Healthy No Matter What: How Humans Are Hardwired to Adapt

Copyright © 2023 by Alejandro Jadad and Tamen Jadad-Garcia

All rights reserved.

Published in the United States by Crown, an imprint of Random House, a division of Penguin Random House LLC, New York.

Crown and the Crown colophon are registered trademarks of Penguin Random House LLC.

Library of Congress Cataloging-in-Publication Data

Names: Jadad, Alejandro R., author. | Jadad-Garcia, Tamen, author.

Title: Healthy no matter what / Alex Jadad and Tamen Jadad-Garcia.

Description: First edition. | New York: Crown, [2023] | Includes bibliographical references.

Identifiers: LCCN 2022026398 (print) | LCCN 2022026399 (ebook) | ISBN 9780593240823 (hardcover) | ISBN 9780593240830 (ebook)

Subjects: LCSH: Health. | Health behavior.

Classification: LCC RA776 .J225 2023 (print) | LCC RA776 (ebook) | DDC 613—dc23/eng/20220714

LC record available at https://lccn.loc.gov/​2022026398

LC ebook record available at https://lccn.loc.gov/​2022026399

Ebook ISBN 9780593240830

crownpublishing.com

Cover photograph: Eoneren/Getty Images

ep_prh_6.0_148355211_c0_r0

Contents

Cover

Title Page

Copyright

Introduction

Chapter 1: We Got It All Wrong

Chapter 2: How Are You Feeling?

Chapter 3: Adapt-Ability

Chapter 4: The Toxic Stress Load

Chapter 5: You Are What You Think

Chapter 6: Spaces Matter

Chapter 7: Trust Your Gut

Chapter 8: The Company You Keep

Chapter 9: Getting Out of Your Own Way

Chapter 10: When Is Enough Enough?

Chapter 11: Surviving the Medical Industrial Complex

Chapter 12: You Are a Formidable Marvel

Dedication

Acknowledgments

Notes

About the Authors

_148355211_

For thousands of years humans tried to fly by mimicking birds. They created all sorts of contraptions, most of which centered on the ability to flap wings. All along, they overlooked the other animals and plants that were gliding and floating around them without even having wings.

This obsessive focus on one approach is exactly what each of us has been doing to achieve a long and healthy life. We are following the wrong assumptions, oblivious to the tools that we have right in front of us and persistent despite the repeated failures.

The equivalent of flapping wings is eliminating disease. Fighting illnesses through medical interventions has been the persistent method used for millennia to achieve a healthy life. This approach has made success impossible. Even by regularly exercising, eating well, getting good sleep, and meditating, we are still only scratching the surface of the possibilities to achieve this goal.

In fact, through our studies on thousands of people, we have found that 90 percent of what people need to feel healthy is actually outside of the medical system. Yet our fixation leads us to offer medical solutions to most social and emotional problems. Someone who is lonely can easily end up with a prescription for depression.

Building on data and experiences from millions of people around the world, this book presents a view of what can make a healthy and long life possible, despite the presence of disease. It is a practical guide that condenses the best scientific knowledge and insights from medicine, psychology, and sociology, going from the microscopic to the colossal.

We also underscore that you are equipped with the versatility and the tools to overcome practically any obstacle that prevents you from being healthy. At the core of all this is your natural gift of adaptation. It combines a kind of superpower and a defense mechanism that have evolved over billions of years through a practically infinite amount of trial and error. This book introduces you to this ability and offers pointers for how to put it into action.

As you go through the book, we introduce you to your lesser-known senses and ask you questions that have a highly sophisticated predictive power, including one that could predict your prospects of living or losing 20 years of life.

We also give you words to decode, describe, and deal with practically any challenge to your health in a wide range of contexts, regardless of your cultural background or socioeconomic circumstances, all based on scientific evidence.

We will show you trees that heal, pills that are labeled as fake but still work, how big cities are the best places for living past 100 years old, and why making comparisons between you and your peers can kill you.

