Skip to main content

Could Americans ever give up their pills?

By Aaron Carroll
updated 6:48 PM EST, Wed February 5, 2014
Exercise may be just as good as pills for some conditions. But Aaron Carroll says for patients and doctors, pills are easier.
Exercise may be just as good as pills for some conditions. But Aaron Carroll says for patients and doctors, pills are easier.
STORY HIGHLIGHTS
  • Study found exercise may be as effective as pills in fighting some medical conditions
  • Aaron Carroll: When doctors write prescriptions, they and the drug company make money
  • Carroll: Exercise costs almost nothing, if at all, but people aren't prone to do it
  • Carroll: Numbers of people who take statins for heart disease will overpower those exercising

Editor's note: Aaron E. Carroll is a professor of pediatrics at the Indiana University School of Medicine and the director of its Center for Health Policy and Professionalism Research. He blogs about health policy at The Incidental Economist and tweets at @aaronecarroll.

(CNN) -- Some friends and colleagues have been up in arms about an article in Wednesday's New York Times that discussed how exercise may be as effective as medication in treating heart disease and other medical conditions.

Those who fall on the side of more traditional medicine think this is crazy and believe that the studies supporting lifestyle changes ignore the hard and fast outcomes promised by drugs. Those who fall on the side of more alternative medicine, or have a more holistic, bent have no trouble with these findings and believe lifestyle has always been far superior to pharmaceutical treatment.

Aaron Carroll
Aaron Carroll

The truth is that both sides are correct -- to a point. That, of course, makes both sides a bit wrong, too.

The research was published in October in the British Medical Journal. It was a meta-analysis, or study of studies, of previous meta-analyses of research that investigated whether exercise or drugs reduced the chance of death from coronary heart disease, stroke, heart failure and diabetes. Four of the previous meta-analyses covered exercise interventions and 12 covered drugs.

No difference in efficacy between the exercise and drug interventions was found in respect to coronary heart disease and diabetes. In other words, they performed the same in terms of reducing your chance of death. With respect to stroke, exercise performed better than some drugs. With respect to heart failure, some drugs performed better than exercise.

Runners take part in the ultramarathon in California. \n
Runners take part in the ultramarathon in California.

What can we take home from this type of study?

Well, the first thing to note is that lifestyle changes can make a big difference in a person's health. Exercise interventions, which are often far less intensive than you might think, can significantly reduce your chance of dying from these conditions. Exercise can also help you to shed pounds if you're overweight or obese. It can even make you look a little better.

Many people report secondary gains of improved mood and quality of life when they're more active. The secondary gains from a more active lifestyle are not to be minimized. Exercise is usually cheap, if not free, and has relatively few side effects.

Getting someone to exercise, however, is not easy. A lifestyle change is, by definition, a change in how you live your life. That can be difficult, and many patients will choose to take drugs instead. Taking a medication can be far simpler, and a doctor can prescribe it immediately. Many of my physician friends believe it's more likely that a patient will comply with taking prescription pills than with advice to exercise.

But that's part of the problem with our medical system. Every time a doctor writes a prescription, he or she probably earns some money. The pharmacy that dispenses the meds makes some money. And, of course, the pharmaceutical company that makes the medications makes money, too. The health care system understands and even encourages this practice. Insurance pays for it without issue.

But the same health care system is not at all equipped to deal with lifestyle change. No one makes any money if you're more active. No one would ever think to write a prescription for a gym membership, which could easily cost less than some medications, with the same potential outcomes.

It's thought that the recently released guidelines for assessing and preventing cardiovascular disease could lead to more than a billion people taking statins worldwide. That is, as you can imagine, a huge amount of money going to those types of drugs.

It's highly unlikely that a similar number of people will be encouraged to exercise. One is considered "doing something" by the health care system; the other is not. One is paid for by the health care system; the other is not. But as evidence amasses that lifestyle interventions are as beneficial as medical ones, it may be time to rethink how that system works.

Follow @CNNOpinion on Twitter.

Join us at Facebook/CNNOpinion.

The opinions expressed in this commentary are solely those of Aaron Carroll.

