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NOVEMBER / DECEMBER 2005

AROUND HARVARD

This article originally appeared in the October 2005 Harvard Health Letter and is provided courtesy of Harvard Health Publications.

Do doctors practice what is preached?

A survey of the Harvard Medical School faculty shows that, yes, mainly they do. Healthy habits and low BMIs prevail.

So, what do you do, doctor? Many of us have been tempted to ask that question. We gave in to the temptation in a big way and surveyed the Harvard Medical School faculty about their health habits and a variety of other health-related issues.

Some of our interest is just plain curiosity. We’re also reviving a tradition: the faculty received similar surveys in 1982 and 1992. Perhaps we can also take some encouragement from what this group does and thinks. If medical school faculty keep up with the fruit and vegetables and find time to exercise, perhaps we can do the same. We posted a copy of the survey and the complete results at http://www.health.harvard.edu/healthextra.

Results
Of the 15,229 faculty members who were e-mailed the survey, 2,115 (13.8%) responded. We cast the widest possible net: In addition to the medical school’s full, associate, and assistant professors, surveys were sent to fellows and doctors at the medical school’s teaching hospitals. Results were collected from early June through early July 2005.

Even now, “Harvard faculty” may conjure up notions of older, white males. We didn’t ask about race, but a significant fraction of the respondents were younger (40% under age 40) than the Harvard faculty stereotype — and, significantly, almost half (44%) were women.

Medicine today is increasingly specialized, so it’s not surprising that 42% of the respondents were specialists and just 9.5% were primary care physicians. Another 42% said they were primarily researchers — a reflection of the academic orientation of the medical school.

One important proviso: The medical school hasn’t assembled a demographic profile of the complete faculty, so we can’t be sure how representative our respondents are. As a result, they speak for themselves, not for the entire faculty. It may be that those who voluntarily fill out an e-mailed questionnaire about health habits are also those with the healthiest habits. Still, because of the large number of respondents, we do have a good-sized slice of the Harvard Medical School faculty to mull over and examine.

Diet. Most of the respondents are paragons of dietary virtue. The vast majority (82%) eat breakfast. And large numbers said they eat at least three servings of fruit or vegetables on most days and rarely or never go to fast-food restaurants. About half (51.2%) said they drink in moderation (one to five drinks per week) — another plus in the healthy lifestyle ledger, because moderate drinking seems to be cardioprotective. A solid majority (57%) prefer olive oil over other vegetable oils, butter, or stick margarine.

The faculty members aren’t perfect. Government guidelines say we should have three servings of whole-grain products a day, but only a third of the faculty said they eat that much. The American Heart Association recommends two servings of fish per week, but only 46% said they eat that much fish.

Doctors are increasingly encouraged to talk to their patients about nutrition and diet — especially now, amid an obesity epidemic. An impressive 80% (162 out of 202) of the primary care doctors said they talk regularly or often to their patients about their diets. That’s encouraging.

When we broke down the dietary results by age, gender, and professional specialization, we didn’t see any huge departures from the overall results. A greater percentage of men than women had 10 or more servings of alcohol per week (5.3% versus 1.5%). Men were also likely to eat fish more often, perhaps because women of childbearing age are told to limit fish consumption because of mercury contamination that could harm the fetus. When we compared the 847 faculty members under age 40 to the 112 who are 70 and over, some differences did emerge. The older faculty members included more butter eaters and frequent drinkers, whereas the under-40s were more likely to eat fast food and skip breakfast.

Exercise. Respondents’ exercise habits were equally impressive. More than half (58.1%) said they exercise at least three times a week. And most said their exercise sessions last half an hour and are at least moderately intense (e.g., walking three to four miles per hour). Walking and jogging were the favorite forms of exercise, but we were impressed by the range of activities listed in the “other” box: badminton, ballet, working out on an elliptical trainer (a contraption designed to spare the hips and knees), “heavy-duty farming,” ice hockey (“very intense”), tai chi, qigong, and yoga. One weary but well-exercised parent wrote, “I do lots of physically exhausting work in the house (small children).”

Body weight. Using responses for weight and height, we calculated body mass indexes (BMIs). The average BMI was 23.9, which is on the high end of the 18.5–25 healthy range. Still, almost two-thirds (65.3%) of respondents were in that category. That’s pretty good, considering that only about a third of Americans have a healthy BMI.

Of course, for the faculty, the flip side is that about a third are overweight or obese. That may explain why almost half of the respondents said they’ve tried to lose weight sometime in the past five years. The current craze for low-carb dieting was evident. About a third had gone that route. But a larger fraction (55%) tried to lose weight by simply cutting back on the amount they ate (portion control).

