I have worked a number of years in trauma and emergency medicine, and have learned a few lessons about human nature along the way that I think may be of benefit to others. Our tendency as human beings to carry around an Optimism Bias is probably one of our most deadly traits. The Optimism Bias loosely states that we have an inherent tendency to believe that things will work out; that we won’t suffer the fate of others even if we have the same behaviours or risk factors. This tendency is the only logical explanation I have for why we still smoke, eat poorly, slack off on our exercise, ignore stress, take unnecessary risks and avoid the doctor. It may be why it seems that half of the patients I have ever seen for myocardial infarction insist that their symptoms are “only heartburn”. I am not laying the blame on the rest of the world here, nor am I ignoring my own guilt. I am now working hard to change this trait in my own life and I hope others will do the same. With this bias, comes other factors that I feel make it difficult to follow a truly life-changing plan for significant life extension.
Many practitioners of modern medicine must also share the blame. They are people, thus share the same belief system as the rest of society, which means they expect people to age and die, and often that expectation keeps them from doing everything they can to make someone healthy. I am sure most people are familiar with the term “code blue”, which is hospital-speak for a cardiac arrest. When a “code blue” is called, a highly trained “crash team” rushes to a patient’s bedside to begin resuscitation efforts. There is a lesser known practice that is the shadowy cousin of the “code blue”. It is called a “slow code”. It is when the medical team thinks you are beyond help. Maybe you’re too old, or maybe you’ve been down too long in the field. A “slow code” goes through all the same steps as a “code blue”, but with much less enthusiasm and speed. I believe this is a disgrace. It is the medical practitioner deciding, based on his own value system, how hard to try to save you, and when to look away. In many cases she is probably right and the decision is medically sound, however the logic may be seriously flawed;
“In all probability, this person won’t make it. If they do, it will only be for a day or two on life support.”
“Why should I bother?”
“Mr. Smith has lived for 80 years already, that’s more than enough time.”
“Let him just pass away peacefully.”
If Mr. Smith has a living will that states he doesn’t want heroic measures, then all is well and good. But what happens to the life extension enthusiast in this situation who cannot advocate for themselves? Many relatives of these patients share this ‘deathist’ view, and go along with that decision. They comfort themselves in the concept of “passing away” or saying that a person has “expired”.
Please; milk expires, people die.
This attitude isn’t restricted to life and death decisions. Diabetes management is a prime example. Patients are often advised of a blood-glucose range to maintain through diet and medication. Often, depending on the ability of the patient to comprehend and comply with these instructions, their ranges are set much higher than what is considered optimal. The belief often is “better too high than too low”, because “too low” will kill you quickly, whilst “too high” may take a few years to do the same. It is therefore easier to blame the patient than the physician. Years of marginally elevated blood glucose levels hasten cardiovascular disease, renal failure, peripheral vascular disease and blindness. It almost guarantees the patient will have higher morbidity if he survives into his later years at all.
Laboratory and diagnostic tests can be biased towards expected outcomes, depending on who is interpreting the test. For example, cranial CTs are routinely performed in emergency departments for diagnosis and treatment of various maladies, especially headaches and head trauma. In some jurisdictions, this is the only CT that is read by the emergency physician rather than the radiologist. This means that this test only gets a cursory look, to distinguish immediately life threatening problems from the rest. If your brain isn’t bleeding or your skull isn’t fractured, you will likely be told everything is fine. This can lead to a false sense of security for patients experiencing smaller, less obvious lesions that may be ticking time bombs. Not all blame can fall to practitioners; it is imperative that you understand your healthcare so that you can effectively advocate for yourself. It isn’t all nefarious. Emergency departments in North America are generally filled to capacity, understaffed by over-caffeinated, well- meaning people that just want to keep you alive to hospital admission or discharge. It is not the place for thorough examinations or follow- up. Their role is to manage emergencies, not diagnose illness. Their role can be clouded by their own innate cognitive biases.
People need to educate themselves, to a fairly sophisticated level, about their own risk factors, illnesses, and treatment options in order to become effective advocates for themselves. If you cannot do it yourself, ask for help. You would be surprised to know how many patients I have encountered who arrive with a bag of medications, yet cannot tell me for what conditions they have been prescribed. This amount of blind trust in another human being will likely see you reach the end of your life as a “slow code” or at the least, unnecessarily take years or even decades off your life.
It is predicted that the Singularity will be upon us circa 2045. Whether this is truth or fantasy matters little. What is important is that for every year we stay alive, we increase our chances of reaching a time when medicine will know more, and do a better job of keeping us alive. If Dr. Aubrey de Grey is correct, there will be a point in the near future when we will reach “escape velocity”; when we will add more than a year of life expectancy to every year that we live. Every choice we make between now and then will determine if we live to see that day.
This essay is an introduction to a series of essays that will be my attempt at keeping us all alive and well. It comes from my experience as a patient advocate, Registered Nurse, and from my passion for radical life extension and indefinite life spans.
The following is a list taken from the World Health Organization of the top ten causes of death in the wealthiest countries of the world. I will attempt to tackle these, as well as other approaches and suggestions to surviving the pre-Singularity era in future writings.
Top Ten Causes of Death in High Income Countries, 2011
(Deaths per 100 000 population)
- Ischaemic Heart Disease 119
- Stroke 69
- Trachaea, bronchus and lung cancers 51
- Alzheimer’s Disease and other dementias 48
- COPD 32
- Lower respiratory infections 32
- Colon and rectum cancers 27
- Diabetes Mellitus 21
- Hypertensive Heart Disease 20
- Breast Cancer 16