You will learn that as much as the traditional medical system can save lives, it can also be a hotbed of lethal threats. Recognizing that it offers 10 percent of what you need to feel healthy, we provide evidence about whether, how, and when to use it, while showing you how to get the best possible results and avoid being harmed. We will peek behind many curtains and give you access to places that are traditionally reserved for insiders.

To start, we want to bring you into an exclusive room where world leaders once gathered, unaware that they were playing a part in a greater story.

WE GOT IT ALL WRONG

Do you know anyone who has never been to the doctor, not even as a child? How many of the people in your life have back pain, depression, high blood pressure, diabetes, or cancer? The answers to these questions illustrate a problematic situation: It is practically impossible to live a life free of illness or disease.

At first glance, it seems like there is no escape. If absence of disease is a prerequisite for being healthy, then we are set up to fail. Regardless of what we do, how much we exercise or meditate, or how well we sleep or eat, it is impossible to have a disease-free life.

If the absence of disease is the cornerstone of what qualifies as health, then we are stuck with an impossible mission. A long and healthy life is completely out of reach for every single person on the planet. Indeed, this was the case up until 2008.

The Shake-Up

The temptation was irresistible. Hundreds of the most prominent leaders from the healthcare sector, including dozens of ministers of health, ministers of finance, ambassadors, and investors from across the planet, were assembled in a magnificent eastern European concert hall that had been turned into an elegant conference venue for a meeting held in June 2008. The agenda, which was specifically focused on the impact of health systems on people’s health, had just been interrupted to celebrate the 60th anniversary of the World Health Organization (WHO).

A microphone was being used by participants to express their appreciation of and gratitude for the first institution to garner the support of all members of the United Nations. The WHO was established following World War II as a way to showcase, naïvely, how generous and caring humans could be toward one another.

As Alex approached the microphone, he could remember how disturbed he had felt a few months earlier by a question he had been asking himself persistently. It had come to him while he was recovering from an awful medical test that had finally ruled out a diagnosis of colon cancer. This was the same question he was about to ask the entire room. It was perhaps the one for which he should have had an answer, especially given that he had been either a student, physician, or professor at some of the top medical schools in the world during the past 30 years.

When he reached the microphone, he looked at the audience, paused, and asked: What is health?

The audience’s surprise quickly turned into nervous murmuring. The moderator was clearly unsettled by the change in mood. Seizing the opportunity, and using an even more emphatic tone, Alex then asked: "What do we mean by health?"

The room went quiet. He waited in silence. After a few more seconds, someone stood up and said something like: Doctor Jadad, the definition of health appears at the beginning of the constitution of the very institution whose 60th birthday we are celebrating today! Then the man proceeded to recite the statement that Alex had learned as a very young medical student and that had remained unchanged for six decades: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Following an intentionally long pause, Alex replied with a question to everyone in the room that revealed the true intention of his inquiry: "Could you please raise your hand if you have complete physical, mental, and social well-being?"

After a few moments of self-evaluation, only one hand went up. Just one, out of thousands.

Looking at the single respondent, Alex noted that this person was the perfect exemplar; a gift for making his vital point. Alex said: Impossible! You are wearing glasses. You have at least one eye disease.

All the moderator could say was: Thanks for such interesting questions.

After the session, a colleague approached Alex and said: You normally throw grenades at our meetings. That was a nuclear bomb!

A Justified War

How could a definition of health that condemns most people to be not healthy have been proposed in the first place? Requiring a state of complete physical, mental, and social well-being and not just the absence of disease disqualifies most people from being considered healthy. Just by having dental cavities (which occur in almost 100 percent of adults), by feeling tired or hungry, by worrying about a loved one, or by being concerned about debt or an exam, you would not be considered healthy according to this definition.

What could have possibly motivated all members of the United Nations to endorse such a view of health? An easy answer is that the WHO definition should be regarded as an aspirational gesture. It could have been inspired by the strong sense of optimism that followed the Second World War. Yet another possibility is that the definition was driven, from the beginning, by an interest in the expansion of medicine into all aspects of life.

