If Alexander the Great was alive today he would have most probably conquered North America. Thus he would no longer need to go around the world in search of immortality. As like many of us living in the 21st century, he would get to live much longer. In 2013, average life expectancy in the world was 71 to 74 years of age, depending on your gender, and it continues to increase. However, the question is would Alexander the Great be happy living longer? Sadly, the answer is no. He would probably be disappointed about his quality of life. Today, statistics show that living longer does not necessarily equate with increase in happiness.
Instead of celebrating a longer life and enjoying the wisdom and experience he had gained through his life, Alexander would have to spend the majority of his time in medical centers, doctors’ offices, laboratories and radiology centers. He would be diagnosed with one or more chronic diseases such as heart disease, stroke, cancer, diabetes, obesity, arthritis, and/or depression, dementia, etc. and would be at least on two medications to control his blood pressure, cholesterol, diabetes, and other health conditions. In the US about 50 percent of adults- 117 million people—have one or more chronic health conditions while 25 percent have two or more chronic health conditions. Approximately, 70 percent of adults take at least one medication. Similar numbers can be found elsewhere in the world, and they continue to grow.
Alexander the Great would be under constant stress to prevent ailments. He would spend a lot of money on useless vitamins and antioxidants. He would eat a very boring diet and exercise excessively in the hope of preventing diseases. He would have to undergo many medical screening tests every year to make sure he is disease free. The doctors would do very expensive genetic analysis on him to assess his risks for developing future diseases. And these screening tests would most probably predict that he is at the risk of developing many ailments including Alzheimer’s-illnesses, which in reality he might never even end up with. However, Alexander would lose a lot of sleep over these predictions, become highly stressed out and end up with depression. He will have to spend a lot of money on experimental therapies, medications, and remedies in the hope of preventing such illnesses. He will take even more medications and develop polypharmacy or drug cascade syndromes regardless of the fact that these preventative measures may not be effective at all and may even harm his body.
Why would the quality of life be so poor for Alexander the Great in 21st century? There are at least two reasons: one is because we live in a capitalist country and the second is that we live in a modern society with a robotic mentality.
Let’s discuss the first reason-Living in a capitalist country. Our Health care system is based on a fee for service structure. Doctors are incentivized base on the number of tests and procedures they prescribed. Pharmaceutical, biotechnology and medical device companies need to increase their profit by at least 15% per year. Therefore, they need to sell more drugs, invent more tests and build more detection devices. Hospitals need to increase their share of profit each year as well and they will enforce these tests & unnecessary surgical procedures on their patients. On top of that, fear of malpractice drives doctors to do more testing. The problem isn’t just doctors. Patients also believe that more is better. New tests and treatments succeed in part because the general public tends to idolize technology.
Let’s talk about vitamins-Vast marketing campaigns at every corner entice people to take drastic measures such as taking vitamins and supplements, which is a $68 billion USD global market. The public is falsely informed that these measures will lead them toward achieving better health, regardless of the fact that there is no evidence indicating their benefits. Scientific data collected over many years indicate that supplements are not contributing to better health and could even be very dangerous for people. For example, they can interact with your existing medications and be detrimental to your health. The general public does not need vitamins and mineral supplements if they eat a balanced diet and are in good health and do not have medical conditions. Furthermore, over 100,000 OTC (Over The Counter) medications and supplements exist in the market. Yet they are not regulated by the FDA (Food & Drug Administration) and there is no evidence indicating their benefits. Since they are not regulated by the FDA the manufacturers of such supplements do not have to prove their safety or efficacy in any format.
Now let’s talk about the second reason-We live in a modern society with a robotic mentality. This kind of mentality tells us that for every single problem, there is a quick fix-even if there is no logic behind it. You fix things with either medications or interventions! We are like a “Robot”. If one piece does not work, we can replace it!! But in realty this is not the case.
