The current culture of medicine is to wait until things become bad enough to warrant an intervention. This strategy leaves patients living longer lives but at an already decreased level of health and function. It’s time to focus on prevention and “square the longevity curve”.
Medicine today is more reactive than proactive. We unfortunately allow disease to progress until it becomes bad enough to warrant an intervention. This is the “whack-a-mole” style of medicine you may hear many other preventative medicine physicians talk about. This style of dealing with problems as they arise is likely rooted in what medicine used to be like only 100 and some years ago.
Reactive medicine works for infections, but not chronic disease
Back then, infectious diseases were the leading causes of death. Unlike the chronic age-related diseases that are the leading causes of death today, infections are treated only when they present themselves. We won’t “whack” someone with antibiotics until they get a bacterial infection. This style of medicine makes sense with acute infections, but not for the chronic age-related diseases like cardiovascular disease, cancer, dementia, and diabetes that are the leading causes of morbidity and mortality today.
These diseases progress slowly over years and because they don’t cause illness acutely it is all too easy to let things get out of hand. Let insulin resistance go on for years and we get diabetes. Let high blood pressure and high cholesterol go on for years and we get heart disease. Let poor sleep habits go on for years and we get dementia.
Waiting too long to intervene and extend lifespan
By the time these health issues are significant enough to require medical attention, individuals’ healthspan (the time spent in reasonably good health and able to do the things we want to do) has already diminished considerably. At this stage, modern medicine excels in keeping people alive, often extending their lifespan significantly. However, the quality of these additional years is frequently compromised. Individuals are often too burdened by their diseases to fully enjoy the extra time that medicine provides.
For example, the fatigue and shortness of breath that accompanies heart failure may prevent someone from going to that wedding or family reunion. The muscle weakness that can result from stroke may leave someone dependent on others to care for them, or unable to communicate effectively. The pain associated with diabetic neuropathy may prevent someone from enjoying walks with their dog. The list goes on and on.
Notice in the graph above how the red line curves down but is abruptly pulled to the right after healthspan has decreased by about 50%. This reflects the fact that we’re catching (and effectively treating thus prolonging lifespan) people too late in their chronic disease processes. So people are living longer but at a level of health that most of us would be dissatisfied with. Compare that to the yellow curve, where a high level of healthspan is maintained until late in life. This should be the goal of medicine.
Medical attention is proportional to the severity of disease
However, working in medicine over the years, I’ve noticed that the amount we care is directly proportional to the severity of the disease. Moderately high blood pressure doesn’t get as much attention as heart failure. Prediabetes doesn’t get as much attention as end stage kidney disease. Unhealthy alcohol use doesn’t get as much attention as cirrhosis. And so on. This is true not only in clinical practice but research funding as well. Attention culminates when a patient, sickened by years and years of cumulated chronic disease, dies in the hospital leading to perhaps the most dramatic and resource-intensive reaction in all of medicine, the “code blue”.
Don’t get me wrong, I think these chronically sick people need and deserve a significant amount of attention from the healthcare system. However, I think it’s time we redistribute focus and resources slightly more towards keeping people healthy rather than just mitigating disease once it’s already happened.
Looking forward to Medicine 3.0
This reactive approach highlights a critical gap in our healthcare system. While the advancements in medical technology and treatments are remarkable, there is a growing need for a shift towards proactive health optimization. I believe this mentality, the “Medicine 3.0” that Peter Attia has popularly coined, that focuses just as much on prevention as it does on treatment of disease, is the future of medicine.
By focusing on preventive measures and early interventions, we can potentially maintain optimal healthspan thereby “squaring the longevity curve”, ensuring that the additional years gained are not just longer but also healthier and more fulfilling.