Dare to Be 100: Actual Causes of Death

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I proclaim, again, that the most significant scientific paper that has been published during my long science career is this one. Of the millions generated globally, of the many thousands that I have read personally this paper by Mike McGinnis and Bill Foege in JAMA, 1993 is extraordinary (1). It simply states that the millions of signatures on the world's death certificates are all wrong. Cancer doesn't kill you, heart disease doesn't kill you, diabetes doesn't kill you, what kills you is the antecedent behavior that you have done to cause this pathology that shows up after the fact.
The implication of this is immense.

The Medical Industrial Complex pays no attention because it is so busy getting rich providing pills and surgery and devices that it cannot address the ultimate issue which is behavior change. We don't die, we kill ourselves. But there is no pill for behavior change or operation or device. If there is no market it doesn't seem to get done.

Take cigarettes. Millions of unsuspecting persons have been spared the horror of dying because of their smoking obsession. They are now chuckling in the avoidance of their otherwise fore-doomed existence. True, industry has addressed smoking through patches and pills, but I have not yet heard of anyone suggesting anyone proposing finger amputation as the answer to smoking habituation. Millions of lives are now saved by not smoking. However, America does delight in supplying the Third World with these stalks of death, shameful!

My acknowledged obsession is with physical activity which I believe to be the panacea that we seek. How do we get people to move more? The editors of a major finance journal called me and asked my opinion whether the popular activity monitors are doing any public health good. My answer was prosaic in asserting that if they can assist in encouraging a more active lifestyle that is a value. But the truth of course is that most of them are consigned to the bedside drawer and languish there. Certainly our epidemic of obesity smirches our intelligence. Can step counters counter obesity? You answer.

Another of my concerns involves arthritis which is nearly epidemic in us older folk. This approaches tragedy proportions in that when we are in joint distress we tend to move less, and this makes us at risk for all of the subsequent deteriorations that accompany inactivity. In my book Next Medicine I made the suggestion for the creation of a new medical subspecialty called Preventive Orthopedics. As things stand now this is an oxymoron. There is no prevention in orthopedics. It's all about repair either surgical or pharmacologic.

But what about not getting arthritis in the first place? Arthritis is very much a predictable end product of mechanical dysfunction. This should be identified and rectified early in life and cheaply, and save the millions and millions of dollars that derive because of inactivity.But there is no money in prevention. Zimmerman's law asserts that "no one notices when things go right." This is the mantra of the Medical Industrial Complex.

So McGinness and Foege's article is the capstone of my argument. Pay attention to the first principles of health. And don't get sick in the first place.

McGinnis JM , Foege W Actual Causes of Death JAMA 1993 270:2207-2212.