What is Health?

I came across an interesting article in the New England Journal of Medicine this week that gave me cause to think about health in general and how it is measured.  The study was looking at asthma and studied it in two ways.  The first was by measuring the amount of air a person exhales in one second.  This is quite standard and is used frequently to see how well one is doing with their disease.  The second measurement was to simply ask the patient if they were feeling short of breath or not.

There were three groups of patients.  One group received an inhaler containing albuterol.  Again this is a very standard medication used to treat asthma.  It relaxes the muscles that surround the airways allowing for improved passage of air.  Another group received acupuncture and the third group received a fake treatment-or placebo.  In regards to the air measurement, the medication was overwhelmingly effective compared to the other two arms.  However, by symptom scores the acupuncture and the medication were rated the same.  The question then is asked, which group was healthier?  It is easy to say that it is the group with the best airway measurements but that is not why patients come to see the doctor.  They do not come and state, "doc, I just don't feel like I am getting enough air out of my lungs in the first second that I breath."  They say, "I am short of breath."  From a doctor's standpoint, what recommendations do I give my patients?  I would enjoy hearing what you think about this.

As I have contemplated this further, I have thought that we cannot just go by how a patient is feeling.  There are plenty of medical conditions that can be detected at an asymptomatic state.  If nothing is done at the time, the disease can progress with possible deadly consequences to follow.  For example, why would anyone agree to undergo screening for colon cancer?  This requires taking medication to flush out the colon, go to a facility where powerful sedative medications are given so that a scope can be inserted into the colon.  None of that is going to make a patient feel any better.  However, if a polyp is found, cancer is averted.  The consequences of not finding colon cancer at an early stage are far worse than what it takes to have a colonoscopy performed.  Another example is hypertension.  It is called the silent assassin for a reason.  For many years there will be no symptoms in patients with elevated blood pressure.  Eventually, though, the heart will either weaken, develop arrhythmias or succomb to a hear attack due to blood vessel blockages.  Strokes can occur in the same fashion.  Therefore, the answer to the question, "why would a doctor recommend that a patient who feels fine take a medication that may have side effects?" is that it just may save their life.

Continuing with the theme of hypertension, let me ask: Who is healthier?  A patient with a blood pressure of 120/78 who is taking three medications to keep his blood pressure down, is overweight, does not exercise and eats out about twice a week? or a patient with a blood pressure of 120/78 who is on no medications but exercises five days a week, keeps his weight down and watches what he eats?  The answer seems obvious does it not?  However, I frequently see patients who will look at the number, take the pills and make no effort to do more on their own feeling that everything is just fine.


In summary, health, I believe is more than how we feel, though that is an important component.  Health is also how we live.  Health is more than the absence of disease.  Healthy living lowers our risk for future disease as well.