Rethinking Modern Medicine: Andrew Rudin, MD, on Why Lifestyle Must Come Before Intervention

For much of the last half century, modern healthcare has followed a familiar pattern. When disease appears, the response is swift and technologically sophisticated. Prescriptions are written. Procedures are scheduled. Devices are implanted. From cholesterol lowering injections to elective cardiac stent placements, the prevailing narrative has been clear: advanced medicine is the primary solution, and lifestyle change is a secondary consideration, if it is considered at all.

Andrew Rudin, MD, an interventional cardiologist and electrophysiologist, believes this order has been reversed. In his view, medication and surgery should be powerful tools reserved for when they are truly needed, not default responses to every abnormal test result or risk marker. His perspective is not rooted in ideology or trend, but in decades of clinical experience and a careful reading of the data.

“This is not about saying medication or surgery is wrong,” Dr. Rudin explains. “They save lives every single day. They are essential to modern medicine. The problem is that they have increasingly become the first step instead of the last. That shift has consequences.”

When Technology Becomes the Default

Cardiology offers one of the clearest examples of this problem. Each year in the United States, hundreds of thousands of cardiac stents are placed. While stents are unquestionably lifesaving during heart attacks and unstable cardiac events, Dr. Rudin points out that many are performed electively in patients who have little or no symptoms.

“For decades now, the data has shown that elective stents in patients without symptoms do not reliably prevent heart attacks or extend life,” Rudin says. “Yet patients continue to believe they are lifesaving procedures, because that is how the system has framed them.”

This disconnect between evidence and perception troubles him deeply. Patients often assume that visible blockages on imaging must be fixed immediately, even when blood flow is adequate and symptoms are absent. In many of these cases, optimal medical therapy and lifestyle changes provide equal or better long-term outcomes without the risks associated with invasive procedures.

Dr. Rudin emphasizes that this is not a failure of technology, but of sequencing. When intervention comes before understanding the root cause, care becomes reactive rather than strategic.

The Hidden Costs of Overuse

Beyond procedures themselves, Dr. Rudin raises concerns about the cumulative effects of diagnostic overuse. Advanced imaging has transformed medicine, but it is not without cost. CT scans, in particular, expose patients to ionizing radiation that accumulates over time.

Projections published in 2023 estimated that CT imaging could contribute to approximately 103,000 future cancer cases over the lifetime of exposed patients in the United States. Dr. Rudin finds this deeply concerning.

“A noticeable proportion of oncology patients may have developed cancer linked to prior diagnostic imaging,” he notes. “That is a sobering realization. These are risks most patients are never fully informed about.”

When imaging is used thoughtfully, its benefits outweigh its risks. When used reflexively, it can quietly create long-term harm. For Dr. Rudin, this reinforces the need for a more measured approach that prioritizes clinical reasoning over routine escalation.

Why Patients Are Looking Elsewhere

As confidence in purely procedural medicine erodes, patients are increasingly seeking alternatives. This shift is reflected in the explosive growth of the global wellness market. According to the Global Wellness Institute, the sector exceeded $5.6 trillion in 2022 and is projected to reach $8.5 trillion by 2027. In the United States alone, wellness spending has surpassed $2 trillion, accounting for roughly one third of the global total.

This growth is not driven by fad or fashion alone. It reflects a collective realization that long-term health cannot be achieved through prescriptions and procedures alone.

“People are starting to recognize that the way we have been doing it is not sustainable,” Dr. Rudin says. “Prescribe first, operate second ignores the foundations of health. Nutrition, exercise, sleep, and stress management have a far greater impact on longevity and quality of life than we have traditionally acknowledged.”

He cautions, however, that the solution is not to abandon conventional medicine in favor of unproven wellness claims. The answer lies in integration, not replacement.

Following the Data, Not the Dogma

Dr. Rudin’s views on lifestyle medicine are not new, nor are they driven by recent trends. More than twenty years ago, he delivered grand rounds at a university medical center on the benefits of low carbohydrate diets. At the time, such ideas were considered controversial, even radical.

“The evidence was already there,” he recalls. “Improved lipid profiles, lower blood pressure, meaningful weight loss. But culture lags behind science.”

Even today, many patients still believe that avoiding dietary fat is inherently healthy, despite decades of research showing that sugar, refined carbohydrates, and ultra processed foods play a far greater role in metabolic disease. Dr. Rudin sees this gap between evidence and public understanding as one of the most pressing challenges in healthcare.

His approach is pragmatic rather than ideological. He encourages patients to cut sugar, eliminate processed foods, and focus on whole, nutrient dense nutrition. These changes, he argues, often deliver survival benefits that far exceed the marginal gains of adding another medication.

Lifestyle as the First Line of Defense

For Dr. Rudin, lifestyle interventions are not adjuncts to care. They are the foundation. He believes that addressing insulin resistance, chronic inflammation, poor sleep, and unmanaged stress can dramatically alter a patient’s trajectory, often reducing the need for aggressive medical therapy altogether.

This does not mean ignoring disease or delaying necessary treatment. It means restoring proper order. Identify root causes first. Stabilize physiology. Then, if needed, use medication and procedures with precision and purpose.

“Patients do not need dogma from either side,” Rudin says. “They need the truth, supported by evidence, and a path that actually helps them heal.”

Bridging Two Worlds of Medicine

Dr. Andrew Rudin’s voice is part of a growing movement within medicine that seeks to bridge the divide between conventional care and wellness focused approaches. Rather than positioning them as opposing philosophies, he views them as complementary tools that must work together.

Life saving procedures will always have a place. So will advanced medications. But when they are used without addressing the behaviors and environments that drive disease, their impact remains limited.

“It takes medical professionals who understand both worlds to guide patients through the noise,” Dr. Rudin explains. “There is more information than ever, and much of it is conflicting. Patients need clinicians who can help them interpret evidence, not just offer another prescription.”

Restoring the Foundations of Health

At the core of Dr. Rudin’s philosophy is a simple but powerful idea. Real healing does not begin with the next test or the next procedure. It begins with restoring the foundations of health that modern life has steadily eroded.

Nutrition that supports metabolic balance. Movement that strengthens the cardiovascular system. Sleep that allows the body to repair itself. Stress management that calms chronic inflammation. These are not alternative concepts. They are biological necessities.

As healthcare continues to evolve, Dr. Rudin believes success will be measured not by how many interventions are performed, but by how many are avoided through prevention and understanding.

In shifting the focus from reflexive intervention to thoughtful, evidence based care, Andrew Rudin, MD, is helping redefine what progress in medicine truly looks like.