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
July 24, 2014 -- Updated 1349 GMT (2149 HKT)
Patrick Cronin and Kelley Sayler say the world is seeing nonstate groups such as Ukraine's rebels wielding more power to do harm than ever before
July 23, 2014 -- Updated 2205 GMT (0605 HKT)
Ukraine ambassador Olexander Motsyk places blame for the MH17 tragedy squarely at the door of Russia
July 24, 2014 -- Updated 1142 GMT (1942 HKT)
Mark Kramer says Russia and its proxies have a history of shooting down civilian aircraft, often with few repercussions
July 24, 2014 -- Updated 1853 GMT (0253 HKT)
Les Abend says, with rockets flying over Tel Aviv and missiles shooting down MH17 over Ukraine, a commercial pilot's pre-flight checklist just got much more complicated
July 24, 2014 -- Updated 1317 GMT (2117 HKT)
Mark Kramer says Russia and its proxies have a history of shooting down civilian aircraft, often with few repercussions
July 24, 2014 -- Updated 1637 GMT (0037 HKT)
Gerard Jacobs says grieving families and nations need the comfort of traditional rituals to honor the remains of loved ones, particularly in a mass disaster
July 24, 2014 -- Updated 1413 GMT (2213 HKT)
The idea is difficult to stomach, but John Sutter writes that eating dog is morally equivalent to eating pig, another intelligent animal. If Americans oppose it, they should question their own eating habits as well.
July 23, 2014 -- Updated 1630 GMT (0030 HKT)
Bill van Esveld says under the laws of war, civilians who do not join in the fight are always to be protected. An International Criminal Court could rule on whether Israeli airstrikes and Hamas rocketing are war crimes.
July 23, 2014 -- Updated 1205 GMT (2005 HKT)
LZ Granderson says Ronald Reagan went horseback riding and took a vacation after the Korean Air Crash of 1983. So why does the GOP keep airbrushing history to bash Obama?
July 23, 2014 -- Updated 1338 GMT (2138 HKT)
Aaron Miller says Kerry needs the cooperation of Hamas, Israel, Egypt and others if he is to succeed in his peacemaking efforts
July 23, 2014 -- Updated 1251 GMT (2051 HKT)
Errol Louis says the tragic death of Eric Garner at the hands of the NYPD has its roots in the "broken windows" police strategy from the crime-ridden '80s.
July 23, 2014 -- Updated 1408 GMT (2208 HKT)
Gordon Brown says the kidnapped Nigerian girls have been in captivity for 100 days, but the world has not forgotten them.
July 23, 2014 -- Updated 1127 GMT (1927 HKT)
Ruben Navarrette says Texas Gov. Rick Perry is right to immediately send 1,000 National Guard troops to the U.S.-Mexico border in response to the border children crisis.
July 22, 2014 -- Updated 1356 GMT (2156 HKT)
Ukraine's president says the downing of MH17 was a terrorist act, but Richard Barrett says it would be considered terrorism only if it was intentional
July 22, 2014 -- Updated 2015 GMT (0415 HKT)
Robert McIntyre says the loophole that lets firms avoid taxes should be closed
July 22, 2014 -- Updated 1535 GMT (2335 HKT)
Jeronimo Saldana and Malik Burnett say Gov. Perry's plan to send National Guard to the border won't solve the escalating immigration problem.
July 22, 2014 -- Updated 1742 GMT (0142 HKT)
Sally Kohn: The world's fish and waters are polluted and under threat. Be very careful what fish you eat
July 22, 2014 -- Updated 1242 GMT (2042 HKT)
Les Abend says threat information that pilots respond to is only as good as the intelligence from air traffic controllers. And none of it is a match for a radar-guided missile
July 21, 2014 -- Updated 1235 GMT (2035 HKT)
Frida Ghitis: Anger over MH17 is growing against pro-Russia separatists. It's time for the Dutch government to lead, she writes
July 21, 2014 -- Updated 1227 GMT (2027 HKT)
Julian Zelizer says President Obama called inequality the "defining challenge" of our time but hasn't followed through.
