Repeat After Me: “Prevention Works!!!”

For once, some good news: Plain and simple, prevention works. 


“The message from our analysis of the data from the EPIC-Potsdam study is clear: adopting a few healthy behaviors can have a major impact on the risk of morbidity.  The participants with all 4 healthy lifestyle factors had a reduced risk of major chronic disease of almost 80% compared with those with none.  These results applied equally to men and women.”  So say the authors of a new research report that appears in today’s issues of the Archives of Internal Medicine.


But wait a moment.  As pointed out in an editorial in the same issue, this really isn’t news.  We’ve known this for a long time. 


So if we know so much, why can’t we do something about it?  That, my friends, is the $64,000 question.  Or perhaps that figure is really outdated.  Today, it’s the multibillion dollar question.  Just go ask the folks in Washington.


The research took a lot of effort, but is stunningly simple in its theory. 


The researchers followed over 23,000 people in Potsdam, Germany for around 8 years.  They measured four markers of a healthy lifestyle, including: never smoking, a body mass index less than 30, performing 3 ½ hours a week of legitimate physical activity such as bicycling or sports, and following a healthy diet including a high intake of fruits, vegetables, whole grain bread and low red meat consumption.


After entering the study, the researchers followed the participants to see if they developed cancer, diabetes, a heart attack or a stroke.


The good news was that almost everyone had at least one healthy behavior “marker,” and only 4% had none.  On the other end of the scale, 9% had practiced all four elements of a healthy lifestyle.


The impact of doing the right things for one’s health was dramatic:


  • If you had all four healthy behaviors, your chance of getting a serious illness was reduced by 78%.  The impact of a healthy lifestyle was the same for men and women.


  • Having a BMI less than 30 had the greatest overall impact, followed by never smoking, physical activity for 3 ½ hours a week or more, and adhering to good dietary habits.  Having a BMI less than 30 was a very strong protective factor with respect to diabetes.


  • Never smoking exerted a stronger protective effect on heart attack and diabetes than on stroke and cancer.


  • Physical activity reduced diabetes and heart attack more than cancer


  • A healthy diet decreased the risk of cancer, diabetes, stroke and cancer.


  • If you never smoked and had a BMI les than 30, you had a risk reduction of 78%, similar to someone who practiced all four healthy behaviors.


  • You can mix and match the healthy behaviors, but all of the combinations had a benefit in reducing serious, chronic disease.  The combination with a surprising effectiveness on reducing risk was physical activity and healthy diet, which was greater than the researchers had expected. Even current and former smokers reduced their risk of serious illness if they practiced other healthy behaviors.


So what does this study tell us?


First, as noted at the beginning of the blog, prevention works.  No surprise there, I guess, since the authors themselves point out there have been several studies which all point in the same direction.


But it also leaves open the question that frustrates so many of us:  If we know so much, why is it that we accomplish so little when it comes to diet, exercise, smoking cessation and maintaining a healthy body weight?


As the authors note, “Although improvements in some behaviors have occurred, notably the decline in the prevalence of smoking, substantial proportions of the population still engage in behaviors that are not conducive to achieving and maintaining health.”


They go on to say, “The data from the EPIC-Potsdam study show the unfulfilled potential of preventing chronic diseases.  Adhering to the recommendations for the 4 lifestyle factors considered in our analyses can potential yield enormous reductions in the onset of major chronic disease such as (cardiovascular disease), diabetes and cancer…”


“Our results and these of others emphasize the importance and urgency of continuing vigorous efforts to convince people to adopt healthy lifestyles.  Because the roots of these factors often originate during the formative stages of life, it is especially important to start early in teaching the important lessons concerning healthy living.”


Not exactly what I would call a news flash, but nonetheless a very important message for all of us to hear and incorporate into our daily lives.

The editorial which accompanied the article, written by David Katz, MD from the Yale University School of Medicine, points out that we have known for some time that tobacco use, diet and physical activity account for a huge number of premature deaths in the United States every year.


As noted by the writer, “If ever a matter of public importance belied the notion that knowledge is power, this decade of underutilized knowledge was it.  And if we are once again to be updated in 2013 (regarding the number of premature deaths),there is little cause to think, based on our progress to date, that we will have fared much better across an informed expanse of 2 decades, although progress in tobacco control warrants honorable mention.”


Not a very ringing endorsement of our progress in helping people lead healthier lives, is it?


Some people say we are trapped by our genes.  Dr. Katz points out that “even gene expression submits to the power of lifestyle…With the knowledge we have already in hand, we can nurture nature.”


