Menus Subscribe Search

Follow us


Dr. Walter Bortz

Dr. Walter Bortz (PHOTO: LUCAS AZNAR/PACIFIC STANDARD)

Prescription for an Ailing Care System: Combat Health Illiteracy

• December 06, 2012 • 4:00 AM

Dr. Walter Bortz (PHOTO: LUCAS AZNAR/PACIFIC STANDARD)

Dr. Walter Bortz of Stanford University argues that we need to shift our medical system’s focus from disease to health.

Dr. Walter Bortz, a clinical professor of medicine at Stanford University, vividly recalls a meeting in which officials of the medical school outlined plans for a new hospital.

“The director regaled us of all its glories, telling us, ‘We’re going to have this and this and this,’” he said. “I put my hand up and asked, ‘But what are you doing to keep people out of the hospital?’”

He got no answer, of course. But the question sums up Bortz’s mission in a nutshell: He wants to change the basic relationship between the public and the medical establishment. He argues that people need to take charge of their own bodies, and health institutions need to educate and guide them toward optimal health.

Bortz calls this approach “Next Medicine,” which is also the title of his latest book (published by Oxford University Press). The author of six other books and 131 research papers (at last count), the extremely active 82-year-old is a recognized authority on aging. During a recent conversation over lunch, he talked about his ongoing effort to shift the focus of the medical establishment and combat what he calls “health illiteracy.”

What’s the fundamental problem with today’s medical system, as you see it?

The two tools in medicine’s black box are pills and (surgical) tools. They work for certain things, but not for either diabetes or aging, which are the two big global health challenges today. What are we going to do with 600 million disabled old people? We need a new paradigm—not illness, not disease, but health. I’m trying to help shape that process.

What’s stopping us from shifting to a prevention and health-maintenance orientation?

It’s about the locus of control. Medicine wants to control, because that’s where the money is. People don’t want to take care of themselves; they want somebody to do it for them. That’s the historic moment we are at.

Many will read this and ask, “Isn’t our health largely determined by our genes?”

Only 15 percent. That figure is taken from twin studies, since they share precisely the same genetic pattern. And it may be less than that, since the seeming influence of heredity may be a product of shared family values. Genetics play a role, but it’s blamed for too much.

If they’re not blaming their genes for illness, people often say, “Well, I’m just getting old.” Is that a cop-out?

It wasn’t until I pulled my Achilles tendon that I was able to define aging. My leg became frail. But what is frailty? It’s not a disease. Is aging a disease? No. So it needs a different explanatory platform. It became my scientific responsibility to find it. I wrote a major paper in JAMA in 1980 called “Disuse and Aging.” It differentiates disuse, which is reparable, from aging, which isn’t. It’s an important differentiation. We were accepting (so many physical limitations) and saying, “That’s just aging.”

I hearken to the serenity prayer: Change what you can, accept what you must. We now know that “Are you fit or are you frail?” and “Are you a resource or a liability?” are choices. Fitness is a 30-year aging offset. Biologically, a fit person of 80 is like an unfit person of 50. To me, that’s profound.

So the rate at which we physically decline …

… Is up to us. My doctor son and I calculated that, if you’re not fit, you get older at a rate of 2 percent per year. If you are fit, you get older at a rate of one-half percent per year. You can’t see the difference over a short period, but you can over 30 years.

How do we get people to take responsibility for their own health?

My rubric is, if you’re going to change behavior, you need three things: information, opportunity and incentive. An overweight woman suffering from diabetes who comes to me as a doctor will expect me to give her a pill. She doesn’t have the information that her weight is contributing to her disease. We must give her health literacy. It’s medicine’s responsibility to allow her to take care of herself.

The second is opportunity. It’s no good having the knowledge if you don’t have the time or resources to implement it, or you only have McDonald’s in your neighborhood.

Then there’s incentive. When you pay your income tax, why not be rewarded for having a certain BMI? It’s not that different from (making people wear) seat belts or helmets. Why not embed a pedometer in your body? Every April 14th, you would see what your pedometer setting is and plug that into your tax return.

What changes need to be made in the health-care system?

We’re saddled with wrong personnel. We have all these specialists. We need to downscale that. You don’t need more neurosurgeons; we need more nurse practitioners. You can’t say, “Don’t operate” to a surgeon—that’s who they are—but you can have a Kaiser-type system that rewards people for staying healthy. Get rid of fee-for-service medicine.

What did the Affordable Health Act get right, and what did it get wrong?

The important thing that is did was ensure near-universal coverage. It was unconscionable that we were the only (industrialized) country in the world that did not have total coverage. But the question becomes: coverage of what? Do we simply have a license to have a daily MRI?

We need to create a whole culture of health. If we don’t have sidewalks, we need city planners (to make sure they’re built). If we have too much sugar in our diets, we need farmers (to grow healthier foods). We need to ask ourselves, “What is health?”

These ideas usually come from people outside the medical establishment. Do you have unusual authority to make such a critique?

I’m inside the tent. My dad was president of the AMA. I have all these credentials. I wanted Oxford to publish my book Next Medicine because I thought it was the place to try to impact my profession. They welcomed me immediately.

You still train doctors at Stanford. Is the new generation of physicians thinking more holistically?

Yes. Three or four years ago, I heard about a guy at Harvard named Eddie Phillips, who started the Institute for Lifestyle Medicine. I thought it was amazing that an academic institution would put their imprint on such an institute. Stanford would never do it! So I have sent Stanford med students there, and we now have a course on lifestyle medicine, which was originated by the students. It’s a wonderful way to shame the faculty.

Tom Jacobs
Staff writer Tom Jacobs is a veteran journalist with more than 20 years experience at daily newspapers. He has served as a staff writer for The Los Angeles Daily News and the Santa Barbara News-Press. His work has also appeared in The Los Angeles Times, Chicago Tribune, and Ventura County Star.

