Leaders in Medical Education: Dr. David Katz, Founder of the True Health Initiative

katz 3As founder of the True Health Initiative, Dr. Katz also serves as founding director of the Prevention Research Center at Griffin Hospital and as president of the American College of Lifestyle Medicine. He received his BA from Dartmouth College; his MD from the Albert Einstein College of Medicine; and his MPH from the Yale University School of Public Health. Katz is Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, CT, and founder and president of the non-profit Turn the Tide Foundation.

Known internationally for expertise in nutrition, weight management, and chronic disease prevention, as well as integrative care and patient-centered care models, Katz is active in patient care, research, teaching, and public health practice. He established and formerly directed one of the nation’s first combined residency programs in Internal Medicine and Preventive Medicine, and served as Director of Medical Studies in Public Health at the Yale School of Medicine for eight years.

Dr. Katz is a prominent voice in health & medicine in the media. He has published scientific articles, textbook chapters, newspaper columns and 12 books to date. He has consulted on obesity control and chronic disease prevention and is a peer reviewer for numerous leading medical journals.

 

How did you first become interested in medicine?
In some ways, I found my way to medicine for superficial reasons. My father was a cardiologist so I had an example of medicine as a career in the house. We are all influenced by things in person and I did admire my father. I was also a rambunctious kid who routinely fractured his bones and I had loving attention from the orthopedic doctor who kept putting me back together. I was a healthy kid, but I just constantly got injured and spent much of my youth in one cast or another.

Ultimately a career choice has a lot to do with understanding our character. I was a successful student, which is naturally part of the formula for medical school. I also liked the challenge intellectually of mastering a large, demanding body of knowledge. I was also very interested in having autonomy in my career, and didn’t like the idea of a boss. I don’t say that as something I’m either proud or ashamed of, it’s just an attribute I had. I was also raised by Calvinist principles to work hard and contribute something meaningful. In Wall Street, you move people’s money around, and that didn’t call out to me. I wasn’t especially interested in money. I wanted to make a difference. It’s not a source of pride, it’s just how I view the world.

 

What compelled you to pursue Internal Medicine?
My choice of Internal Medicine was a product of uncertainty. I was fascinated by everything at ward during medical school. Since I hadn’t settled on any narrow aspect of medicine, I was interested in the great breadth of expertise Internal Medicine provides. I’m a big picture person and that accounts for what happened afterwards in my career. I believe that Internal Medicine still provides the biggest window to the world of medical care as well as the greatest expanse of content and an array of opportunities to influence patient health over a lifetime.

 

What drew you to pursuing a career in public health?
My interest in public health was a product of my internal medicine training. During my residency I spent 100+ hours a week mostly in hospitals filled with extremely sick people. Going back to the propensity I had for seeing the big picture, I couldn’t help but appreciate that maybe 8/10 of those beds were filled by people who never needed to get that sick in the first place. Although I had great respect of the work, I still saw the imperfections of our treatment of patients and saw myself thinking about humpty dumpty and how all of the King’s horses and all of the King’s men couldn’t unscramble the egg once it cracked.

We have increasing technology, more pharmaceutical drugs, MRI, and much more in today’s society, allowing us to delay death, overcome aspects of illness, but we don’t produce vitality. We still cannot restore vitality, and once it’s gone, it’s lost. The issue is however, that it doesn’t need to be gone.

I do love the intimacy and humanity of patient care, and there really isn’t anything to rival it. I thought the best I can do at the bedside of sick person isn’t nearly as good as being involved with them 20 years earlier and influence their environment, social network, and behavior to prevent them from arriving at where they are now. The thing is, once they are this sick, there’s often times no turning back.

 

Can you delve a bit more into your background and how you got to where you are right now?
For those of you planning a career path, I would say that a career path might be like kayaking or canoeing while in White Water Rivers. You can choose the canoe, kayak, and river, but a lot of what will happen along the way is about the current. You cannot plan or predict it. You can only know where you might want to go.

I would encourage current medical students to think about the difference they want to make in the world today, and how they really would like to spend their time in the future. What are the activities that will populate the hours of your day while also giving you a sense of gratification?

I knew what difference I wanted to make in the world and the kind of things I liked to do. I figured out that I liked patient care and wanted that as part of my career. I also liked teaching, and during my internal medicine training, I wanted to do clinical research and felt that I needed to do that as part of my career.

In my career, one thing led to another and I went on to train in preventative medicine because I needed a certain skill-set to pursue the career I wanted. I started shopping around and received quite a bit of advice. Once I found the Yale Preventative Medicine Residency on Nutrition and Lifestyle, I decided to continue my studies there with a second residency. I did my MPH as well because it represented a specific skillset showing I had the skills necessarily to do the things I wanted to do, clinical research in particular.

Shortly after my second residency, I developed a combined training program in internal medicine and preventative medicine, and directed it for a time. It was located at Griffin Hospital, a Yale-affiliated community hospital. I then applied to the CDC to create a prevention research center. At the time there were 14 of them around the country and the CDC was providing funds to build more. I read what the grant would support, and I realized I could use residents from the combined training program to serve as the workforce for this Prevention Research Center. The residents would also benefit their careers by taking part in this center. We ended up getting the grant, and in 1998, the Yale Prevention Center opened its doors at Griffin, and I have directed it ever since.

My work heading this center eventually opened the door to many other opportunities. Once you develop programs in the community to tend to get pulled into new directions where you do things like talk to schools and workplaces. This really helped grow my network.

I also began to write a weekly preventative medicine column in the New Haven Register. I keep this up to this day, and have written over 1000 newspaper columns.

