I really don’t like old movies. Any film before say, 1995, and it’s going to be hard to get me to watch it. The special effects are bad, lighting isn’t as good, pixels aren’t as sharp. It’s just bleh.
While movies are my “screw old things” arena, we all have something of this nature. Particularly with the digital revolution, it seems more and more has to be new and now. Yesterday is old. The person who, a week after their iPhone 6 is purchased, is already wondering when the next one will be out. The guy who leases cars because he can’t stand his car model to be less than the year in which is he living. And let’s not even start with how long women are entertained by a new pair of shoes. (I’d say about a half hour into wearing them.)
This is never ending. The next thing is always right around the corner. The rumors are constant, the talking heads always predicting, the neurosis of missing out on something. New is exhausting.
One gets in this cycle that what’s new must be better. What’s old mustn’t be relevant anymore. A perfect example of this is the 24 hours news cycle. When you have to cover news 24 hours a day, there is only so much you can bleed out of one story. Often, it’s not even a day’s worth. Once you’re done blood letting, it’s on to the next thing. Yet so often nothing meaningful gets accomplished. Should Roger Goodell have a job? Did he lie? We need a “conversation” about domestic violence…Just like we needed a conversation about race, police power, police brutality and more due to #FergusonMissouri. Or guns and mental illness after #SandyHook. But wasn’t there that Columbine thing? (When hashtags didn’t exist.) New can be deluding and diluting.
Look at healthcare. Everyone wants the most recent, innovative, (purported to be) ground breaking procedure. Every doctor is on the “cutting edge.” I know because their office pamphlets tell me so. You can see inside my body using a machine that makes a magnetic field stronger than the earth’s, which aligns all my hydrogen atoms, helping to form an image of the inside of my body? Let’s do that. It must help, even if that’s thousands of dollars more than a simple physical exam. As we push the limits further and further, more time, effort and resources are often needed. New can be expensive.
If new was always better, then alright. But new isn’t always better. MRIs don’t necessarily improve patient outcomes. They often lead to unnecessary costs, unnecessary surgery, and over-treatment. (Other imaging techniques can lead to cancer.) You often don’t know what the unintended consequences are until you’re in the midst of them. New is untested.
However, the things that have been around a while, they’re not only relevant, they’re more relevant. If something sticks around, it’s for a reason. It’s probably not too expensive, and it’s tested.
It reminds me of a business philosophy I enjoy. I saw Jason Fried talk about this, and it was some advice given to him by Jeff Bezos (CEO of Amazon). “Focus on the things that don’t change.” “Find the things that don’t go out of style.” For Amazon, they love to focus on quicker shipping. None of their customers are going to wake up tomorrow and say, “Man, I really wish my package got here slower.”
For Fried, who works on web based software, his company focuses on customer support. None of their customers are going to wake up tomorrow, or in ten years, and say, “I wish my tech support email was taken care of more slowly. I wish the service rep had less time to talk to me.” They also make a point to improve how quickly their software operates. If it comes down to making an app for the newest phone or focusing on making their software faster, they go with the latter. There could be a new phone or device next week; there won’t be a “we need slower software” mentality next week. [1]
When it comes to health, I like to apply the same mentality. What treatments or modalities can we use that have been around for a long time? This can help bring us back down to earth. Give us solace. Rather than the never ending journey for new treatments, new information, endless Google searches for some radioactive, space age technique, what about examining things that have lasted through all these technological shifts?
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Origins of health science
As far as we know, biomedical science started ~3,000 years ago in Mesopotamia and Egypt. According to Ken Saladin’s Anatomy & Physiology, they “treated patients with herbal drugs, salts, physical therapy, and faith healing.”
About 600 years later (~400 BC), our first scientific physician, Hippocrates, wrote ‘‘eating alone will not keep a man well; he must also take exercise. For food and exercise work together to produce health.” “The preservation of health depends on abstaining from satiation and abandoning the disinclination to exertion.”
Five hundred years later, a physician named Claudius Galen took medicine to another level.
“Galen, who borrowed much from Hippocrates to arrive at his own significant contributions to medicine, structured his medical ‘‘theory’’ around the ‘‘naturals’’ (of, or with nature – physiology), the ‘‘nonnaturals’’ (things not innate – health), and the ‘‘contra-naturals’’ (against nature – pathology). Central to this theory was health and the uses and abuses of the ‘‘six things nonnatural:”
1) air,
2) food and drink (diet),
3) sleep and waking,
4) motion (exercise) and rest,
5) excretions and retentions, and
6) passions of the mind.
If the nonnaturals were observed and practiced in moderation, health would be the result. But if not followed, performed in excess, or put into imbalance, disease or illness would result.”
