Aging, suffering, and the inevitability of death: Let's keep it real, and ignore the quacks

My friend Paul Taylor, longtime journalist and former executive at the Pew Trusts, has just published a new book called “This Is Getting Old: Two Boomers and Their Generation at Dusk”. It has two main topics. The first is an often-disturbing analysis of the impact of the “Boomer generation” as a whole, focused on their (our) massive accumulation of money, fighting for society’s resources to be directed to us, and shockingly, away from those who need it most, children. There are clearly many different indviduals in this generation, as well as subgroups (since boomers were born 1946 to 1965, the usual characterizations of us in our youth, activism in the late 1960s, obviously are only about the older part of that cohort). He makes the point that not only did this generation, as many before, get more conservative as they aged, but that only a portion of them were ever progressive. And the contrast between their generosity to their own children and grandchildren, and their parsimony toward most of society’s children is, at least coincidentally (as he states it), or definitely (as I think) about the color, race, and ethnicity of the majority of today’s children. Did I say this was shameful? If not, I do!

The other focus of the book is the aging of his, their, and our generation, focusing particularly on one couple (a terrific, impressive, warm and active couple), but also full of data on what is happening to all of us. Which is the same thing that happened to everyone before us, getting old and eventually dying. We may be dying older, and dying of different things, and (many of us) having more healthy and productive years before we die, but we all die. And for many of us, perhaps most of us, as all through history, that dying will be preceded by a period – which can be short or be many years – of suffering, of being sick, in pain, losing our mental faculties, or all of these. Guaranteed. While billionaires are being quite successful in avoiding (at least for themselves) the other of that famous pair, taxes, avoiding death is, even for them, only a science fiction cryogenic dream for them that has not yet happened. Thank goodness. If there are any people that the future does NOT need preserved for them to deal with, it is the billionaires most assiduously working on it!

So, we need to remember not only the inevitability of death, but the suffering that so often precedes it. We boomers have been watched it in our parents, our older relatives, and, sadly, many of our peers. It is well to remember the myth of Tithonus, who was granted eternal life by Zeus, but not eternal youth. He continued to age, alive and living sicker and more decrepit. A more modern self-deception: a few decades ago, I was the only physician in a health policy class. Each week one student had to make a presentation to the class on a particular topic. The student who addressed the issue of “long term care” did present data, but then added that in their opinion the need for long-term care would decrease because people were taking better care of themselves, exercising and eating better and not smoking. I pointed out that this would obviously increase the need for long-term care, as people would less often die young from heart attacks and more often live older and older (if not eternally, like Tithonus) with more and more care needs. I suspect I even said something like “if you want to decrease the need for long term care, have people smoke, drink, eat poorly, not exercise and drop dead in the 40s and 50s”.

But that student, and others, were young. Somehow, they conflated living a more healthful lifestyle, and having better health in the near and medium term, with not ever confronting getting old, sick, and dying. That is purely wishful thinking. While living more healthfully is a good idea, it cannot prevent the inevitable. And yet, many people, even today, believe this that somehow they can and (more venally and evilly) are selling it to others. Some of these ideas are commonly associated with folks like Secretary of Health and Human Services Robert F. Kennedy, Jr. (how painful to associate that name and that title!) and the MAHA (Make America Healthy Again) movement. Like the MAGA (Make America Great Again) of Donald Trump, the key point is the “again”. In the case of MAGA, it depends on what your definition of “great” is – probably America was if it means slavery, racism, subjugation of women, and constant wars, with military budgets making up the biggest part of public spending, the funding of which comes disproportionately from those with lower incomes.

In terms of MAHA, while there may be a bit less subjective flexibility about defining “healthy” than “great”, there is definite disagreement about the road to health. For example, a recent study by the Edelman Trust Barometer produced the table below. About a quarter to a third
of Americans believe each of these falsehoods, and 70% believe at least one, with a whole bunch of folks who “don’t know”. Edelman calls these claims “false or unproven”, which is generous. To a greater or lesser degree, they are all false. The most dangerous are the claims about vaccines, which are good, and to a large degree the reason that boomers and others are likely to live as long as they are. As a t-shirt I have seen correctly asserts “Vaccines cause adults”!

