Conventional medicine has a long record of impressive achievements. Antibiotics revolutionized the treatment of infections from trauma, injuries, and bacterial and parasitic pathogens. Vaccines had a similar impact on reducing the burden of acute, infectious disease. Anesthesia made it possible to perform surgery without the sheer agony and pain that characterized it in the past, and antisepsis (the creation of a sterile surgical environment) greatly improved survival rates after surgical procedures. Radiologic imaging and other laboratory tests and procedures have enabled us to more accurately diagnose disease. Advances in childbirth (such as anesthesia, cesarean section, and forceps delivery) have significantly reduced infant mortality. Organ transplantation has offered hope for people who would otherwise have no other options.
Collectively, these advances led to a dramatic increase in human lifespan in the industrialized world—especially in the last century. If you were born in 1900, there was a good chance you’d be dead before your fiftieth birthday. Today, if you live in the United States, you can expect to live for seventy-eight years. If you live in other countries like Canada, Japan, or Monaco, your lifespan is even longer: eighty-one, eighty-two, and ninety years respectively.
But these are just averages. Centenarians—people who reach the age of 100 years or more—are the fastest growing segment of the population. Estimates suggest that if the population of centenarians continues to rise at its current pace, there could be close to 1 million people of 100 years of age or more in the United States by the year 2050.
What’s more, medical advances have not stopped—they’re continuing at an accelerated pace. In our lifetimes, we can expect to see everything from bionic eyes that allow blind people to see, to electronic “defibrillators” implanted in the brain that stop seizures, to precision treatments that kill cancerous cells without harming healthy cells, to robots that can perform certain procedures more safely and effectively than human surgeons.
Sounds incredible, right?
While there’s every reason to celebrate these advances, both past and future, it’s also important to recognize the other side of this coin: the meteoric increase in chronic disease, and its dramatic effects on our health, our quality of life, and even our lifespan.
A Longer Life, But With Poorer Health
It’s wonderful that our lifespans have increased, but if we spend our final years—or even decades—of that longer life suffering from not just one, but multiple chronic diseases, is that something to be proud of? In fact, this is exactly what studies suggest is happening. A paper published by researchers at the University of Southern California found that although lifespans for both men and women increased in the U.S. over the past forty years, so too did the proportion of time spent living with disability and chronic disease. “We could be increasing the length of poor-quality life more than good-quality life,” said lead author Eileen Crimmins, USC University Professor and AARP Professor of Gerontology at the USC Davis School of Gerontology (Crimmins et al. 2016).
Imagine a woman, Latisha, who is diagnosed with Crohn’s disease at age twenty-seven. She has crippling abdominal pain, indigestion, and urgent diarrhea several times a day. These symptoms make it difficult for her to work, engage in leisure activities, and enjoy her life. She sees a gastroenterologist, and after trying several medications, can at least partially control her symptoms. But the steroid she is taking has significant side effects, including increased appetite and weight gain, particularly around the mid-section. By the time Latisha turns thirty-five, she has become obese and has developed type 2 diabetes. These conditions cause further suffering and require more medication. A few years later, her mother passes away and the stress of that event triggers a flare in her Crohn’s symptoms. The medications that had previously controlled it no longer work, so her doctor prescribes infliximab, a biologic drug that is used to treat autoimmune diseases. While infliximab brings her gut symptoms under control again, it causes several side effects, including extreme fatigue, headache, and constant muscle pain. These symptoms interfere with her sleep, and her fatigue worsens.
At some point, the symptoms become so pronounced that Latisha can no longer work. She goes on short-term disability, hoping that she’ll be able to recover and return to her job. But after a year, she has not only not improved, she’s gotten worse. She didn’t have long-term disability insurance, so she goes on Medicaid. Understandably, she becomes depressed. Her physician prescribes an SSRI, which helps to some extent but also causes new symptoms, like dizziness, nausea, and agitation.
By the time Latisha turns sixty-five, she’s taking nine prescription medications and several over-the-counter drugs. She is unable to work, has an extremely limited social life, and spends much of her time at doctor’s offices and pharmacies, battling with Medicaid representatives to secure care, and researching her conditions. Eventually, Latisha declares bankruptcy because of her growing medical bills. Unable to afford private housing, she is forced to move into a Medicaid-sponsored nursing home, where, against all odds, she manages to live until age eighty-four.
I wish I could say that Latisha’s story is unusual; unfortunately, it’s all too common. Latisha lived a relatively long life—exceeding the average life expectancy in the United States by several years. But was she able to live a rich and fulfilling life? Were these extra years meaningful and rewarding?
The situation is even more dire with children. The proportion of kids with chronic disease has risen dramatically over the past two decades. Twenty-seven percent of children now suffer from chronic disease, up from just 13 percent in 1994 (Van Cleave et al. 2010). This is heartbreaking. A chronic disease in an adult may mean twenty or thirty years of suffering. But a chronic disease, or multiple chronic diseases, in a child may mean sixty, seventy, or even more years of suffering.
Consider a child, José, who develops asthma, allergies, eczema, and ADHD before the age of ten. And imagine that these conditions persist until he passes away at age eighty-eight. Although these conditions aren’t life threatening (except for asthma, which still kills 250,000 people a year), they can be debilitating and significantly reduce quality of life—especially collectively. This means that José will be suffering unnecessarily for more than sevendecades.
Is this the kind of life we want to live?
Or, a Shorter Life With Poorer Health?
