Hunger for Life, Hunger for Wellbeing – The Digital Revolution has Failed our Health

colinchamp January 29, 2020 12 Comments

“We need to get her to eat.”

This was the common remark verbalized by Mrs. Jones’ family members during her weekly visits to check in and make sure she was tolerating her chemoradiation. In fact, this was an all too common discussion that often left cancer patients’ frustrated with themselves and their pleading family members who were prodding them to eat more.

These well-intentioned family members were almost always oblivious to the fact that a loss of hunger – a common side effect of several cancer treatments – is usually followed by a loss of desire to eat. We often forget how much taste drives hunger; without a taste for food, the once pleasurable activity of eating becomes a dreadful chore.

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Fast forwarding several years to the present, a report was recently published in the Journal of the American Medical Association, “Life Expectancy and Mortality Rates in the United States, 1959-2017.” The authors analyzed the recent data from the National Center for Health Statistics, Center for Disease Control, and the US Mortality Database. As a physician in the country with the largest healthcare spending habits in the world, reading this left me both humbled and mortified.

Unsurprisingly, between 1959 and 2016 life expectancy skyrocketed, increasing by almost a decade from 69.9 years in 1959 to 78.9 years in 2016.¹ The most rapid increase was seen between 1969-1979. The reasons for this rise were plenty, including improvements in sanitation, antibiotics, and housing. However, longevity did not continue skyrocketing. In fact, the rise slowed quite a bit in the 1980’s, plateaued by 2011, and peaked in 2014. Since then, the curve has headed downward for three consecutive years, the first drop since the artificial dip created by the Great Depression and World War I.

The decline has been subtle when we zoom in on the last three years, but a deeper look into the decline exposes some signals that things may be worse than they appear. Infant mortality – the massive killer of the past – has continued to drop along with mortality rates in children, adolescents, and elderly adults. While all good news, combining these rises with the overall drop in life expectancy indicates that decline in other areas may be even worse. Sure enough, offsetting this potential positive was the biggest increase in mortality, dragging down all categories when it came to life expectancy: the overwhelming increase in mortality among young and middle-aged adults between 25-64 years old.

Why are Middle-Aged Adults Dying?

Antibiotics, sanitation, and advances in medical care helped defend our bodies from those common infectious villains that stood as a frequent cause of death in our near-distant past. Defeating them, however, has seemingly opened the door for the for a new villain: ourselves. According to the Center for Disease Control, between 2000 and 2016 death rates from potentially self-inflicted disorders and diseases closely related to lifestyle increased, including suicide, injuries, Alzheimer’s disease, chronic liver disease, and septicemia; these are five of the 12 leading causes of death.² The latter reason, septicemia, is death from complications of infection. Yet, even this has increased alongside a preventable cause of disease as chronically elevated blood sugar in individuals with insulin resistance, or roughly a third of the US population,³ alters the body’s normal immune response to infections.⁴ Paralleling these issues, Alzheimer’s disease, now known as type 3 diabetes, is strongly linked to insulin resistance,⁵ as is chronic liver disease.⁶ Healthy lifestyle changes can combat both.^7,8

In other words, infections and harmful critters used to kill us, but we have now become our own worst enemy, either directly or through neglect.

Culprits in the Decrease in Life Expectancy

The major contributor to the increase in mortality, and perhaps the saddest, is the large increase in death from drug overdoses, suicides, and organ system diseases, especially those related to alcoholism. The latter is less clear as rates of alcohol consumption have not undergone large changes, though some have suggested that while overall rates have minimally changed as a whole, rate of excessive consumption and binge drinking has increased for some individuals. Overall, death rates from alcohol use and disorder have gradually risen.

However, another major cause of liver disease less often discussed is non-alcoholic fatty liver disease (NAFLD). Fatty liver disease accompanies obesity, and much like in the latter process where excess adipose tissue accumulates in unwanted places, in NAFLD, it collects in the liver. The exact cause of fatty liver beyond obesity is a controversial area; while its incidence rises in parallel with obesity, individuals with insulin resistance and diabetes have nearly 2.5x the risk of fatty liver disease than insulin-sensitive individuals, potentially pointing a finger at processed foods and carbohydrate-laden diets.⁹ Concerning data reveal that nearly a third of the US now has non-alcoholic fatty liver disease, and two thirds of obese individuals have NAFLD.¹⁰

Recently, the increase in self-harm related death rates has been attributed to the middle-aged adults who were “passed by” in their jobs due to work shifts and technology, erosion of the socioeconomic standing of middle aged white males, or even the all too common mid-life crisis. This theory only goes so far as, alarmingly, the largest relative increase in suicide rates was observed in adolescents and children.