 

 

Unpasteurized (ie, raw) milk has in fact caused lots of deaths because of bacterial contamination. Testimonials from dairy farmers who drink it all the time are not valid for urbanites who are consuming it days after milking, when the bacteria in it that would have been killed by pasteurization has had time to multiply, The other false claims may not cause death, but sure can cause suffering; I suffered a lot of dental cavities as a kid before our water was fluoridated. Fluoride is definitely helpful to dental health (excessive amounts can cause unsightly, but NOT dangerous, mottling of teeth). Avoiding acetaminophen in pregnancy can cause pain. And on animal protein: it is not more healthful than plant protein, it is in fact, generally less healthful. As is animal fat (e.g, tallow, lard). 

These false claims are relatively easy to refute, although it is not easy to convince people who believe them that they are wrong; these are two different things. But what of the amazing plethora of other magical health claims, today’s equivalents of snake oil (in promises for great health, not to mention quackery). Early in his book, Taylor writes 

Don’t pick up this book expecting to find the magic formula for staying forever young. I ain’t got one. You’re better off cruising TikTok, where a bustling industry of anti-aging influencers serves up a bottomless banquet of science and quackery. They treat aging as a curable condition, death an avoidable fate. 

Sigh. It would be wonderful if these nostrums could keep you healthy and keep you from dying. But they don’t. That doesn’t keep them from being a “bustling” (and profitable!) industry.

Three points:

1) Natural is not necessarily better or safer. That is a fallacy. Anything that actually has biologic effects can have the ones you want, and the ones you don’t (side effects). If it doesn’t have any biologic effect, it’s not helping either.

2) Don’t be a sucker. Yes, Big Pharma is evil, but there is much better data on whether and how its products work than those of the MAHA-hood.

3) If it sounds to good to be true, it probably is.

"It was the best of times, it was the worst of times": Threats to the public's health from Medicaid cuts, MAHA, and others

“It was the best of times, it was the worst of times…” begins Dickens’ “A Tale of Two Cities”, and people have used that phrase to describe all kinds of times in the 150+ years since it was published in 1859. But maybe not today. In some ways, I guess, it could be the best of times for some privileged people in wealthy countries; never in history have so many people been able to enjoy things like enough food to eat, shelter, air that is breathable, water that is clean, heat in the winter, A/C in the summer, travel for long distances by plane, for many distances by private car, etc., etc. In every way, often ones that seem to us to be mundane, a lot of us enjoy a standard of living that could not be imagined even by the wealthy of Dickens’ time or earlier. Of course, that is only for some of us in the world, it is likely the majority in wealthy countries, even those working people living paycheck to paycheck.

But even in those wealthy countries we see too many who do not enjoy those benefits, who are living on the streets, who sleep in shelters or sewer grates or parks, who are freezing in winter and roasting in summer, who do not have enough to eat, who cannot get basic health care for their needs, and often have additional needs related to mental health or alcohol or drug use. We see children being abused and neglected by parents who do not have the wherewithal or support they need. We are, some of us, outraged and angry, some of us at them, and others of us at the system in which they live. Because we have a society that actively chooses to make the lives of many people worse so that the most privileged can have more.

And, once we leave wealthy countries such as the US, it becomes phenomenally worse. The number of people starving or suffering in wars and armed conflicts is incredible. Gaza is one obvious example, and it is horrific – the government of Israel using the all too real fact of centuries of oppression and anti-Semitism to destroy another people, the Palestinians, killing tens of thousands, displacing millions from their homes, destroying what infrastructure they had stingily allowed to be built – this is not wrongly called genocide. And there is Somalia and South Sudan and Ukraine in wars, and whole continents of people whose best days are the ones on which they get something to eat.

So, is it the worst of times? The policies being followed by the US government under President Trump and the bootlicking GOP Congress and the Supreme Court to which he appointed a disproportionate number of members, are leading us steadily downhill in virtually every part of the public arena. But the fact that they keep getting worse indicates that we have not yet reached bottom, we are not yet in the Europe of the late 1930s and 1940s even. But it does keep getting worse, in the US and across the world. It hits on so many fronts – the economy, basic human rights, climate, war – that it is difficult to even keep up.

