A REAL WELLNESS PERSPECTIVE ON WEBMD’s FRIGHTFUL OXYMORON

WebMD produces a daily E-newsletter called Inside WebMD. Targeted to laypersons, it’s free and informative with tips that help readers recognize, understand and deal with common medical issues.

However, the December 18 edition contained a piece about lifestyle that illuminates a common problem when doctor organizations promote healthy behaviors. Doing so, of course, is a grand idea that should be applauded, but doctors seem to have a hard time releasing responsibility to patients. In fact, they sometimes inadvertently tether patients to a parent/child relationship when they describe exercise, nutritious food choices and other health-enhancing activities as medicine. Let me offer an example.

WebMD’s prevention article contained the following:

1. Lifestyle medicine is an evidence-based approach to treat, reverse, and prevent chronic disease by addressing the root causes, including diet, exercise, sleep and social support. Health professionals trained in lifestyle medicine will write specific prescriptions for exercise and diet, along with medication.

2. WebMD! Here’s a bit of breaking news: a wellness lifestyle is not lifestyle medicine. There is nothing medical or medicinal about it. Skills and behaviors associated with reason, exuberance, exercise and nutrition (athleticism) and personal freedoms (liberty) need not be tied to, approved by or under the supervision of medical personnel. Furthermore, we do not need prescriptions, specific or otherwise, from doctors or anyone else for exercise and diet.

Prevention is good and life enrichment is even better. Doctors (and medical organizations) can and should promote both, but the latter is independent of matters medical.

By linking lifestyle with medical care, WebMD shifts some responsibility to caregivers, when in fact healthy lifestyles are sustained by a conviction that it is up to us consumers to make daily choices that enable and sustain wellbeing. Medical doctors and all manner of experts can provide advice and care, but a healthy lifestyle must be a passion, a personal commitment and a rewarding source of satisfaction to the individual. Lifestyle is no more a medicine than medicine is a lifestyle.

Of course, WebMD is not the first group to bandy about the oxymoronic phrase lifestyle medicine. Over the course of several decades, I’ve seen it many times and, on a few occasions, convinced well-meaning offenders to choose a more appropriate, non-dysfunctional description of doctor support for healthy exercise, diet and other choices.

Even Wikipedia acknowledges the phrase, noting that it is a branch of medicine dealing with research, prevention and treatment of disorders caused by lifestyle factors. That is something entirely different, however, from the WebMD usage of lifestyle medicine. Coaching and supporting people on better ways to shop for and cook healthy food should be part of medical practice; asserting that it is the role of medical practitioners is taking a good thing to another level that benefits neither doctor nor client.

In summary, WebMD needs a new catch phrase for its interest or involvement in promoting healthy habits and practices.

The Life of Mammogram Inventor Stafford L Warren

Stafford L. Warren was one of the most significant contributors to radiology during his lifetime. He not only was the first doctor to perform a mammogram, but was also had a hand in turning UCLA into one of the most prestigious medical universities in the country, was a special assistant on mental disabilities to Presidents John F Kennedy and Lyndon B Johnson, and aided the U.S. government in testing of nuclear weapons before speaking out about the dangers of nuclear fallout from weapons testing, which were controversial at the time. However, his strong opinions would eventually be considered, leading up to the Partial Nuclear Test Ban Treaty in 1963.

Born in New Mexico in 1896, Stafford L. Warren attended the University of California, Berkeley, and graduated with his Bachelor of Arts degree in 1918. Heading to the University of California, San Francisco, he graduated with his Doctor of Medicine degree in 1922 and later did post-doctoral work at John Hopkins School of Medicine and Harvard University.

Warren became an Assistant Professor of Medicine at the University of Rochester School of Medicine in 1926. Since the Department of Radiology was brand new at the time, Warren was one of the original group of medical professionals that Dean George Whipple chose to staff the school. By 1930, Warren was an Associate Professor of Medicine. He began to study the work of Albert Salomon, a sociologist from the University of Berlin who produced over 3,000 images of mastectomy specimens and extensively studied the many forms and stages of cancer in the breast. Since Salomon wasn’t keen to recognize the life saving aspects of his discoveries, Warren expanded on his research, using radiology to track changes in breast tissue and developing a stereoscopic technique in which the patient would lie on her side with one arm raised while being X-Rayed. This was a huge breakthrough for breast cancer detection, as it allowed diagnosis of breast cancer to be possible without surgery. Warren subsequently published “A Roentgenologic Study of the Breast” in 1930. Today Warren is cited as the inventor of the mammogram for his breast imaging technique. Each year mammograms are responsible to diagnosing millions of breast cancer cases, effectively saving the lives of women the world over.

Warren, having now tackled a major milestone in his career and developing a new life saving technique, then went on to take on a new project: overseeing the health and safety of thousands during the Manhattan Project. His new role meant being responsible for the safety aspects of the detonation of the Trinity nuclear test in Alamogordo, New Mexico on July 16, 1945. He later handled radiological safety when he led a team of surveyors to Japan, and to the Bikini Atoll in 1946, where more nuclear testing was done. Warren was in charge of assessing the radioactive contamination of the environment and atmosphere, which he was appalled by.

In response to this, in a piece for LIFE magazine in 1947 he wrote, “The development of atomic bombs has presented the world with a variety of formidable scientific, moral and political problems, nearly all of them still unsolved.” He went on to write an in depth analysis of the effects of the bombs, people and environment affected, the time length in which the effects of the bomb lasted, safety measures used during the Bikini expedition in which “a month passed before men could stay on some of the ships for more than an hour”, and “300 men of the safety section lived and worked in the contaminated area to protect some 42,000 other members of the Bikini expedition. Every group which entered the target area was accompanied by a safety monitor who determined how long it could stay.” The men were then bathed carefully when they returned, and if their Geiger counters indicated radioactive contamination they had to be bathed again. “Occasionally when a man had taken off his protective gloves in the ‘hot’ area, the safety section had to dissolve the outer layer of skin from their hands with acid.” Clothes and other materials found too contaminated were sunk into the ocean a mile below the surface, because there was literally “no other way to keep them permanently away from human beings.”

In the article, Warren concluded that atomic weapons can never be prepared for by anyone involved, and that “no defense would have been effective. The only defense against atomic bombs still lies outside the scope of science. It is the prevention of atomic war.”

Warren left his position in 1946, becoming the Chief of the Medical Section of the Atomic Energy Commission, which is a civilian agency that succeeded the Manhattan Project; and later he was awarded the Army Distinguished Service Medal and the Legion of Merit for his contributions to radioactive and atomic weapons safety.

In 1947, Warren was once again at the helm of a brand new medical university, this time UCLA, which had been voted on to establish a medical school for Southern California. He was appointed as the school’s first dean. In 1951 the first students, 28 in total, were enrolled, and there were 15 faculty members. By 1955, when the class graduated, there were 43 faculty members. The UCLA Medical Center officially opened in 1955, and Warren oversaw many milestones and achievements while there, including the addition of schools for Dentistry, Nursing, and Public Health.

Warren not only was responsible for the invention of the mammogram, but for a number of impressive achievements involving radiological safety and education. His invention and teachings continue to save lives every day, and for that he stands as one of the great medical innovators of our time.