Obesity-related deaths continue to rise, alongside deaths related to hypertension. This is likely less of a surprise, as these increases parallel the climbing rates of obesity within the US.

Other changes, like increased rates of pedestrians killed by cars, are also not astonishing given the massive number of drivers texting and on their phones while operating their vehicles. I have personally seen four car wrecks in the last week alone, including witnessing a driver cross three lanes while texting and never once looking at the road. Though I live in quiet North Carolina, I cannot even ride my bike to work because distracted drivers scare me to no end.

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While we are watching life expectancy drop, the US continues its spending on health care providing the unfortunate irony of this entire situation. The stark contrast in healthcare spending has surfaced as yet another of the many areas where consumerism has failed us, yet the response has strangely been more consumption. Additionally, the drop in life expectancy and the multitude of causes signals that the current health of our nation has less to do with healthcare and more to do with our deeply ingrained behaviors and changing habits.

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The Issues with Ignoring the Important Issues

The reality of these staggering numbers is that the most commonly discussed issues in the media – carbs this, fat that, terrorists, red meat, and vegetables – have little to do with these changes. In fact, the most frequently discussed issues are often the least important when it comes to our health. This fact caught the eye of researcher extraordinaire, John Ioannidis, who has earned a reputation for pointing out the absurdities of many medical studies, especially when they translate to health recommendations. In his recent analysis of these intertwining issues in medicine, research, and the media, “Neglecting Major Health Problems and Broadcasting Minor, Uncertain Issues in Lifestyle Science,” Ioannidis points out that the media far too often focuses on the minutia, while ignoring the elephants in the room.¹¹ Rather than bring legitimate concerns to the surface, this focus instead draws our attention to the wrong issues, eliciting anger, fear, and dismay along the way. News, much like social media, has become purely a form of entertainment, an opiate of the masses, instead of a source of general and useful information. This opiate seduces people with its addictive tendencies, but instead of pacifying them, leaves them angry (and often still wanting more). Adding more fuel to the fire is the reality that fake news travels faster and further than real news.¹² Drug use is rising all around us, and it is not only in the form of pills.

Like with most drugs, the most effective solution is to avoid them in the first place; in this case, label it for what it is, a poor source of entertainment, and limit exposure. In fact, while more than half of us reading this will die from cancer and heart disease, both diseases that are heavily influenced by our lifestyle, they are covered by news sources less than 15% of the time. Terrorism and homicide, on the other hand, will kill less than 1% of us. Yet, news sources dedicate 60% of their coverage to both.

In other words, a large portion of the population is spending countless hours watching media coverage of negative topics that have no foreseeable beneficial influence on their lives. These voyeuristic hours become wasted opportunities to enjoy and improve their lives and relationships through action. The result is instead a bombardment with negative messaging where viewers are force-fed scare tactics demonstrating how terrible life has become due to terrorism and countless murders. This one strikes home for me as it was always mindboggling to see my 96 year-old grandmother, in her suburban community outside of Pittsburgh, spending countless hours watching the news and incessantly voicing her concern of a possible terrorist attack in her community (where, in reality, not picking up dog droppings was probably the worst thing that could happen).

We are seeing an increase in the negative and irrelevant message of the news, an unfortunate increase in suicide, alcoholism, and injuries within the U.S., and we continue to see a large rise in diseases related to obesity, like cardiovascular disease, cancer, and diabetes. At this point, we have to ask ourselves how related are all of the above?

