If this Disease don’t Getcha, Another One Will?
I apologize for the negative sounding context of the title, which is “catchy title speak” for the point that the gradual conquering of deadly maladies has increased life expectancies to the point where the next current medical mysteries kill us. Actually, there are many positives here…the relative mastery of infectious disease (by antibiotics and vaccines) in the last century, and the knowledge that better diets/exercise/less smoking/less drinking have reduced heart attack/stroke for starters. But looking at the history of life-ending things, the elimination of one just gets you to the point of being nailed by another?
I am fascinated by articles about life 100 years ago, when things were actually quite different (though in some ways they seemed similar). If you watch a movie made in 30’s (for instance), they have cars and phones and generally act and talk the way we do today. However, behind the scenes, many of that era still did not have electricity or running water (let alone cars and phones), while health wise they were a relative mess. For instance, the top three causes of mortality in the US in 1920 were 1) Infectious Disease (22% of all deaths) 2) Heart Disease and Stroke (21%) and 3) Cancer (7%), while the average US lifespan was 53 years. After incredible reductions in infectious disease and infant mortality (often related to those same infectious diseases), we entered mid century with lifespans approaching 70. After upticks in heart disease/stroke, accidents, and pulmonary diseases in the middle of the last century (much due to technology and an epidemic of smoking and drinking since subsided) modern incidence of heart attack/stroke is down, diabetes/Alzheimer’s deaths up, cancer level, with an average lifespan of 79 years. It all suggests that in the 1920s, your chances of dying at birth or under 50 by infectious disease was much higher, while after those diseases were conquered by the 70s, you moved into a tier where smoking/drinking/auto accidents were more likely to claim your life by age 70. Finally, in modern times when roads are safer, smoking/drinking diminished, and healthy diets more the norm, we’ve moved into the tier where cancer, diabetes, or Alzheimer’s are just as likely to claim our lives by age 80 as heart attack/stroke.
There are many other interesting facts brought out by these data sets. The overall risk of dying (about 0.95% in 1921…understandable when your average lifespan was only 53) rose to 1% in 1945 (although infectious disease had been conquered, people were seemingly drinking, smoking, reckless driving, soldiering themselves to an early death) and down to around 0.85% today (it would be even lower if self-imposed things like suicide and HIV hadn’t come on the scene). About the time we stopped smoking and drinking, we seemingly began to eat too much refined starch and red meat, rather undoing our successes in the direction of “Western Diet diseases of old age” (Diabetes, kidney disease, Alzheimer’s, and some cancers). The cancer stats are somewhat encouraging (down slightly), especially when you realize there are much better diagnostic tools these days (one wonders if they always knew a person was dying a cancer death in the old days). A resurgence of kidney disease (prevalent in the 20s, disappeared from the top 10, recently appearing again) goes along with the surge in diabetes, and possibly the recent popularity of NSAIDs. Infectious disease, so famously “conquered” last century, may be making a small comeback, as human encroachment into new areas (HIV, Ebola, Covid-19) has released new and difficult viral strains, while overuse has beget antibiotic resistance. With death rates in general down and life expectancies up, will humans begin to self-destruct in the future? (recent upticks in suicide and accidental deaths, which include murder, would suggest so).
The rise and fall of heart disease/stroke is a particular mystery. The conventional wisdom is that it was fueled by smoking/drinking and a trans fat-heavy diet, popular during the last century (remember Crisco?). Statin manufacturers would have you believe that in addition to smoking/drinking subsidence, lower cholesterol levels are the reason. My own belief is that the survivors of the 1918 Flu epidemic carried a sort of epithelial tissue time-bomb (similar to the long-term epithelial damage by Covid-19 thought to be implicated in future strokes). No one is sure about this, but the heart attack/stroke epidemic (characterized by seemingly healthy 50 year old males that were dropping dead in the 60s) suspiciously subsided after the pre-1918 cohort passed on. As for our better “fat-free” diets, we have largely supplanted it with a carb-heavy diet, which may not be substantially better for our hearts and blood vessels. Judging from the stats, this carb-epidemic may have begat over amped immune systems in the elderly, who live longer but suffer from obesity, diabetes, kidney disease, and perhaps cancer and Alzheimer’s. In any case, relative improvements in heart health may have pushed end-of-life cardiac events to later in life, giving the other nasties a chance to get you first.
It is interesting to note here also that lung cancer was relatively unknown in 1921 (a largely pre industrial era) and that today, nearly 30% of lung cancers may be of the non-smokers variety. In addition, there is a growing epidemic of “pulmonary obstructive” diseases, which may be linked to not only smoking, but to dirty air and possibly gut biomes/immune systems messed up by too many antibiotics. “Clean air” states such as Hawaii and California are also noticeably healthier, from a longevity standpoint.
Of course, the “wild cards” that can skew longevity numbers are devastating wars, runaway pandemics, and general turmoil/genocide of the magnitudes of 40s Ukraine/1350 Bubonic Plagues/70s Cambodia. Though even these haven’t appreciably slowed population numbers and lengthened lifespans in the past 100 years, that could all change. There may even be scenarios where civilization “forgets” how all the infectious diseases were defeated in the first place (for the record, sanitation, mosquito nets, antibiotics, and vaccines) Recent anti-vax and anti-science sentiment does not leave much encouragement in this department. Will future beings believe that “natural defenses” will protect us? Well then, at least have the sense to separate the poop from the water supply and not inhale too much smoke.
The big bad beasts waiting for those that survive infancy, infectious diseases, accidents, diabetes, heart attacks and strokes into their 70s are currently cancer and Alzheimer’s. There is even a new theory that if you can survive the inflammatory diseases of bad diets, lack of exercise, and old age, your aging cells actually start protecting you from cancer and Alzheimer’s, around 85 years of age. After that, frailty may set in (as indicated by the many nonagenarians that suffer from falls and then perhaps don’t survive the hospital visit), or perhaps ultimately the heart simply wears out. In any case, there is hope around the corner that cancer and Alzheimer’s may be managed so that most of us WILL in fact live into our nineties.
But then…is something else lingering out there, waiting to get us?
(O’Neil, 2021),(cdc.gov/nchs/data/dvs/lead1900_98.pdf, n.d.),(https://www.prb.org/usdata/indicator/deaths/table/, n.d.)