And health and health care? The focus of this blog? Still lots of bad things, starting with the cynical, opportunistic, and dangerous policies being implemented by the Secretary of Health and Human Services (HHS), Robert F. Kennedy, Jr., the director of the Centers for Medicare and Medicaid Services (CMS), Dr. Mehmet Oz, and others in the administration, which become more and more outrageous. And, of course, the negative impact of the President’s “Big, Beautiful Bill” on those dependent on Medicare and Medicaid will be dramatic. STAT News recently reported that the Congressional Budget Office (CBO) estimates 11 million people will lose their health coverage as a result of Medicaid cuts. That is a lot of people, and only a very tiny percentage are the “boogeymen” cited by the GOP as deadbeats, adults capable of working but not seeking work. In fact, most people on Medicaid are children and their mothers, and most Medicaid dollars are spent on caring for seniors and disabled people in long-term care, and most able-bodied adults receiving Medicaid are already working, sometimes at more than one job, but making less than the standard (often 138% of the Federal Poverty Level). In my state, Arizona, that is less than $22,000 a year for a single person, and it is similar for families and in other states. The outrage is not that there are people receiving Medicaid who should be able to work, but rather that people working full-time can be paid so little that they qualify for Medicaid and other federal benefits. Many of these folks are working for high-profile (and high-profit!) corporations such as Walmart and McDonald’s, as reported by CNBC in 2020 (and probably is worse now!) Medicaid, by the way, is not a benefit paid to individuals (such as welfare or SNAP) but rather is paid to medical facilities for providing care to eligible individuals. To the extent that there is fraud, it is more likely to be on the part of those providers than the individuals. And cutting Medicaid threatens the continued existence of many of those providers, particularly rural hospitals which are, because the population that they serve has a higher percent of poor, disabled, and elderly people, more dependent upon Medicaid payments.

Medicare is also being harmed, in less obvious ways than the cuts to Medicaid, largely by encouraging the movement of Medicare recipients into private, insurance company-run plans called Medicare Advantage. I have often discussed the details (e.g., Open Enrollment Season for Medicare and Medicare Advantage: What you should know, Oct 7, 2024) but, in brief, insurance companies get paid more than Medicare spends on “traditional Medicare” (TM) recipients, and use some of it to provide benefits that are attractive, especially if you are not really sick. Of course, it is not then Medicare, but an insurance package, a PPO or HMO paid for with Medicare dollars, and the insurance company can (and often does) deny claims, as they do for their non-Medicare insurance packages, which TM does not.

And what about RFK, Jr., and his MAHA (“Make America Healthy Again”) campaign, including his disparagement of vaccines and advocacy for unproven (and sometimes proven-to-be-dangerous) treatments such as unregulated use of stem cells, and other “alternative” treatments, including saying “‘Charlatans’ Are No Reason to Block Unproven Stem Cell Treatments” even though “some methods have resulted in blindness, tumors and other injuries”? I’d say there is great cause for concern, but would also recommend reading the sympathetic and balanced discussion of MAHA supporters by Katelyn Jetelina, “Your Local Epidemiologist”. She distinguishes between leaders of the movement, like RFK, Jr., about whom she says “I don’t believe RFK Jr. is acting in good faith. His record is riddled with contradictions and falsehoods. His tactics often erode trust under the guise of restoring it. Treating him as a serious partner would be a mistake,” and the grass-roots. Many of these people feel that they are not getting accurate information (often they are not), many (appropriately) distrust Big Pharma and associate the mainstream medical and public health disciplines with it, and some are advocates for the magic benefits of “alternative” treatments such as stem cells. But a big issue that she identifies is their desire for “autonomy”, to make their own decisions on health care (where to go and what to do, what treatments to use, etc.) rather than be forced into using vaccines, or taking pharmaceuticals when they don’t want to. This is a big issue. In many areas, particularly infectious disease, individual autonomy that says “we don’t want vaccines” can lead to big disease outbreaks (like the ones we’ve recently seen of measles, which include deaths of unvaccinated children). The issue of individual autonomy vs. the public good is a longstanding tension, and of particular potency in the US.

So, what is there to say? I say do get vaccinated. Vaccines do not cause autism. Childhood vaccines, as is often stated, cause adulthood – because children do not die of polio, measles, or influenza, or epiglottitis and meningitis from H. influenza B, and hepatitis, and all the other conditions which at best cause significant suffering even when they do not lead to permanent disability or death. Vaccines are a good thing.

Swimming in polluted water, as RFK, Jr., has done is a bad idea. Taking your grandchildren along with you, as he has also done, is a really bad idea.

And yes, cutting millions of people, most of whom are hard-working, off of Medicaid, is another really bad idea.

 

 

For a balanced description of the terrible abuses that were carried out in the name of medicine and public health by Nazis, Americans, and others, see the excellent podcast “Doctors Gone Bad: Physicians, Dictatorships, and Warrior Cultures” by Dr. Martin Donohoe, part of his outstanding podcast series “Prescription for Justice”.