Skip to main content

Could Americans ever give up their pills?

By Aaron Carroll
February 5, 2014 -- Updated 2348 GMT (0748 HKT)
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
December 19, 2014 -- Updated 2134 GMT (0534 HKT)
President Obama has been flexing his executive muscles lately despite Democrat's losses, writes Gloria Borger
December 18, 2014 -- Updated 1951 GMT (0351 HKT)
Jeff Yang says the film industry's surrender will have lasting implications.
December 18, 2014 -- Updated 2113 GMT (0513 HKT)
Newt Gingrich: No one should underestimate the historic importance of the collapse of American defenses in the Sony Pictures attack.
December 10, 2014 -- Updated 1255 GMT (2055 HKT)
Dean Obeidallah asks how the genuine Stephen Colbert will do, compared to "Stephen Colbert"
December 18, 2014 -- Updated 1734 GMT (0134 HKT)
Some GOP politicians want drug tests for welfare recipients; Eric Liu says bailed-out execs should get equal treatment
December 18, 2014 -- Updated 1342 GMT (2142 HKT)
Louis Perez: Obama introduced a long-absent element of lucidity into U.S. policy on Cuba.
December 16, 2014 -- Updated 1740 GMT (0140 HKT)
The slaughter of more than 130 children by the Pakistani Taliban may prove as pivotal to Pakistan's security policy as the 9/11 attacks were for the U.S., says Peter Bergen.
December 17, 2014 -- Updated 1600 GMT (0000 HKT)
The Internet is an online extension of our own neighborhoods. It's time for us to take their protection just as seriously, says Arun Vishwanath.
December 16, 2014 -- Updated 2154 GMT (0554 HKT)
Gayle Lemmon says we must speak out for the right of children to education -- and peace
December 17, 2014 -- Updated 1023 GMT (1823 HKT)
Russia's economic woes just seem to be getting worse. How will President Vladimir Putin respond? Frida Ghitis gives her take.
December 17, 2014 -- Updated 0639 GMT (1439 HKT)
Australia has generally seen itself as detached from the threat of terrorism. The hostage incident this week may change that, writes Max Barry.
December 12, 2014 -- Updated 2020 GMT (0420 HKT)
Thomas Maier says the trove of letters the Kennedy family has tried to guard from public view gives insight into the Kennedy legacy and the history of era.
December 15, 2014 -- Updated 1456 GMT (2256 HKT)
Will Congress reform the CIA? It's probably best not to expect much from Washington. This is not the 1970s, and the chances for substantive reform are not good.
December 15, 2014 -- Updated 2101 GMT (0501 HKT)
From superstorms to droughts, not a week goes by without a major disruption somewhere in the U.S. But with the right planning, natural disasters don't have to be devastating.
December 15, 2014 -- Updated 1453 GMT (2253 HKT)
Would you rather be sexy or smart? Carol Costello says she hates this dumb question.
December 14, 2014 -- Updated 2253 GMT (0653 HKT)
A story about Pope Francis allegedly saying animals can go to heaven went viral late last week. The problem is that it wasn't true. Heidi Schlumpf looks at the discussion.
December 14, 2014 -- Updated 1550 GMT (2350 HKT)
Democratic leaders should wake up to the reality that the party's path to electoral power runs through the streets, where part of the party's base has been marching for months, says Errol Louis
December 13, 2014 -- Updated 2123 GMT (0523 HKT)
David Gergen: John Brennan deserves a national salute for his efforts to put the report about the CIA in perspective
December 12, 2014 -- Updated 1426 GMT (2226 HKT)
Anwar Sanders says that in some ways, cops and protesters are on the same side
December 11, 2014 -- Updated 1439 GMT (2239 HKT)
A view by Samir Naji, a Yemeni who was accused of serving in Osama bin Laden's security detail and imprisoned for nearly 13 years without charge in Guantanamo Bay
December 14, 2014 -- Updated 1738 GMT (0138 HKT)
S.E. Cupp asks: How much reality do you really want in your escapist TV fare?
December 11, 2014 -- Updated 1828 GMT (0228 HKT)
Rip Rapson says the city's 'Grand Bargain' saved pensions and a world class art collection by pulling varied stakeholders together, setting civic priorities and thinking outside the box
December 13, 2014 -- Updated 2310 GMT (0710 HKT)
Glenn Schwartz says the airing of the company's embarrassing emails might wake us up to the usefulness of talking in-person instead of electronically
December 12, 2014 -- Updated 2233 GMT (0633 HKT)
The computer glitch that disrupted air traffic over the U.K. on Friday was a nuisance, but not dangerous, says Les Abend
ADVERTISEMENT