*This is a combination of previous posts. I wanted to have the entire idea collected in a single page.
Medical Problems of the 21st Century
Pause and think about what diseases concern you you today. What diseases do you see or hear about frequently? Which conditions affect someone close to you? Those that populate my mind are cancer, heart disease, obesity, diabetes, depression, and dementia, among others. There is something that connects these seemingly disparate diseases, they are all chronic diseases. A chronic condition can be defined as a physical or mental health condition that lasts more than one year, causes functional restrictions, and requires ongoing monitoring or treatment . Let’s break down this definition.
Chronic disease can be physical or mental. We interpret the world through differentiation. We like to have clear cut distinctions, labels, and discrete entities which have specific meaning. The disease process, of course, exists in the natural world, outside of our psyche and outside of our distinctions. In the natural world these clear boundaries we perceive are not so well defined, as things exist on a continuum or gradient. I make this point to emphasize that although we separate physical and mental diseases, they are not exclusive to one another. From the perspective of the disease, there is no distinction between the mind and the body. This means that even though we may consider depression to be a “mental” condition, there are very real physical effects of depression. Just as there are very real psychological effects of cancer. Disease is not limited to the artificial boundaries we use to perceive the world.
A chronic condition lasts more than one year and requires ongoing monitoring or treatment. There is a lot to unpack here. Many of us may believe that modern medicine has a drug or procedure to fix the majority our ailments. The so called silver bullet. However, if a disease is still lingering after a year, then clearly there has been no drug, no treatment, and no procedure that has done anything to remove or reverse the disease. We certainly have many tools to suppress symptoms that arise from the disease, but the root, the disease state itself, remains relatively untouched. And when the disease remains untouched, you get exactly what the definition tells us, ongoing monitoring and treatment. Ongoing monitoring and treatment is a euphemism for lifelong prescription medications (often with side effects that instigate the need for additional medication), frequent visits to the doctor, numerous referrals to specialists, occasional trips to the emergency room – all while the actual disease remains largely unchanged beneath its cloak of symptoms. And lastly, we get to the real kicker with chronic disease, chronic disease causes functional restriction. So not only do you get to deal with the disease for an extended length of time, but the life that you are able to live is no longer the life you have lived. There is the obvious loss of time and money associated with the ongoing monitoring and treatment, but the real problem is the decrease in quality of life. Dependencies are limitations. Chronic disease erodes the body’s ability to thrive, reduces its capacity to function, and forces dependencies on medical interventions that seem to only be bailing water from a boat riddled with holes.
Modern medicine has saved countless lives, and it will save and improve the lives of many more. However, I think it is largely missing the mark when it comes to the prevention and treatment of chronic disease. The numbers almost seem fake. 45% (and growing) of Americans have at least one chronic disease. 25% have multiple chronic diseases. Chronic disease is responsible for 7 out of 10 deaths in the United States. 96% of all Medicare spending goes towards the treatment of chronic disease and 83% of Medicaid spending . And these are just a few of the statistics. Chronic disease is clearly demanding a different approach. *Side note, you may not use Medicare or Medicaid, but if you think you are not paying for these expenses, you would be dead wrong.*
How Chronic Disease Manifests
Chronic conditions affect the entire human organism. They are not limited to a single organ or tissue, but manifest complications throughout the body and mind. It seems that something so ubiquitous can only arise from that which is just as commonplace. These are lifestyle diseases.
Our lifestyle is an ecosystem in which the components of our body are forced to function. It is no different than the way other aspects of life organize all around us. The plants and animals that flourish in the tropical rainforests are vastly different than those that inhabit the northern hardwood forest, which look nothing like the creatures of the desert. Life suits itself to its surroundings.
Ecosystems are a collection of energy transforming machines. The outputs of one machine are the inputs of the next, and this cycle allows for different pieces to function and grow together. Each ecosystem contains unique sets of raw materials, or primary inputs. These would include things like amount of sunlight, rainfall, soil conditions, temperature, and diversity of organisms. These parameters are essentially the gatekeepers of what type of life will develop in that particular environment. Life is dynamic, diverse, and infinitely creative. These primary inputs drive the creative output of life. Only the organisms (energy converting machines) that are best suited to their particular environment will survive the endless competition for resources.
Chronic disease is a form of life that emerges from the primary inputs of our body. It is the group of machines best suited to the inputs of the way we live our life. It is type of life selected for through the environment we live in! Therefore, if the inputs are not changed, the disease state will continue to thrive, and we will be forced to live a life confined by chronic disease.