Furthermore, I began to get involved in local media on TV and actually worked at GMA and wrote on nutrition topics for Oprah’s O’ Magazine. Now most of my media activities are with online writing for the USNWR, Huffington Post, About.com, and Linkedin.

I write now because my view of lifestyle medicine is that we can do a lot of good with what we already know. In fact, we might be able to eradicate 80% of chronic disease with what we know and reaching the right people. I have over 550,000 people following me and I can reach many more people writing than I could do in 1-on-1 patient counseling.

Preventative medicine is about reaching people with a message and empowering them, and media is just a potent means of accomplishing that.

 

I know you have done a lot of work with regards to Obesity. I was wondering what 2-3 changes we need to see in the US to help curtail its rising obesity rates?
The first and most fixable issue with obesity is we have to stop bickering with one another about the best way to eat. The fundamentals of weight loss involves eating well and being active. Everyone seems to understand what the stay active part is. There just seems to be lack of understanding of what eating well means.

To reduce Obesity in the US, I believe we should:

  • Rally around the fundamental truths and stop procrastinating in the endless beauty pageants: On the topic of eating well, we have a new best-selling fad diet book every week. Morning shows show present a new diet every day. The medical community should rally against it and express healthy eating and how time honored it is by bringing up the vast array of research and work done in all environments, notably the blue zone (the group of the healthiest people in the planet and their lifestyles). We need to actually defend what a healthy diet looks like
  • Rise up against the festering hypocrisy: We are so riled up about the topics of childhood obesity and rising rates of diabetes. But while we are so worried about this, we still run on Dunkin and market multicolored marsh mellows as part of a complete breakfast. We have read that companies are purposely work to make their foods addictive. However, we don’t see the outrage towards those companies. There’s hypocrisy right now with us allowing the predatory exploitation of our children. Until we snap out of our delusion and see the toxic hypocrisy, we are unlikely to make progress.
  • Focus on Health and family in the long-term: We need to make sure that this is about health and family and not about weight and children. The best way to address things is to have families pursue health together. It’s shown that families who eat well together do better than families that go on and off diets. Also, the age of dieting needs to die because diets are labeled as things adults go on, leaving children behind.

 

I see that you have a very strong web presence. What role do you see social media serving in the future of medicine with more and more doctors beginning to use it?
The Glimmer Initiative (glimmerinitiative.org) is predicated on the fact that in this age of social media, everyone has a microphone and can broadcast their opinion. The result of that is perpetual confusion within the general public due to competing opinions reverberating endlessly. This as a whole is the peril of social media.

It used to be a Doctor’s challenge to teach people things they didn’t know. Our challenge now is much greater in that doctors have to unteach people things that they know, a majority of which is wrong because the internet is just a bottomless pit of misinformation.

We can use it for good, and the combination of megaphone and expertise is much better than a megaphone and an opinion. Doctors need to be careful and band together as a joint chorus. Otherwise we can actually be harmful by providing disjointed opinions.

It’s a problem when you have psychiatrists with best-selling books on weight-loss who are fat themselves and lack expertise in the area. I try to stick with what I know, and if it is an opinion, I will indicate that clearly.

We also need a bracing dose of humility so that we don’t mouth off when we have a microphone in front of our face. We have to be able to admit that we aren’t an expert on a particular area if we are asked a question on a topic which we don’t typically focus on.

 

What are 2-3 changes you would like to see regarding how healthcare is run today?
In some ways this is a parallel topic. I’ll will argue that in some ways we have a disease care system and not a healthcare system. Everything we have spoken about is true healthcare and cultivating health at its origin. It is actually a cultural enterprise to target healthcare.

A much greater investment in this cultural reorientation, helping health at an origin, instead of dealing with a disease after its onset.

In the disease care setting, we need to handle access better. As we speak, I’m fighting on behalf of a college student in Florida with a rare cancer whose insurance company is blocking coverage to chemotherapy even though his oncologist has recommended the treatment. Decision making authority should be in the hands of the qualified expert physician and his/her patient.

I think that basic medical care should be a universal human right. It seems almost against the American spirit to debate this issue. Consider the human response and not the appropriate economic response here. When a child on the beach encounters a shark attack, nobody stops to ask if the child who is bleeding has insurance. We intervene to save lives and ask questions on if the bill can be paid later. Why are we not doing this all of the time? Healthcare is a human character and should be a universal human right.

 

What advice do you have for individuals interested in a career in public health?
If you are a medical student, the motivation is that you want to be a doctor and want to be involved in patient care. You can do both and there is something compelling about the immediacy of patient care and impact of public health practice.

In terms of pursuing a career in public health, it’s too vague, you need to think about your difference in the world. Those means can involve public health, policy, research, education, disaster preparedness, etc. It’s a combo of what difference I want to make and the best way I can get there.

If you are wondering if you should get an MPH, I would think in terms of skill set you might need, the differences you want to make, and the activities you like. Are they all aligned? I found my MPH, which I got after my training in IM, to be enormously rewarding. But, I loved the work. I wasn’t simply pursuing letters to add after my name. I went there because I specifically needed a skillset I didn’t have which allowed me to conduct Interventional clinical research surrounding chronic disease prevention.

 

Do you have any final thoughts regarding the medical profession as a whole?
I think medical school students today are hearing a different story about medicine. A lot focus is on the politics and hearing about topics such as EMR, admin oversight, and intrusions. Frankly all those things are true, and medicine is changing. However, it’s still the best thing there is.

There are aggravations of course, but those exist in any career, and the view on medicine has changed significantly over time, but the reality is that some of the best people we have in this world go into medicine.

Some of my colleagues are the best people I’ve ever met, deeply caring and altruistic. We are there in those moments tending to our fellow human during times of desperate needs and can address that need in a way nobody else is empowered or privileged to do so.

 

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