced. The fundamentals of naturally thin people are as follows:

1.          They don't eat unless their body is HUNGRY.

2.          They eat EXACTLY what they want - EXACTLY what will satisfy them.

3.          They don't eat unconsciously; they ENJOY every bit of what they are eating and they are aware of the effect the food is having on their bodies.

4.          They STOP eating when their bodies are no longer hungry.

To read the rest of the book review, please go to

 www.delmeyer.net/bkrev_DietsStillDon'tWork.htm.

To read other diet reviews, please go to www.healthcarecom.net/bkrev_Health.htm#Diets.

The Zone Diet by Barry Sears, PhD

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