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This is the fifth in a weekly series of diaries that deal with healthy positive approaches to the process of ageing. They all carry a tag of [ageing gracefully] and can be found by searching on that tag.

Archive to All Aging Gracefully Diaries

After some of the previous discussions it seems to me that it would be a good idea to take a general look at the matter of medical risk and how one goes about making choices about managing it. We have all had the experience of seeing a news article offering medical advice about something that everybody should do or something that everybody should not do. It is often difficult to know whether to take such advice seriously.

There are general health guidelines that have the endorsement of a substantial proportion of the medical profession at a particular point in time. There are always people, including some physicians, who disagree with some aspect of that cannon. That often involves a debate about what has been conclusively proven as the cause of a particular medical problem. Smoking tobacco has become very widely regarded as a very unhealthy habit to indulge in. It is been implicated in a variety of medical problems. Lung cancer is one of them. There are instances of people who are heavy smokers who never develop lung cancer and there are people who have never smoked who get lung cancer. Tobacco companies are very fond of claiming that it has never been conclusively proven that smoking causes lung cancer. Here's an article making such a claim. You can find the same thing in dealing with a variety of other chronic health problems.

I would be useful to step back and look at the history of medicine and health care. Up until the 20th C infectious disease was the main cause of serious illness and death. Average life expectancy remained around 40 years. Most people never got old enough to have to deal with atherosclerosis and Alzheimer's. Infectious disease has a clear and specific causative mechanism. It is a bacterium or a virus. Typhoid fever is caused by the bacterium  Salmonella enterica enterica, serovar Typhi. If a person became infected with this disease, other factors impacted the issue of how severe an illness they were likely to have and the chances of their surviving it, even in the era before modern antibiotics, but they didn't cause the disease.

Between the sanitation movement and the development of antibiotic drugs bacterial infections have largely been brought under control in the developed world. Vaccinations can provide immunity to viral infections. Infectious disease in no longer a major cause of death. Average life expectancy in industrialized nations has now doubled over the past century to exceed 80 years. That has drastically altered the completion of health and health care.

All life is finite. That is true of plants and animals. It comes to an end. The open questions are when and how, not if. That brings us to the question of risk. Risk is a matter of probability not of direct cause and effect. While I am sitting in front of my computer in the house there is a low probability if my having an accident. If I go out and get into the car to go to the grocery, the probability of being in an accident increases. If you add factors such as reckless driving and bad weather it increases some more. If I do have an accident it won't be risk that caused it. It will be hitting another car or a utility pole that caused it. Yet statistics can be used to calculate the probabilities of such an occurrence based on the driving experience of a large number of people. I am a cautious driver. I pay attention to things that increase my risk of being in accident. I haven't had one for many many years. There is no absolute guarantee that I won't have one this afternoon.

I think that a similar perspective is useful in processing information about medical risk. The process of aging is essentially about increasing risk. The body's organ systems begin to slow down and function less efficiently. The chronic conditions that are associated with advancing age don't happen suddenly. They develop over time. Take the process of atherosclerosis. It involves the build up of plaque on the walls of arteries. This is a process that happens slowly over a long period of time before it reaches a point of obstructing blood flow to a significant degree. It can then result in heart attack or stroke.

There have been several long term studies of large populations that look at statistical correlations with eventual clinical outcomes. They have found correlations with smoking, diet and exercise. That is not the same thing as direct scientific proof as in this specific bacterium causes this particular infectious disease. Correlation can be a coincidence as in there's a typhoon in Indonesia and it's raining in Baltimore. The two events are happening at the same time, but it is very unlikely that they are related. A correlation can also indicate that something is a contributing factor to an outcome with out being the sole cause. The more often a correlation is demonstrated and the stronger the relationship the more likely that it is a contributing factor.

If you Google "tips for healthy living" you will get a huge list of links. Among all of those are some frequently recurring items that represent prevailing medical opinion. For any one of them you can find people who disagree with them and some of those people will have MD after their name. Part of their argument will usually be based on a statistical analysis of clinical data claiming that the case is not scientifically proven. By and large those are not people who are deliberately and maliciously telling lies. They are people who are skeptical of prevailing opinion. In the history of human inquiry prevailing opinion has many times proven to be incomplete or just plain wrong.

That leaves the average consumer of health care with a choice of who to believe. One's choice will be influenced by various considerations. People have different basic attitudes about risk. Many people start out being willing to seek risk and adventure when they are young and become more cautious and careful as they get older. My basic attitude is that I am risk adverse. I like life to be orderly and predictable. That applies to financial investments as well as health considerations. There is also the issue of what one thinks of the health care industry and the medical profession. While I have criticisms about how health resources are allocated and financed, I have generally found the physicians that I have dealt with over the years to be competent people who were basically attempting to do well by me. A couple of times I have changed doctors because I didn't feel that the care I was getting was entirely appropriate, but I didn't have to go very far to find care that I was comfortable with.

So, being a basically cautious person who has reasonable confidence in the medical profession and who has a collection of chronic medical problems that need active management, my approach is to make a conscientious effort to follow the prevailing medical advice. Other people take a different approach. They may choose to follow various alternative forms of health care. They may choose to just let the chips of health fall where they may.

So I'm spending time riding my bike and avoiding eating things that may not be good for me. Does that leave me better off than someone who takes a less cautious approach to managing life? In the first place I am quite certain that I am not being medically harmed by giving up on things. I am giving up short term gratification in the hope of longer term benefit. There is the possibility that I could be killed in an accident tomorrow and all of that sacrifice could then be viewed as being wasted. I estimate the risk of the accident as being lower than the risk of a stroke. Ultimately it is a personal choice, but  I do think that weighing risks vs benefits is a sound way to approach making important choices and decisions, regardless of ones ultimate choice.  


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