“Across an expanse of policies, practices, programs, personal responsibility, and political will yet to be mustered and some cases yet to be devised—we have miles to go before we sleep.”


Couldn’t have said it better myself.  Now that I think about it, I have said it myself, time and again and again and again.  And so have many others.


We are frustrated in our efforts to change behaviors, and clearly need to find better ways to get to the goal. 


Hopefully—and this is the political message of this blog—our current national debate about health care reform will get back to the core issues facing us as a nation, one of which is how we pay for and encourage prevention.


Knowing you can reduce one’s risk of getting a serious disease by 78% to me sounds like a very powerful incentive to make changes. Now all we need is the personal and national will to get the job done.


Somehow, we need a huge attitude adjustment around prevention and healthy lifestyles. 


How we get there is the billion(s) dollar question.







Filed Under: Diet | Exercise | Prevention


J. Leonard Lichtenfeld's Biography

Dr. Len

J. Leonard Lichtenfeld, MD, MACP: Dr. Lichtenfeld currently serves as Deputy Chief Medical Officer for the American Cancer Society in the Society's Office of the Chief Medical Officer located at the Society's Corporate Center in Atlanta. Dr. Lichtenfeld joined the Society in 2001 as a medical editor, and in 2002 assumed responsibility for managing the Society's then newly created Cancer Control Science Department which included the prevention and early detection of cancer, emerging cancer science and trends, health equity, quality of life for cancer patients, the science of cancer communications and the role of nutrition and physical activity in cancer prevention and cancer care.  In 2014, Dr. Lichtenfeld assumed his current role in the Office of the Chief Medical Officer where he provides extensive support to a number of Society colleagues and activities. As a result of his over four decades of experience in cancer care, Dr. Lichtenfeld is frequently quoted in the print and electronic media regarding the Society's positions on a number of important issues related to cancer. He has testified regularly in legislative and regulatory hearings, and participated on numerous panels regarding cancer care, research, advocacy and related topics. He has served on a number of advisory committees and boards for organizations that collaborate with the Society to reduce the burden of cancer nationally and worldwide. He is well known for his blog ( which first appeared in 2005 and which continues to address many topics related to cancer research and treatment. A board certified medical oncologist and internist who was a practicing physician for over 19 years, Dr. Lichtenfeld has long been engaged in health care policy on a local, state, and national level.  He is active in several state and national medical organizations and has a long-standing interest in professional legislative and regulatory issues related to health care including physician payment, medical care delivery systems, and health information technology. Dr. Lichtenfeld is a graduate of the University of Pennsylvania and Hahnemann Medical College (now Drexel University College of Medicine) in Philadelphia.  His postgraduate training was at Temple University Hospital in Philadelphia, Johns Hopkins University School of Medicine and the National Cancer Institute in Baltimore. He is a member of Alpha Omega Alpha, the national honor medical society.  Dr. Lichtenfeld has received several awards in recognition of his efforts on behalf of his colleagues and his professional activities.  He has been designated a Master of the American College of Physicians in acknowledgement of his contributions to internal medicine.  Dr. Lichtenfeld is married, and resides in Atlanta and Thomasville, Georgia.

6 thoughts on “Repeat After Me: “Prevention Works!!!”

  1. As a physically active woman who got breast cancer in her 30s, I have to say that while I understand why there needs to be focus on prevention, it is also very frustrating that so many people think that cancer is preventable. I can’t tell you how many people have suggested that I did something to cause my breast cancer, whether it was not being “positive” enough, or eating the wrong foods, or whatever. It’s wrong to make patients feel guilty about their disease, or to sell the notion that if you eat well or exercise you won’t get sick. The last woman in my support group who died was a vegetarian marathon runner. What could she have done differently? Why don’t we see more portrayals of this kind of person in the media? Why does everyone want to blame the victim? To convince themselves that they’ll be safe if they do whatever they’re doing?

  2. Laura, your comments are right on target. As a matter of practice, I usually put a comment to the effect that many cancers are not preventable and that many cancers escape screening tests that are known to be effective.

    I apologize for not having done so in this blog, and will endeavor to remember to do so in the future. Having cancer is difficult enough. Wrestling with “what could I have done differently?” only adds to the burden.

  3. I am a retired professor of nutriton and fitness at Santa Ana College in California. I strongly agree that the problem is how to encourage people to make changes. I did that with a great deal of success with my students for 32 years, although I think it took 20 years to get it right! In retirement I wrote a simple book with short chapters that focus on that 64,000 dollar question. How to encourage change. From the feed back I got it seems to have work for a considerable number of readers.
    Now you may assume I am just trying to promote a book but that is not the whole story. To get the message out I recently offered the book for FREE on my website It is my way of contributing to our biggest health problem….How do you get people to change?