The Health of Our Society

Not surprisingly, there are many shades of thought and theory on the reasons for this downward trend in life expectancy in the US and increase in deaths related to self-harm; yet, our societal direction may stand out as shouldering the largest part of the blame. If this is indeed the case, we would expect that approaching a solution from the medical side may do little to alleviate the problem. Cultural and societal phenomena may hold the lion’s share of responsibility, as their rapid infiltration into all aspects of our daily life through media has led their influence to reach epic levels never before experienced. The alarming reasons for the drop in longevity may be mere indications of the recent erosion of our health, and several major societal shifts have occurred resulting in unexpected consequences, including:

1. Pseudo Social Engagement and Interaction:

Traditional social outlets have been eroded, as we rapidly moved away from social clubs (link bowling alone), religion, family, communities, local groups and other tribal mentalities to a glorification and infatuation with the almighty corporations, social media, and countless hours on the pseudosocial internet. The former may not have always provided positive influence within our lives, however, as part of the digital revolution, the latter has left us feeling alienated, alone and angry. According to Joe Bernstein, senior technology reporter for BuzzFeed News:

“It incentivizes forms of engagement that make Americans feel less empowered and more alone than ever, to the benefit of very few. It seizes some of the best, noblest human instincts — to share, to know, to connect, to belong — and harnesses them to a degrading system of profit.”

While it is easy to criticize these types of views for glorifying a past that was far from perfect, the point is less a critique that all things new are bad while all things old are good, but rather that dedicating the majority of our waking hours to frequently soulless work for massive corporations (to emphasize this point, less than a decade ago, a presidential campaign went as far as telling us that “corporations are people” illustrating their personification) intermixed with superficial addictive online social engagement may leave us lacking a deeper connection to others that we require as part of our inner wiring. Furthermore, this reliance on our job and online social “interaction” may lead us down the path of conveniencism and consumerism, oppose arete and fare bella figura, and avoid many good opportunities to find purpose in life.

(As a side note, many of us are fortunate enough to have found work that fulfills our purpose in life, but these options are limited for most. However, far too often work is simply for a pay check. The latter is obviously fine as we need financial support, yet, big companies have repeatedly shown us that they may not have our best interests in mind. If these are the source that we are turning to for fulfillment or purpose, especially if our lives are lacking both, it may be unsuccessful. In fact, while most of us clock in at our corporations, sitting at a desk or cubicle for countless hours throughout the week, each day we are only productive for about 3 hours. Nothing screams soullessness like sitting at a desk all week doing nothing.

2. The Attention Industry and Confusing Distraction with Purpose:

The business “crime” of attention larceny took off throughout the 20^th century and exploded in the 21^st. The former may have been the same period where life expectancy rapidly climbed, but during the this time, with the entrance of television into the home, followed by home computers and the spread and accessibility of the internet, we welcomed advertisers into our homes. A consequence unforeseen by the average American was the willing handover of our attention to the budding attention industry.

Television was predicted by some to become “the worst cultural opiate in history” with its incessant push to “degrade the sensibility of the country.”¹³ This may have been a bit of a stretch, but it reveals the fear some had – even as far back as the 1950’s – of the barrage of advertising that television would inject into our homes, cannibalizing our time. Our private sanctuaries were infiltrated with constant sales pitches, leaving no escape. Worse off, advertisements were eventually camouflaged as entertainment, competing with each other as more sensationalistic as they vied constantly for more of our attention with an incessant push to get us to desire more. Over time, this noise becomes difficult, if not impossible, to turn off.

The internet and instant access – now with one day shipping – has taken this advertising pitch and our desire for more to a whole new level. In the past, we had to manually turn the television on to expose ourselves, but devices have alleviated us from this task as they now alert us when there are new ads. Phone rings and dings and our Pavlovian response have become commonplace in the home; whether we are in the middle of a conversation with family, eating dinner, or even holding our newborn baby, when the phone dings we go running like a conditioned mouse.

The result may not be so good for our health and sense of purpose. Furthermore, with instant access, why cook your food when you can buy it premade? Why take care of a garden when you can buy everything you need and more. Why converse or play games with your spouse and children when you can watch others doing this? Heck, why cook when you can sit on a couch and watch others cook while enjoying your premade food? And perhaps most dangerous, why actively do anything when you can sit back and watch others on social media live a lifestyle that you can’t afford (and they usually can’t either), buy products we can’t afford, and vie for a contrived sense of social approval through likes and thumbs up. Instant access turns into instant excess, and we keep telling and showing ourselves that our actions are not important, items are. And we, the consumers, are left rendered without purpose.

