The Valuation of Physician Advice

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The most general advice physicians give to patients is to watch their weight, exercise, drink if you must, but only in moderation, and don’t smoke. Turns out, given the current value put on a quality year of life, that the advice is worth almost a million bucks.

There are any number of ways to measure the value of physicians’ advice for preventative measures, the current study’s outcome was years free of chronic illness. The participants were Europeans involved in a number of longitudinal studies but all free of 6 chronic illnesses (type 2 diabetes, myocardial infarctions, coronary deaths, strokes, cancers, asthma, and COPD) at the beginning of the study; and with information on their weight, smoking and alcohol history, and leisure activities. Roughly 116,000 individuals, average age 43, 61% women, were followed for a mean of 12.5 years.

Before jumping to the results, let's address the definitions and caveats. Weight was based on BMI, smokers divided into never, former or current, and activity based on self-reported activity or roughly 2.5 hours of moderate activity [1]. It was a European study, so drinking up to 2 glasses a day for women and 3 glasses a day for men was “optimal,” no alcohol was intermediate (you have to love the Europeans) ,any more was considered a poor lifestyle choice. Each choice provided a score of 0-2, with 8 being optimal. 

As with many of these studies, the lifestyle choices were determined only once, at the beginning of the study, so behavior may have changed. More importantly, many of the people with “healthy” lifestyles but with a chronic disease already present at the beginning of the study were excluded. So, as always, apply as many grains of salt as you believe necessary. 

  • For men and women, an optimal lifestyle resulted in 30 disease-free years, a poor lifestyle, only 21 years
  • Disease-free years were “dose” related. With each good or better behavior adding an additional year
  • More good news, in addition to a BMI of <25, you only needed two other of the lifestyle choices to get that additional disease-free interval of 9 years. The bad news, of course, is that BMI is a measure of what you eat, how you metabolize it, and how much energy you expend, leaving some wiggle room on the lifestyle choices.  

The broad outline remains clear, prevention can add disease-free years to one’s life, and are rarely as expensive as the cost of treatment, physically, fiscally, and psychologically. One wonders why the advice is so often unheeded. Why is it easier to take a pill than to go for a walk?

 

[1] This might include gardening, dancing, riding a bicycle at 10 miles per hour, or playing doubles tennis.

Source: Association of Healthy Lifestyles with Years without Major Chronic Diseases JAMA Internal Medicine DOI: 10.1001/jamainternmed.2020.0618