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- Page navigation anchor for Is evidence based medicine the real Trojan horse?Is evidence based medicine the real Trojan horse?I enjoyed reading your thoughtful analysis of lifestyle medicine1 but worry that it is evidence-based medicine itself that is the ‘Trojan Horse’ that has smuggled in numerous harmful, unnecessary pharmaceutical interventions. Applying the same crude methodology to ‘lifestyle medicine’ misses the common sense that the majority of these interventions are extremely likely to help, whether evidenced or not, but also likely not to cause harm. Relying on validation from EBM before applying our objective common sense is precisely what has eroded the trust of our patients and opened us to justifiable claims of professional arrogance in dismissing alternative approaches to healthcare. Nobody is arguing that these are not more effective when applied at a population health level, but this should not preclude GPs from applying our professional common sense in tailoring sensible and safe lifestyle interventions for our patients.Reference1. Nunan D, Blane D, McCartney M. Exemplary medical care or Trojan horse? Br J Gen Pract 2021; 71 (707): 229-232.Competing Interests: None declared.
- Page navigation anchor for Exemplary medical care or Trojan horse? An analysis of the ‘lifestyle medicine’ movementExemplary medical care or Trojan horse? An analysis of the ‘lifestyle medicine’ movement
Thank you for an interesting article which rightly highlights the many vested interests across the colourful and evolving landscape of health services for chronic disease.
That said, the general premise of the article seems to be to suggest a dichotomy, which in reality I am sure is a false dichotomy - individualised v public health centred care. There is room for both!
I agree that the umbrella term 'lifestyle medicine' can be surreptitiously and dishonestly secured to poorly evidenced practices, by practitioners with a keen eye for profit. However, it seems rather 'lumpish' to associate the BSLM with these kinds of behaviours.
I think the 'bang-for-buck' commentary is fair, in recognising that public health policy can be a very powerful tool. However, entities like the BSLM, alongside honest individual lifestyle medicine practitioners, aim to influence public health policy, using latest peer-reviewed evidence. We should also be mindful that the individual approach may serve more than the individual patient, since improved health is often a subject for discussion with friends and family, and the improved health behaviours of a parent for example, are likely to cascade positively to children.
I would fully expect that BLSM and the Centre for Evidence Based Medicine both are firmly committed to an evidence-based approach to healthcare.
Competing Interests: None declared. - Page navigation anchor for Behavioural determinants of health: individual versus societal responsibilityBehavioural determinants of health: individual versus societal responsibility
Nunan et al draw our attention to the emphasis of so-called ‘lifestyle medicine’ on behavioural determinants of health and the responsibility of individuals for behaviour modification.¹ Whilst it is important to address the leading behavioural determinants of premature mortality in England, namely tobacco use/unhealthy diet/alcohol and drug use/physical inactivity,² the authors rightly highlight the importance of considering the wider determinants of health.
An important point being made here is that overemphasis on health behaviours and individual-focussed interventions (intentional or unintentional) may actually increase health inequalities and draw attention away from the main drivers of poor health, namely the wider socioeconomic and environmental determinants of health. As the Marmot reviews have shown us, differences in socioeconomic status are associated with dramatic differences in rates of premature mortality and disability; the 2020 review reported a 12 year difference in healthy life expectancy at birth between the most and least deprived regions of England.³ Moreover, a recent cross-sectional study of 2.5 million premature deaths in England found that 1/3 of these deaths were attributable to socioeconomic inequality.⁴
Clearly, a balance must be struck between individual responsibility and wider societal/governmental responsibility. It is important not to minimise individual responsibility for one’s...
Competing Interests: None declared. - Page navigation anchor for Distinguishing ‘lifestyle medicine’ from pseudoscienceDistinguishing ‘lifestyle medicine’ from pseudoscience
Nunan and colleagues caution against uncritical adoption of so-called ‘lifestyle medicine’.¹ We agree that as healthcare professionals we need to be careful to avoid unwittingly implementing or condoning non-evidence-based practices. The authors raise an important point regarding a central tenet of ‘integrative medicine’, in that it seeks to integrate so-called complementary and alternative medicine (CAM) with ‘conventional medicine’. Credulously welcoming CAM with open arms as part of integrative medicine may give undeserved credibility and legitimise practices with weak/no evidence of efficacy or worse, evidence of harm. We previously argued the case for abandoning the umbrella term CAM,² due to its ambiguous definition which groups a “highly heterogeneous group of health-related practices with significantly different evidence bases” and therefore risks conflating evidence-based treatments with pseudoscientific practices. Put simply, any healthcare intervention championed as part of lifestyle medicine should be evaluated and subjected to the same level of scientific rigor as all other healthcare practices.
We suspect that we may inadvertently enable non-evidence-based practices to pervade healthcare as a result of a fundamental desire to practice holistic medicine and support patients’ self-management, combined with a perception that many ‘alternative’ interventions are low ris...
Competing Interests: None declared. - Page navigation anchor for Lifestyle medicine is no Trojan Horse: it is an inclusive, evidence-based and patient-focused movementLifestyle medicine is no Trojan Horse: it is an inclusive, evidence-based and patient-focused movement
We welcome positive aspects of Nunan et al’s article and the opportunity to briefly discuss their analysis. However, likening lifestyle medicine to a Trojan Horse implies deception and malice; and is both unworthy and unjustified.