From here, it is easy to see how dissatisfaction of our lives and envy of theirs becomes a common theme. Worse off, the electronic opiate becomes more addictive as users are left unable to stop checking updates incessantly, let alone even put the device down. This resulting addiction is fully by design, starting with Facebook and expanding to the other social media platforms; electronic opiates were created with the intent of extreme addiction. Case in point, Sean Parker, the infamous creator of Napster and later Facebook investor, told an interviewer:

“When Facebook was getting going, I had these people who would come up to me and they would say, ‘I’m not on social media.’ And I would say, ‘OK. You know, you will be.’ And then they would say, ‘No, no, no. I value my real-life interactions. I value the moment. I value presence. I value intimacy.’ And I would say, … ‘We’ll get you eventually.'” “I don’t know if I really understood the consequences of what I was saying, because [of] the unintended consequences of a network when it grows to a billion or 2 billion people and … it literally changes your relationship with society, with each other … It probably interferes with productivity in weird ways. God only knows what it’s doing to our children’s brains.” “The thought process that went into building these applications, Facebook being the first of them, … was all about: ‘How do we consume as much of your time and conscious attention as possible?'” “And that means that we need to sort of give you a little dopamine hit every once in a while, because someone liked or commented on a photo or a post or whatever. And that’s going to get you to contribute more content, and that’s going to get you … more likes and comments.” “It’s a social-validation feedback loop … exactly the kind of thing that a hacker like myself would come up with, because you’re exploiting a vulnerability in human psychology.”

Both of the examples listed above have intertwined as we turned our backs on our many habits and hobbies of the past and instead towards more of the opiate, requiring constant entertainment, even if this entertainment is advertisements in disguise, or perhaps worse, social media pitching us an unattainable reality. Our attention has been hijacked, leaving us doing less and wanting more. Much like number 2 above, this constant battle for our attention has raised the stakes higher and higher, to the point where marketing now sensationalizes every aspect of our lives, news (and no longer just the habitually immaterial local news) reports smut, murders, fires, and gossip as though it were important for anyone to know, while constantly attempting to fuel outrage and advertise more products. Social media responds to sensationalistic and outrageous comments with thumbs ups, likes, and more followers. This constant barrage of addiction and outrage would be expected to catch up with us eventually, and it has.

The attempts at online addiction seem to be working quite well.

Trading Resilience for Entertainment

In other words, we have traded those activities that promote health, happiness, and resilience for distraction disguised as entertainment. Worse off, it wasn’t even a fair trade. The negotiators knew what they were taking was far more precious than what they were offering, but the disguise helped camouflage this. We are now left with highly entertained but fragmented and incomplete lives, especially when it comes to our typical daily activities. It is difficult to complete anything when one is constantly interrupted.

This loss of action stands in opposition to views of independence from the not too recent past. We used to cherish our physical and mental independence. For instance, when dealing with elderly patients in the medical field, we often refer to instrumental activities of daily living to quantify how able a person is to engage in their normal life and maintain their coveted independence. Yet, this evaluation is rapidly becoming irrelevant as many younger people no longer engage in a handful of these activities and freely hand over their independence. Something that would be emotionally catastrophic to an elderly person is now seemingly met with embracing arms in the wide-ranging younger generation.

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Instrumental activities of daily living vary, but include:

• Cleaning and maintaining the home
• Preparing meals and cleaning up afterwards
• Managing finances
• Shopping for necessities
• Engaging in communication
• Moving around the local community
• Caring for oneself, pets, and others
• Religious/spiritual observance

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Instrumental activities of daily living can also be considered activities of living with purpose. In other words, eating, sleeping, moving, loving, talking, and growing. I would categorize activities of nonliving as excessive shopping, buying, consuming, excessive internet browsing, virtually connecting instead of physically connecting, addictive social media behaviors, gossiping, and withholding activities of living to experience each and any of these.

Perhaps therein lies part of the solution: a return to instrumental activities of daily living. Much like when a quarterback starts a football game by throwing a series of short passes to get into a rhythm, these simple tasks can remind us on a daily basis that life takes some work and effort, but it is worthwhile.