Unfortunately, the situation may be even worse than previously described. Recent studies suggest that today’s children are the first generation expected to live shorter lifespans than their parents (Olshansky et al. 2005). This should serve as a wake-up call, since life expectancy has been on an upward trend in the industrialized world (a few temporary dips during pandemics notwithstanding) for as long as we’ve been measuring it.
This projected decrease in life expectancy has been attributed mostly to the explosion of chronic diseases like obesity and diabetes in children. Obesity and diabetes are associated with significant morbidity and mortality, and are primary risk factors for heart attacks and cancer, which remain the number one and number two causes of death in the U.S., respectively.
The Sneaky Rise of Chronic Disease
It might feel like our situation today snuck up on us. But if we look with 20/20 hindsight, we can see that it happened quickly. As recently as the 1950s and 60s, for example, obesity was rare. Our health has changed so dramatically that many of us alive today can remember those days. If you look at family photographs from fifty or sixty years ago, you may be surprised by how much leaner most people were. That’s because you’ve become used to a population where two of three people are overweight and one in three is obese.
Chronic disease is now a defining feature of Western society, and unfortunately, it’s also one of our exports. As developing countries adopt our lifestyle and dietary habits, they are also starting to develop these diseases at an alarming rate.
In the next chapter, we’ll discuss three reasons why chronic disease has exploded across the industrialized world. But first, let’s take a closer look at just how prevalent—and frankly, alarming—chronic disease has become.
The Colossal Burden of Chronic Disease
It’s hard to overstate just how serious this problem is. If we look at the facts, we’ll realize we’re on a frightening trajectory.
One in two Americans now has a chronic disease, and one in four has multiple chronic diseases. Chronic disease causes seven of ten deaths in the U.S. and accounts for 86 percent of healthcare expenditures (and 99 percent of Medicare dollars!), 91 percent of prescriptions, and 76 percent of physician visits (NCCDPHP 2016; NIEHS 2015, 295; Johns Hopkins University Partnership for Solutions 2000).
The burden of chronic disease
The financial burden of chronic disease is so enormous it’s hard to comprehend. The U.S. spends $3.2 trillion a year on healthcare (Munro 2015). This is equivalent to 18 percent of our gross domestic product, or roughly $10,000 for every man, woman, and child in America. This might not be so bad if these stratospheric expenditures led to superior results. They don’t. Although our healthcare system is the most expensive in the world by far, on many measures of performance, it ranks last out of eleven developed countries (Schneider et al. 2017).
The U.S. is certainly worse off than other countries, but that doesn’t mean they aren’t struggling as well. Chronic disease will generate $47 trillion in healthcare costs globally by 2030 if the epidemic is unchecked (Duff-Brown2017). That’s more than the annual GDP of the six largest economies in the world!
Are We Headed Toward a Future Where Everyone Has a Chronic Disease?
I wish I could tell you that things are looking up, but that’s simply not true. There’s every indication that the chronic disease epidemic will get worse before it gets better (unless we embrace the approach I’m advocating in this book, of course).
A new report from the Centers for Disease Control (CDC) found that 100 million Americans—nearly one in three—have either prediabetes or diabetes (CDC 2017b). A full 88 percent of people with prediabetes don’t know that they have it, which is significant because statistics show that prediabetes progresses to full-fledged type 2 diabetes in just five years if untreated. Most disturbingly, the rate of type 2 diabetes in children and teens is increasing by almost 5 percent a year (NIH 2017).
According to the American Autoimmune Related Diseases Association (AARDA), 50 million Americans (approximately one in six) have an autoimmune disease. In comparison, cancer affects 9 million Americans and heart disease 22 million. Researchers have identified 80–100 autoimmune diseases and suspect at least forty additional diseases of having an autoimmune basis (AARDA 2017).
More than 5 million Americans are living with Alzheimer’s today, but that number is expected to more than triple by 2050. Every sixty-six seconds, someone in the U.S. develops the disease. Alzheimer’s is now the sixth leading cause of death in the U.S.; the number of deaths has increased by 89 percent since 2000. Alzheimer’s kills more people than prostate and breast cancer combined, but it doesn’t just affect the people who are diagnosed: 35 percent of caregivers for people with Alzheimer’s or dementia report that their health has gotten worse due to their responsibilities (Alzheimer’s Association 2017).
A recent study documented a 52 percent decline in sperm concentration and a 59 percent decline in total sperm count in men over a nearly forty-year period ending in 2011 (Levine et al. 2017). A decline in sperm count and concentration leads to a decreased probability of conception. The authors of the study speculated that increased exposure to endocrine disrupting chemicals in the environment may be partly to blame for this trend.
Finally, according to the latest estimates, one in forty-five children now have autism spectrum disorder, up from just one in 500 in 1999 (Zablotsky et al. 2015). This is not only due to increased rates of detection. More children will be diagnosed with autism this year than AIDS, diabetes, and cancer combined. The effects of autism are debilitating, far-reaching, and lifelong.
A Slow-Motion Plague
These statistics are unequivocal proof that our current approach to healthcare is failing, and that the consequences are severe. But we don’t tend to see this as an emergency as we might if there were a bird flu or pandemic; we just see it as our life.
A better way of understanding the impact of chronic disease is as a slow-motion plague. Although it may not match the scale of the bubonic plague in the Middle Ages in terms of mortality, it’s arguably an even bigger problem because of the sheer numbers of people affected and the wide range of those effects. I don’t think it’s an exaggeration to suggest that our very survival as a species is at stake.
Given this, it’s imperative that we embrace a new model of healthcare with the potential to not only stop the increase in chronic disease but reverse it. In the next chapter, I’ll explain why conventional medicine, at least in its current configuration, will never be able to achieve this goal.