Beyond treatment: Reframing health in our ill-health systems

Many advanced countries have a government-managed system to provide medical care. When an individual falls ill, he or she has access to medical or surgical care, whichever is appropriate.

It is important to understand that this type of intervention does not usually return the patient to perfect health. The doctor’s job is to evaluate the nature of the problem and then, by the selective use of drugs, most of which are poisons, create a situation in which the patient can function in a way which approximates to normal. In the case of a surgical problem, the idea is to remove the malfunctioning part, for example an inflamed appendix, or alternatively to insert an artificial part such as an artificial hip or knee. The aim is to enable the patient to function in a way that permits him or her to live a productive life within the limits of a new and essentially artificial normality. The various vaccination programs are designed to prevent illness.

Such facilities are essential and should not be minimized by stating that they are badly named. They are not National Health Services; these systems deliver medical services and should be designated National Ill-health Services.

Some people object to such services because they believe them to be socialist in origin. In doing so, they parade their ignorance. The first “welfare state” in modern times, including medical insurance, was introduced by German chancellor Otto von Bismarck between 1883 and 1888. His motivation was clear when he said, “Give a working man a pension, and he loses his interest in revolution.”

So, what about health? It is more than just the absence of illness. It includes a feeling of well-being. To examine what that means, we must begin by examining who and what we are in an evolutionary way.

Examining who and what we are in an evalutionary way

We know that we, you and I, are Homo sapiens. Homo means “man” in the sense of human. The term Homo sapiens means “wise man” or “knowledgeable man.” It is sobering to learn that there were 21 species of Homo in evolutionary history, but the number had shrunk to nine by about 300,000 years ago. We, Homo sapiens, shared the planet with Neanderthals, Denisovans, Homo erectus, and Homo rhodesiensis. It has been argued that because Homo sapiens has a larger and more effective brain, our ancestors killed the other sub-species in the struggle for existence. A recent argument dismisses that interpretation. There is archaeological evidence that Heidelberg man was as inventive and imaginative as our ancestors and, just as important, there is DNA evidence that the two species interbred. There are people today who are carrying genes from Heidelberg man.

Homo sapiens came out of Africa and was probably carrying microbes to which the species had become immune. But the other species that inhabited Europe and Asia did not share that immunity, with fatal consequences. In recent times, the indigenous populations of the Pacific Islands and parts of America were destroyed by European colonists in this way about 300 years ago.

The result of these pandemics 300,000 years ago was that Homo sapiens, our remote ancestors, became the dominant mammalian species on the planet.

We live today in organized societies which we call civilizations. The first of such societies developed 6,000 years ago. Simple arithmetic demonstrates that 98% of the time that Homo sapiens dominated the planet, the species survived successfully as hunter-gatherers. But when one considers evolutionary survival, it is more appropriate to consider the figures as numbers of generations. The problem with this is that it is unclear how to define a generation.

Expectation of life tables compiled in recent times do not help because they vary from country to country and even among regions in one country. Part of the reason is that these tables include the effect of infectious diseases, which can reduce populations dramatically. At the moment, the estimate is that if a human can escape such threats, he or she can live for about 70 years.

These 70 years can be divided into three stages.

The first is from birth to 15 years. The human infant is vulnerable and relies on its parents to see that (s)he survives childhood and early adolescence without coming to harm.

By age 15, the individual is sufficiently mature to be self-sufficient, and that means finding food and reproducing. Reproductive activity is what secures the survival of the species. This stage ends at about age 40. From 40 years onward, the individuals may contribute to family and community activity. But for most, reproduction is over, thus they make no further direct contribution to species survival. So it is reasonable to argue that a generation constitutes 40 years.

It is interesting that the Children of Israel wandered for 40 years in the desert so that the generation that had been corrupted by life in Egypt would be replaced by a new and more assertive generation that would fulfill its duty to live in the Land of Israel. Presumably Moses’ 120 years was part of his exceptional quality.

If one accepts that a generation is 40 years, then the 6,000 years of civilization is equivalent to 150 generations, while mankind’s total over 300,000 years of existence is 7,500 generations, which is also 98%. Since our hunter-gatherer ancestors evolved to be a dominant species, modern human beings should obtain useful information by considering their lifestyle. Diet is an obvious subject to consider.

The “gathering” part of our ancestors’ activity involves finding natural vegetables, fruits, and nuts. We can still do this, although our current vegetables have been cultivated. Fruits have a particularly pleasant taste, so it is a fair bet that they were popular.

Our ancestors hunted for meat, using stone tools. Their prey would be free-range animals, which means that their flesh would be leaner than what is available today. Smaller animals could have been the target of individuals, but large prey would be hunted by groups. Cooking would have started when man discovered how to make fire. Without kitchen utensils, cooking was limited to grilling. One can conform to this ancient diet by removing fat from meat by a kitchen knife, and the size of a portion can be reduced in the same way. It is clear that our ancestors were neither vegetarians nor vegans, but it is probable that they did not over-eat.

The industrial production of food makes over-eating a risk. That risk should be avoided, but the occasional use of such calorie-rich products is harmless, provided it remains occasional.