July 21, 2014 -- Updated 1157 GMT (1957 HKT)
Gene Seymour says the 'Rockford Files' actor worked the persona of the principled coward, charming audiences on big and small screen for generations
July 21, 2014 -- Updated 1417 GMT (2217 HKT)
Daniel Treisman says that when the Russian leader tied his fate to the Ukraine separatists, he set the stage for his current risky predicament
July 18, 2014 -- Updated 1642 GMT (0042 HKT)
Andrew Kuchins says urgent diplomacy -- not sanctions -- is needed to de-escalate the conflict in Ukraine that helped lead to the downing of an airliner there.
July 19, 2014 -- Updated 0150 GMT (0950 HKT)
Jim Hall and Peter Goelz say there should be an immediate and thorough investigation into what happened to MH17.
July 18, 2014 -- Updated 1507 GMT (2307 HKT)
Pilot Bill Palmer says main defense commercial jets have against missiles is to avoid flying over conflict areas.
July 20, 2014 -- Updated 1755 GMT (0155 HKT)
Valerie Jarrett says that working women should not be discriminated against because they are pregnant.
July 21, 2014 -- Updated 1953 GMT (0353 HKT)
David Wheeler says the next time you get a difficult customer representative, think about recording the call.
July 18, 2014 -- Updated 1933 GMT (0333 HKT)
Newt Gingrich says the more dangerous the world becomes the more Obama hides in a fantasy world.
July 18, 2014 -- Updated 1011 GMT (1811 HKT)
Michael Desch: It's hard to see why anyone, including Russia and its local allies, would have intentionally targeted the Malaysian Airlines flight
July 17, 2014 -- Updated 1914 GMT (0314 HKT)
LZ Granderson says we must remember our visceral horror at the news of children killed in an airstrike on a Gaza beach next time our politicians talk of war
July 17, 2014 -- Updated 1206 GMT (2006 HKT)
Sally Kohn says now the House GOP wants to sue Obama for not implementing a law fast enough, a law they voted down 50 times, all reason has left the room.
July 17, 2014 -- Updated 1214 GMT (2014 HKT)
A street sign for Wall Street
Sens. Elizabeth Warren, John McCain and others want to scale back the "too big to fail" banks that put us at risk of another financial collapse.
July 17, 2014 -- Updated 2016 GMT (0416 HKT)
Newt Gingrich writes an open letter to Robert McDonald, the nominee to head the Veterans Administration.
July 18, 2014 -- Updated 1601 GMT (0001 HKT)
Paul Begala says Dick Cheney has caused an inordinate amount of damage yet continues in a relentless effort to revise the history of his failures.
July 18, 2014 -- Updated 1404 GMT (2204 HKT)
Kids who takes cell phones to bed are not sleeping, says Mel Robbins. Make them park their phones with the parents at night.
July 25, 2014 -- Updated 1237 GMT (2037 HKT)
Buzz Aldrin looked at planet Earth as he stood on talcum-like lunar dust 45 years ago. He thinks the next frontier should be Mars.
July 16, 2014 -- Updated 1804 GMT (0204 HKT)
Mark Zeller never thought my Afghan translator would save his life by killing two Taliban fighters who were about to kill him. The Taliban retaliated by placing him on the top of its kill list.
July 17, 2014 -- Updated 1518 GMT (2318 HKT)
Jeff Yang says an all-white cast of Asian characters in cartoonish costumes is racially offensive.
July 17, 2014 -- Updated 0124 GMT (0924 HKT)
Gary Ginsberg says the late John F. Kennedy Jr.'s reaction to an event in 1995 summed up his character
July 16, 2014 -- Updated 1641 GMT (0041 HKT)
Meg Urry says most falling space debris lands on the planet harmlessly and with no witnesses.
ADVERTISEMENT