"Peak Health": Avoiding Global Malaise

I have previously discussed the Peak Oil issue and the applicability of that concept and metaphor to productivity levels in the pharmaceutical industry - Peak Pharma.  Further navel-gazing leads me to wonder if "Peak Health" might also occur - a point that history will look back on as the beginning of the decline in global well-being. 

In many developing countries, the traditional diet of locally produced plant staples supplemented with locally reared meat is being replaced by imported grain, industrial meat and processed foods. This has reduced the incidence of disastrous famine and the extra calories have allowed societies to show gains in average height, infant survival rates etc.  However, the "Western" diet - promoted by the international food industry and gradually taking over world culture - is high fat, high sugar, low fibre.  Apart from smoothing out supply and demand, the exchange of traditional diets for global food will eventually have a bad effect on health. 

We in the developed world are encouraging developing nations to go from "thin malnutrition" with calorie deficit to "fat malnutrition" with calorie excess.   To use a Roman Empire analogy, we are in danger of going from barbarism to decadence without passing through civilisation.

In developed countries, where food is now so easily available and cheap that a quarter of all purchased food is wasted , obesity is reaching epidemic proportions, triggering rises in diabetes, heart disease and cancer.

Peak Health
Unless we act soon we are in danger of passing a point of global "Peak Health". As the world's people get richer, on average, we expect our lives to get healthier and our quality of life to carry on improving.  But environmental, social and health factors may slow down and even erode the gains that society has previously enjoyed.

Peak Mammoth
Although prehistoric humans may not have had the "nasty, brutish and short" life that is commonly assumed, it certainly involved hard work and risk.  Being badly wounded by a tusk, spear or fall was probably often fatal, but the fossil evidence seems to show that during their short lives prehistoric people were in good physical shape. Most of the time, calorie intake balanced calorie output.  But the hunter-gatherer life is precarious and we learned (and evolved) to let the good times roll. The fat put on when food was briefly abundant was a lifesaver when times were hard. Those who could efficiently convert excess calories to weight tended to survive famine and reproduce.  Even after the transition from hunter-gathering to farming, having a calorie intake barely sufficient for survival was the daily reality for most of mankind until quite recently - and of course still is for many. But the evolutionary irony is that the survival mechanisms which brought us through the ice ages are obsolete. Now that calories are permanently in oversupply for many of us, we are storing reserves for a famine that never comes.
 
We have made great strides in controlling or eradicating the factors that have killed people over the millennia, through modern medicine, more efficient agriculture, better understanding of nutrition, and the mechanization of arduous tasks. The data  for life expectancy over time show the results - an average human will live around twice as long as their great great grandfather. This last two hundred years in global health has been like the discovery phase of the oil industry, with major leaps forward and continuously improving "output". 

However, the horsemen of the apocalypse haven't necessarily been defeated. They may just have changed tactics. Our own prosperity, the very thing that drove these initial improvements in our collective well-being, may yet prove to be the brake on global health. 

Peak An Pie
On average, we eat more and do less physical work than our ancestors.  Most of the world doesn't need to risk spearing the mammoth any more, when they can get a mammoth burger (super-size me!) brought to their cave.

With less physical activity and more calories, obesity, diabetes, cancer, heart disease and other chronic conditions are starting to exact a heavy toll on our collective health and wellbeing.  The explosion in counterfeit drugs, my own minor obsession, has the potential to add to this mix unless controlled. Will global average lifespan eventually decline? It has happened already in Russia.

Peak From Behind The Sofa
So what to do about it, if Peak Health and its aftermath does become a danger to our kids and future generations?

To continue the oil analogy, maybe there are undiscovered reserves of health, waiting to be found? New medical advances could counteract the declining health factors discussed above, but that's not the right way forward and we shouldn't rely on it. Medical research has a habit of taking longer than expected to deliver results.

We could certainly change the way we distribute healthcare.  By focusing on prevention, diagnosis, treatment and cure - in that order - we can change global healthcare priorities for the better. This doesn't have to achieved by social engineering or hugely expensive public health systems. There are great business opportunities to be had in the next fifty years by doing healthcare differently from how it was done in the previous half century.

Another, entirely impractical but probably effective, approach would be to ration food globally. The physical fitness of UK citizens was never better than when food was rationed during and after the Second World War. Calorie restriction (with adequate nutrition) seem to extend lifespan in many species.

How about taking an economic approach, with a tax on saturated fat, or on the artificial addition of sugars to processed foods?  A carefully-designed, selective levy on certain harmful food ingredients and additives could both curb consumer demand and shift manufacturing patterns away from the most harmful foods.

