Myth busting

Chronic disease is not inevitable or natural, even with age

To stem the rising tide of chronic disease, we must alter the elements of our environment.

In the 1830s, British settlers in New Zealand imported European rabbits for food and sport. With no native predators, the rabbits soon took over. Accounts from the period describe thousands of hectares run through with burrows, and huge tracts of arable land destroyed by overgrazing.

In a desperate bid to stem the scourge, the New Zealanders brought in a natural predator of the rabbit – ferrets. Without native predators to pick them off, the new imports did well. But they also played a prominent role in the decline of several endangered bird species, including the kiwi, the weka, and the kakapo. It’s a familiar parable (Mark Twain even riffed on it) about unintended consequences, and the danger of applying reductionist logic to a world that is characterised by extraordinary interdependence and complexity.

As a physician, I can’t help but be reminded of ferrets in New Zealand as I write prescriptions for the drugs we use to manage chronic disease. Hydrochlorothiazide for high blood pressure. Sulfonylureas, a class of medication used to treat Type 2 diabetes. Statins for heart disease.

Don’t get me wrong, these drugs work. They absolutely save lives. But the human body is a precisely interdependent system, and these drugs are like sledgehammers. The ferrets did kill rabbits, but they were such an indelicate intervention that they wrought their own special havoc on the native ecosystem. The kakapo might never again be seen on the New Zealand mainland. How much collateral damage are we inflicting on the human ecosystem with our powerful medicines?

Perhaps more than we think. Hydrochlorothiazide, a widespread treatment for high blood pressure, increases haemoglobin A1C and impairs glucose tolerance. These are indices of insulin resistance, which is associated with diabetes, obesity, cardiovascular disease and dementia. Hydrochlorothiazide raises LDL cholesterol and triglycerides, and lowers HDL cholesterol – a pattern known to confer increased risk of cardiovascular disease.

Sulfonylureas have been shown to increase the risk of cardiovascular disease as well.

And statins, some of the most widely prescribed drugs in the United States, have been found to impair glucose tolerance and increase the risk of diabetes.

While there is no doubt that the collective benefit of these medications currently outweighs their adverse effects, it’s remarkable that many of the drugs we give to treat chronic disease can actually increase the risk of those selfsame diseases. It speaks to the intricacy of human biology, and to the crudity of even our most advanced pharmaceuticals. Twain would have loved the irony.

External forces of chronic disease

The hope of academic medicine is that research ­– especially in molecular biology and pharmaceuticals – will save us. As we zero in on the elusive, primordial mechanisms of disease, we can design ever more precise pharmaceuticals, or even cures.

But rather than producing any outright cures for chronic disease, decades of basic science research seem to have yielded a different kind of truth – that the human body is an incredibly, devilishly complex system. The deeper we dig, the more convoluted becomes the pathophysiology of chronic disease. What has become clear is that these chronic diseases – high blood pressure, diabetes, cardiovascular disease – are manifestations of aberrant metabolisms, rather than a lone faulty switch buried somewhere within our cells.

There seem to be no silver bullets. Causation at the molecular level, deep inside the body, appears to be beyond our current reach. But what about pushing against the ultimate cause – not within us, but in the outside world? Are we fated to follow the New Zealanders’ folly, causing damage with every effort to treat? Or, can we learn what external forces have made us so chronically ill, and push back there?

Perhaps we can. It turns out that traditional cultures across the globe, from hunter-gatherers to pastoralists to horticulturists, have shown little evidence of chronic disease. It’s not because they don’t live long enough – recent analysis has found a common lifespan of up to 78 years among hunter-gatherers, once the bottlenecks of high mortality in infancy and young adulthood are bypassed. We can’t blame genes, since many of these groups appear to be more genetically susceptible to chronic disease than those of European descent.

Evidence suggests it is how they live. Though traditional cultures span an immensely diverse gamut of lifestyles, they share a common denominator defined by the absence of modern banes: absence of processed foodstuffs, absence of sedentary lifestyle, and likely absence of chronic stressors.

The lifestyle factor

Indeed, evidence suggests that lack of chronic disease in these groups flows from how they live, how they move, how they eat. Diet looks to be an especially powerful driver – adoption of a Western diet, rich in processed foods, has mirrored the development of chronic disease worldwide, and prospective studies with healthy and diabetic subjects have documented the powerful influence of food on health. Physical exercise, long touted as merely a means to calorie disposal, turns out to have complex endocrine and metabolic effects on insulin signalling, stress response, sleep, mental health, and even neuronal function in the brain. What the science seems to say is that an ancestral way of life aligns the machinery of our metabolisms toward good health.

Thus it appears that our bodies aren’t, after all, destined for chronic disease as they age – rather, it is the environment we’ve put them in that should bear the blame.

