by Byron Johnston Starting Strength
Iatrogenesis: from the Greek “Brought forth by the healer.” Normally used in medical terms to mean harm done by medical exam or treatment planning/delivery. I am repurposing it for this article to draw attention to another kind of harm that can happen, brought forth by well-meaning people in decision making positions.
In the past 10 or more weeks of lockdown here in England I have heard some truly bizarre policies and decision making, and sadly many incidents of iatrogenesis; from numerous conversations and internet threads I know I am not the only health professional to be talking about this. This article is my strength coaches’ perspective. My bias is that I want people to become strong and healthy by training and exercising and eating a balanced healthy diet. I would like my profession to embrace the health impact that we can have and guide people to ways to spend less time in doctors’ waiting rooms, thereby freeing up the time of medical professionals to manage the cases that only they can.
Our leaders are currently making decisions about our health, how to keep us healthy, and how to guide us to be healthier. There’s just one problem: they appear to lack the understanding of what health really is, let alone having any idea about how to guide someone to become healthy. In fact, they are not even healthy themselves, and consequently it’s proving hard for them to make sensible health decisions for the more than 55 million people in England.
The decision makers for policy in England believe health is simply an absence of sickness. And that makes sense, because if you are surrounded by and consulting with medical doctors then you will get an answer relevant to their concerns. These doctors are being confronted with a waiting list of sick patients. They are under pressure to manage a packed quota of patients every day, to meet targets and prescribe medicines where needed. I’ve yet to meet a GP who is not rushed. They don’t need their time to be cut any shorter per patient, and so “not sick” patients can be shuttled across to being designated as otherwise healthy, leaving only the long list of cases needing medical intervention.
Doctors are concerned with sick patients, and rightly so, but the upshot of this is that “not sick people” then become labeled as and may start to identify as “healthy.” True health is not merely the absence of sickness – it cannot be, any more than health can come from a pill.
The WHO already outlined in their 2003 report the prevalence of non-communicable diseases (NCDs) and reported that we are now mostly becoming sick and dying as a result of them. Those with pre-existing medical conditions that are chronic such as hypertension, type-2 diabetes, obesity and cardiovascular disease are at greater risk of dying or serious complications should they fall victim to coronavirus.
The stinger is that those NCDs can be massively affected for the positive with lifestyle changes. Changes like 1.) increased and correctly performed physical activity, in line with 2.) healthy eating guidance, the two principle products driven by the many fitness professionals and establishments throughout the United Kingdom. All of these have been ordered to close and stay closed during this time.
What is the General Public’s Attitude toward Health?
If you were to ask someone, “Whose responsibility is your career?” Instinctively and logically they know to answer that the responsibility is theirs. Now ask, “Whose responsibility is your health?” Again, I predict a resounding, “Well, mine, of course!”
But in reality, many people take actions that don’t seem to match their words. Many times, people make declarations like this and yet when it comes to their health, they wait for sickness to appear and then go get a prescription. A pill that makes them feel better now, today! People like fast medicine as much as they like fast food.
The reality is that both you and I know people who would answer the health question “Mine, of course!” and yet do no physical activity, are not motivated to begin doing so, and eat a diet that will contribute to ill health.
Basic nutrition is not included on the national curriculum in this country any more than First Aid is.
It’s mind-boggling in the face of an obesity epidemic. Consequently, many people do not know the simple basics of healthy eating and managing their weight, and once into their 20s and 30s and beyond consequently have less interest in using basic nutrition and physical activity for a healthy outcome.
And, why would they? If people have been taught to believe that health means “not sick right now,” then they may also believe there is no course of action to be taken. Combine this with government guidance that says gyms and activity done in gyms should not be pursued because of the current risk of getting sick, and it becomes all too easy for people to hand over responsibility for their own health.
This broad demographic of people are precisely the ones that benefit the most from the guidance of a trainer or coach in a professional facility. They have the most to lose by being led away from taking responsibility for their health, and the most to gain from readdressing this balance.
Many of you reading this article understand the value of strength training for health outcomes. You may even have a home gym set up as I and many of my clients do, and you have absolutely no intention of handing over your investment in your health to a third party that isn’t even healthy themselves. We associate with like-minded people, but most of the rest of the population doesn’t do what we do and wouldn’t know where to begin. This is where experienced coaching at gym facilities comes in.
With Respect to the Ongoing Government Closure of Gyms…
I think professionals such as myself would be happier with this were it not for the government and their advisers being unable or unwilling to make those health measures work for themselves, to the point where senior members caught coronavirus and then got caught breaking their own lockdown measures we were all told to follow on pain of prosecution or fines.
It saddens me that people who have already disassociated from their responsibility over their health would now see the media headlines supporting what I mentioned and go on to give up all together on health. They may be so disconnected from the situation that they go out of their way to place themselves in situations that could lead to them catching this disease that has been so very disruptive.
