Why Behavior Change is Better Medicine than Drugs

One of the preconceptions that people have about "personalized medicine" is that it comes down to pharmaceuticals - that we'll use our personal information, most likely genetic information, to identify specific drugs that will work best for us. The problem with this conception, though, is that it still assumes a reactive medical establishment, where we're stuck treating chronic disease, rather than taking decisive action earlier to ward off disease altogether. (Another problem is the lack of such drugs in the pharma pipeline, but that's another issue.)

The real promise of personalized medicine, to my mind, is that we'll be making earlier decisions based on our specific and granular understanding of what our risks are, and using that information to choose better behaviors, well before we may need drugs. (This is why I prefer the term "predictive medicine," but that's just semantics.)

I got some evidence for this line of thinking yesterday in a conversation with Dr. Dean Ornish, the well-known diet guru who is also a respected scientist (and it should be said, fan of Wired, where I work). A few months ago, Dr. Ornish and colleagues published some intriguing data in the Lancet, based on a study that assessed how behavior change affects telomeres, the ends of our chromosomes that control how long we live. Ornish's work showed that drastically improved behavior change - better diets and more exercise - actually increased telomerase, the enzyme that lengthens telomeres. In other words, better behavior probably lengthen our lives. Ornish also recently published a complementary study in the Proceedings of the National Academy of Sciences that found behavior change may even change gene expression. The study showed that genes associated with cancer, heart disease and inflammation were downregulated or "turned off" whereas protective genes were upregulated or "turned on." Though it was a small study, of  30 men, the evidence is impressive, insofar that it demonstrates that behavior change works not just on a metabolic level, but on a genomic one as well.

Now obviously behavior change of the sort that these studies uses is intensive and thorough, on a scale that few people are likely to get close to. For the PNAS study, the men were assigned a "low-fat, whole-foods, plant-based nutrition; stress management techniques; moderate exercise; and participation in a psychosocial group support." As Dr. Ornish acknowledges, these are expensive services to provide. But what may be more important is the demonstration of principles - collaborative groups, and feedback loops that make people conscious of what they're eating and how much they're exercising. These are sound principles that anyone can adopt.

Dr. Ornish has an op-ed in today's Wall Street Journal, co-authored by alternative medicine gurus Deepak Chopra and Andrew Weil, that elaborates on these principles and places them in a broader context of preventive medicine. Alternative medicine gets a lot of gruff from the traditional medical establishment, and I confess I myself am more comfortable with data and metrics than the "feel good" mechanisms that Chopra prostilitizes. But what's emerging, as Dr. Ornish's work and the op-ed shows, is that the two aren't mutually exclusive. There is sound data behind the preventive medicine that goes by the name of "wellness," there's a method to it that's more effective than pharmacology. That doesn't make behavior change any easier. But at least we know it's the better medicine.

Thomas GoetzComment