Archive post by ront February 13, 2012 Comments Off on A new model of health promotion and disease prevention for the 21st century – A Review
Ron Teeguarden’s Notes
I posted this article on my blog site in 2008, addressed to newly elected President Obama. Soon thereafter, I re-built my blog site and did not re-post any articles. But, with health care in the news every day, and the nations health care model still undecided and being remodeled, I wish to post it again now.
This is a review of a fantastic, decidedly rational, visionary article published in the summer of 2008 in the British Medical Journal, a conservative medical journal of extremely high standing. I found this article, written and signed by twelve distinguished scientists at major research institutions in the United States and Great Britain, to be a powerful, profoundly thoughtful, timely declaration of the need for a paradigm shift in the way we view and practice medicine, healthcare and health cultivation in the 21st century. It calls for a shift in direction for which many people have been calling for some time now.
With the spawning of the holistic health movement in the United States in the latter half of the 1960s, we first saw the beginnings in the western world of this inevitable shift. Over the last forty-five years, millions of people have developed a different vision of what it means to be healthy, to have a healthy lifestyle, to live holistically and in a positive manner. Not content to live life ignorantly, millions upon millions of books have been sold on the subject of healthy living. The holistic health arts have reached a point of acceptance at every level of our society. That was not always true. Forty years ago a person with a holistic attitude was an odd-ball, and a practitioner with a holistic approach was a quack. Now we know that even the President of the United States takes herbs (we cannot tell you how we know this, but we know first hand that it is true).
The nature of the holistic health arts is to focus on “well being.” And though the concept of “healing” is universally appealing, the concept that it is even better to be healthy so that you do not require healing is even more powerful. My great teacher, Taoist Grand Master Sung Jin Park, once said to me: “Do not be the ‘healer,’ be the ‘light.’” Healing is awesome. The world needs healers and plenty of healing to be sure. But ultimately, it must be better if we can somehow reduce the need for healing by mastering the ways of life that foster peace and harmony, and health and well being.
Until now, this may have seemed utopian and whimsical. But we have entered a time of great change. Everything is changing. And in many ways the changes are overtly logical and obvious. For example, it suddenly is obvious to everyone that by going “green” we can improve our lives in a multitude of ways that a few years ago would have felt absurd. The exact same thing is happening in the field of healthcare. We, as a society, know that healthcare is necessary, but we all know that the Western model is expensive and in many cases risky. Look at what is happening with antibiotic resistant bacteria. We may soon enter a period where antibiotics as we have known them are no longer of any value.
The Western model of medicine has focused for well over a century on healing disease so as to relieve suffering, save lives, and to improve and extend life. This is indeed a compassionate approach at its roots and in practice, and is certainly to be admired and appreciated. Nevertheless, it may turn out that it is a losing battle to always chase after the disease. It is becoming financially more and more expensive to develop drugs that are effective and safe. Technology is expensive. Insurance is very expensive for most people. More and more people are now coming to the conclusion that it is better to stay healthy, to stay fit, to avoid disease by living right, by eating right, by doing right.
This is the dawn of the holistic age in the healing arts. Medical research has entered a new phase as well. Thousands of studies have been conducted, and thousands more are being conducted that are exploring the issues pertinent to achieving true health and promoting true well being, even as we age. This research has now reached critical mass, and as a result it is becoming apparent that for the first time in the Western world, we can actually practice a paradigm that features the promotion of radiant health and opposed to a medicinal paradigm that only focuses on disease. Researchers will of course continue to seek ways to cure cancer, cardiovascular disease, diabetes, and a thousand other diseases that torment humans and animals. But some are realizing that we are now very close to understanding how to prevent these diseases in the first place, thus avoiding the need to cure them in many instances.
This wonderful proposal for a new model of health promotion and disease prevention for the 21st century is almost like the Diamond Sutra to Buddhism, or the Sermon on the Mount to Christianity. I hope with all my heart that the President and his advisors somehow read this short article and take its practical and hopeful premises to heart.
Our susceptibility to disease increases as we grow older. Robert Butler and colleagues argue that interventions to slow down aging could therefore have much greater benefit than those targeted at individual disease.
New model of health promotion and disease prevention for the 21st century
- Robert N Butler, president, International Longevity Center, New York, USA
- Richard A Miller, professor, University of Michigan, Ann Arbor, MI, USA
- Daniel Perry, executive director, Alliance for Aging Research, Washington, DC, USA
- Bruce A Carnes, professor, University of Oklahoma, Oklahoma City, OK, USA
- T Franklin Williams, professor emeritus, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA,
- Christine Cassel, president, American Board of Internal Medicine, Philadelphia, PA, USA
- Jacob Brody, professor, University of Illinois at Chicago, Chicago, IL, USA
- Marie A Bernard, professor, University of Oklahoma, Oklahoma City, OK, USA
- Linda Partridge, director, Institute of Healthy Ageing, University College London, London
- Thomas Kirkwood, director, Institute for Ageing and Health, Newcastle University, Newcastle
- George M Martin, scientific director, American Federation for Aging Research, Seattle, WA, USA
- S Jay Olshansky, professor, University of Illinois at Chicago, Chicago, IL, USA
Many countries now have ageing populations and are facing an increased prevalence of age related diseases and escalating healthcare costs. However, if ageing is combined with extended years of healthy life, it could also produce unprecedented social, economic, and health dividends. In recent decades, scientists have shown that the underlying biological processes of ageing, which give rise to most diseases and other age related health problems, can be delayed. We argue that a concerted effort to slow ageing would provide a broad strategy for primary prevention that would greatly enhance and accelerate improvements in health at all ages.