An example of this happened recently when thousands of people packed into tight beaches at the south coast of England.
Those people and others gathering at large events have no doubt become thoroughly fed up with lockdown restrictions, and are now simply doing as they please – provided that doesn’t involve a visit to their local gym.
What is more frustrating for professionals like myself is the client that depends on us and is genuinely trying to pursue a healthy lifestyle. These clients don’t merely want to train, they need to train. Training for them keeps ongoing medical conditions in check, and they are being blocked from doing so as gyms continue to be subject to enforced closure.
To be fair and balanced in this discussion, there are reasons behind the closure decision and partly fitness professionals should shoulder some of the blame. At the outset of lockdown, businesses and professionals were divided into two groups: essential and non-essential.
All gyms of all types from small studios with 2 coaches delivering in person sessions in a 1:1 coach-to-client ratio were grouped together with large facilities that might have 3000 members and 100 people on the gym floor every evening with just a couple of instructors and a receptionist at the facility.
In other words, all gyms were placed in a folder labeled as “leisure,” then leisure became non-essential.
Exercise As Medicine, Not Entertainment
“Medicine” has largely come to mean pharmaceuticals prescribed by doctors, and we’ve seen that exercise has come to mean leisure. Now the time has come to reframe exercise into the health category.
“If physical activity were a drug, we would refer to it as a miracle cure, due to the great many illnesses it can prevent and help treat.” Those are the words of the Chief Medical Officers for the UK (CMO report Sept 2019), a recent quote for our recent times. Here is another one for you: “Eating alone will not keep a man well; he must also take exercise. For food and exercise work together to produce health.” That one is more than 2000 years old, and comes to us from the Greek physician Hippocrates. So, there is our timeline, and somewhere along it health became the consumption of pharmaceutical medicines, and exercise became “leisure.”
To save the pushback, let me clarify: as opposed to being sedentary, if you only do exercise that is entertaining then I am just fine with that. That is healthier than no exercise at all. However, I’d rather deal with the prescriptive aspect of exercise, one that will help us defeat the situation of iatrogenesis in the future by getting ahead of it. To do that we have to formulate a different way of thinking about exercise.
A large part of the fitness industry is thought of as leisure businesses. It’s enjoyable, sociable, and entertaining. There is a large impressive building in my town that has an ice rink, a restaurant, a bowling alley, a pool with a wave machine, and also a gym, attached to the side; they are very much rooted in leisure and are quite happy to be there.
I believe it’s a mistake to categorize all exercise and all gyms as “leisure.” Not all of the fitness industry is leisure, and it is a misunderstanding for all gyms and studios to be placed into that category or to allow themselves to be labeled this way. This is the great big problem for those people who have been depending on exercise for its medicinal properties – people that I have coached and seen being coached in the kinds of gyms that you’ll find coaches like me in. These are people with MS or Parkinson’s, with arthritis, or on weight-loss journeys away from obesity, those with years of back pain behind them that are now successfully alleviating that with strength training.
At the start of lockdown in England, one of the principle government instructions was to “Protect The NHS.” Anyone who is serious about barbell training should have a copy of The Barbell Prescription. And with about ten minutes of reading that book it becomes abundantly clear that the correct type of exercise can achieve that outcome.
Training in the way that it can be done for health properties is powerful medicine and keeps people off of NHS waiting lists and out of a doctor’s offices.
The Fourth of July
Approaching 4th July, we knew a big announcement about the opening up of services was on its way. And just a few days ago the government advised that many services would now be able to open to the public. Gyms are ordered to stay closed.
From 4th July in England you’ll be able to have a hairdresser touch your head and face for an hour, but you won’t be able to go to a private gym to seek the help of a fitness professional to improve your blood pressure and cardio vascular health, or help you with your back pain, or help you on your physical recovery post-cancer, or hold back degenerative conditions such as osteoporosis.
Bizarrely we now have an agreed-upon travel corridor with parts of Europe, that means that you could fly to Spain, train in a gym there and then fly back to the UK and that would be just fine.
For like-minded professionals, it has fallen upon us in conversations, interviews, and ideally in writing to lay out our position more clearly. We must explain that healthy is not merely the absence of sickness. If anything, the criteria might be closer to: sick/not sick/healthy. With healthy being an active pursuit with intent. We should take steps where appropriate to work closer with local doctor’s clinics and other professionals identified as health practitioners, such as registered dietitians and physical therapists.
If we want to be respected and seen as essential, we need to shine some light on the outcomes and scientific research that confirms the benefits of training.
We should be drawing attention to those benefits by reaching out to local media, hosting local podcasts and community well-being talks. We’ll have to exceed our normal output of just coaching our clients to help the bigger picture hit home. Anyone who has applied the Starting Strength method knows that the results speak for themselves, and now it’s up to us to engage the audience.