Dr Paul Clayton 2013
According to the crude stats, we’re living longer. According to the Global Burden of
Disease Study, an enormously expensive and rather fatuous exercise in number-crunching
funded by the Gates Foundation and just published in the Lancet (Salomon et al ’13), global life
expectancy has risen from 59 in 1990 to 70 today. According to the medical profession and
the pharmaceutical industry all is increasingly for the best in this, the best of all possible
worlds. And according to those who really know, this is claptrap. In fact, it is nothing
short of a public health disaster.
A very large part of the increase in global life expectancy is due to reduced infant mortality in the developing world, which has been achieved with improved sanitation, clean water and
immunisation programmes. But what has modern medicine done for life and health expectancy for adults?
Male life expectancy has fallen in the UK compared with the 19th century
The results have been mixed, to say the least. In the UK, for example, and comparing like for
like, the situation for men has worsened significantly over the last century and a half. In
mid-Victorian England, male children aged 5 could expect to achieve, on average, another 75
years of life (Charlton & Murphy ’04, McNay et al ’98). By 2002-2006, the life expectancy of boys born to parents with routine occupations (formerly ‘working class’) had fallen to 74.6 years
(ONS ’11) – a loss of 5 years.
Women have done better. Mid-Victorian girls aged 5 could expect another 72 years of life
(Charlton & Murphy ’04, McNay et al ’98), and in 2002-2006, the life expectancy of girls born
to C1-C2 parents was 79.7 years (ONS ’11) – a gain of nearly 3 years.
Why have men and women fared so differently? The answer is simple: in the 19th century, female life expectancy was dragged down by multiple pregnancies (contraception
was basically unavailable) and the perils of childbirth. Family planning and better
obstetrics (such as doctors learning to wash their hands between patients) have given
women an average of three more years of life.
Why have men lost life expectancy? The answer again is simple: nutritional standards
have fallen hugely since the 19th century, thanks to the modern food industry and to our
low-energy lifestyles. Our appalling nutritional status condemns us to an unnecessarily high
risk of acquiring, as we age, one or typically more of the non-communicable degenerative
diseases; and thus we spend far more of our old age suffering from the so-called diseases of
civilisation than ever before (Clayton & Rowbotham ’09, Lim et al ’13, Vos et al ’13,
Murray et al ’13).
Cancer is dramatically increasing
The resulting increased need for medical resources has driven up healthcare spending
from circa 1% of GDP in the second half of the 19th century (Clayton & Rowbotham ’13), to approximately 18% today (UK Public Spending ’12); and it is getting worse. According to leading oncologist Professor Karol Sikora: “The incidence of cancer is dramatically increasing … the last eight cancer drugs approved by the US Food and Drug Administration will cost over £10,000 a
month per patient … no healthcare system can afford this …” (Sikora ’11, Sullivan et al ’11).
Unfortunately, it’s not just cancer. If diabetes, coronary artery disease, dementias (and cancer)
are diseases of civilisation, we are certainly becoming more civilised. But conversely, this
is telling us that none of the on-going pandemics of degenerative disease is
inevitable; they are not occurring because we are growing older (we are not, much); but are
being triggered by our unhealthy lifestyles and sustained, often life-long dysnutrition—which
results in chronic inflammation.
Degenerative diseases cannot be cured with drugs
These diseases cannot be cured with drugs, and so increasing numbers of us develop health
problems that cause many years of pain, disability and mental distress (Lim et al ’13, Murray
et al ’13, Vos et al ’13). This is no ‘distressing irony’, as the papers’ authors call it, but a direct result of the way in which medicine is practised.
20th century medicine focused on the curative treatment of bacterial, fungal and protozoal
infection with antibiotics; the prevention of infection via immunisation; and the (noncurative)
treatment of symptoms of noncommunicable disease, using specific and often hazardous drugs.
Doctors are taught to disregard nutrition
Taught at medical school to disregard nutrition, 21st century doctors remain fixated on drugs
even though the literature linking nutrition and nutrients to health outcomes is growing at a
rate of hundreds of papers per week. They ignore the root causes of the flood tides that
wash, every day, the victims of poor diets and lifestyles into their surgeries.
