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Afterword to WHAT YOUR DOCTOR WON'T TELL YOU: The Real Reasons You Don't Feel Good and What YOU Can Do About It by Doctor David Sherer
What are we to make of a situation where the wealthiest and most powerful nation in the world, a country that spends the most per capita on healthcare ($10,209 per person in 2017—$2000 more than the second-place country, Switzerland), has such poor health outcomes? What does it reveal about both our health and our healthcare system when a pandemic like that of COVID-19 wreaked such havoc here and has brought our nation to its knees? Will we ever learn the lessons we need to in order to reign in our out of control healthcare spending, improve the quality of our lives in our later years, and help prevent the chronic diseases that are even now affecting our younger people?
The answers to these questions lie between the covers of this book. Our health habits are abysmal. Period. Our diets and physical activity regimens are very much out of tune with natural human biology, which through evolution fine-tuned itself to foster a balance between the amount and type of calories we consumed with our physical efforts in obtaining those calories. Today, we are seeing the ravages of not hewing to the habits of our hunter-gatherer ancestors. Yes, I know we live in different times. I am fully aware that we cannot and never will go back to a way of life that has been extinct for thousands of years.
Technology and medicines have lengthened our lives and, under current social constructs, improved them by measures that are difficult to fully comprehend. But at what cost? I can tell you that the current trends are unsustainable—we will never be able to afford the ever- increasing costs of longevity and the chronic diseases that accompany it—unless some medical miracle comes along. As I have insisted throughout this book, only changes in attitudes and behaviors about who we are as biologically distinct animals in a complex world will mitigate the damage we have already inflicted upon ourselves.
The COVID-19 pandemic is a case in point. The issues related to that pandemic are so complex and so controversial that I will not even attempt to address a handful of them. I will say this: no one, and I mean no one, alive today knows the truth behind the novel coronavirus, because the truth, at this time, is unknowable. No one knows, for example, how many people have died as a direct result of COVID-19. It may be far more or less than the statistics touted. No one knows the true infection rate in a given population, and no one knows for certain what measures have or have not helped to prevent the spread of the infection. Common sense tells us that social distancing, mask wearing (in certain instances, not all), and sanitary methods such as handwashing appear to have been beneficial in “flattening the curve.” The areas of the country that opened up in June and July of 2020 appear to have suffered from that easing of restrictions. In hindsight, the images of revelers crammed on the beach in Coney Island, New York, and in public places in Florida, Texas, Arizona, and California are cringeworthy now. What were people thinking? That they were immune from a virus shown to be more contagious than the flu and with a greater tendency toward unpredictably dangerous behavior?
But let us not lose sight of the lessons learned so far. COVID-19 was and is so deadly, if the mortality statistics are accurate, primarily because Americans are so chronically sick. Data from the June 24 edition of The Economist concurred: “In hard-hit rich countries, about 60% of all deaths from the disease are among people 80 and older. America . . . is an exception. Data released on June 16th by the CDC show that the country’s death toll skews significantly younger. There, people in their 80s account for less than half of all COVID19 deaths; people in their 40s, 50s, and 60s account for a significantly larger share of those who die.”
And then the article offers conjecture as to why this is so. When I read it, I could only nod my head in understanding:
"Why is America such an outlier? . . . Americans may be less healthy than their European peers, e.g., because they tend to be more obese."
What have I been saying all along? That obesity is the “mother of all diseases.” That obesity places you at risk for hypertension, diabetes, acid reflux, cancer, degenerative joint disease, heart disease, and a host of other maladies. Because it is common knowledge that those individuals with chronic illnesses fare far worse when infected by COVID-19 than their healthier counterparts, a primary aspect to the answers we seek are staring us straight in the face.
Surely, it has to be more complex than that. There must be other answers, known and not known, as to why one person versus another would die from COVID-19. I am not saying obesity is the only factor in explaining the higher death rate among Americans. But sometimes the simplest answers are the compelling ones. It is something to consider carefully.
Scientists are now trying to formulate treatments and vaccines to help defeat the novel coronavirus. Here in my own backyard, the federal government just threw $1.6 billion at the Gaithersburg, Maryland, company Novavax, to develop a working vaccine and provide, by the start of 2021, one billion doses to the American public. Operation Warp Speed, the name of the federal project tasked with developing a vaccine for COVID-19, involved the spending of almost $4 billion in efforts to get America vaccinated. Alex Azar II, the U.S. Secretary of Health and Human Services said of this specific effort: “Adding Novavax’s candidate to operation Warp Speed’s diverse portfolio of vaccines increases the odds that we will have a safe, effective vaccine as soon as the end of this year.”
