Healthful Ignorance: What You Don't Know Will Kill You

Question: What influenced your medical training?


David Katz: When I went to medical school, I was taught about two basic kinds of diabetes: juvenile onset and adult onset. From the time I did my training in medical school to the end of my residency we were already seeing the transformation of adult onset diabetes into Type II, which is what we call it now, which from my perspective is a euphemism we have draped over this condition to conceal the fact that what was a chronic disease in midlife is now epidemic in children. Frankly, Type II diabetes in a seven year old is adult onset diabetes. We just don’t want to confront that unpleasant fact.

So this was the big picture. This was what was playing out around me. And also I was very much influenced by a seminal publication that came out in 1993 and this was really just at the end of my training in internal medicine. As I was training in preventive medicine, a paper came out in a journal of the American Medical Association called “Actual Causes of Death in the United States”.

Now, up to this time in front of any audience, lay audience, professional audience, it wouldn’t have mattered, if you posed the question: What is the leading cause of death in the United States? Most people would get it right. They’d guess heart disease. They’d either know or they’d guess and they’d be right. And if you pushed them and said “Okay, how about the second leading cause?” they’d usually get that right too and say “Cancer.” By the third, the non-professional members of the audience would start to get a little bit uncertain. It happens to be stroke and then diabetes.

Well, two authors, McGinnis and Foege, published this paper in 1993 that said, “You know it isn’t all that illuminating. When someone dies of a heart attack, to say the cause of that is disease of the heart, there’s not much of a revelation there. What we really want to know is what caused that. What are the underlying root causes of all this pathology?” Well they did the math. They reached the conclusion that of the 2 million deaths that occurred in the United States each year, give or take, roughly half are premature and deferrable by changing this very short list of modifiable behaviors we all control everyday – topped by tobacco use, dietary pattern, physical activity.

I found that extremely compelling. And the people who were ahead of the curve and addressing this issue around me were beginning to say, “Any health care professional who doesn’t address these behaviors, who doesn’t address the influence of lifestyle on health, whatever else you do and however well you do it, you’re at the margins of what matters.” And I didn’t want to be at the margins of what matters. So the rest is history. I dedicated myself to learning everything I could about these lifestyle factors and their influence on health. And in particular, and this remains the challenge today, finding ways to convert knowledge to power. Because the gap between what we know and what we do belies the notion that knowledge is power. There are steps in between and when it comes to preventing chronic disease, we have not yet adequately taken those steps in between.


Recorded on: July 06, 2009

When it comes to preventing chronic disease, the gap between knowledge and action belies the notion that knowledge is power, according to health expert David L. Katz.

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