Only about 20% of our health and life expectancy is based on risk factors for disease; the other 80% can be boiled down to quality of life, which Hadler sums up with two questions: "Are you happy in your socioeconomic status, and do you like your job? It's very powerful."
That is quite the claim, so I started reading the book this weekend. It’s called Worried Sick and it’s by Nortin Hadler, a medical doctor and professor at UNC-CH.
I’ll give a crude summary of [my interpretation of] his thesis:
Although life expectancy has been rising as “premature” causes of death have been falling, life span seems to hit a wall at the magic number of around 85 years of age. It’s at this age that people, no matter how well they’ve lived, tend to drop dead. Of course it’s possible to live longer than that, and we all know examples of people who have lived well past 85, but those people, we must bear in mind, are exceptions.
The implication is that medical treatment, no matter how effective it is against the particular fire it is fighting, is highly unlikely to significantly extend a person’s life, because all the fires tend to start burning at once.
Cancer, heart disease, Alzheimer’s, as horrible as they are, are merely labels that we give to the proximate cause of our demise. Although these are the primary checkmarks that go on death certificates, these and all other diseases account for only 25% of our life-expectancy.
What’s far more likely to kill us before the age of 85 is a dissatisfaction with our position in life. This gives rise to “artificial epidemics” that “play out well beyond the walls of the clinic” and that “will not respond to pharmaceuticals and that cannot be surgically excised.” This, says Hadler, accounts for 75% of our mortal hazard.
What we have, then, is contemporary medicine that “nibbles at the frays of the other 25 percent of mortal hazard” — the proximate causes of death, rather than the giant underlying gorilla of “life satisfaction.” Health care, in comparison to this vague thing we are calling “satisfaction with life,” is fairly small potatoes, accounting for, optimistically, 10 percent of mortal hazard.
How can the $2.2 trillion health care industry defend itself against the claim of “small potatoes”? Interventional cardiology and cardiovascular surgery, of course! For an immodest fee, we’ll unclog your arteries and extend your life!
But wait.
Trials comparing CABG surgery with medical treatment found that, with the exception of a small group, the patients who had CABG did not live any longer than those treated medically. A significant percentage of CABG patients died before they could leave the hospital, about half had a stormy recovery, nearly that many had memory loss at a year, and half suffered cognitive decline at five years that was beyond that observed in their birth cohort.
The story is similar, or worse, for angioplasty and stents, neither of which can be shown to offer any important advantages.
And that small group that's the exception? That's 3 percent small. Three percent of all patients happen to have a type of blockage that is treatable, and for this group CABT can increase their probability of five-year-survival from 65% to 85%.
The bottom line, he says, is that no one should be as concerned about the proximate cause of their demise as they are about the likelihood that their course in life will be satisfying.
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I’ll share my reactions in the next couple of days.