Disease is a confluence of genetic predisposition and environment, more heavily influenced by the latter. Our genes are no more than a starting point. A beginning state from which we can move largely in any direction. There are certainly those diseases in which the individual’s fate is sealed from the beginning, but these are few and far between, and much less interesting for no other reason than they are entirely out of our control. The vast majority of disease can be viewed as an opportunistic drive, capitalizing on particular set of environmental factors at a particular time.
We need a definition of our environment. It will function as an all encompassing term, denoting any phenomena, internal or external, that exerts any level of influence on the human organism. This includes, but is not limited to, the food (or food like products) we consume, physical movement (or lack thereof), our thoughts, social and family interaction, light exposure, sleep, emotional state, etc. These environmental factors represent the tools we have at our disposal to create a state which minimizes probability of disease gaining a foothold. These are our primary inputs.
These are the levers with which we can influence our health outcomes. You will notice I did not list medications, surgical procedures, or any other “medical interventions.” The goal is to construct a suitable environment so that we do not develop the conditions requiring complex medical intervention. Disease is constantly probing for a chink in our armor. This has been clearly displayed in the recent COVID-19 pandemic. It affects individuals in vastly different ways, posing a more significant risk to those already dealing with underlying health conditions (diabetes, obesity, etc.). We cannot control when our bodily ecosystems are going to be challenged by some external threat, but we can certainly try to maintain our defenses. We can push back against those lifestyle diseases that increase our risk. We can stack the deck in our favor.
Gambling On Health
We largely proceed through our days with little to no surprise. That is to say, what we expect to happen, largely does happen. In a way, this is what our nervous system has developed to do. It reduces the infinitely complex world around us to groupings of patterns, allowing us to process our surroundings and act. However, even with this predictive modeling capability that is hardwired into us, we also know that the unexpected will eventually happen. At some point, at some place, our models and predictions are completely shattered, and chaos dominates our perspective.
Imagine we each have a 365 sided dice, and every morning we have to roll the dice one time. If the dice lands on 2-365 (any number besides 1), our day is to proceed completely as expected. However, if the dice lands on 1, life is going to demand much more from us on that day. Maybe that is the beginning of a common cold, a bout of depression, an especially stressful event, the onset of neurodegeneration (that won’t be be detectable for another 20 years), back pain, a blood clot, a broken hip, stroke, heart attack, etc. Each outcome would certainly be unique to every individual, but the idea holds true for all. We all have to roll the dice every day, and chaos is lurking right around the corner.
I am proposing that we have the ability to change the size the dice we throw. We have the tools to create a robust organism that is capable of withstanding the chaos that life throws our way. I believe we have the capability to throw a 10,000,000 sided dice. That we can dramatically decrease the odds of a disease being able to capitalize on our health. The actual numbers are completely irrelevant. The idea is that we can continuously add to our dice, become more resilient, more vigorous, and more adaptable. But the 1 will always be present – even that illusory person of optimum health can be outmatched by the forces of mother nature. We should all look to increase our odds because the pursuit of health is a game we are forced to play everyday, and it only gets harder.
It should be emphasized that we can certainly decrease the numbers on our dice. In fact, the world we live in today is conducive to many behaviors that would reduce our chances of avoiding disease. Society often promotes (sometimes below the level of our conscious awareness) actions that diminish our resiliency and increase the probability that some disease will take hold. If we do not act with intention and awareness, the gravitational pull of our environment will slowly deteriorate the dice we have to throw. The ecosystem we find ourselves in today cultivates those machines of chronic disease. And it almost certainly becomes a matter of when instead of if.
The things I will talk about are nothing new. It is not cutting edge science coming to save the day. It is about finding a way to do the hardest thing in life, change the way we live. Will power sucks, it comes and goes with the wind. Diets don’t work. And the answer is not sleeping less so we can do more. We all have access to incredible levers that completely influence our state of health or lack thereof.
This concludes the table setting of our health situation in the 21st century. Going forward we will be more focussed on the strategies available to push back against chronic disease. There are issues on all levels from the healthcare institutions and laws to the individual choices we all make. We will discuss many of them, but the focus will be on the individual and the choices we can each make on a daily basis to improve our lives and the lives of those around us. I will be starting medical school in less than four months. I am going in with the acknowledgement that there are big problems with our healthcare system. Chronic disease is the downstream effect of the way we live our lives. Every individual has to take the responsibility on themselves. If we fail to give proper importance to sleep, food, movement, and our mental or emotional state, we are selecting for chronic disease. It starts today, and health is a conscious decision we all have to make day in and day out. Through food, movement, sleep, and management of stress you can create the ecosystem that pushes against chronic disease.
- Raghupathi W, Raghupathi V. An Empirical Study of Chronic Diseases in the United States: A Visual Analytics Approach. Int J Environ Res Public Health. 2018;15(3):431. Published 2018 Mar 1. doi:10.3390/ijerph15030431