But isn’t this obvious? Yes, physicians and public health researchers have long acknowledged the influence of environmental elements on health, but we remain beholden to a paradigm that places first priority on mastery of molecular mechanisms. The sophistication of our sciences is a triumph, and technological progress must no doubt continue. But we know enough about the environmental determinants of health to act, even if we don’t fully understand the mechanisms.

Our ship is sinking, and the current approach is akin to bailing with a thimble. If we are to stem the rising tide of chronic disease, we must alter the elements of our environment that promote chronic disease. With the global price tag of chronic disease projected to rise to $30 trillion by 2030, we simply can’t afford not to.

The writer is a medical resident at the Massachusetts General Hospital in Boston.

This article was first published on Aeon.

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How technology is changing the way Indians work

An extensive survey reveals the forces that are shaping our new workforce 

Shreya Srivastav, 28, a sales professional, logs in from a cafe. After catching up on email, she connects with her colleagues to discuss, exchange notes and crunch numbers coming in from across India and the world. Shreya who works out of the café most of the time, is employed with an MNC and is a ‘remote worker’. At her company headquarters, there are many who defy the stereotype of a big company workforce - the marketing professional who by necessity is a ‘meeting-hopper’ on the office campus or those who have no fixed desks and are often found hobnobbing with their colleagues in the corridors for work. There are also the typical deskbound knowledge workers.

These represent a new breed of professionals in India. Gone are the days when an employee was bound to a desk and the timings of the workplace – the new set of professionals thrive on flexibility which leads to better creativity and productivity as well as work-life balance. There is one common thread to all of them – technology, tailored to their work styles, which delivers on speed and ease of interactions. Several influential industry studies and economists have predicted that digital technologies have been as impactful as the Industrial Revolution in shaping the way people work. India is at the forefront of this change because of the lack of legacy barriers, a fast-growing economy and young workers. Five factors are enabling the birth of this new workforce:

Smart is the way forward

According to the Future Workforce Study conducted by Dell, three in five working Indians surveyed said that they were likely to quit their job if their work technology did not meet their standards. Everyone knows the frustration caused by slow or broken technology – in fact 41% of the working Indians surveyed identified this as the biggest waste of time at work. A ‘Smart workplace’ translates into fast, efficient and anytime-anywhere access to data, applications and other resources. Technology adoption is thus a major factor in an employee’s choice of place of work.

Openness to new technologies

While young professionals want their companies to get the basics right, they are also open to new technologies like Augmented Reality, Virtual Reality and Artificial Intelligence. The Dell study clearly reflects this trend — 93% of Indians surveyed are willing to use Augmented/Virtual Reality at work and 90% say Artificial Intelligence would make their jobs easier. The use of these technologies is no longer just a novelty project at firms. For example, ThysenKrupp, the elevator manufacturer uses VR to help its maintenance technician visualize an elevator repair job before he reaches the site. In India, startups such as vPhrase and Fluid AI are evolving AI solutions in the field of data processing and predictive analysis.

Desire for flexibility 

A majority of Indians surveyed rate freedom to bring their own devices (laptops, tablets, smartphones etc.) to work very highly. This should not be surprising, personal devices are usually highly customized to an individual’s requirements and help increase their productivity. For example, some may prefer a high-performance system while others may prioritize portability over anything else. Half the working Indians surveyed also feel that the flexibility of work location enhances productivity and enables better work-life balance. Work-life balance is fast emerging as one of the top drivers of workplace happiness for employees and initiatives aimed at it are finding their way to the priority list of business leaders.

Maintaining close collaboration 

While flexible working is here to stay, there is great value in collaborating in person in the office. When people work face to face, they can pick up verbal and body language cues, respond to each other better and build connections. Thus, companies are trying to implement technology that boosts seamless collaboration, even when teams are working remotely. Work place collaboration tools like Slack and Trello help employees keep in touch and manage projects from different locations. The usage of Skype has also become common. Companies like Dell are also working on hi-tech tools such as devices which boost connectivity in the most remote locations and responsive videos screens which make people across geographies feel like they are interacting face to face.

Rise of Data Security 

All these trends involve a massive amount of data being stored and exchanged online. With this comes the inevitable anxiety around data security. Apart from more data being online, security threats have also evolved to become sophisticated cyber-attacks which traditional security systems cannot handle. The Dell study shows that about 74% of those surveyed ranked data security measures as their number one priority. This level of concern about data security has made the new Indian workforce very willing to consider new solutions such as biometric authentication and advanced encryption in work systems.

Technology is at the core of change, whether in the context of an enterprise as a whole, the workforce or the individual employee. Dell, in their study of working professionals, identified five distinct personas — the Remote Workers, the On-The-Go Workers, the Desk-centric Workers, the Corridor Warriors and the Specialized Workers.

Dell has developed a range of laptops in the Dell Latitude series to suit each of these personas and match their requirements in terms of ease, speed and power. To know more about the ‘types of professionals’ and how the Dell Latitude laptops serve each, see here.

This article was produced by the Scroll marketing team on behalf of Dell and not by the Scroll editorial team.