Vitamins and supplements. Experts suggest taking a multivitamin as a nutritional safety net, and 77.7% of the faculty members who filled out our survey said they were heeding that advice. A sizable minority (26.3%) take extra vitamin C when they have a cold, though the evidence for that making much of a difference is slim. Few faculty members take fish oil capsules (9.4%). But calcium supplements are popular, especially among women (48.6%) and those over age 50 (36.2%). Vitamin D, which may be more important than calcium for osteoporosis prevention, hasn’t really caught on. Only 8.4% of respondents said they took vitamin D, though the percentage was higher among women and older faculty members.

Alternative medicine. Surveys report that about a third of Americans routinely use some form of alternative medicine. Few of our survey respondents have had chiropractic (12.8%) or acupuncture (11.5%) treatments, but over a quarter (28%) have taken an herbal supplement. In choosing a word to describe their attitude toward alternative medicine, half picked “curious,” “open-minded,” or “enthusiastic.” As you might expect, that figure goes down with age, with a corresponding increase in the number of skeptics. Over all, 16.8% identified themselves as skeptics, but among those ages 70 and over, the figure was 39.1%. Gender also made a difference, with more men than women (23.4% versus 8.1%) describing themselves as skeptical.

Menopause. A comparatively small group of 141 women said they had experienced menopausal symptoms worth treating. Most used either low-dose estrogen alone (31%) or low-dose estrogen with progestin (53%) to treat them. A majority (63%) of those who take hormones kept on taking them despite negative results from the Women’s Health Initiative. The Initiative is a large, government-funded study that has found that postmenopausal hormones increase the risk for heart disease and breast cancer. The 45 women who tried alternatives to hormones favored soy and black cohosh.

Sleeping habits, living wills, miscellany. Most of the respondents get six to seven hours of sleep, though a significant minority (12.8%) gets by on less. More specialists (17%) said they were short sleepers, compared with researchers (10%) or primary care physicians (7.6%). (Maybe they got used to sleeping less when they were going through all that extra training.) Over 80% of the primary care physicians and two-thirds of the specialists said they got a flu shot every year — not bad but the specialists could do better. Over 90% of all the respondents had a primary care physician and most (61%) said they had had a physical exam within the past year. About a third of the respondents had a living will, although the proportion goes up with age: Almost three-quarters of those ages 70 and over have one.

Heart disease. Most of the respondents rated their heart disease risk as low. After all, most of them are relatively young (64% under age 50), don’t smoke, aren’t overweight, and use olive oil.

The 174 (8%) who rated their risk as moderately high or above were taking many of the right steps to lower their risk: exercise and eating less saturated fat and more fiber. Interestingly, 32% were taking vitamins to reduce their risk. Some studies suggest that B vitamins reduce heart disease risk by lowering homocysteine levels. We were surprised, though, that only 42.2% were taking a statin drug. With the drumbeat of favorable study results for statins, and the push toward lower and lower cholesterol levels, we thought it might be more. Ignorance may be the explanation, because 41% of those in the higher risk category didn’t know their LDL level. But when we narrowed the group to just those ages 50 and over, the percentage of statin users increased to 69%. Aspirin use among the men ages 50 and older (the group most likely to get the heart disease benefit) with self-rated elevated risk was high (83%).

Cancer. Just 39 of the faculty members who answered the survey said they smoke. That’s 39 too many, but a small percentage. A larger group (24.1%) smoked sometime in the past, though we didn’t ask how much or for how long. That number gets larger with age; in the ages 70 and older group, exactly half answered yes. Of course, when today’s septuagenarians were young men and women in the 1940s and early 1950s, smoking had cachet and the cancer (and heart disease) risks were largely unknown.

The faculty members are conscientious about cancer screening tests. Over 75% of those ages 50 and over said they’d gotten a colonoscopy. Two-thirds of women ages 40 and over indicated that they get a mammogram every year. Among women ages 50 and over, that fraction grew to three-quarters. There’s debate about the PSA test for prostate cancer, but 84% of the male faculty ages 50 and over had been tested.

Less than perfect. By and large, the faculty members who answered the survey are doing the right things to live long and healthy lives. But there are some outliers. For example, we found 119 couch potatoes (faculty members who exercise less than once a week for under 30 minutes at mild intensity). And 45% of non-exercisers reported eating less than two servings of fruit or vegetables on most days. Of all the respondents, we spotted 40 who said they eat more stick margarine — which is full of the trans fat that is bad for the cardiovascular system — than other types of fat. And 42 confessed to eating at fast-food restaurants several times a week.

Because the survey was anonymous, we don’t know that much about these wayward faculty members. Perhaps they have their own theories about health risks and protections. Or maybe they’re like many people and have difficulty finding the time and discipline needed to achieve that ideal healthy lifestyle.