Rise of human longevity
Life expectancy at birth rose by a remarkable 30 years in developed countries during the 20th century, initially because of reductions in infant, child, and maternal mortality and then because of declining mortality in middle and old age. In 1900, about 40% of babies born in countries for which reliable data existed were expected to live beyond age 65. Today in these same countries more than 88% of all newborns will live past age 65 and at least 44% will live beyond age 85. This dramatic extension of life has provided social and economic benefits.
The traditional medical approach to ameliorating modern chronic diseases has been to tackle them individually, as if they were independent of one another. This approach flows naturally from our experience with acute diseases, where patients seek medical care for one condition at a time. In fact, applying this same strategy to infectious diseases in the 20th century helped to deliver the first longevity revolution.4 Although some infectious diseases have chronic effects on health (such as malaria and HIV infection), and others remain difficult to treat (including tuberculosis and most viral diseases), public health efforts to combat these diseases have made it possible for people in today’s developed nations to live long enough to experience one or more of the degenerative and neoplastic diseases that are now the dominant causes of morbidity and death.
Diminishing returns from disease specific model
Medical research worldwide has already accomplished much, and is certain to achieve more in decades to come, but its effectiveness will become limited unless there is an increased shift to understanding how ageing affects health and vitality. Most medical research teams are oriented towards the analysis, prevention, or cure of single diseases, despite the fact that nearly all of the diseases and disorders experienced by middle aged and older people still show a near exponential increase in the final third of the life span. Now that comorbidity has become the rule rather than the exception, even if a “cure” was found for any of the major fatal diseases, it would have only a marginal effect on life expectancy and the overall length of healthy life.
The change in strategy we are calling for requires a systematic attack on ageing itself. Although such a strategy was clearly articulated more than a quarter of a century ago, there has been little progress towards making the necessary changes. However, recent advances in understanding the complex biological mechanisms responsible for ageing suggest that it is feasible to translate this strategy into practice. Evidence in models ranging from invertebrates to mammals suggests that all living things, including humans, possess biochemical mechanisms that influence how quickly we age and that they are adjustable. It is possible—for example, by dietary intervention or genetic alteration, to extend life span and postpone ageing related diseases such as cancer, cataracts, cognitive decline, and autoimmune diseases.
We are not calling for the modification of human genes to extend healthy life—that would not be practical, useful, or ethical. However, investigating how genetic mutations influence the basic rate of ageing is likely to provide important clues about how to develop drugs that do much the same thing.
Attempts to develop preventive measures against individual conditions related to ageing have been, for the most part, frustrating and unsuccessful. But in striking contrast, all of these conditions, and more, can be ameliorated or postponed simultaneously by well validated interventions that slow ageing. The interventions that have worked in laboratory animals are not now appropriate for disease prevention in humans. However, we believe that exploration of the mechanisms by which ageing can be postponed in laboratory models will yield new models of preventive medicine and health maintenance for people throughout life, and the same research will also inform a deeper understanding of how established interventions, such as exercise and healthy nutrition, contribute to lifelong wellbeing.
The potential of fundamental research into ageing to contribute practical benefits to improve health at all ages, but particularly at older ages, has been under-recognized by most of the scientific establishment, and, importantly, by many of those who decide on allocation of resources for health research. Now that most people in developed nations reach old age in reasonable health, and scientific progress has been made on interventions capable of postponing nearly all the diseases and disabilities that affect older people, the time has arrived for national policies to support and develop practical interventions that slow ageing.
The research strategy that we propose is intended to supplement, rather than substitute for, research into specific diseases, which will continue to discover new and improved therapies and approaches to preventive medicine. We propose, however, a large increase in resources available for investigations into how diseases such as type 2 diabetes, congestive heart failure, Alzheimer’s disease, Parkinson’s disease, osteoporosis, sarcopenia, and most cancers, either interact with ageing or share mechanisms in common with it. We further propose greatly increased funding for basic research into the fundamental cellular and physiological changes that drive ageing itself.
