Health & Wellness

Lifestyle choices deserve equal weight

“Think about that. We are medicating people who are, statistically speaking, unlikely to have an event in the first place.”

Photo Courtesy of Livestrong.com

W. Gifford-Jones MD & Diana Gifford-Jones

June 13, 2026

There is a common organizational saying: structure drives behaviour. In institutional theory, it’s called path dependence. Once a structure or pattern is established, it becomes self-reinforcing. This is a problem in medicine. Researchers and specialists become deeply immersed in their own areas of expertise. They network within tight knowledge clusters. They protect their territory, and when they train recruits, they filter out viable solutions to problems before deliberation even begins.

This is the story, or an important part of a complex story, of the commitment by so many experts to statins in the treatment of heart disease.

A large meta-analysis recently published in The Lancet and reported in the British Medical Journal concludes that most of the side effects listed in statin leaflets: memory loss, depression, fatigue, sleep disturbance, erectile dysfunction, occur no more often in those taking the drug than in those taking a placebo. Regulators are now considering changes to product labels. Experts speak of powerful reassurance. We are told confusion has gone on long enough.

Here is the question: reassurance for whom?

I am not lambasting the research. Randomized trials involving more than 120,000 participants deserve respect. If the data show that many feared side effects are less common than thought, they then provide consumers with that information.

What I object to is the triumphal tone and the relentless march toward medicating ever larger swaths of the population without an equally forceful message about personal responsibility and informed choice, choice that includes information on treatment options that go beyond pharmaceutical drugs.

Seven to eight million adults in the UK already take statins. If guidelines are followed to the letter, that number could climb to 15 million, and what is the public message? Not, “Let’s first talk about your waistline, your diet, your blood pressure, your exercise habits, you’re smoking.” Not, “Let’s see what happens if you walk briskly for 30 minutes a day.” Not, “There are safe, effective, natural alternatives to the drugs.” Instead, it is, “Do not worry. The pills are safer than you think.”

That is pharmacological management.

Doctors complain that negative publicity has led patients to refuse statins or stop taking them. They suggest that switching between different statins reinforces misinformation, but patients are not irrational. They are wary, and in today’s pharmaceutical marketplace, where billions are at stake, wariness is not a character flaw.

When a study funded by a major heart foundation reassures us that side effects are minimal and uptake should increase, skepticism is healthy. Not cynical. Healthy.

Yes, cardiovascular disease is a leading killer. Yes, lowering LDL cholesterol reduces risk, but medicine has drifted from treating disease to treating risk scores. The new threshold recommends considering statins for people with less than a 10% ten-year risk of cardiovascular disease. Think about that. We are medicating people who are, statistically speaking, unlikely to have an event in the first place.

Lifestyle changes can reduce cardiovascular risk by 30%, 40%, sometimes more. Weight loss lowers blood pressure and improves blood sugar. Exercise raises HDL cholesterol and reduces inflammation. A Mediterranean-style diet lowers cardiovascular events, but lifestyle medicine takes time. It requires conversation, follow-up, and motivation. A prescription takes 30 seconds.

The pharmaceutical industry thrives on expanding definitions of risk and broadening treatment thresholds. That is the business model, but physicians are not supposed to be extensions of that model. They are supposed to be educators and advocates.

When the dominant message is “Don’t worry, just take the pill,” they fail in that role.

This column offers opinions on health and wellness, not personal medical advice.

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Written By W. Gifford-Jones MD & Diana Gifford-Jones

Dr. W. Gifford-Jones, MD is a graduate of the University of Toronto and the Harvard Medical School. He trained in general surgery at Strong Memorial Hospital, University of Rochester, Montreal General Hospital, McGill University and in Gynecology at Harvard. His storied medical career began as a general practitioner, ship’s surgeon, and hotel doctor. For more than 40 years, he specialized in gynecology, devoting his practice to the formative issues of women’s health. In 1975, he launched his weekly medical column that has been published by national and local Canadian and U.S. newspapers. Today, the readership remains over seven million. His advice contains a solid dose of common sense and he never sits on the fence with controversial issues. He is the author of nine books including, “The Healthy Barmaid”, his autobiography “You’re Going To Do What?”, “What I Learned as a Medical Journalist”, and “90+ How I Got There!” Many years ago, he was successful in a fight to legalize heroin to help ease the pain of terminal cancer patients. His foundation at that time donated $500,000 to establish the Gifford-Jones Professorship in Pain Control and Palliative Care at the University of Toronto Medical School. At 93 years of age he rappelled from the top of Toronto’s City Hall (30 stories) to raise funds for children with a life-threatening disease through the Make-a-Wish Foundation. Diana Gifford-Jones, the daughter of W. Gifford-Jones, MD, Diana has extensive global experience in health and healthcare policy. Diana is Special Advisor with The Aga Khan University, which operates 2 quaternary care hospitals and numerous secondary hospitals, medical centres, pharmacies, and laboratories in South Asia and Africa. She worked for ten years in the Human Development sectors at the World Bank, including health policy and economics, nutrition, and population health. For over a decade at The Conference Board of Canada, she managed four health-related executive networks, including the Roundtable on Socio-Economic Determinants of Health, the Centre for Chronic Disease Prevention and Management, the Canadian Centre for Environmental Health, and the Centre for Health System Design and Management. Her master’s degree in public policy at Harvard University’s Kennedy School of Government included coursework at Harvard Medical School. She is also a graduate of Wellesley College. She has extensive experience with Canadian universities, including at Carleton University, where she was the Executive Director of the Global Academy. She lived and worked in Japan for four years and speaks Japanese fluently. Diana has the designation as a certified Chartered Director from The Directors College, a joint venture of The Conference Board of Canada and McMaster University. She has recently published a book on the natural health philosophy of W. Gifford-Jones, called No Nonsense Health – Naturally!

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