Shortening Life
For years we all lived with the fears of the two-headed health monster snatching us before our prime. While it is probably hard to deny that both heart disease and cancer are strongly genetically-linked, I always considered heart disease to be a lifestyle disease and cancer a genetically-predispositioned disease. I can almost hear the uncomfortable rustling of people who immediately disagree with my characterization for some personal experiential reason. We all have friends or family who have gotten something terrible like lung cancer from a bad decision in their youth to start smoking. We probably also have friends or family who have some sort of congenital heart defect that has thwarted their marathon-running, vegan-eating efforts to stay heart healthy. But somewhere along the way, we have all had to reconcile in our minds how we individually feel that our health is governed most. Are we more the product of nature or the product of our chosen environment? I’m not certain I’ve ever thought about it this way before, but this is an example of why I like writing so much these days. This exercise in forced mental expectoration means that I cough up new thoughts and perspectives almost every day. The mini word association process starts with a chosen title that is a pithy set of words that seem intriguing at that moment and then drive my mind in any of several strange directions. At the moment, I am mired in the interesting statistics put together by the CDC about the leading causes of death in America and how that has changed over the years as our demographics, lifestyles and medical strengths have changed.
The winner and still champion for many years (100 years to be exact) has been heart disease. Before that, respiratory diseases like pneumonia and influenza killed more people than anything else. But in this week of the release of the 2020 census data that is putting on display all of the changing demographics of the United States (no real shockers, we are getting more urban, more diverse and less rural and white), it is interesting to ponder what tends to fell us. The Twentieth Century was certainly a century of heart disease, and if you include death by stroke, which is closely related to affairs of the heart, it overwhelmed the death tolls of the 1900’s. I, for one, grew up thinking I had to try to prevent myself from getting heart disease by doing something…mostly eating better or exercising more. I also grew up thinking that I needed to hope I could dodge the cancer bullet. But you can tell the difference in the thinking just by looking at how I just described these two beasts. One I felt I could prevent with healthy effort, the other I felt I needed more luck than clean living to avoid. The exception to this delineation comes from the evils of smoking. We started thinking, with the help of the Surgeon General’s cigarette pack warning label, that smoking causes cancer. But then we also began to recognize that smoking also causes coronary artery disease. Whenever I would describe my family history, I would, for the past thirty or so years, say that my father had died of heart disease…but that he had been a heavy smoker for years. The messaging was quite intentional. I was trying to say to the world and probably to myself that his coronary affliction was less about genetics and more about his lifestyle choice to smoke heavily.
As soon as I hear of someone getting cancer, I ask some question about whether that was prevalent in his or her family history. Was there a predisposition? I then usually ask whether the person smoked or lay out in the sun unwisely as a fair-skinned youth. I think we can all agree anecdotally (yes, I know there is lots of empirical data available, but we get our minds around these things through inference from anecdotal data) that both genetics and lifestyle matter in some degree or tendency to contributing to our longevity.
If you look at the CDC list of leading causes of death in America, you will see that before 2020 there were ten on the list in this order:
1. Heart disease
2. Cancer
3. Unintentional injuries
4. Respiratory disease (COPD)
5. Stroke
6. Alzheimer’s
7. Diabetes
8. Influenza & Pneumonia
9. Kidney disease
10. Suicide
As you might imagine, I can’t talk about death in America without referencing COVID, which now slots in independently at #3, but would have been #2 at least if annualized (since it began only in March). If you start grouping these sub-categories (I declare openly that I am not qualified for this medical exercise), you might well be seeing that we are reverting to respiratory illness as perhaps the new leading cause of death as coronary prophylactics rise as virus pandemics also rise and, importantly mutate ahead of our attack on them. Normally I would put respiratory disorders in the category of genetically predisposed afflictions, but I’m not so sure the current political environment allows for that. One can easily make the case that thanks in particular to our prior president’s penchant for knowing that he knows best, the nation was pushed into a loyalty vice that forced otherwise sensible people to abandon science and make a clear lifestyle decision to prefer infection, disease and death over sound health via silly rhetorical posturing towards individual freedom.
I think the penny has dropped now and the tide is turning gradually to a more sensible approach to COVID prevention and treatment. Things like monoclonal antibodies are making a difference. The speed with which biomedical industry has responded to the crisis is nothing short of impressive. Granted, the research was not from ground zero and was somewhat underway, but still, bandaging this pandemic versus how long it has taken to address heart disease or cancer is still impressive. The two traditional top death-dealing villains are not as directly addressable as combating a virus (I take nothing away from immunologists for their advancements), but still we see the stark interplay between nature and lifestyle choices in the determination of the deadliness of these causes.
At an age leaning into 68 years, I figured that if I made it this long without having one of those two monsters bite me in the ass, I would be sliding into home and declaring it a win. I have always figured that if Psalm 90:10 gave man three score ten, that was my point of demarcation. That’s not intended as a limit and I never took it as such, but I have always figured that any time I get after three score ten is bonus time for which I will be extra grateful. I see COVID as the unanticipated risk that I feel just can’t be allowed to bite me where the monsters have not. Kim and I both feel that extra caution (travel, social distancing, etc.) is a small price to pay for a lifelong game. So guess what? We have more time at home than expected. At this time of year, with a good day being in the low 80’s and a bad day over 90, all days involve putting on shorts. If there’s a planned business call (expert witness work) there’s a button-down shirt. If there’s just a work day, I keep it simple with a t-shirt. But every day is a shorts day. It has occurred to me that there is irony in all of this. Life has dealt me a shortening life as I extend my life into and hopefully beyond three score ten.