Is it good? Worth reading? As someone said about “Paradise Lost,” I didn’t wish it were longer.
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Full article without paywall: How to Die in Good Health The average American celebrates just one healthy birthday after the age of sixty-five. Peter Attia argues that it doesn’t have to be this way. (New Yorker)
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Zeke Emanuel (Obamacare architect, brother of Rahm, and Biden covid advisor) talking his book:
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Zeke Emanuel: “I think this manic desperation to endlessly extend life is misguided and potentially destructive.”
I have no problem if Zeke Emanuel, or anyone else, wants to live a shorter life. I think people should have the right and ability to choose.
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He does not seem to beloved in improvements in Healthspan’s
But here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.
Interestingly he seems to disagree with that too…
Nor am I talking about waking up one morning 18 years from now and ending my life through euthanasia or suicide. Since the 1990s, I have actively opposed legalizing euthanasia and physician-assisted suicide.
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OK - it sounds like I don’t agree with him on anything then 
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My parents have lived fulfilled happy lives traveling until 75 when my mother had a heart attack a couple weeks ago. They’ve had to cancel their next 3 trips.
If you’re unhealthy at age 65, you’re doing something woefully wrong.
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Or you’re terribly unlucky.
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Clearly he doesn’t get the extended health span aspect of all of this, or maybe that hasn’t been pushed enough. Although I know Attia pushes it.
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Not sure people realize that some people are just genetically dealt a really crappy hand in life. I see patients that are only 45 or 50 and have multiple progressing illnesses that will not dramatically improve. Heart disease, vascular disease, diabetes, obesity, autoimmune disease.
If your 60, or 70 and your out exercising everyday, and you’re generally healthy, be thankful.
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After delving into both articles, it’s clear that Zeke Emanuel’s perspective comes across as grounded and rational. In contrast, Peter Attia appears to be grappling with personal struggles, which may cloud his reasoning. While I do endorse Attia’s concept of medicine 3.0, prioritizing prevention, his overall stance warrants careful scrutiny.
Living a long life is appealing, but it’s essential to ensure that longevity is accompanied by vitality and productivity. Mere survival without quality of life seems to miss the mark entirely.
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It is a false dilemma between these 2. The reality, is 15-20% of outcomes are based on genetic factors and 80% at least based on lifestyle choices. So the 50 year old with CAD that I see in the ER is rarely there due to an awesome lifestyle and having risk factors managed. At least 70% of the current 4 trillion dollars spent on healthcare in the U.S. is on disease that is markedly able to be eliminated by proper life choices and pre-emptive management. We are wasting huge amounts of money, and there is a lot of human suffering.
Needless to say, Americans are living with multiple co-morbidities on average for 15-16 years before death. Each of these co-morbidities likely influences cognition … and yes, staying alive for this long impaired, and increasingly so, is not good.
In Loma Linda - there is compressed time of co-morbidities to death, unlike that stated in the article. We have proof of this - and goal is exactly this, live functional, and then when this changes die quickly. We are doing the opposite right now, and the trend continues.
So it isn’t an impossible goal - it is instead a goal that requires planning, and understanding how to optimize a number of things. Also being realistic. I don’t think but 1% of people are going to be out doing the workouts Attia thinks are so important. The advice and planning for health needs to allow most people to be able to accomplish it. The problem is, the default of fast food, horrible diet, sedentary lives, and lack of pre-emptive care certainly leads to a situation where 75 years old is well beyond the expiration date for many.
The question is what does 75 years old look like? If it is like my mom, and when I visit her, we do 9 mile hikes at 8,000 ft with her leading the way and me having to to work to keep up. That’s great. If it looks like dementia, sarcopenia and a nursing home … then certainly, please sort out how to let me die.
We have people who at 50 years old, who look like 80 year olds, and 95 year olds who are functioning like 65 year olds.
The context is critical; the age isn’t the issue, the functional status … if maintained gives reason to live, and when this is lost gives reason to be done ASAP and not kept alive by well meaning family members in a condition that one wouldn’t subject your pet dog or cat to.
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Is your 20%/80% based on scientific data, observation, or opinion? I would think the genetic portion should be much higher.
No this is based on scientific data. Do a search - you’ll find sources indicating as little as 10% and most around 15-20%. The genetics aren’t that high - everyone likes to complain about this. E.g. - you’ll know as a fellow EM Physician - the family that all of them get CAD. Well they also are all obese, don’t manage their health and smoke … bad health choices run in families (and seem to get worse with each generation, at least lately) – and these individuals seem to often confuse this with the small component genetics is making and ignore the massive control they have over their health outcomes.
If you look at the AHS - diverse genetic populations living a certain lifestyle get massive benefits = the only remaining Blue Zone in the world at this point … that can’t be genetics - it can only be lifestyle. It is based on these observations and many others that assessment of the relationship is made.
However, I’m not going to cite a whole lot of papers on this - simply enough to say - do a search on it - and you’ll find sufficient opinion based on fact to see that this is a reasonable middle of the road estimate.
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Is obesity considered genetic or environmental? I’ve always thought of it as environmental but I’ve changed my mind on that recently.
Isn’t it both? Genetics can play a role in how much appetite you have and how well your body can process nutrients. But in the absence of food, no one can become obese.
Anything genetic requires many generations for DNA to somehow change. So what % of obese people today had obese relatives 4 generations ago?
It is lifestyle, hyperpalatable food, screen time, and learned habits – so heritable from parents - e.g. obese parents - look at their children - increased rate. But based on learned habits, not genetics as the primary driver.
It’s not a blame issue but, it isn’t due to their genes.
Asians moving to the US from native lands rapidly worsen health outcome, diabetes, obesity … did their genes change in 1 generation?
Without the life choices there won’t be obesity. Some people naturally have a more difficult time due to how they grew up and habits.
If I put someone on a glp1/gip agonist and work on lifestyle change, get them to learn new habits and get to IBW then gradually wean them off, and they maintain IBW… no DNA changed, ., gene expression may have based on lifestyle. So what caused them to be obese in the first place if lifestyle modifies it?
I do however agree there are some genetic factors that can make people have a bigger appetite - but it is how they act on this.
@KarlT will hopefully enjoy this … as it gives support to the genetic component - but more on an epigenetic basis: https://youtu.be/3ckimoZ9BW4
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Emanuel, who served as a special adviser to the Obama Administration, told me. “No one’s got that evidence.”
So the guy behind Obama’s decision not to take a statin?