More Life Means More Illness

Life expectancy has been increasing. This is taken as a sign of better health. That’s a mistake. A recent study suggests why. Published in the Journal of Gerontology, the study by Eileen Crimmins and Hiram Beltrán-Sánchez found that while life expectancy increased over the decade from 1996 to 2006, so did the number of years that people will spend with disease and disability.

You might think, “Well, sure. You live longer, you’re bound to spend more time sick.” But that’s not necessarily true. And it misses the point. What these researchers are saying is that while years are added, even more of those years will be filled with suffering. For example, a man who was 20 years old in 2006 will live a year longer than a man who was 20 years old a decade earlier. However, the number of years he’ll spend suffering from a disease or disability will be 2 years more than the 20 year-old of 10 years ago. In other words, a year of life was gained, but two years of suffering were added. One step forward, two steps back.

This is far from the common assumption of 30 years ago when the expectation was that the marvels of modern medicine would not only continue to extend life but prevent the ravages of aging and chronic disease. In fact, quite the opposite seems to be the case. Discussion swirls around issues such as overdiagnosis and overtreatment as well as the possibility that we’ve saved those who would otherwise be dead and instead sustained them in a state of chronic illness.

I don’t disagree with either idea. I’d add that the very practices that keep us alive cause us to descend into infirmity. I’d also add that environmental exposures in the broadest possible sense—not just what we’re used to thinking of as pollution but the proliferation of stress-inducing forms of technology in our personal and collective life—have been increasing with well known effects.

But there’s an obvious one that the researchers themselves point to: while conventional science has triumphed at the heroic task of keeping the machinery of the human body going, it has failed utterly in preventing the onset of the chronic illnesses and disabilities that require those heroic interventions. Too much treatment, not enough prevention. Too much medicine, not enough health. Sounds like a good title for a book.

I’m going to make a leap here to another report that came out last week. This one, published in Chemical & Engineering News of all places, describes the rapidly advancing science of the human microbiome. This is the study of all of the micro-organisms that live on and in us symbiotically and, with us, form an ecology. We literally couldn’t live without them. And they’re not just in our gut. They’re everywhere, doing all sorts of useful things with and for us. And it turns out that every human-microbe eco-system is unique. There are similarities, to be sure, just as there are similarities among ecologies—the redwood ecology where I live is similar to but not the same as the redwood ecologies further up the California Coast. The point of which is that ecologies work through complex interactions. An interesting topic in itself, but what it highlights for me is that chronic illness is a disruption to a complex ecology. Instead, the conventional way of thinking looks at chronic illness as a matter of treating one thing with one intervention.

The concept of metabolic syndrome is a good example. Over 20 years ago, Gerald Reaven, a Stanford cardiologist, observed that the people who were more likely to have heart attacks also had sub-clinical symptoms of metabolic disruption such as insulin resistance, inflammation, and high blood pressure. He called it Syndrome X. He pointed to this complex of symptoms as indicating a deep imbalance in energy metabolism that ought to be the appropriate object of treatment. In other words, it was a complex phenomenon with many interconnected elements: energy metabolism, immunity, circulation, digestion, and hormones. The imbalance doesn’t come out in one way but many. For example, along one path heart disease lurks while along another diabetes.

Conventional science didn’t know what to do with this idea, so it re-named in metabolic syndrome and made it about obesity. The treatment became nothing more than a collection of treatments for the symptoms—only now they didn’t have to wait for a full-fledged diagnosis to intervene. They could launch someone on statins or hypoglycemic drugs before that person was officially diagnosed with heart disease or diabetes because the patient had metabolic syndrome. This counts as prevention. The possibility of a new way of approaching chronic illness was lost to a commitment to well worn pathways. That approach has failed.

That failure is an example of the unexamined life.

What begs for examination is our ecology, which is where and how we live and who we live with, whether it’s our microbe fellow travelers or the people who are our co-conspirators or the technologies to which we become extensions or the natural wonders we inhabit with inattention or the effluents from our way of life that come back to bite us. Understanding that takes us beyond a science of health that has its origins and logic in patching soldiers back together so they can be thrown back into battle.

So we live longer and as a consequence suffer even longer. For every year we go on living, we lose more to illness and disability. A friend of mine too often says, “We’re not supposed to live like this.”