And the tides are rising. Overweight, diabetes, hypertension, cardiovascular disease, cancer –
all of the chronic degenerative diseases – are driven by lifestyle factors. Not enough
exercise, fruits or vegetables, and too much smoking, alcohol, salt, omega 6 fatty acids and
fast food. And all these factors are going in the wrong direction.
Shoppers are buying less healthy food
Supermarket food prices are rising much faster than incomes and as a result, shoppers are
buying less healthy food and more of the fatty, filling, salty products that provide both comfort
and disease. In the last year there has been a 10% fall in fruit and vegetable purchases, with
an even greater fall (22%) in low income homes (DEFRA ’12). This study of more than 6,000
households compared actual food consumption to the government-recommended eatwell plate
(itself a very low standard), and concluded that ‘neither low income households nor all
households are close’ to achieving it.
Chris Murray, Professor of Global Health at Washington University and a lead author of the
global study, summarised his team’s findings. “Very few people are walking around with
perfect health,” he said, “and as people age, they accumulate health conditions. This means
we should recalibrate what life will be like for us in our 70s and 80s. It also has profound
implications for health systems as they set priorities.”
We cannot afford a future based on drugs, surgery and expensive medicine
I agree that very few people have perfect health, but the rest of Professor Murray’s
statement represents a profound failure of courage and intellect. It implies that a globally
ageing population will inevitably become sicker, and that this must be planned for in a
framework based on drugs, surgery and expensive medicine. It ignores the fact we
cannot afford this future. It ignores the fact that current trends will degrade life and health
expectancy way beyond these basic demographics; and it effectively ignores the
fact that the only way to prevent these tides of disease is to cut them off at source, by
improved nutrition.
Let us hope that the growing evidence base linking good nutrition to better health will
eventually overcome the resistance of the pharma lobby and become incorporated into
government policy, agricultural practice and food design. The barriers between us and
vastly better health are no longer scientific, but political.
REFERENCES
Charlton J, Murphy M, editors. The Health of Adult Britain 1841–1994. 2 vols. London: National Statistics; 2004.
Clayton P, Rowbotham J. 2013; work in progress
DEFRA 2012. http://www.defra.gov.uk/statistics/files/defra-stats-foodfarmfood-
familyfood-2011-121217.pdf
Lim et al 2012. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013 Dec 15;380(9859):2224-60.
McNay K, Humphries J, Klasen S. Cambridge Working Papers in Economics. Cambridge: 1998. Death and Gender in Victorian England and Wales: Comparisons with Contemporary Developing Countries.
Murray CJ et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013 Dec 15;380(9859):2197-223.
Office for National Statistics 2011. http://www.ons.gov.uk/ons/rel/health-ineq/
health-inequalities/trends-in-life-expectancy–1982—2006/trends-in-life-expectancyby-
the-national-statistics-socio-economic-classification-1982-2006.pdf
Salomon JA, Wang H, Freeman MK, Vos T, Flaxman AD, Lopez AD, Murray CJ. Healthy life expectancy for 187 countries, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.
Lancet. 2013 Dec 15;380(9859):2144-62.
Sikora K ’11. http://www.telegraph.co.uk/health/healthnews/8791979/Thebig-C-cancer-treatment-is-increasingly-unaffordable.html
Sullivan R, Peppercorn J, Sikora K, Zalcberg J, Meropol NJ, Amir E, Khayat D, Boyle P, Autier P, Tannock IF, Fojo T, Siderov J, Williamson S, Camporesi S, McVie JG, Purushotham AD, Naredi P, Eggermont A, Brennan MF, Steinberg ML, De Ridder M, McCloskey SA, Verellen D, Roberts T,
Storme G, Hicks RJ, Ell PJ, Hirsch BR, Carbone DP, Schulman KA, Catchpole P, Taylor D, Geissler J, Brinker NG, Meltzer D, Kerr D, Aapro M. Delivering affordable cancer care in high-income countries. Lancet Oncol. 2011 Sep;12(10):933-80
UK Public Spending; http://www.ukpublicspending.co.uk/uk_budget_pie_chart
USA stats: http://www.infoplease.com/ipa/A0005140.html
Vos T et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013 Dec 15;380(9859):2163-96