Peak Optimism
Maybe the Peak Health idea is half-baked scaremongering about an issue that boils down to individual freedom and choice.  None of the top-down approaches discussed above are easy, and we all have to take individual responsibility for our actions in making healthier choices, but my hunch is that we also should do something collectively at the policy level to prevent Peak Health (and the subsequent downslope) becoming reality.

Dementia and Cancer Funding

Further to my last post, there is an interesting BBC report on Alzheimer's disease funding, based on a study called Dementia 2010.  The study finds that Alzheimers costs much more to manage but attracts much less research funding than cancer, stroke or heart disease.

Cancer, though a very tricky research area, is a great example of the "treatment over prevention" preference of today's healthcare agenda. The cheapest way to cut the rate of cancers would be to persuade people to lose weight, eat more fibre (especially green vegetables), stop smoking and drink less alcohol.  Governments don't do this very aggressively, especially in the case of diet. Why not tax saturated fat like tobacco, for example?

Cancer has a ubiquity, emotive urgency and immediate devastating impact that makes it relatively easy to attract funding to the area, and I don't minimise the personal impact on those affected, but there is another, practical, reason why the drug industry has neglected dementia.  Oncology clinical trials are over in a short period of time, usually.  Results are measured in the weeks or months of extra life gained. Drugs can be tested and marketed within "reasonable" timeframes and budgets.

Dementia takes years to develop and progress, so clinical trials of new drugs also need to be long.  Worse than that, the effects of the disease and the treatments are subtle so the trials need to involve a lot of people if they are to show benefits with any statistical confidence. The costs are therefore huge for treatment studies and almost prohibitive for prevention studies.

As our society ages, the number of dementia sufferers in the UK may pass 1 million in the next fifteen years. Each of these patients requires expensive, long-term care which will be an expensive drain on state finances.  The situation is the same in all developed countries and will eventually be replicated globally as average lifespan improves.

Notwithstanding the difficulty and cost of the research, it will prove a good social investment to rebalance funding priorities and to work harder to prevent and cure dementia. In the drug industry, ROI is king (French speakers please pardon my pun). This one case where we need to find a better way of giving the drug industry that return-on-investment and bringing the risks down to acceptable and investable levels.

Fat Profits For Counterfeit Victoza?

The newly approved Novo Nordisk product, Victoza(R) is set to be a blockbuster. Indicated for type II diabetes, in conjunction with exercise and diet control, it addresses a huge and growing global market. As we collectively get fatter and the prevalence of type II diabetes goes up, there will be a rising demand for products like Victoza(R) and this looks like a good step forward in treatment.

However, the internet buzz about Victoza(R) giving more effective weight loss than existing therapies such as GSK's Alli(R) will also drive demand for "off-label" use - by people who don't have type II diabetes but want a more effective diet pill. Since physicians are not supposed to prescribe Victoza(R) for weght loss alone, there is a danger that people will look for it in unofficial channels such as internet pharmacies. 

New "lifestyle drugs" always attract counterfeiters into the market, eager to exploit the embarrassed and the unwary. Don't get Victoza(R) from anyone except your regular physician. If you need it, you'll get it, but if she won't prescribe it, that's for good medical reasons. Don't risk your health by looking elsewhere.

If this were a drug would you develop it?

Try Googling "live longer" and you will get so many hits that you'd need a very long life just to view them all.  Clearly there is a lot of interest in health and longevity and all sorts of people, from the well-meaning to quacks and charlatans, are lining up to take advantage of it. Diet, lifestyle, exercise, faith, alternative medicine - all are staking a claim to help us live a better and longer life.  But do any of these things stack up?  What if I were leading a pharmaceutical industry research team, and we examined the evidence for each claim as if it were a drug candidate? Would I recommend any of these approaches to the CEO for further investment?

For another project, I am doing some research into nutrition and alternative medicines.  I'll check out the claims for anything that one can swallow and digest, basically.  I'll be looking to see what, if any, scientific basis these claims may have, based on scientific literature evidence.   I'm leaving out psychological, exercise and faith-based life extension, to keep the project manageable. 

I won't be doing any amateur clinical trials on human guinea pigs because (a) it is generally frowned upon by most of the worlds regulatory and judicial systems and (b) lifespan research takes a long time (the clue is in the name) and you and I have short attention spans.

Personally, I am a fan of walnuts after meeting an academic who raved about their positive nutritional benefits. I have them every day on my breakfast cereal. I will either live forever or die choking with an ironic expression on my face and milk on my trousers. If you have any personal favourites (with or without evidence of efficacy) please pass them on and I'll take a look.

Picture: steffenz