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　　From The New York Times

　　By Kate Murphy

　　Apr.17, 2007

　　Teaching Doctors to Teach Patients about Lifestyle

　　Everybody knows that diet, exercise and other aspects of lifestyle play a significant role in health. But the specifics are less well understood.

　　To what extent does lifestyle cause or contribute to disease and disability? And what exactly is a healthy lifestyle anyway? There is much confusion about what type of diet or exercise is best, not to mention how much sleep, stress or sex is ideal. Nor is it clear how best to motivate people to change their habits.

　　This lack of clarity has inspired a growing movement to inform health professionals and patients about the importance of lifestyle in preventing and treating disease. Its aims are to disseminate scientific research about what it means to live well and to encourage doctors and other providers to incorporate this knowledge into their practices.

　　Two years ago, a group of doctors founded an organization with the goal of making lifestyle medicine a credentialed clinical specialty and a part of basic medical training. Symptomatically treating disease without assessing patients' lifestyles or offering them guidance on how to change is "irresponsible and bordering on neglect," said Dr. John H. Kelly Jr. , president of the fledgling organization, the American College of Lifestyle Medicine.

　　A professor of preventive medicine at the Loma Linda University School of Medicine in California, Dr. Kelly said the group was formed because of people like his uncle.

　　Given a diagnosis of heart disease, the uncle had a stent surgically implanted to open a clogged artery but received no advice on how he might change his lifestyle, even though research shows that diet, exercise and stress management could greatly improve his condition.

　　Dr. Kelly says lifestyle medicine is essential in fighting the national epidemics of obesity, diabetes and cardiovascular disease. "We cannot solve the health problems of society unless we change our focus from acute, episodic care to health promotion and wellness-lifestyle medicine," he said.

　　The Centers for Disease Control and Prevention reports that 1.7 million Americans die and 25 million are disabled each year by chronic diseases caused or made worse by unhealthy lifestyles. And a 2005 study in The New England Journal of Medicine predicted that average life expectancy in the United States would decline in the next 20 years as a result of unhealthy lifestyles, reversing a trend dating to the 1850s. The American College of Lifestyle Medicine has 150 members in a wide array of specialties-nutritionists, ophthalmologists, gastroenterologists and oncologists, among others. Helping their cause is a new publication, The American Journal of Lifestyle Medicine, which appears every other month with peer-reviewed research on the way daily habits affect health.

　　"Bottom line is we want to promote the science, education and practice of lifestyle medicine,'' Dr. Kelly said.

　　Lifestyle medicine proponents include researchers and clinicians from the fields of medicine and public health. While they agree on the importance of questioning patients about their lifestyles and giving tailored advice on how to make improvements, there remains disagreement about who should provide such counseling and with what sort of training. Nor is there a widely accepted prescriptive approach for encouraging patient compliance.

　　“We know lifestyle interventions can be very powerful, often more effective than drugs or surgery," said Dr. JoAnn Manson, a professor of epidemiology at Harvard's School of Public Health and a member of the editorial board of the new journal. “But we need to provide the scientific evidence an how to incorporate that knowledge into practice."

　　Doctors may vaguely recommend that patients lose weight or get more sleep, for example, but they do not necessarily, know how to help them do it.

　　Moreover, many physicians themselves have unhealthy habits that may prevent them from offering advice.

　　"Sleep-deprived doctor who scarf candy bars for lunch tend to feel inhibited in counseling others when they aren't exactly setting an example," said Dr. Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health and a member of the lifestyle medicine college's board of advisers.

　　"Primary caregivers at least should have extensive training in lifestyle medicine," Dr. Willett said. “And it's reasonable for there to be a medical specialty" so patients can consult a trained practitioner who is certified as an expert in the field.

　　Others say lifestyle medicine should be incorporated into every facet of health care.

　　"I don't think it's appropriate to segment it off," said Dr. Thomas W. Rowland, chief of pediatric cardiology at Baystate Medical Center in Springfield, Mass., who routinely counsels children and parents on how to adopt health lifestyles. "it needs to be a fundamental part of every doctor's practice and therefore a part of every medical school's core curriculum."

　　Still, he acknowledges that there are significant obstacles, because lifestyle consuming is time-consuming and is seldom compensated by Medicare or health insurers.

　　Reimbursement is a chief concern of the American College of Lifestyle Medicine. The group plans to lobby Congress to that end. And it wants Congress to require that patients be informed about the relative effectiveness of lifestyle changes before receiving certain medications--including blood pressure, acid reflex and cholesterol drugs-and before undergoing procedures like back surgery, bypass surgery and stent placement.

　　But first, Dr. Kelly said, patients and insurers need to be assured of the professionalism of lifestyle medicine providers.

　　Some doctors say the movement suffers from fringe elements that advocate unproven strategies like strict vegan diets and daily saunas .

　　“Lifestyle medicine has to be scientifically base to distinguish it from all the quackery out there," said David R. Brown, senior behavioral scientist in the division of nutrition and physical activity at the disease control center.

　　Dr. Kelly agreed. "We need to have a certification process in place with rigorous, evidence- based standards," he said.