More From Tom Jacobs

A weekly roundup of the best of Pacific Standard and PSmag.com, delivered straight to your inbox.

Recent Posts

October 24 • 4:00 PM

We Need to Normalize Drug Use in Our Society

After the disastrous misconceptions of the 20th century, we’re returning to the idea that drugs are an ordinary part of life experience and no more cause addiction than do other behaviors. This is rational and welcome.


October 24 • 2:00 PM

A Letter to the Next Attorney General: Fix Presidential Pardons

More than two years ago, a series showed that white applicants were far more likely to receive clemency than comparable applicants who were black. Since then, the government has spent hundreds of thousands of dollars on a study, but the pardons system remains unchanged.


October 24 • 12:00 PM

What Makes You So Smart, Middle School Math Teacher?

Noah Davis talks to Vern Williams about what makes middle school—yes, middle school—so great.


October 24 • 10:00 AM

Why DNA Is One of Humanity’s Greatest Inventions

How we’ve co-opted our genetic material to change our world.


October 24 • 8:00 AM

What Do Clowns Think of Clowns?

Three major players weigh in on the current state of the clown.


October 24 • 7:13 AM

There Is No Surge in Illegal Immigration

The overall rate of illegal immigration has actually decreased significantly in the last 10 years. The time is ripe for immigration reform.


October 24 • 6:15 AM

Politicians Really Aren’t Better Decision Makers

Politicians took part in a classic choice experiment but failed to do better than the rest of us.


October 24 • 5:00 AM

Why We Gossip: It’s Really All About Ourselves

New research from the Netherlands finds stories we hear about others help us determine how we’re doing.


October 24 • 2:00 AM

Congratulations, Your City Is Dying!

Don’t take population numbers at face value.


October 23 • 4:00 PM

Of Course Marijuana Addiction Exists

The polarized legalization debate leads to exaggerated claims and denials about pot’s potential harms. The truth lies somewhere in between.


October 23 • 2:00 PM

American Companies Are Getting Way Too Cozy With the National Security Agency

Newly released documents describe “contractual relationships” between the NSA and U.S. companies, as well as undercover operatives.


October 23 • 12:00 PM

The Man Who’s Quantifying New York City

Noah Davis talks to the proprietor of I Quant NY. His methodology: a little something called “addition.”


October 23 • 11:02 AM

Earliest High-Altitude Settlements Found in Peru

Discovery suggests humans adapted to high altitude faster than previously thought.


October 23 • 10:00 AM

The Psychology of Bribery and Corruption

An FBI agent offered up confidential information about a political operative’s enemy in exchange for cash—and they both got caught. What were they thinking?


October 23 • 8:00 AM

Ebola News Gives Me a Guilty Thrill. Am I Crazy?

What it means to feel a little excited about the prospect of a horrific event.


October 23 • 7:04 AM

Why Don’t Men Read Romance Novels?

A lot of men just don’t read fiction, and if they do, structural misogyny drives them away from the genre.


October 23 • 6:00 AM

Why Do Americans Pray?

It depends on how you ask.


October 23 • 4:00 AM

Musicians Are Better Multitaskers

New research from Canada finds trained musicians more efficiently switch from one mental task to another.


October 22 • 4:00 PM

The Last Thing the Women’s Movement Needs Is a Heroic Male Takeover

Is the United Nations’ #HeForShe campaign helping feminism?


October 22 • 2:00 PM

Turning Public Education Into Private Profits

Baker Mitchell is a politically connected North Carolina businessman who celebrates the power of the free market. Every year, millions of public education dollars flow through Mitchell’s chain of four non-profit charter schools to for-profit companies he controls.


October 22 • 12:00 PM

Will the End of a Tax Loophole Kill Off Irish Business and Force Google and Apple to Pay Up?

U.S. technology giants have constructed international offices in Dublin in order to take advantage of favorable tax policies that are now changing. But Ireland might have enough other draws to keep them there even when costs climb.


October 22 • 10:00 AM

Veterans in the Ivory Tower

Why there aren’t enough veterans at America’s top schools—and what some people are trying to do to change that.


October 22 • 8:00 AM

Our Language Prejudices Don’t Make No Sense

We should embrace the fact that there’s no single recipe for English. Making fun of people for replacing “ask” with “aks,” or for frequently using double negatives just makes you look like the unsophisticated one.


October 22 • 7:04 AM

My Politicians Are Better Looking Than Yours

A new study finds we judge the cover by the book—or at least the party.


October 22 • 6:00 AM

How We Form Our Routines

Whether it’s a morning cup of coffee or a glass of warm milk before bed, we all have our habitual processions. The way they become engrained, though, varies from person to person.


Follow us


Politicians Really Aren’t Better Decision Makers

Politicians took part in a classic choice experiment but failed to do better than the rest of us.

Earliest High-Altitude Settlements Found in Peru

Discovery suggests humans adapted to high altitude faster than previously thought.

My Politicians Are Better Looking Than Yours

A new study finds we judge the cover by the book—or at least the party.

That Cigarette Would Make a Great Water Filter

Clean out the ashtray, add some aluminum oxide, and you've (almost) got yourself a low-cost way to remove arsenic from drinking water.

Love and Hate in Israel and Palestine

Psychologists find that parties to a conflict think they're motivated by love while their enemies are motivated by hate.

The Big One

One company, Amazon, controls 67 percent of the e-book market in the United States—down from 90 percent five years ago. September/October 2014 new-big-one-5

Copyright © 2014 by Pacific Standard and The Miller-McCune Center for Research, Media, and Public Policy. All Rights Reserved.