Howard Friedman - The Longevity Project

The focus on specific diseases and treatments (in medical schools and at the National Institutes of Health) is so strong that a new term had to be invented to deal with health promotion and disease prevention. The word wellness— only several decades old—was invented, broadcast, and popularized by humanists and social scientists to counter the dehumanizing overuse of medical technology and the overspecialization of physicians. Specialists could treat your disease, but if you wanted to stay healthy or be treated as a whole person, you would need to seek a promoter of wellness.

Many programs thus have been set up to promote wellness . But if you think about it, what’s wrong with the perfectly good word health ? What was wrong was that approaches to health were so tied up with disease that scientists interested in the positive aspects of health had to get away from the term and say they were studying wellness.

This confusion of health and disease led to many problems. People began turning to physicians to deal with all sorts of difficulties that traditionally had been addressed by friends, family elders, clergy members, chefs, coaches, hygienists, and mentors. Medical tests and procedures were sometimes applied to people who were basically fine, or who needed some coaching, or who would get better with time and healthy friendships. Many times physicians could help, but there were also side effects, medical errors, and spiraling costs. Medical treatment began consuming an ever-larger share of the gross domestic product. We could see that this would be impossible to maintain, and someday the sheer economic pressures would cause a reevaluation of this narrow view of health—that our day would come.

Health care became so focused on treating every problem with medication that we used to joke that someday someone would propose a huge pill full of potent medications, for everyone to take daily. Just think, with enough pharmaceutical collaboration, we could swallow one huge capsule each evening and treat cholesterol, overeating, alcoholism, insomnia, headaches, aging, depression, shyness, sunburn, hypertension, inattention, inactivity, and erectile dysfunction, all at once!

Distressingly enough, it now turns out that the joke was on us. There are real “polypills” under development and real proposals in circulation for “polypills” for everyone. Give all the world this huge pill and disease rates will plummet!

But not for us, because we know that there are often things you can do to configure your individual pathway to health and long life and to nudge yourself onto a smoother track. Targeted pills have helped millions and saved many lives; they are needed if you’ve developed a specific disease or condition that is clearly a threat to your life. But polypills—or any all-in-one quick fix—are a poor way to set most people on paths to long life.

There is no doubt that an unfortunate individual can be suddenly struck by a bus or by a virulent infection. There is no point in blaming the victim, and there is no way to have near-perfect control over your health. Many times, awful things happen for no rational reason. But, as we have discovered over and over in our studies, some pathways are much healthier than others, and many people have made their own luck by following them.

Most research on long life looks for the genes and the drugs that will delay aging. It is fascinating and important research but has no wonder pill for us. Ironically, many people overlook or misunderstand the less exotic but much more effective tools already at our disposal.

The patterns and pathways to long life that we have uncovered make a significant difference in health and longevity—on average, many account for five or more years of life. If you put them together, you find the reasons why many bright, healthy children live to their seventies, eighties, and even nineties or hundreds, while many other bright, healthy children go on to die in their fifties and sixties.

It may be surprising to realize that there are only a few things that are reliably known to be directly and consistently bad for health. The complexities surrounding good health are the key reason why many touted remedies sound plausible but are merely folklore. What are the simple, direct threats, and what are the more subtle, complex ones?

The first direct threats are toxins (or poisons) in sufficient amounts. Inhaling cigarette (tobacco) smoke brings a toxic stew of chemicals into direct contact with sensitive internal organs. Ingesting lead (from lead paint or pollutants) or other heavy metals, or pesticides, or polluted air, clearly kills human cells and damages organs.

The second sort of direct threat to health is radioactivity. Too much exposure to radiation will make you sick or kill you, whether it is from radon in your basement, fallout from nuclear weapons or nuclear waste, or too many medical X-rays (especially CT scans) in your hospital. Radioactive exposure is cumulative, meaning that risk rises with each exposure.

The third kind of health threat is virulent infectious diseases—certain viruses, bacterial infections, and fungus infections—which start to overwhelm the body’s natural defenses, especially when it’s already weakened. Here is where health care resources are concentrated. That is, here is where our health system does a very good job of developing and providing vaccines, and where physicians do an excellent job of administering pharmaceutical treatments to fight serious infections.

The most obvious direct threats to health involve trauma—the car crashes that crush skulls, the drownings that suffocate lungs, and the gunshots that sever arteries. Here is where surgeons and emergency physicians provide modern medical miracles.

But then things start to get complicated. Significant genetic abnormalities, sometimes inherited and sometimes due to damage from the environment, cause an important amount of disease and death. But many times, the problem will only appear if the environmental circumstances allow or elicit it. For example, if you are genetically prone to certain allergies or to certain addictions or to depression, you have no problem if the allergen or the addictive substance or the triggering stress is not available to you.

When other common areas of health promotion enter the picture, everything is open for dispute—which foods to eat, which medications to take, how to limit stress, which screenings to ask for, which physical activities to engage in, and which personality traits will put you at risk. They are very relevant but not simple to sort out. Why is there so much uncertainty when it comes to these aspects of health?

The human body is in a constant state of change and development, and so any single intervention can have varying results. At the extremes, the effects are clear—not only is dehydration a problem but even drinking too much water can kill you. High stress is a problem but so is awful boredom. The correct balance is hard to know at a single point in time. This is why pathways—long life paths—are so important. The healthy Terman participants did not know much about exercise classes, meditation breaks, or happiness courses, even though exercise, stress, and mental health are important. Their healthy life pathways helped them stay on track, and when challenges knocked them off the route, they persisted in finding the way back.

What have we learned about how to stay healthy and what individuals can do? First, take a deep breath. Second, take a deeper perspective.

The lives of the Terman participants revealed that it is not enough to focus on our bodies. Although individual bodies become ill, and doctors treat patients and not the friends and families of the patients, it is equally important to focus on families, work, and social relations. Social settings and social ties emerged as crucial components of health across the decades. Social relations deeply affect one’s habits, daily activities, long-term plans, and reactions to challenges. The family environment, the divorce of one’s parents, and the stresses of starting school too early all influenced the Terman children’s health for years to come; and their health in old age was clearly linked to satisfaction with their careers, social networks, marital status, and friendships.