The pursuit of extended healthy life through slowing ageing has the potential to yield dramatic simultaneous gains against many if not all of the diseases and disorders expressed in later life. The most efficient approach to combating disease and disability is to pursue the means to modify the key risk factor that underlies them all—ageing itself. Pursuing an aggressive research strategy to devise interventions against ageing suitable for humans requires that it is a goal worth pursuing (it is), and that we have good leads to follow (we do), but it does not require that we know, in advance, which of the current ideas about mechanisms affecting the rate of ageing are most likely to produce effective interventions. A fresh emphasis on ageing should vastly accelerate the health, economic, and social benefits of the extension of healthy life, which we refer to collectively as the longevity dividend.
Contributors and Sources
This article arose from the authors’ efforts to get physicians, scientists, and politicians to understand and appreciate the public health benefits that would accrue from efforts to slow ageing, and distinguish those benefits from the current medical approach to attacking one disease at a time. All authors participated in the drafting and editing of the article and approved the final version. RNB is guarantor.
Published 8 July 2008, doi:10.1136/bmj.a399
Competing interests: None declared
Provenance and peer review: Not commissioned; externally peer reviewed
Ron Teeguarden’s Post Script Commentary
The Chinese had the idea a long time ago. Chinese medicine has had a central and profound influence on the holistic, antiaging paradigm that is now crystallizing in the Western world. It has been fundamentally holistic right from the beginning and emphasizes promoting radiant health and longevity above treating disease as a kind of afterthought.
The Chinese traditionally have divided healthcare into three levels: superior medicine, general medicine and inferior medicine. These three levels were first described in the original classic of Chinese herbalism, attributed to the legendary emperor Shen Nong (the Divine Farmer) more than two thousand years ago. The following section from that classic explains the three levels of herbalism practiced in the Orient since that time:
The Superior Class of herbs are the rulers. They control the maintenance of life and correspond to Heaven. These herbs are not medicines so the taking of these herbs in larger amounts or over a long period of time is not harmful. If you wish to take the material weight from the body, to supplement the energies and nutrients circulating in the body, and to prolong the years of life without aging, you should base your efforts on the herb foods of the Superior Class.”
The General Class of herbs are the ministers. They control the preservation of the human nature and correspond to Man. One part of them possesses medicinal effectiveness, another part possesses preventive effectiveness. For every application, the choice of the suitable herbs should be considered carefully. If you wish to prevent illnesses and to balance depletions and consumption, you should base your efforts on herbs in the General Class.
“The Inferior Class of herbs are the assistants. They control the curing of illnesses and correspond to Earth. They possess a markedly medicinal effectiveness and must not be taken over a long period of time since side effects will likely result. If you wish to remove cold, heat, and other evil influences from the body, to break up stagnation of any sort and to cure illnesses, you should base your efforts on the herbs in the Inferior Class.
Thus the superior class of herbs, also known as the tonic herbs, help “to prolong the years of life without aging, and help the body remain lean and buoyant while improving the circulation and the distribution of energy throughout the body. The general herbs are preventive and help to nip problems in the bud with few side effects. The inferior herbs are the medicines, the uni-directional drugs that may be very effective at treating specific diseases or disease conditions, but must be watched carefully by a physician because they almost always have potential for side effects.
Of the several thousand herbs used in the Chinese herbal system, there is an elite group of less than a hundred herbs known as the “superior herbs,” also known as the tonics. The most famous and important herbs associated with Asian herbalism all fall into this superior herb, or tonic, category.
These superior herbs are not considered to be “medicinal” in the usual sense of the word. They are notused to treat specific diseases or disorders. Herbs that are strictly medicinal fall into the Inferior Herb class because they often cause side effects and because they do not develop the Three Treasures. The tonics are used to promote over-all well being, to enhance the body’s energy, and to regulate the bodily and psychic functioning, to protect the body and mind so as to create what the Chinese call “radiant health.” The superior herbs provide this adaptive energy in abundance and are thus a primary source of true human empowerment.
The superior herbs are the most prized of all herbs, for it has become clear over many centuries that the tonic herbs can make a very major contribution toward ultimate well being. They can be consumed on a daily basis to fortify us for the adventure of life and to help us take full advantage of life’s richness. Of course, in order to achieve Radiant Health, one must work on all aspects of one’s life, but the tonics are considered to be an essential tool on the path of Radiant Health.
The superior herbs can thus be defined as herbs which promote a long, healthy, vibrant, happy life, without any unwanted side effects even when taken over a long period of time. Essentially, the tonic, or superior herbs, are wonderful, healthful “super-foods” which benefit our well being in ways that more common foods cannot. And they have a protective, balancing, vitalizing quality beyond that of any other herbs. They are generally consumed as a supplement to a well balanced healthy diet for the purpose of completing our nutritional needs.
Those of us who have studied tonic herbs believe that they are going to play an expanding role in the new health paradigm of the 21st century. We are so fortunate to have available to us at this time a virtually complete repertoire of tonic herbs from around the world. An everyday consumer now has better access to premium grade tonic herbs than even Chinese emperors of the past. If we take advantage of these tonic herbs, we are likely to find ourselves feeling healthier for many years to come.