Figuring out who is sick and who is healthy turns out to be much trickier to answer than we had thought.
Take the startling example of the thyroid gland. A recent article in the New England Journal of Medicine analyzed this and other cases. It is now plausibly estimated that almost 100% of people, if they had their thyroids dissected for examination by the newest methods, would show signs of cancer or pre-cancerous mutation. The closer you look, with the new high-powered techniques, the more cancer and cancer-like states that you find. And no matter how finely you slice the tissue, there may always be smaller tumors that fit into the spaces between the slices. The same is true for prostate cancer. Almost 50% of men between sixty and seventy years old would show signs of the disease if examined in this way. Almost 40% of women age forty to fifty would show signs of breast cancer under the new microscopes.
What seems to be happening is that the scanners are opening our eyes to the very deep depths and long pre-histories of disease—depths and lengths that go far beyond what we are used to thinking of as the safe confines of serious illness. It is a situation that is emphasized by the new technology, and brought into focus by it, but not exclusively tied to it. It’s just that now it is much easier to look so closely.
When the hearts of soldiers in the Vietnam and Korean wars were carefully examined in post-mortem autopsies, fully 77% and 45%, respectively, showed signs of pathologic lesions. The average age of these soldiers was only 22. Children under three years old, and even fetuses, regularly have the earliest signs of heart disease. And the case is the same for almost any disease you choose to look at closely. Sickness, in dormant or slow-moving or precursor forms, is so pervasive as to be more than common. Which is to say that if you track sickness back down to its smallest and earliest traces, you are driven to the conclusion that, in one way or another, we are all sick.
The Complex Nature of Health
But if this is true, then who is healthy? If we all apparently have or will have identifiably cancerous thyroids or lungs or prostates, or sclerotic blood vessels, or whatever—are we all suffering from disease? But then what of the many smaller, newly detected tumors that seem to be inactive or dormant? As to some degree they must be, since the same numbers of people seem to be dying from cancer and the other conditions, even with all the newly perceivable tiny tumors.
There are at least two conclusions to draw from the more widely apparent incidence of diseased states. The first is that there are many more non-threatening forms of mutation than we thought. If most people will show what we think of as cancerous change in the thyroid, but only the same relatively small (but increasing) number of people are dying from it, then perhaps we need to redefine what cancer means in this context. These kinds of changes may be common because there are mutations that look like life-threatening cancer but aren’t. Perhaps we need to redefine these small, early-stage indications as not pre-cancerous but “potentially” cancerous or “usually benign” or something similar. The point would be to acknowledge that it is hard to distinguish them absolutely from actual cancers, but that they don’t necessarily progress to full-fledged active disease.
But once you think about this expanded incidence of apparent disease, and try to figure out how to separate the good and the bad things that look similar, you will soon enough begin to ask a second, further question. Not only what distinguishes similar-looking things that are good or bad, but what is it exactly that keeps the small benign changes from moving over into the bad, dangerous area? And conversely, what is it that triggers the onset of actual disease, those small alterations that nudge the once-dormant condition down the road toward pathology? We may all be sick, but how do we stay healthy-sick rather than sick-sick? In both cases, for the good and for the ill, the fundamental answer, in all its life-changing generality, is ecogenetics.
“Health,” I want to insist, is still the pleasure of good bodily functioning. We still have the life goal of making the most of the time we have, unimpeded by pain and sickness. But it turns out that we’re managing these things at a much deeper level, and much more constantly, than we previously thought. Health is a complex concept that includes the possibility of disease and pre-disease states. Disease is a complex concept that must include the possibility of future health. The lines are not so easy to draw—and we need to get used to living along the line, rather than only on one side or the other.
And this leads me to the most important point in all of this for genechanger.com and my upcoming book (out April 21), The Gene Therapy Plan. Another part of what changes with the wider view from the new science is how we can go about doing the best for ourselves in the time we have. Health is closer to sickness, yes, and sickness is closer to health. But because we know this, and because we can now trace the workings of our health-regulating processes down to the smallest genetic details, we can do more than we ever thought possible to swing the balance of “health” in our favor—toward longer, happier fulfillments of our own choosing. This is the central tenet of genechanger.com: The new definition of health fundamentally includes what we make of it. We can be “healthy” despite the diseases lying dormant inside us, because we are ecogenetically well-managed.
Why Genechanger is the New Game Changer
So it bears repeating that ecogenetics is happening all the time. It is neutral with respect to our health, but we can guide it toward the conditions that we desire. Our genes determine everything that happens to us, in sickness and in health, but we can help to determine the environments in which the genes do their determining. It’s a two-way street, and the traffic is flowing constantly.
But this does not diminish the fact that this new view of health may seem startling. It certainly does require a cognitive shift to accept that most of us are already “diseased” in some ways, and that threatening (though maybe inactive) sickness is not the province of only the seriously ill. But if we back up for a moment, I think we can see that this new view is not quite as new as it seems. Or, rather, it is showing us an old truth in a new light. What the new imaging technologies and the ever-more-granular disease registries are telling us is something we already know very well—that we are mortal.
But again, this is something we already know, just as we know—if we pause to think about it—that the goal of life is not life at the expense of death. The goal is to make the most of the time we have, to live with dignity and balance and pleasure, and to avoid as much as possible the discomfort and pain of disease as well as conditions like obesity and premature aging, so we are free to pursue our goals. So let me be very clear and strongly optimistic: Just because most healthy people actually have some sort of disease in them—because we are mostly healthy-sick rather than simply “healthy”—it makes no sense to regard our “health” as being corrupted by “disease.” We live along the line of health and sickness, and that is a wonderful, exhilarating, enlivening place to be. An example is cancer: Almost all adults have some dormant cancer cells and soon 50% will develop active cancer at some point in their lives. Therefore the goal is to use ecogenetics to keep dormant cancer cells dormant and if you are in the 50% who has active cancer, the goal is to make the active cancer cells dormant and keep them in that state. This I believe is the true revolution and evolution in the prevention and treatment of disease, in general, and is the central tenet of The Gene Therapy Plan- Taking Control of Your Genetic Destiny Through Diet and Lifestyle.