(References at end.)
One of the next prominent physicians, Maimonides, wrote in the year 1198:
“If man were to conduct himself as he manages the animal he rides, he would be safeguarded from many ailments…Yet he himself eats indiscriminately, without measure. Moreover, he takes into consideration the activity of his animal and exercises her, so that she does not stand still forever and be ruined. Yet he does not do this for himself, or pay attention to the exercise of his own body, which is the cornerstone of the conservation of health and the avoidance of most ailments.”
I think we get where this is going. From the inception of medicine -our earliest records- to modern day practice, history is littered with a few themes. Two of the most prominent being watch what you eat and move a lot.
I was initially surprised when I realized nearly 100 years ago a guy named C.H. McCloy wrote a paper, “How about some muscle?” essentially pleading for exercise to come back in vogue. To reiterate, that was written almost a century ago. When you step even further back, you realize health practitioners have been harping on this for thousands of years. It’s one of the few things there is not only contemporary universal agreement on, but agreement throughout medical history.
What other treatment or health modality can you say this about? If we consider exercise and getting people to eat less a technological innovation, what other technology is on the same level? I don’t mean health, I mean anything. You have to look at the utmost basic. Fire, the wheel, clothing, language…good categories to be a part of!
We have not shown any inclination these basic principles of health, move and watch what you consume, are going to get supplanted. If anything, they are coming back into vogue stronger than ever. Yes, there is that thing called a Black Swan. Where just because things have gone a certain way does not guarantee they will continue to do so. (Don’t bet on the future solely based on the past.) Much like Jeff Bezos isn’t betting on a Black Swan of “Eh, people will one day not care about shipping speed,” I don’t think I’d bet on “One day I’ll be able to eat whatever I want and be fine.” Hell, even the guy who invented the Black Swan theory – Nicholas Taleb- exercises and worries about what he consumes. (His specific health advice isn’t all that great, but that’s a different matter.)
We used to think the Gods gave us diseases; the Ancient Egyptians used mashed up dead mice as a paste for toothaches, much of Galen’s recommendations were based on dissections of pigs and monkeys, Maimonides thought fruit was bad. It’s only 50 years ago doctors were recommending smoking. And up until maybe 15 years ago, we used to think the brain was non-malleable.
We should not hold everything physicians say and have said as gospel. (I could easily see someone making a case for physicians, throughout history, on average, doing more harm than good.) We should instead look for the similarities. So many treatments have come and gone. So many will come and go. But for thousands of years some tenets have stuck around. Worry about how much you consume and how much you move. [2] Technology is moving faster than it ever has. Many more “game changers” are going to be on CNN, Fox, and the Huffington Post. They will be alluring. As you hear, see and read about them each day, smile knowing you’re investing in the things that won’t be obsolete. That you’re engaging in things you know work. Things that aren’t as expensive. Things that aren’t new.
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Some of the information and quotes above can be found from the paper Exercise is Medicine: A Historical Perspective and essay Moses Maimonides: Regimen of Health. [1′]
[1] I recognize the irony here: With something like Amazon, they may very well implement new procedures or techniques in order to accomplish quicker shipping. The principle, not the method, is the point. Drones for delivery? Fantastic => New method of delivery; same principle of quicker delivery.
(With healthcare, you may do something like focus on making a physical exam better, opposed to chasing after new imaging techniques.)
I want to also mention Jason and his company Basecamp recently launched an online magazine called The Distance. The focus of the magazine is to profile businesses that have been around 25 years or more.
And then here is Fried discussing his relationship with Bezos, as well as this principle:
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[2] To be specific:
- Shoot for 10,000 steps per day. That’s roughly 100 minutes of steps per day, or five miles.
- Whatever is a healthy bodyweight for you, take that weight, multiply it by 15, and eat that many calories each day. (Example: 150lbs x 15 = 2250 calories per day.)
[1′] For our footnote within a footnotes: In reading Maimonides’ treatise on The Regimen of Health, he writes repeatedly about all these various concoctions. Mix this with that, that with this, use this ingredient, that ingredient. It sounded eerily similar to what contemporary medicine does with drugs. Part of me thinks in three thousand years of doing this, maybe we’ve hit a ceiling with how far that approach can take us. That as much as I look back and read his work and go, “Christ, this is such primitive thinking” that we’ll look back on ourselves now and go, “Geez, remember trying to use drugs to make people healthy? Such a silly idea.” With the amount of time and money that’s been poured into something like a (safe) weight-loss pill, that still hasn’t come to fruition, perhaps it’s not possible.
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Posted on September 17, 2014