In part 6 of this Exclusive Interview, Dr. Jeffrey Mechanick talks with Diabetes in Control Publisher Steve Freed during the AACE 2018 convention in Boston, MA about why the prevention of diabetes complications faces challenges, and how behavioral medicine may help change that.
Dr. Jeffrey Mechanick, MD, FACE, FACR, FACN, ECNU is the Clinical Professor of Medicine and Director of Metabolic Support in the Division of Endocrinology, Diabetes and Bone Disease at the Icahn School of Medicine at Mount Sinai, NY.
Transcript of this video segment:
Freed: So, you mention you have an activity center at Mount Sinai. Do you find that the medical professionals use that facility?
Mechanick: So, one of our aspirations would be to have this scale up so that it would be more widely available for the professional staff and for the ancillary staff in the hospital. But more and more, a lot of them are being referred in or self-referring in for medical care. So, it’s available a la carte – you can come in and have the exercise physiologists see you or the nutritionists or you can have the whole package with a cardiologist and endocrinologist see you, etc. But it’s within the context of preventive care. If we had a healthcare system that fully reimbursed and fully supported an infrastructure where for every American, we had access to qualified and experience exercise physiology, physical activity, the built-in environment with running trails, stairs to encourage people to take those instead of elevators, healthy food buffets at medical conferences and work, and if in schools we got rid of the candy machines – a lot of this has been done. Much of this was pioneered and amplified but our former first lady [Michelle Obama]. A lot of this has been advanced and supported by many government agencies and by many aspects of industry of the healthcare environment but here’s the question, why don’t we see more of it? Now one of the answers is an emerging concept that arose from our 2014 obesity consensus conference, that, in general, Americans place little value on obesity care, diabetes care, chronic care – being healthy. We’re more consumed with other aspects of life like money and materialistic goods. I realize this is a big statement and we as doctors need to sort of dig ourselves out of this pigeonhole of just worrying about people when they get very, very sick and they’re in the hospital which consumes a lot of money from the healthcare system. Instead, we should be trying to understand the behavioral medicine component, the socioeconomic component, the motivations, and the ways to really make a dent in primordial, primary, and secondary prevention to decrease the prevalence of chronic illness.
Freed: Do you feel that financial incentives would be a big boost to motivating people?
Mechanick: So, that’s behavioral economics and there’s two sides to the coin there. At face value, many people would say that behavioral economics works – you add a taxation to those that have kiosks for barbeque and hotdogs on the streets of New York City and you subsidize the fruit stands that are selling apples. There are problems with that. First of all, there is a little bit of a game theory involved because what about the fruit store that is on the street that is going out of business? Also, we know from studies, scientifically, that when the money runs out, people revert back to their old habits. There is no legacy effect, essentially, with behavioral economics.