“3-4-50,” Bioethics, and the Church

In bioethics, we focus—necessarily, I suppose—on rules and principles to address concerns at the boundaries of human life. Compelling as this may be (How shall we limit the mischief committed in the name of progress? How shall we forge a “grand solution,” if one is even accessible, to ensure that everyone gets the medical care he needs?), I sometimes wonder whether we are barking up the right trees—or, maybe I should say, barking at branches while the trunk rots.

In partial response, I give you Dr. Nick Yphantides: disciple of the Lord Jesus Christ, Chief Medical Officer for San Diego County, and brother of one of the elders of my congregation. He describes how our “health care” is really “sick care” for preventable, lifestyle-related conditions. While many have commented on this, Dr. Nick’s formula is simple—3-4-50:

o Three behaviors—poor diet, lack of exercise, and tobacco use—lead to
o Four diseases—cancer, heart disease, Type 2 diabetes, and lung cancer—which cause
o Fifty percent of deaths—in San Diego and the U.S., and the world (at least, the industrialized world).

Whatever other arguments we have about medicine, ethics, economics, and politics, if we would attend to the “three,” we would do ourselves a lot of good, make ourselves healthier in the balance, and probably dramatically lower the costs of our “sick care.” We can debate that last point, and expensive medicine will not go away overnight, but changing the three harmful behaviors seems common sense about which there is broad agreement.

Oh, by the way, Dr. Nick used to weigh 467 pounds. Now he weighs 194. It’s all described on his website, HealthSteward.com, and his book, My Big Fat Greek Diet. (Note that if you Google on “healthy stewards” you can also pull up websites addressing fitness.)

All well and good—but is there a specifically Christian take on this? I worry about “Christian” approaches that seem more faddish than theologically grounded. My grandparents’ Christian bookstore used to carry a title, The Fat is in Your Head (I think Revell was the publisher), and who can forget the exercise video “Firm Believer” (get it?) from the 80’s?

Well, Dr. Nick’s testimony is that the Christian approach is both simple and foundational—be a steward of the health of the gifts our God-created bodies are. He starts with Jesus’ admonition to the Pharisees to “clean the inside” first, and the outside WILL follow. From there, Dr. Nick proceeds to ground seven “pillars” of health stewardship in love and gratitude. Read more about this on his website and in his book. HealthStewards is a specific ministry for Dr. Nick—“Building the kingdom through shrinking the body,” as he tells me in an e-mail.

It seems to me there is a legitimate Christian stance by which we, in recognition of who we are as God’s creatures, joyfully encourage each other and those outside our community to live more healthily—starting from youth. I think such a stance is gentle and grace-based, not legalistic; that it steadfastly AVOIDS stigmatizing anyone; that it encourages moderation while avoiding some sort of asceticism while also reminding ourselves that gluttony and sloth are two of the Seven Deadly Sins; that it fosters a culture of “personal best” rather than pursuit of some ideal, especially of fitness or beauty; and that it admits of some freedom on the margins (I’m in the Presbyterian Church in America, or “PCA,” which, as the joke goes, stands for “pipes, cigars, and alcohol [or ammo].”)

Two final points, for now: First, I’m terribly ambivalent about the proper scope of government paternalism over all this. I am sympathetic to restrictions on smoking but find Mr. Bloomberg’s limits on soda sizes misguided, for example. Second, while it is tempting to start discussions of “3-4-50” with the costs of “sick care,” I think the usefulness of that approach is limited. Less Type 2 diabetes means less expense to control blood sugar or treat the complications of diabetes, for sure. But coronary bypass and colonoscopy and the latest drug for breast cancer may still be relatively expensive in the U.S., for one, and for another, I read that knee replacements for active seniors are becoming a cost-driver for Medicare.

What do you, readers of this blog, think about all this? For the moment, it’s off to the gym for me. I’m 6’3” and 220, making me 20 pounds overweight by BMI. And I wish, at age 55, that I was built like an NFL safety. Sooooo not gonna happen….

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Joel Goodnough, MD
Joel Goodnough, MD
7 years ago

Your points are all good. But healthy life style and cost control are separate issues. It is good to have a healthy life style for a better quality of life and to honor that which God has created. I don’t think it is yet proven, however, that a healthy life style leads to lower health care costs. It may be cheaper to die quickly from lung cancer or a heart attack at a relatively young age. And preventative medicine many times leads to false positives and unnecessary follow up testing. Giving control to the consumer through high deductible, catastrophic insurance and cost transparency may lead to lower costs. Many symptoms are self limited and do not indicate a major illness and therefore do not require a “free” trip to the doctor. The prognosis of some cancers (such as breast and ovarian) is not changed through annual physical exams but such exams can lead to unnecessary testing.

Jon Holmlund
Jon Holmlund
7 years ago

Oh, agreed–that’s why I made the point I did in my last full paragraph. If we were all non-smoking reasonably active people who are at or near ideal body weight range, it may not lower our medical costs, but I’d love to “do the experiment,” so to speak. I’ve actually asked Dr. Nick, a public health expert, to visit the blog and weigh in here. Let’s see if he does. BTW, I think that he is also more a fan of a Canadian-style health insurance regime than you (or I). But the issues are different. Also, what I was writing about did not assume anything about the scope and frequency of active preventive care services. That, too, is a different kettle of fish, and a more complex one, when one attempts to account for improved productivity of a healthier population, for example. And “surveillance” of cancers in remission is yet another kettle of fish. Finally, a point I didn’t address is the relationship between socioeconomic status and obesity. Is fitness, in point of fact, a privilege enjoyed by the wealthy in the contemporary U.S.? But, these are questions better addressed in separate posts and discussion strings.

Nick Yphantides
7 years ago

Thank you so much Jon for your generous post and for posting these considerations. Ultimately I see this as a matter of stewardship…personal and societal. If our health is a God given gift, what does it say about our attitude towards the giver of the gift in the way we handle and care for that gift. From a societal perspective while it is true that so few have beeen able to make meaningful lifestyle changes for large studies to quantify the outcome, it is not hard to imagine that smoking, physical inactivity and unhealthy diets are major factors in the chronic disease burden in America today. I like to joke that our body is the Temple not the Cathedral of the Holy Spirit and appropriately motivated stewardship has potential for powerful testimonial impact. With our ministry we say we are “building the kingdom through shrinking the body” as ultimately the solutions have to come from the inside out. Thanks upon thanks Jon!

Steve Phillips
7 years ago

We sometimes forget that much of ethics is how we live every day. This is a good reminder of that. So I’ll dust off my exercise bike and ride for a while since it is getting a little too cold here in Indiana to exercise comfortably outdoors.