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Image by Emma Simpson on Unsplash.

A recent New Yorker article explores the topic: How to Die in Good Health.  

“One day, we’re going to die. What should that mean for how we live today?” That’s what the article’s author says. And that’s a question we don’t ask enough. 

The article focuses on Dr. Peter Attia’s fight to prolong our years of health by specific measures of diet and exercise. It contrasts those efforts with the cynicism of Ezekiel Emanuel, an oncologist, professor, and vice president at the University of Pennsylvania.

Peter Attia has a best-selling book Outlive. Besides the book, he works with private clients who presumably pay him $2500 for consultation. 

This amount is not as extravagant as it might seem. I recently considered visiting an integrative medicine clinic at a local hospital, a major teaching center in Philadelphia. Although the clinic was associated with the hospital, the doctors did not take most insurance.

As a marketer, I felt they were being deceptive when they did not make this statement on their website; I only found out when I filled out a form. Furthermore, they answered my query with a form letter (mostly focusing on their non-insurance policy) and a recommendation for a service I didn’t want. When I followed up with another query, they were silent. 

According to the article, Attia makes his patients take extensive blood tests. He uses diagnostic tools that most doctors avoid. For instance, he tells people their likelihood of getting Alzheimer’s, although there’s no way to prevent it or treat it.  

Ezekiel Emanuel is most famous for his article in Atlantic Magazine, which the editors titled I Want to Die At 75. You can google his name to watch follow-ups, on YouTube.

He doesn’t want to go the route of assisted dying. He plans to decline medical procedures, such as chemotherapy. After 75, he reasons, life changes drastically for most people, and not in a good way. As the article noted, he’s now 66 but he hasn’t changed his mind.

.Most importantly,  Emanuel scoffs at Attia’s premise.  “The idea that you’re going to get another healthy decade of life just by doing the things he says is hocus-pocus,” says Emanuel.  Exercise and diet will improve our lives but it’s hard to show that Attia’s suggested regimens will be better.

 Meanwhile, the article explains, the time you spend training to live longer is time you don’t get back. 

The article mentions Eric Topol, a cardiologist in a teaching center. Topol points out that some of the activities to prolong life might prolong our suffering. “There’s no evidence for living a long life and then falling off a cliff,” paraphrases the author.  

Ultimately, the debate boils down to this: How much can we extend a meaningful life?

Ezekiel Emanuel reminds us that,  “Living a long time is not an end in itself. If it becomes the focus of your life . . . that is one of the worst mistakes you can make.”

Peter Attia says, “I want to know that I gave it my all. We have this one shot. Wouldn’t it be a shame if we didn’t make the most of it?”

The average patient has an additional problem. We don’t know the odds. For instance, doctors encourage a lot of people to take statins. I’ve yet to see an article where statins provide more than 2% or 3% absolute risk reduction in heart attacks and strokes, Doctors usually give us the relative risk numbers: “These drugs reduce heart attacks by 36%.”

It seems to boil down to values. I have a specific section in my book.

I’ve been told that values change as we approach our deathbed. But we need them to start out.

We also don’t know how much we’re influenced by lifestyle and how much by our genes.

We’re told, “Heredity is the gun but lifestyle pulls the trigger.”   Sometimes, though, you see people who eat healthy and exercise but still die of cancer or heart disease. On the other side, I once knew someone who was overweight and chain-smoked; she was the only survivor in her family. Everyone else died of heart disease.

So we’re left wondering how to establish our values with incomplete information. And we have two medical doctors taking exactly opposite views.  I must admit, I’m inclined more towards Ezekiel Emanuel. But I hedge my bets by avoiding sugar, at least most of the time.