  4. If you can get past the cacophony of noise about ideology and politics in the health care reform debate there are some discussions going on that I think are very worthwhile. It seems we often learn things in a crisis that we’re not paying much attention to under normal circumstances. For instance, who’d ever heard of credit default swaps before the economy tanked?

    The same thing is happening around health to some degree. Dr. Len made a strong case above for the life-extending power of prevention (I don’t use the term “life saving” because I think it’s an emotionally loaded term rather than a scientific term), yet last week an opinion piece in the Washington Post by Charles Krauthammer decried “The Myth of Prevention.” Turns out we’re talking about apples and oranges here: humanity and ethics vs. dollars and cents. However, to my mind it’s a good thing to have the opportunity to discuss widely what we mean when we use the term “prevention,” how we achieve it, and what it’s worth. As Laura’s comment compellingly illustrates, ambiguous or imprecise use of the idea can have significant personal consequences for disease sufferers.

    After seeing Frank Addelman’s generous invitation to download his book , I did precisely that last Friday. I read several chapters and I intend to complete it. “Get Your Act Together” emphasizes how to reach a lifestyle emphasizing beneficial habits of exercise and good nutrition. But the very next day as I was standing in the check-out line at my supermarket (btw, in the past 6 weeks to increase my exercise I’ve been walking the half-mile to my supermarket rather than driving) the cover of Time Magazine screamed at me: “THE MYTH OF EXERCISE.” The author maintains that the conventional wisdom that exercise is a mainstay of losing weight and mitigating the adverse health consequences of overweight needs to be re-evaluated or at least examined more thoroughly in light of recent evidence. As usual, the picture is not as simple as we might think or want. * It’ll be interesting to see what others have to say about the article.

    Indeed, to my mind one of the upsides of our current national debate is the chance to flesh out some of the health issues that don’t ordinarily get much attention. In my experience people who are motivated to do something–especially about their own health–have reasons that are as personal and individual as they are. The trouble is that a lot of the admonitions about positive lifestyles tend to be rather general, sometimes conflicted, or delivered in a blizzard of informational bits and pieces. (Frank’s book is a welcome exception.) New-habit adoption is usually an uphill battle against considerable inertia, so any opportunity to clarify what works and how people can apply lifestyle prescriptions to their own lives is an opportunity not to be lost.


  5. In my opinion the factor of synergism between carcinogens has been overlooked. The data about Male Breast Cancer at Camp LeJune is an example. Question has been early onset and increased incidence. From the information I know there were at least 2 carcinogens in the water at LeJune until the mid 80s. Synergism between carcinogens Albert Segaloff,MD & I reported in our paper. The Synergism Between Radiation and Estrogen in Producrion of Mammary Cancer in the Rat. Cancer Research:31:166-8 Feb,1971 would explain both questions. We demonstrated that the time to develope a cancer from exposure to only 1 carcinogen was cut by 50% due the synergism between the 2 carsinogens we used and instead of 1-2 cancers in the mwmmary chain exposed to both there was total carcinogenesis. Others have confirmed the synergism between carcinogens we first reported. In the BIER reports there is documentation of synergism between smoking and radon in production of lung cancer in miners. wsm md

  6. Data on the synergism between carcinogens is provided in my comment posted at 2:42PM. In my opinion synergism between radiation and estrogen we documented in our 1971 paper also applies to the incidence of breast cancer in women who take hormones. A basic radiobiology fact is that radiation exposure to growing breast tissue increases the incidence of breast cancer. This is why annual mammography for women is started at age 40 as breast tissue growth under natural conditions has stopped by that age. Consider what happens with hormone intake. As a mammographer I have seen fatty breast go to dense breasts with often cyst formation in 3 years especilly with the hormone combination of estrogen and progesterone. The hormone stimulated breast tissue growth is frequently not symetric so the patient has to come back for a cone down view or a diagnostic mammogram every 6 months. Also as the breast becomes denser due to hormones the radiation dose to obtain a good picture goes up. The hormone intake and increased radiation dose in these women,therefore, would meet the criteria for the synergism recorded in our 1971 paper to increase the incidence of cancer and shorten the time to develop the cancer. The shortened time to develope cancer due to synergism would also explain the more rapid decrease in breast cancer rate than was expected due to decreased hormone use. Considering the above and increased experience with other breast imaging studies I would suggest using ultrasound or MRI to evaluate the changing pattern in the breast of women taking hormones to decrease the radiation dose thereby reducing the potential for synergistic effect. wsm md

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