ADVERTISEMENT
Part of complete coverage on
updated 2:45 PM EDT, Thu April 17, 2014
Michael Bloomberg and Shannon Watts say Americans are ready for sensible gun laws, but politicians are cowed by the NRA. Everytown for Gun Safety will prove the NRA is not that powerful.
updated 9:28 AM EDT, Thu April 17, 2014
Ruben Navarrette says Steve Israel is right: Some Republicans encourage anti-Latino prejudice. But that kind of bias is not limited to the GOP.
updated 7:23 PM EDT, Wed April 16, 2014
Peggy Drexler counts the ways Phyllis Schlafly's argument that lower pay for women helps them nab a husband is ridiculous.
updated 12:42 PM EDT, Wed April 16, 2014
Rick McGahey says Rep. Paul Ryan is signaling his presidential ambitions by appealing to hard core Republican values
updated 11:39 AM EDT, Wed April 16, 2014
Paul Saffo says current Google Glasses are doomed to become eBay collectibles, but they are only the leading edge of a surge in wearable tech that will change our lives
updated 2:49 PM EDT, Tue April 15, 2014
Kathleen Blee says the KKK and white power or neo-Nazi groups give haters the purpose and urgency to use violence.
updated 7:56 AM EDT, Wed April 16, 2014
Sen. Sheldon Whitehouse and Rep. Henry Waxman say read deep, and you'll see the federal Keystone pipeline report spells out the pipeline is bad news
updated 7:53 AM EDT, Wed April 16, 2014
Frida Ghitis says President Obama needs to stop making empty threats against Russia and consider other options
updated 5:29 PM EDT, Tue April 15, 2014
Peter Bergen and David Sterman say the Kansas Jewish Center killings are part of a string of lethal violence in the U.S. that outstrips al Qaeda-influenced attacks. Why don't we pay more attention?
updated 12:41 PM EDT, Tue April 15, 2014
Danny Cevallos says families of the passengers on Malaysian Airlines Flight 370 need legal counsel
updated 11:23 AM EDT, Mon April 14, 2014
David Frum says Russia is on a rampage of mischief while Western leaders and Western alliances charged with keeping the peace hem and haw
updated 7:56 AM EDT, Mon April 14, 2014
Most adults make the mistakes of hitting the snooze button and of checking emails first thing in the morning, writes Mel Robbins
updated 1:54 PM EDT, Mon April 14, 2014
David Wheeler says as middle-class careers continue to disappear, we need a monthly cash payment to everyone
updated 7:55 AM EDT, Mon April 14, 2014
Democrats need to show more political spine when it comes to the issue of taxes.
updated 11:55 AM EDT, Mon April 14, 2014
Donna Brazile recalls the 50th Anniversary of the Civil Rights Act as four presidents honored the heroes of the movement and Lyndon Johnson, who signed the law
updated 9:17 AM EDT, Mon April 14, 2014
Elmer Smith remembers Chuck Stone, the legendary journalist from Philadelphia who was known as a thorn in the side of police and an advocate for the little guy
updated 2:56 PM EDT, Sun April 13, 2014
Al Franken says Comcast, the nation's largest cable provider, wants to acquire Time Warner Cable, the nation's second-largest cable provider. Should we be concerned?
updated 11:22 AM EDT, Fri April 11, 2014
Philip Cook and Kristin Goss says the Pennsylvania stabbing attack, which caused grave injury -- but not death, carries a lesson on guns for policymakers
updated 3:06 PM EDT, Fri April 11, 2014
Wikipedia lists 105 football movies, but all too many of them are forgettable, writes Mike Downey
updated 10:32 AM EDT, Fri April 11, 2014
John Sutter and hundreds of iReporters set out to run marathons after the bombings -- and learned a lot about the culture of running
updated 12:49 PM EDT, Fri April 11, 2014
Timothy Stanley says it was cowardly to withdraw the offer of an honorary degree to Ayaan Hirsi Ali. The university should have done its homework on her narrow views and not made the offer
updated 10:16 AM EDT, Fri April 11, 2014
Al Awlaki
Almost three years after his death in a 2011 CIA drone strike in Yemen, Anwar al-Awlaki continues to inspire violent jihadist extremists in the U.S, writes Peter Bergen
updated 9:21 PM EDT, Fri April 11, 2014
David Bianculli says Colbert is a smart, funny interviewer, but ditching his blowhard persona to take over the mainstream late-night role may cost him fans
updated 1:31 PM EDT, Thu April 10, 2014
Rep. Paul Ryan says the Republican budget places its trust in the people, not in Washington
updated 5:28 PM EDT, Thu April 10, 2014
Aaron David Miller says Obama isn't to blame for Kerry's lack of progress in resolving Mideast talks
updated 11:22 AM EDT, Mon April 14, 2014
David Weinberger says beyond focusing on the horrors of the attack a year ago, it's worth remembering the lessons it taught about strength, the dangers of idle speculation and Boston's solidarity
updated 12:32 PM EDT, Thu April 10, 2014
Katherine Newman says the motive for the school stabbing attack in Pennsylvania is not yet known, but research on such rampages turns up similarities in suspects and circumstances
updated 2:39 PM EDT, Wed April 9, 2014
Wendy Townsend says the Rattlesnake Roundup -- where thousands of pounds of snakes are killed and tormented -- is barbaric
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT