Poverty, Epidemics, and Prevention. Bernard Lown

The last paragraph in a recent email from a physician in the developing world to ProCor, an international health philanthropy, stopped its founder, Bernie Lown, dead in his tracks:

“You talk of the choices between doing what is proper by prescribing frequently useless pills because that is expected of you, or doing what is right, saying:

‘I think I can see my destiny: fighting windmills of Big Pharma . . . losing the money I could earn by playing their game, but keeping my sanity by telling [patients] (based in scientific knowledge and evidence): ‘I know that pill, and I know that you don’t need it.’

‘I am trying hard, and I hope I will always be able to lead by example. Otherwise it is just nonsense.’

Lown replies: “In a strange way you have put your finger on the pulse of an issue that is roiling our thinking. Being vendors of relevant cardiovascular health information with a focus on prevention appears increasingly inadequate for stemming the mounting epidemic of non-communicable disease now engulfing the developing world. No amount of preaching of healthy diets of fruits and vegetables, of exercise and of cessation of smoking will reverse this epidemic.

The reasons are evident. The economics of poverty counters persuasive scientific arguments by the far more coercive arguments of daily reality. Furthermore, governments are heavily subsidizing processed foods and doing little to promote innovative possibilities for healthy living. What is happening with tobacco bears on the discussion? Only governmental policies and punitive economic pressures have lowered its awesome toll in industrialized countries.

It is more intellectually satisfying to deal with aspects of the metabolic syndrome, to decry obesity, to prescribe pills or to detect value in gastric banding procedures than to gather evidence relating to why slum living and poverty favor cardiovascular disease.

‘Playing their game,’ at first glance, appears the only game in town. But you well recognize the Faustian bargain–the loss of one’s “sanity”–by which I assume you mean moral integrity.

The struggle for justice and equity profoundly impacts on health and therefore should be part of a physician’s agenda. To act on these principles is an endless challenge. . . But rejecting a life lacking moral value is not a negative. Indeed, it is the greatest positive attainable for human beings–a fulfilled life.” (Henry Blackburn)

Reference

With permission of Bernard Lown, MD, Founder and Chairman of ProCor; ProCor Newsletter Feb.20, 2008