Regardless of the initial motivation behind it, this definition of health acted as a nod of approval, an open door, to advocates of a new global war—one that was desirable and just. This war would be fought by medical professionals as its soldiers, armed with weapons created by science, produced by factories, and deployed in institutions. It would be known as the war against disease.

The motivation of humanity to choose this path was justified, to a large extent, by a major breakthrough: the mass production of penicillin by pharmaceutical companies in the US. The use of penicillin saved at least 100,000 Allied lives during the 11 months that separated D-Day from the final German surrender. Factory-produced penicillin provided solid evidence, for the first time in history, that industrialized scientific innovation could control infections. This achievement was the first clear example of the power of combining biology and the industrial process to conquer death on a large scale. And not just any kind of death: the main cause of human death since time immemorial. At that time, worldwide life expectancy was around 45 years of age, and practically everybody knew someone who had died of blood poisoning, caused by something as minor as a splinter or a sore throat.

The allure of penicillin, known as the miracle drug, made it easy for the public to believe that if it was possible to defeat the most common killer, it would be even easier to eliminate all of the other threats to human well-being. As a result, most industrialized countries started to increase their expenditures on budding healthcare systems, building hospitals and equipping them with the latest technological developments. Simultaneously, university-trained physicians became the dominant group of service providers, gaining exclusive control over the prescription of drugs and medical devices and the performance of surgical procedures.

By the end of the 20th century, this turn of events seemed more than justified. Medicine had successfully come up with effective ways to diagnose and repair important damage to body parts, particularly damage caused by trauma or infection. It also had succeeded in transforming many diseases that were regarded as lethal, such as diabetes and cancer, into manageable chronic conditions. Nevertheless, these gains came with consequences.

As people around the world became increasingly seduced by the promise of industrialized science to find cures for all diseases and to make a state of complete…well-being possible, medicine began to take over more and more aspects of everyday life. By the time the WHO celebrated its 60th birthday, the medical establishment had almost complete dominion over all matters related to health and illness, with its influence extending from before birth to after death. At that point, pregnancy, a natural physiological process that for centuries had been considered a normal part of family life, began to be considered a clinical condition that should be under the full control of the medical profession. As a consequence, the body of a pregnant woman became construed as uncontrollable, uncontained, unbounded, unruly, leaky and wayward. At the other end of the spectrum of a human life, major discussions were taking place around another issue that had been regarded as normal: mourning after the death of a loved one. There were battles about whether it should be diagnosed as major depression. In the end, those who supported this medicalized view won. Subsequently, many people who were grieving became eligible to join the growing number of individuals receiving psychiatric medications.

This expansion of medicine into all aspects of life managed to reduce a large amount of suffering and even eradicate common diseases like smallpox, while simultaneously creating new ones. These accomplishments motivated and fed the growth of a medical industrial complex, resulting in a large gain in political and economic power for those behind it. At the turn of the 21st century, this complex was consuming 10 percent of the combined GDP of the world and was feeding a vast network of pharmaceutical companies, manufacturers of medical devices, insurers, clinical institutions, and educational programs supplying products and services for a profit.

As acute diseases were being cured, chronic conditions emerged as the main targets of medical warriors. These fighters needed to acquire progressively greater levels of specialization and increasingly costly and complex weapons. This had an effect on the financial margins for investors and heightened the risk of conflict between public and private interests. The financial requirement to feed the obsessive pursuit of cures for chronic diseases led to the cannibalization or neglect of other activities. Today, the most advanced economies spend, consistently, less than 3 percent of their healthcare budgets on prevention, with most of their remaining resources going toward funding ineffective or weak treatments.

Before long, it became clear that throwing more money into the medical industrial complex was unlikely to yield new victories. The situation in the US, the country that spends the greatest amount on disease care services in the world, indicates that the opposite might be true. Report after report, over the years, has shown that Americans have the shortest life expectancy and the highest maternal and infant mortality rates as compared with other high-income nations.