Moving Away from Consumerism and Convenience and Back to Activities of Daily Living

We seem to have eschewed action and entered an era of voyeurism that stretches well beyond simple entertainment – media devices accompany us everywhere. Our daily lives have now become constant distraction and entertainment. Simply put, if we are turning to drugs, alcohol, and other costly habits, we may be lacking more meaningful things to turn to. A conceivable solution is the move away from consumerism and convenience, and instead return to activities, hobbies, and a lifestyle that promotes rewarding, satisfying, and fulfilling actions that keep us going, keep us caring, and provide us with purpose. We should be playing the infinte game and avoid the finite ones. Engaging in more doing and less watching seems like a prudent strategy.

Unfortunately, our health and wellness has joined the laundry list of categories that the attention merchants have advertised; we are now sold the idea that we can purchase or hack our way to good health. The media is full of them: The [you name it] Diet, [insert timeline here] weeks to health, millions of detox diets, and hokey exercise classes and routines. Medicine shares its part of the blame as it is full of similar pills, potions, weight loss plans, and even multiple pills to treat multiple medical issues wrapped up into one polypill¹⁴ (medicine has fallen hook, line, and sinker for the consumption bait). The common theme, paralleling our often-reactionary healthcare, is their symptomatic nature and further promotion of convenience and consumption. In other words, we are trying to fix a major part of the problem with more of it.

These “solutions” cut to the core of the problem; our society is being veered in a direction that actively promotes poor lifestyle choices. It has been hijacked by marketers, salesman, and massive corporations that purposefully push us to buy products we don’t need – products that stand in direct opposition to our health and happiness.  How can we, as physicians, aim to improve someone’s health if they spend countless immobile hours watching television and browsing the internet, rarely cooking or eating a meal composed of real food, and have watched passively if not lethargically as the social fabric of their life has been unwound?

Furthermore, our search for health has become social media-fueled outrage and entertainment (simply search for “fat burning” or “best diet”). Turning away from this strategy and towards those same habits and hobbies that we turned our backs on – those habits that are the antithesis of convenience – may lead us down the real path to health.

Hunger for Purpose, Hunger for Life

As a collective society, it seems as though we have lost our way during the quest for entertainment and convenience, overshadowing many of the activities that gave us hunger for life. Thankfully, this path of misdirection does not lead us down a trail of doom and gloom; we may have been our largest enemies as of late, but unlike in the past before sanitation and antibiotics, we have the keys – and autonomy – to fix the major barriers to our health, we just have to know how to apply them.

Many of these solutions are difficult, but a handful may be quite simple. For instance, focusing on the rewarding and meditative processes of growing and cooking real food, socializing with our family and friends while cooking and enjoying our own meals, and benefitting from the physical and mental growth achieved during the rewarding and meditative process of exercise will serve as the antidote to offset obesity-related diseases, while hopefully providing reward, self-worth, and a reason for getting out of bed each morning. Turning away from technology and automation disguised as the solution to our every want and desire, and instead embracing the more simplistic and natural can enable and allow us to live a healthier life that’s more enjoyable, fulfilling, and complete.

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I used to think Mrs. Jones’ family and similar cancer patients were unique in their lack of hunger for life. I was wrong. Regardless of the source interfering with this hunger, it is seemingly becoming an epidemic. Just as Mrs. Jones’ family tried with every effort to increase her appetite, we, as a society, need to whet our appetite for life – our appetite to learn, love, cook, socialize, and most importantly, our appetite to do.

The battle to defeat cancer mimics life in many ways. Without a taste and hunger for food, it becomes a dreadful chore to eat. But without a hunger for life, it becomes dreadful to live. What can we do to increase our hunger for health and our hunger for life?

Hunger for Life References:

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10. Le MH, Devaki P, Ha NB, et al. Prevalence of non-alcoholic fatty liver disease and risk factors for advanced fibrosis and mortality in the United States. Yu M-L, ed. PLoS One. 2017;12(3):e0173499. doi:10.1371/journal.pone.0173499
11. Ioannidis JPA. Neglecting Major Health Problems and Broadcasting Minor, Uncertain Issues in Lifestyle Science. JAMA – J Am Med Assoc. December 2019. doi:10.1001/jama.2019.17576
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