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Wednesday, March 7, 2018

An Epidemic of Wellness?

"What's the definition of a 'well person'?"
"A patient who hasn't been adequately worked up."
- Old physician joke

LOL. Goes to the "medicalization of life" itself. IIRC, it was the curmudgeonly Dr. Thomas Szasz who once riffed irascibly on a "humanectomy" px.

Wish I was at the Mardi Gras of Health IT this year, #HIMSS18. to wit,

Among the goodies in my latest Harper's is an essay by Barbara Ehrenreich.

apropos of our exuberantly-touted mobile digitech-enabled "culture of wellness" of late.
Running to the Grave

By Barbara Ehrenreich, from Natural Causes, which will be published next month by Twelve. Ehrenreich is the author of more than a dozen books, including Nickel and Dimed (Henry Holt). She holds a PhD in cellular immunology.

The pressure to remain fit, slim, and in control of one’s body does not subside with the end of youth — it grows only more insistent as one grows older. Friends, family members, and doctors start nagging the aging person to join a gym, “eat healthy,” or at the very least go for a daily walk. You may have imagined a reclining chair or a hammock awaiting you after decades of stress and physical exertion. But no, your future more likely holds a treadmill and a lat pull, if you can afford access to these devices. You may have retired from paid work, but you have a new job: going to the gym. One of the bossier self-help books for seniors commands:

Exercise six days a week for the rest of your life. Sorry, but that’s it. No negotiations. No give. No excuses. Six days, serious exercise, until you die.
People over the age of fifty-five are now the fastest-growing demographic for gym membership. Mark, a fifty-eight-year-old white-collar worker who goes to my gym, does a six o’clock workout before going to the office, then another after leaving. His goal? “To keep going.” The price of survival is endless toil.

For an exemplar of healthy aging, we are often referred to Jeanne Louise Calment, a Frenchwoman who died in 1997 at the age of 122 — the longest confirmed life span on record. Calment never worked in her life, but it could be said that she worked out. She and her wealthy husband enjoyed tennis, swimming, fencing, hunting, and mountaineering. She took up fencing at the age of 85, and rode a bicycle until her 100th birthday.

Anyone looking for dietary tips will be disappointed; Calment liked beef, fried foods, chocolate, and pound cake. Unthinkable by today’s standards, she smoked cigarettes and sometimes cigars, though anti-smoking advocates should be relieved to know that she suffered from a persistent cough in her final years.

This is “successful aging,” which, except for the huge investment of time it requires, is supposedly indistinguishable from not aging at all. It has many alternative names: “active aging,” “healthy aging,” “productive aging,” “vital aging,” “anti-aging,” and “aging well.” In 2012, the World Health Organization dedicated World Health Day to healthy aging, and the European Union designated that year its Year for Active Aging.

Popular science and self-help books on the topic are proliferating. Among the titles currently available on Amazon are: Successful and Healthy Aging: 101 Best Ways to Feel Younger and Live Longer; Live Long, Die Short: A Guide to Authentic Health and Successful Aging; Do Not Go Gentle: Successful Aging for Baby Boomers and All Generations; Aging Backwards: Reverse the Aging Process and Look 10 Years Younger in 30 Minutes a Day; and, of course, Healthy Aging for Dummies. A major theme is that aging is abnormal and unacceptable. Henry Lodge, a physician and coauthor of Younger Next Year, writes, “The more I looked at the science, the more it became clear that such ailments and deterioration” — heart attacks, strokes, the common cancers, diabetes, most falls, fractures — “are not a normal part of growing old. They are an outrage.”

Who is responsible for this outrage? Well, each of us is individually responsible. All the books in the successful-aging literature insist that a long and healthy life is within the reach of anyone who will submit to the required discipline. It’s up to you and you alone, never mind what scars — from overexertion, genetic defects, or poverty — may be left from your prior existence. Nor is there much concern for the material factors that influence the health of an older person, such as personal wealth or access to transportation and social support.

There is a bright side to aging: declines in ambition, competitiveness, and lust. When Betty Friedan was in her seventies, she wrote a book called The Fountain of Age. As her subjects grew older, she observed, they became “more and more authentically themselves.” They didn’t care anymore what other people thought of them. I can add from my own experience that aging also comes with a refreshing refusal to strive — I feel no need to take on every obligation or opportunity that comes my way.

But even the most ebullient of the elderly eventually come to realize that aging is above all an accumulation of disabilities, often beginning well before Medicare eligibility or the first Social Security check. Vision loss typically begins in one’s forties. Menopause strikes in a woman’s early fifties, along with the hollowing-out of bones. Knee and lower-back pain arise in the forties and fifties, compromising the mobility required for successful aging. The US Census Bureau reports that nearly 40 percent of people aged sixty-five and older suffer from at least one disability, with two thirds of them saying they have difficulty walking or climbing. Yet we soldier on. “You don’t become inactive because you age,” we’ve been told over and over. “You age because you’ve become inactive.”

The goal of successful aging is often described as the “compression of morbidity” into one’s last few years — in other words, a healthy, active life followed by a swift descent into death. But the truly sinister possibility is that for many of us, all the little measures we take to remain fit — all the deprivations and exertions — will lead only to the extension of years spent with crippling and humiliating disabilities. There are no guarantees...

This book ought be a beaut. From the Amazon blurb:
Bestselling author of Nickel and Dimed, Barbara Ehrenreich explores how we are killing ourselves to live longer, not better.