The relentless investment of financial resources to fund the war against disease also highlighted a terrifying possibility, which has remained largely hidden from view: Medicine itself might have become the main cause of preventable deaths. In the US, perhaps the only country for which data have been collected, this seems to be the case. An understandably controversial report published in 2005 estimated that deaths by medicine—or the number of deaths caused by medical errors, complications from medical procedures, and adverse effects of medications—could have ranged from 780,000 to 1 million in 1999. This number is equivalent to seven full passenger jets crashing every day and exceeds by far the number of people who died of heart disease or cancer that year. Since then, medical errors and adverse effects of drugs have been ranked as the third and fourth causes of overall mortality in the country, year after year. When these two sources of mortality are added together, the number of preventable deaths they cause annually surpasses the number of American soldiers who died during the Second World War.

All these disturbing facts lead to two key questions: What needs to change? Is there a practical way to begin?

A Global Overhaul

The answer to both questions emerged just a few weeks after the 60th anniversary of the WHO: A new definition of health was needed.

It was clear that the new version could not rely on the same premises as the original one. Two foundational elements of that definition condemned us all to the ranks of the non-healthy. The first was that no one can have complete physical, mental, and social well-being. The second was that it is impossible to live a life absent of any disease.

Given that this new definition would have a significant impact on the life of every human being, an invitation to the entire world was issued in December 2008. The invitation was to create a new definition of health, together.

A global conversation was launched. Everyone was able to make any contribution they deemed appropriate. With the original WHO definition as the starting point, anyone could propose amendments or alternatives, challenge what was emerging, or suggest ways to enhance it.

The response was overwhelmingly positive. In the first six months, more than a thousand contributions were received from physicians, nurses, managers, researchers, policy makers, community leaders, patients, and other members of the public from more than 50 countries. As the comments were collated, it was very stimulating to see validation of the criticisms of the WHO definition, as well as references to efforts made over the ages to capture the meaning of health and suggestions to replace it.

This response motivated leaders to call a summit in The Hague in 2009. Alex joined inspired contributors to the global conversation, longtime critics of the WHO definition, and the host team to take this effort to the next level. During the gathering, they focused on distilling the main insights collected during the previous year. Their common objective was to transform these insights into something that would be clear, useful, and actionable by anyone, anywhere.

By the end of the meeting, there was a breakthrough. The combination of diverse views and backgrounds had paid off.

The feat of creating a new definition was accomplished through a double maneuver. First, rather than a state, which is fragile and rigid, health should be viewed as an ability. From this perspective, it is something that you can learn, improve, assess, and monitor.

Second, instead of focusing on the unattainable goal of the absence of disease, the new concept of health is directed at something that sets you up for success across various situations and times: adaptability. By consensus, the updated definition of health does not include the words complete or disease.

Taken all together, health can now be defined as:

The ability of individuals or communities to adapt to the inevitable physical, mental, and social challenges faced throughout life.

This fundamental shift marked the beginning of a radically new way for you to make choices and to navigate the medical space, opening new possibilities for you to be healthy, no matter what.

HOW ARE YOU FEELING?

Being healthy is like having a relationship with a loved one whom you have taken for granted, left in the background, and pushed down from the top of your priority list, often because of work and procrastination. When the bond is in jeopardy or gone, it brings a lot of suffering, with multiple regrets at the core, mostly coming from what could have been done and said but was not. Losing a relationship with someone special in your life is something you can likely relate to because of your own past experiences or those of others close to you.

When it comes to your health, how much do you think you would regret neglecting it? What if you knew that taking just 10 seconds to answer a question about how healthy you feel could point to your prospects of living or losing 20 years of life?

By the late 1990s, studies from 12 countries had already shown that just feeling that you are not healthy could actually result in your dying sooner than expected. Since then, hundreds of studies from all over the world have