How Long To Live?

By Dr R Neerunjun Gopee

Most people in the world are choosing to meet their ‘creator’ earlier than later, and health professionals are having a hard time trying to convince them to do otherwise

The Greek thinker Seneca said that life should be like a tale: not how long it is, but how good it is. Everybody, however, has his/her own definition of the good life, from the hedonistic epicurians to the austere minimalists. The reality is that none of us decided the time and place we were born; similarly, unknown to us is the time and place when we will die – but die we will, and must. The balance of medical evidence to date shows that we can do more to hasten our death than to prolong our life, and the same source indicates that most people in the world are choosing to meet their ‘creator’ earlier than later, and that health professionals are having a hard time trying to convince them to do otherwise.

A couple of days ago the results of a large Harvard study, conducted over 20 years and involving thousands of human subjects, were published in the media. It showed that excessive consumption of red meat resulted in the shortening of one’s life by over 10%, and that there was an increased risk of cancer and heart disease. The latter has been known since the 1970s at least: when I was doing my post-graduate surgical studies then we had learnt that the country with the highest incidence of cancer of the colon was the one which consumed the most beef, namely Argentina. That red meat also diminishes the lifespan is a new finding.

Not unsurprisingly, there has been a mixed response to this piece of news in the lay press. At one end of the spectrum are those who queried whether it was better to enjoy one’s life and eat to one’s delight as much red meat, and never mind that one could die suddenly from a stroke or a heart attack at an earlier age. A similar argument has been heard several times about cigarette smoking.

From that point of view, this type of death was preferable to denying oneself the pleasures of smoking and eating, especially red meat, and end up in an old age home, suffering some chronic disease and unable to remember anything and being subjected to the indignities of old age that go with such a state. Others felt that one could live healthily and happily through moderation, and that such restrictions did not mean that one would not be enjoying one’s life as much as those given to excessive consumption.

Simple common sense would tell us that the latter view is the more reasonable one; it is in line with the point made in my article of last week, that a little of everything and a little at a time will allow us to have time for everything, and enjoy our lives too. Long ago, the Buddha had already advocated a ‘middle path’ of moderation, but people are creatures of habits built up from a young age, and change for the better is the most difficult thing to effect in the world. And hence the role of parents in guiding their children from early on so that they acquire sane habits for living and be less inclined as they grow up to adopt risky behaviours that can mar their health.

But how many parents are prepared to invest in such valued time with their children in this rat-race age? Interestingly, in a survey conducted several years ago, many parents who were past their prime – having spent the best years of their lives chasing the will-o’-the-wisp – had replied that their greatest regret was not to have spent more time with their children. And a survey among children too confirmed that what they had missed most in their childhood was having quality time with their parents. So as we push for 24/7 workdays and lifestyles, maybe we should make a mental note of these survey findings, and remember that the most precious gift we have is our life, and that it is only with family and friends that we can enjoy that gift the most. It goes without saying that if we want to do so as long as possible, we should live in a such a way that we keep ourselves in good health. Hence the insistence of health professionals on the need for moderation, combining this with adequate physical activity and social bonding to maintain and enhance one’s mental space.

Achieving this is a slow process, and experts in behaviour modification tell us that a ‘nudge’ approach is more likely to succeed than a hammer and sickle one. And since it is from Harvard that the issue was flagged, let us conclude with what Harvard says:

‘Behavioral Economics: If we all acted rationally, we’d eat right, floss, and take our pills as directed. But of course we can be pretty disobedient about doctors’ orders, which not only is bad for our health but costs hundreds of billions of dollars a year. Behavioral economics tools — gentle prods that nudge us to behave in desired ways — may be more effective than any amount of browbeating by doctors.

‘In a recent HBR blog, John Sviokla and colleagues described how reminders, social pressure, default options, rewards, and other behavioral tricks can be used to improve compliance in stroke and diabetes patients and, surely, anyone else who drops the self-care ball from time to time. Doctors, too, can be nudged as needed to improve care.

‘The experience of one large practice at Partners Health Care in Boston shows the impact of peer pressure: Showing a group of doctors the huge variation in their individual use of a certain radiology test — which exposed a handful of particularly heavy users — reduced test use by 15%.’

Quod erat demonstrandum…

* Published in print edition on 16 March 2012