There are important positive messages conveyed: for example, articulating many of lifestyle medicine’s key drivers (Box 1), plus individual and public health level interventions (Box 2).
However, there are important fallacies too and we seek to correct these:
1. Misrepresenting BLSM only as accrediting GPs. Although 885(~50%) members are GPs/GPSTs, membership includes all medicine disciplines, including internal medicine/surgery/nurses/allied health professionals/trainees. We also have patient members, encouraged to attend meetings through invitations via their clinicians (https://bslm.org.uk/events/bslm-2021-conference/) and read our open access journal, lifestyle medicine (https://onlinelibrary.wiley.com/journal/26883740).
2. Inaccurately linking alternative medicine practices/practitioners to lifestyle medicine; including bracketing BSLM with organisations like the (recently-rebranded) British Association for Nutrition and Lifestyle Medicine and (functional medicine-oriented) Prescribing Lifestyle Medicine
3. Concern ‘lifestyle medicine practitioners...Competing Interests: FNB is Director of Science & Research for the British Society of Lifestyle Medicine and Editor-in-Chief of Lifestyle Medicine, the official journal of the British Society of Lifestyle Medicine, Australasian Society of Lifestyle Medicine, the European Lifestyle Medicine Council and the Korean College of Lifestyle Medicine. Research grants for engagement through, plus spread and evaluation of group consultations (which create the time and space for effective delivery of Lifestyle Medicine) from Sir Jules Thorn Trust, National Institute for Health Research, Medical Research Council. RJP is Director of Undergraduate Public Health Education and module lead for Imperial College London’s undergraduate medicine modules on Lifestyle Medicine and Prevention. RJL is Chair of British Society of Lifestyle, Medicine President of European Lifestyle Medicine Council, Chair of World Lifestyle Medicine Council (formerly known as the Lifestyle Medicine Global Alliance). No other direct or indirect other financial conflicts of interest to declare in relation to Lifestyle Medicine. - Page navigation anchor for BANT welcomes the BJGP article on lifestyle medicine and opens the door to discussions.BANT welcomes the BJGP article on lifestyle medicine and opens the door to discussions.
BANT is encouraged by the BJGP acknowledgement of well-informed drivers validating lifestyle medicine.1 Since its foundation in 1997, BANT has been at the forefront of nutritional therapy (NT) and personalised nutrition in support of its 3,500 members. This individualised approach is founded on principals of lifestyle medicine, where diet and lifestyle are recognised as modifiable factors for therapeutic consideration. A ground-breaking 2021 pilot study by Harris and Benbow highlights the effectiveness of NT in delivering satisfying outcomes.2
Lifestyle medicine is part of a wider paradigm change that has been evolving partly in response to the rise of non-communicable diseases, but most notably in recognition of the individual factors that determine how these diseases express themselves. It has been fuelled by the public response to public health measures, aimed at the general population and unable to serve at an individual level. The result, chronically ill individuals seeking personalised support.
Lifestyle medicine is purposefully patient-centred and provides individualised protocols offering optimum, rather than generic, support. The American Nutrition Association highlight this most eloquently in their 2020 paper ‘Toward the Definition of Personalized Nutrition’3 in which they argue that “a disease-centered, acute care approach is ill suited to chronic conditions that develop over time and h...
Show MoreCompeting Interests: CEO & Director, British Association of Nutrition and Lifestyle Medicine, Lecturer at Centre for Nutrition Education & Lifestyle Management (CNELM) - Page navigation anchor for Exemplary medical care or Trojan horse? An analysis of the ‘lifestyle medicine’ movementExemplary medical care or Trojan horse? An analysis of the ‘lifestyle medicine’ movement
Thank you for this article, however you disingenuously imply that the ‘benefits’ of lifestyle medicine are subjugated on the application of inadequate critique, the inclusion of pseudoscience and ‘alternative medicine’, profiteering and an absence of focus on social and political reduction of poverty and other societal drivers of health inequality by the related beneficial behavioural changes being individualised in their application.
We live in a socio-economic and environmental context over which we have, often, limited or no control. Lifestyle medicine does not just acknowledge this, it proactively advocates for changes at these levels which will improve people’s health and wellbeing.
Examples of good quality lifestyle-based evidence include The Direct Trial for Type-2 Diabetes remission,1 The SMILES Trial2 for depression remission and The Lifestyle Heart Trial3 and related follow ups4,5 for coronary arterial disease reversal.
Further qualified work in this area is presented by the Preventative Medicine Research Institute. The central core of lifestyle medicine is about supported behaviour change at individual and community levels. Until clinicians operate at the level of policy and legislation, their primary focus is on meeting the needs of their patients and community within their scope of capability.
Prescribing lifestyle medicine (supplied by...
Show MoreCompeting Interests: Managing Director of Nutri-Link, Co Founder of Precribing Lifetyle Medicine, Managing Director of Nutri-Link Co Founder of Prescribing Lifestyle Medicine Founder of Clinical Education a NFP organisation, vegetarian, non-coeliac gluten sensitive, teetotal non smoker and exercise enthusiast.