Let’s go back to Alexander the Great. Alexander would have been dependent on Medicare for his healthcare once he turned 65. Medicare would pay for Alexander to get a pacemaker even if it would only extend his life by two weeks! And Medicare would fully pay for diagnosing and treating his cancer even if it would extend his life for just a few weeks to months. However, Medicare would not pay a penny if Alexander needed help at home nor would it pay if he needed a consoler to overcome his anxiety and/or depression. These are tragic stories we observe everyday as geriatricians. I had a patient a few years back with advance dementia in a nursing home. He also had advance colon cancer. He could not eat, was in sever distress and could not recognize anyone. His life expectancy was less than two months. On one of his visits to the ER his family members were instructed to consult with a cardiologist. The cardiologist advised them to get a pacemaker for him. They put a patient with advance dementia and cancer under general anesthesia to give him a pacemaker. And Medicare paid for it. He died less than a month later.
In addition, the society would look down at Alexander the Great and discriminate against him if he lived today since he is no longer young, productive, and a cheap labor. He would probably lose his job and his home paying for healthcare, prescription and over the counter drugs, medical tests and nursing homes. And if he had Alzheimer Dementia, his family would be bankrupted easily in order to take care of him. These are few of the reasons why Alexander the Great would deeply regret his dream of longevity if he lived in our modern society. And this is the realty about aging in the 21st century.
Every single day, 11,000 people reach the age of 65 in the United States. Our society will face huge challenges if we do not fix such problems. My first goal as a geriatrician is to bring into attention a few of these challenges and recommend ways to resolve them. What needs to be done?
The first step is to change our society’s mentality-and by that I mean everyone from politicians, to healthcare providers to educators and the general public’s- about aging. Aging is a normal part of life. We need to respect it instead of fighting it with every method possible and trying to stop it. We should not be ashamed of it. We should not monetize on it. Instead we should concentrate on finding a new definition and path for healthy aging. And make it a happy, joyous, colorful, and a rich journey. If we fight every aspects of aging in front of our younger generation what are we teaching them? We are teaching them that aging is a terrifying process and should be avoided at all cost. We are also teaching them to disrespect aging and the aging population. This needs to be stopped.
We should put our best efforts on early prevention using scientific tools, solid data and logic rather than relying on marketing based fads and myths. We should dedicate more money to research, for example.
Set realistic goals-Maybe this is the time to change the erroneous belief of doctors and patients that there is a fix for everything and that more is always better. We need to ask our doctors more questions about the validity and efficacy of tests, medical procedures and medications. We should spend more time pondering about the short/long term goals of diagnostic tools and treatments. We should consider that changing our life style is often more important than undergoing many diagnostic tests or taking medications. Congressional Budget Office in 2015 estimated that 5 percent of the nation’s gross domestic product-—$700 billion per year –goes to tests and procedures that do not actually improve health outcomes.
We should better educate the aging population about healthy aging, set realistic expectations and goals, and provide support to help them live rich and meaningful lives. Quality of life is very important. We should also openly discuss how we want to die. When do we like to stop interventions and treatments and prepare ourselves for dying. Statistics show that people with higher quality lives accept dying more easily and peacefully than people with lower quality lives.
We should teach our society and the younger generation to treat our elderly right. The elderly should not be forced out of the work force and replaced by cheaper and inexperienced labor. They should not be institutionalized and set aside by the society they built and the children they raised. They should not be taken advantage of, cheated or mistreated in any form or fashion. We owe them our respect, our time, and our gratitude.
Dr. Mehrdad Ayati, MD & Dr. Hope (Arezou) Azarani, Ph.D.
Dr. Ayati is a well-known Geriatrician, speaker, author (Paths to Healthy Aging) and an educator. He is Board Certified in Geriatrics & Family Medicine. Dr. Ayati is an Adjunct Clinical Assistant Professor of Medicine at Stanford University School of Medicine where he teaches Geriatrics and Internal Medicine. He is the Founder of Geriatric Concierge Center.
Dr. Azarani is a Physiologist and co-author of Paths to Healthy Aging. She is the Founder and CEO of Protogen Consulting.