There were reports as of July 2020 from The New York Times that as much as $10 billion would be appropriated by the U.S. Congress toward developing a vaccine against COVID-19. And while it can only be perceived—except to the anti-vaxxers among us—that a safe and effective vaccine is a good thing, it is once again a reminder of the frail nature of American health.
Here is another instance where our poor health habits are costing us, to the tune of 10 billion taxpayer dollars. I am not going to blame anyone or anything for the COVID-19 pandemic. I will, however, categorically state that the pandemic has been made worse by the poor general health of our population. You are free to draw your own conclusions.
The pandemic has taught us other bitter lessons as well. In the June 19th, 2020 edition of The Washington Post, reporter Laurie McGinley wrote that “pandemic-related delays in diagnosis, treatment could be felt for years” with regard to cancer. Norman Sharpless, the director of the National Cancer Institute, noted that because of the pandemic, anywhere from 75 to 90% fewer mammograms and colonoscopies were performed, which is estimated to result in 10,000 excess cancer deaths from breast and colorectal cancer. He warned that “cancers missed now will come to light eventually, but at a later stage (‘upstaging’) and with worse prognoses.”
And cancer care is not the only area of medical intervention that has worsened under the pandemic. The July 9th edition of The Washington Post noted a wave of opioid overdose patients flooding the healthcare system. Reporters William Wan and Heather Long said “Nationwide, federal and local officials are reporting alarming spikes in overdoses—a hidden epidemic within the coronavirus pandemic.” But collateral effects were felt even earlier. In a May 7, 2020 article in Kaiser Health News written by Will Stone and Elly Yu, the authors noted that empty ERs worried doctors who felt potential stroke and heart attack victims were avoiding emergency care due to the pandemic. The authors reported that “The fallout from such fear (of COVID-19 infection) has concerned U.S. doctors . . . while they have tracked a worrying trend. As the . . . pandemic took hold, the number of patients showing up at hospitals with serious cardiovascular emergencies such as strokes and heart attacks shrank dramatically. . . . Across the U.S., doctors call the drop-off staggering, unlike anything they’ve seen. And they worry . . . people who have delayed care . . . will be sicker and [their] injuries will be exacerbated by the time they finally arrive.”
Across the board, whether it be delayed dental care, cancer screening, diagnosis and treatment of acute cardiovascular emergencies, or other disruptions, patients are suffering and dying due to the ramifications and stresses imposed by the pandemic. It will be a long time indeed before we fully understand the full impact of what has befallen us.
So where do we go from here? The answers are clear. We have choices to make, and I am not optimistic. If we learn anything by the example set by the pandemic and the implications to our already inefficient and overstretched healthcare system it is this: You cannot expect the federal government, an HMO, a health insurer, or a healthcare provider to guarantee your health. It is one thing to pay for a health plan, earn a Medicare or veteran’s entitlement, or shell out for a concierge doctor and expect decent basic health coverage. It is quite another to expect that you will not pay the price, that we will not all pay the price, for the destructive habits we continue to embrace. But I harbor no delusions. I know what human nature is. I have seen it in almost four decades of dealing with patients. Many people who are much smarter and more influential than I have said similar things. Former FDA commissioner David Kessler wrote about the obesity problem in his 320-page 2009 book The End of Overeating: Taking Control of the American Appetite. Since that book was published, things have only gotten worse.
That does not mean I cannot try.
No, what it will take to effect true positive change is personal responsibility. You cannot expect things to improve if you yourself do not act. This is not a liberal vs. conservative issue, a Democrat vs. Republican issue, a racial or economic issue—it is a personal choice issue. That is not to say that there do not exist disparities in access to and quality of medical care across the spectrum of American life—many people, especially the poor, the uneducated, and minority groups are the first to suffer these privations. But no demographic of people, rich or poor, of any hue or religion, helps themselves by abusing their bodies.
If you learn nothing else from this book please try to incorporate these crucial messages: Keep your weight in the normal range, with a BMI of between 20 and 25. Limit your intake of processed food and saturated fats. Vary your diet, especially with foods of deep and rich natural colors. Try and keep your relationships close and meaningful. Do not smoke. Drink alcohol moderately and laugh a lot. Run if you can. If you can’t do that, bike or swim. If you can’t do that, walk. Lift some weights, twice or three times a week. Meditate. Consider, with your doctor, if you can get off of some of your medications. Consider supplements. Keep your friends close.
Good luck.