A razor-sharp polemic which offers an entirely new understanding of our bodies, ourselves, and our place in the universe, NATURAL CAUSES describes how we over-prepare and worry way too much about what is inevitable. One by one, Ehrenreich topples the shibboleths that guide our attempts to live a long, healthy life -- from the importance of preventive medical screenings to the concepts of wellness and mindfulness, from dietary fads to fitness culture.

But NATURAL CAUSES goes deeper -- into the fundamental unreliability of our bodies and even our "mind-bodies," to use the fashionable term. Starting with the mysterious and seldom-acknowledged tendency of our own immune cells to promote deadly cancers, Ehrenreich looks into the cellular basis of aging, and shows how little control we actually have over it. We tend to believe we have agency over our bodies, our minds, and even over the manner of our deaths. But the latest science shows that the microscopic subunits of our bodies make their own "decisions," and not always in our favor.

We may buy expensive anti-aging products or cosmetic surgery, get preventive screenings and eat more kale, or throw ourselves into meditation and spirituality. But all these things offer only the illusion of control. How to live well, even joyously, while accepting our mortality -- that is the vitally important philosophical challenge of this book.

Drawing on varied sources, from personal experience and sociological trends to pop culture and current scientific literature, NATURAL CAUSES examines the ways in which we obsess over death, our bodies, and our health. Both funny and caustic, Ehrenreich then tackles the seemingly unsolvable problem of how we might better prepare ourselves for the end -- while still reveling in the lives that remain to us.
Can't wait to read it.

Relatedly, I saw this over at The Atlantic:
Why So Many of Us Die of Heart Disease
Evolution doomed us to have vital organs fail. For years, experts failed us, too.

The Assyrians treated the “hard-pulse disease” with leeches. The Roman scholar Cornelius Celsus recommended bleeding, and the ancient Greeks cupped the spine to draw out animal spirits.
Centuries later, heart disease remains America’s number one killer, even though medical advances have made it so that many more people can survive heart attacks. Some parts of the country are especially hard-hit: In areas of Appalachia, more people are dying of heart disease now than were in 1980.

Haider Warraich, a fellow in cardiovascular medicine at the Duke University Medical Center (and an occasional Atlantic contributor), is at work on a book about how heart disease came to be such a big threat to humanity…
Certainly of interest to me these days. And, that article led me to this book:

From his NPR Fresh Air interview last year:
Doctor Considers The Pitfalls Of Extending Life And Prolonging Death
Humans have had to face death and mortality since since the beginning of time, but our experience of the dying process has changed dramatically in recent history.

Haider Warraich, a fellow in cardiology at Duke University Medical Center, tells Fresh Air's Terry Gross that death used to be sudden, unexpected and relatively swift — the result of a violent cause, or perhaps an infection. But, he says, modern medicines and medical technologies have lead to a "dramatic extension" of life — and a more prolonged dying processes.

"We've now ... introduced a phase of our life, which can be considered as 'dying,' in which patients have terminal diseases in which they are in and out of the hospital, they are dependent in nursing homes," Warraich says. "That is something that is a very, very recent development in our history as a species.”…

I've just started on this book.

I'll close for now with a bit more Barbara Ehrenreich:
In 2000, an Italian immunologist named Claudio Franceschi proposed the neologism “inflammaging” to describe the entire organism-wide process of aging. Far from being a simple process of decay originating in individual cells, aging involves the active mobilization of macrophages to deal with proliferating sites of cellular damage. Today, Franceschi’s theory is widely accepted. The hallmark disorders of aging — atherosclerosis, arthritis, Alzheimer’s disease, diabetes, osteoporosis — are all inflammatory diseases, characterized by localized buildup of macrophages. In atherosclerosis, for example, macrophages settle in the arteries that lead to the heart and gorge themselves on lipids until the arteries are blocked. In type 2 diabetes, macrophages accumulate in the pancreas, where they destroy the cells that produce insulin. Osteoporosis involves the activation of bone-dwelling macrophages, called osteocytes, that kill normal bone cells. The inflammation associated with Alzheimer’s was first thought to represent macrophages’ attempts to control the beta-amyloid plaques that clog up the Alzheimer’s brain. But the most recent research suggests that the macrophages actually drive the progression of the disease.

These are not degenerative diseases, not accumulations of errors and cobwebs. They are active and seemingly purposeful attacks by the immune system on the body itself. Why should this happen? Perhaps a better question is: Why shouldn’t it happen? The survival of an older person incapable of reproduction is of no evolutionary consequence. In a Darwinian sense, it might even be better to remove the elderly before they can use up resources that would otherwise go to the young. In that case, you could say that there is something almost altruistic about the diseases of aging. Just as programmed cell death, called apoptosis, cleanly eliminates damaged cells from the body, so do the diseases of aging clear out the clutter of biologically useless older people — only not quite so cleanly. This perspective may be particularly attractive at a time like the present, when the dominant discourse on aging focuses on the deleterious economic effects of aging populations. If we didn’t have inflammatory diseases to get the job done, we might be tempted to turn to euthanasia...

On this broad topic of aging and chronic maladies, I am reminded of Dan Lieberman's fine book.

I cited and reviewed it here.


Was recently apprised of this book.

Looks very interesting. I am reminded of Einer Elhauge.

BTW, another new read I'm just starting.

Heard this one touted on CNN on Sunday.


apropos of my recent #NeverAgain posts.


More to come...

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