　　Proponents of lifestyle medicine are quick to distinguish it from alternative medicine. “This

　　is mainstream medicine supported by mainstream medical research," said Dr. James M. Rippe, associate professor of cardiology at Tufts University School of Medicine and the editor of The American Journal of Lifestyle Medicine. "The lifestyle medicine movement is not an anti- procedure, anti-medication movement."

　　Rather, he said, it advocates that lifestyle interventions become part of doctor’s arsenal in fighting disease: "For too long we’ve ignored out most powerful weapon when it should be our first line of defense.”

　　词汇注解

　　重点单词

　　extent / iks'tent/

　　【文中释义】n.程度

　　【大纲全义】n.广度，宽度，长度; 程度，限度

　　confusion /kən'fju: ʒə n/

　　【文中释义】n.混乱状况

　　【大纲全义】n.困惑，糊涂; 混淆;混乱，骚乱

　　clarity /'klæriti/

　　【文中释义】n.

　　【大纲全义】n.清晰，明晰

　　inspire / in'spaiə/

　　【文中释义】v.激发

　　【大纲全义】v.鼓舞，激起; 使产生灵感

　　inform /in'fɔ:m/

　　【文中释义】v.通知

　　【大纲全义】v.(of,abouo通知，告诉，报告;告发,告密

　　incorporate /in'kɔ:pər eit/

　　【文中释义】v.具体表现

　　【大纲全义】v.合并，纳入，结合 adj.合并的

　　epidemic /,epi'demik/

　　【文中释义】n.流行病

　　【大纲全义】adj.流行性的;传染的;n流行病;.传播

　　expectancy /ik'spektənsi /

　　【文中释义】n.期待

　　【大纲全义】n.期待

　　decline/di'klain /

　　【文中释义】v.降低

　　【大纲全义】v.下降，衰落;拒绝，谢绝 n.下降;斜面，倾斜，衰落

　　Proponent/prə'pəunənt/

　　【文中释义】n.建议者

　　【大纲全义】n.提议者，建议者;支持者;辩护者

　　counseling/'kaunsəliŋ/

　　【文中释义】n.顾客服务

　　【大纲全义】n.顾客服务

　　超纲单词

　　disseminate v.传播 credentialed adj.信任的

　　symptomatically adv.具有征候地 clogged adj.堵塞的

　　cardiovascular adj.心血管性的 oncologist n.肿瘤科医师

　　gastroenterologist n.胃肠科医师

　　重点段落译文

　　众所周知，饮食、锻炼以及生活方式的其他方面在维持身体健康方面扮演着十分重要的角色。但是具体起什么作用仍不是十分清楚。

　　在何种程度上生活方式会诱发或导致疾病和致残?健康的生活方式到底是什么样的?哪一种饮食习惯或锻炼方式才是**的，人们一直对此困惑不解，更不用说多长时间的睡眠、多大的压力或多长时间的性爱才是理想的了。对如何最有效地激励人们改变自己的生活习惯也不大清楚。

　　正是由于人们缺乏清晰的认识才促使一场运动蓬勃开展，以告诫卫生专业人员和病人，生活方式在预防和治疗疾病中的重要性。这场运动旨在传播一些科学研究的成果，即有关更好地生活意味着什么，同时还旨在鼓励医生和其他医务人员把这些知识应用到实践中。

　　两年前一批医生成立了一个组织，该组织的目的在于让生活方式成为临床专科的特效药并且成为基本医疗培训的一部分。美国生活方式医药大学的一个新兴组织的负责人约翰·凯利博士曾谈道，如果在治疗疾病时忽视评估病人的生活方式或是没有为他们提供如何来改变生活方式的指导。就是一种不负责任和接近于无视的态度。

　　加利福尼亚洲洛玛连达大学医学院预防医学会的凯利教授谈道，这个团体是在像他叔叔那样的人的启示下成立的。

　　他的叔叔经诊断患有心脏病，但是他叔叔没有获得任何有关如何改变他的生活方式的建议——即便有研究表明饮食、锻炼和压力管理在很大程度上可以改善他的身体状况——就接受了一个意在打开一个堵塞的动脉血管的支架植入手术。

　　凯利博士谈道，生活方式这一药品在极力对抗全国流行病，如肥胖、糖尿病和心血管疾病的战役中起着十分重要的作用。他还说，“我们不可能完全解决健康问题，除非我们将注意力从急性的、陈发性的护理健康转移到促进健康的生活方式上来。”

　　美国疾病预防和控制中心有报道称，不健康的生活方式会引发或恶化慢性疾病，每年有170万美国人死于此，而且还有2500万人因此致残。新英格兰医学期刊上一份2005年的研究预言，由于不健康的生活方式——这可追溯至19世纪50年代——美国人的平均生命期望值将在未来20年内减小。美国生活方式医学院有150个成员，涉及各个专业领域的营养学家、眼科专家、胃肠病学家、肿瘤学家及其他专家。

　　虽然生活方式医药倡议者——包括来自各个医药和公共健康领域的研究人员和临床医师，他们均认为查问患者的生活方式，并就如何改善提出针对性的意见是十分重要的，但仍在究竟谁应该提供这样的咨询服务以及提供什么样的培训指导方面存在着分歧。也没有一个鼓励病人遵守的规范性做法能被普遍接受。

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