Mobility is another characteristic of early humanity. When our species left Africa, its members spread over the whole terrestrial map. This was not an overnight process. It took millennia.

Most of this movement would have been achieved by family-sized or slightly larger groups, which means that the rate of travel would have been slowed down by children who were old enough to walk on their own. The advance would not have been achieved by a series of marathon runs. It appears that we must keep walking to be well. While many people enjoy working out in a gymnasium or doing long-distance running, there is no general necessity for this type of activity. But people who have cars should try not to park the vehicle precisely at the entrance of where they want to go. It is wiser to park at a distance and to walk from there to the destination. In a nutshell, keep walking. Those who enjoy the more extreme activities should continue to do so for pleasure.

Apart from neolithic artwork on cave walls, there is no archaeological evidence of how our hunter-gatherer ancestors thought. One can only guess. If they were like us (a reasonable supposition), they would try to explain the natural phenomena with which they were familiar such as sunlight, moonlight, thunder, and lightning. Human activity produced important aspects of their environment, so one can assume that this was the origin of the human-type gods of ancient times. It would also be reasonable to assume that they would argue that what pleased or irritated fellow humans would also please or irritate these human-like gods. This could mean that more sophisticated ideas were a product of later, more advanced societies.

The issue of thought processes must be speculative.

The foregoing statements are generalizations, but many people are more interested in how these aspects refer to them as individuals, and that is a more complicated matter.

The mistake is to think of the body as a static phenomenon. This is not so. We move through time. It is convenient to use the same three stages in the earlier discussion defining a generation. During the first stage, from infancy to age 15, the youngster is entirely dependent on its parents, who should follow the guidelines already described.

Naturally, breast milk is preferable to artificial products. In addition to its nutritional value, breast milk can provide passive immunity to infectious disease. Some children are fat, others are lean; this is a matter determined by their genes. Parents should allow their youngsters to develop in a natural way and not aim to create a body that fits a predetermined plan that they read about. Sophisticated foods, and glucose products in particular, should not be used as a routine, although occasional use as a treat or reward is harmless. The main threat in these early years is infectious disease, which can be avoided by following a recommended vaccine schedule that protects the child until his/her own immune system has matured.

The second, reproductive stage, 15-40, is when people are at their least vulnerable, which is nature’s way of ensuring the survival of the species. At present, the risks are the result of bad behavior – that is, drug, tobacco, and alcohol abuse, all of which can shorten life. Promiscuous and frequent sexual activity presents the risk of sexually transmitted disease, mainly gonorrhea, syphilis (not so common today), candida, and HIV. All are infections. Gonorrhea is bacterial; syphilis is protozoal; candida is a mold; and HIV is a virus. Treatment for the first three is effective, but HIV is a problem for the rest of one’s life. If the individual avoids these risks and there is no pandemic threat from a new pathogen, entry into the third stage of life is almost certain.

The third stage is the most problematic. One is apt to forget that the human body is a heat engine and, as such, it is subject to the second law of thermodynamics, which means that at some stage it stops working. The body combines carbon in the form of glucose with oxygen to form carbon dioxide and releases energy. The heat of combustion in health is 37 degrees Celsius. By-products of the system enter a cycle first described by Hans Krebs in which the key factor is pyruvic or aceto-acetic acid. Chemically this is essentially vinegar, but with the addition of an item with similarity to nail polish. The various molecules which enter this cycle are reconstructed into human protein, and fat, which is a store, and glucose. Excess glucose is stored as starch. This is clearly a complicated process which is why simplistic pseudo- explanations are misleading.

If the system keeps working the individual continues to function as formerly, but if it is thrown out of kilter by a condition like late onset type two diabetes, medical intervention is necessary to provide that person with a situation which allows him or her to continue effectively. However, there is a different type of threat which builds silently. The cancers and Alzheimer disease are examples.

In the cancers’ case the illness begins as a change in a single cell or perhaps one or two. Such a change will be unnoticed but the new tissue which is produced continues to grow until it is big enough to be felt. By that time the illness is well advanced.

The origin of Alzheimer’s disease is almost the opposite. The current view is that the structure of the walls of the arteries that supply blood to the brain has deteriorated. When healthy these walls make what is called the blood brain barrier which is a filter which prevents circulating chemicals, harmful to the cells of the brain, from gaining access them. Once the blood brain barrier deteriorates the brain’s cells are destroyed. In the first instance the loss of one or two brain cells goes unnoticed. But the damage grows and once again the destruction creates recognizable damage.

The slow progress of such conditions makes it impossible to recognize that serious damage is progressing. An individual who behaves normally is considered to be healthy. If someone like that happened to have the misfortune to be killed in a road traffic accident, relatives and friends would say what a tragedy it was that such a vigorous person should die that way, completely unaware that, in the long run, it could have been a merciful release.

Keeping things simple

So, what should an older person do? Keep things simple!

Don’t overeat. Keep reasonably active. Keep an active interest in all that is going on in the wide world and work out how to run things better (not that anyone else will pay attention but who cares?). If there is an election, vote! Don’t sit at home.

And as far as the future goes remember that we have created it in our children, grand children and great grand children. Anything more, who knows? ■