Читать книгу Live right, live longer - Ludwig Heinz - Страница 7

When people ask me as an oncologist, cancer researcher and hematologist, what they can do not to get sick in the first place, I sometimes think of Martha Allen and Robert Tucker. I cannot say whether Martha Allen would have lived so long if her love and concern for her daughter had not compelled her to set those goals for herself. I also cannot say for sure whether Robert Tucker’s bout with cancer would have ended differently had there been friends and family in his life who had stood by him, supported him and cared for his needs, and, when the end did come, to whom he could have said goodbye. Nevertheless, these two outcomes stand for one of the five things that I always enumerate for those who want to take the maintenance of their health into their own hands and contribute to it to the extent possible. Mrs. Allen and Mr. Tucker are examples of the importance of being integrated into a social network, of the value of close human relationships, of the profound effects of loving as well as of being seen and loved for who we are. Our experiences in this connection can have not only healing effects on our mind and spirit but also enormous influence on our body.

Usually patients consult me when they are already ill and not at a point in time when they are still in good health and should be dealing with the question of how to stay that way. It is human nature not to concern ourselves much with our health as long as we have it. We push thoughts of illness aside and do not consult a doctor until we absolutely need to. This often has negative consequences, inasmuch as many illnesses could be prevented that are difficult to reverse once the characteristic symptoms of the disease have appeared.

Because the possibilities of preventive medicine have become a subject of discussion in schools and the media, and because of the efforts of the national health agencies and physicians’ organizations, more and more people are asking themselves what they can do to stay healthy. The awareness of one’s responsibility for one’s own health is growing steadily. This is certainly a welcome development, but it has a problematic aspect, and that aspect is the role of the media.

The amount of information that is in part contradictory and not scientifically founded is also growing, made available to us especially through the internet, and accepted by large parts of the population. This will probably also be the case in the foreseeable future. When the subject is popular and likely to stimulate the human desire for magic or for extraordinary healing power, certain members of the media can make incorrect information public, sometimes because of sloppiness, but more often with a scandal-mongering intent, to maintain circulation, or the number of times accessed, or to attract listeners or viewers.

Thus, society should demand a greater sense of responsibility and the pledge of careful background research. Particularly in medicine, unrealistic claims can create an enormous amount of uncertainty, unrealistic hopes and expectations, which raises the question of whether severe transgressions should be liable to appropriate consequences.

People turn to me as an oncologist in order to discuss, among other things, preventive measures and/or how and which cancers to screen for. During these conversations, it becomes clear that people are unsettled by the anxiety-producing and often contradictory information about cancer, which maintains that there is a generally increasing threat of developing it. This, so stated, is not correct. The risk of developing cancer and dying from it has declined steadily over the past 25 years,¹ but the overall number of cancer cases is rising. This is due to increasing life expectancy, since cancer is for the most part an illness of older persons, and the population, not only in Western countries, is getting older.

Some forms of cancer, such as stomach cancer, have recently become less frequent, whereas others, such as lung cancer, are more frequent. The reduced frequency of stomach cancer presumably has to do with the improved quality of food. Let’s take Europe. In the years immediately after the Second World War, the luxury that today’s throw-away society allows itself was unthinkable.

At the time, many people ate moldy or otherwise spoiled bread when there was nothing else available. They also ate other food that was spoiled simply because the refrigeration was not as good as it is today. The ice man brought ice in blocks to keep food cool in the icebox (in the U.S., too) until the ice melted and had to be replaced, and there was no such thing as a use-by or best-before date on the packaging. Luckily, much has changed since then. Eating moldy and otherwise spoiled food increases the risk of developing stomach cancer, as does the consumption of cured meat, which back then was usual and frequent.

In contrast, lung cancer has become more frequent. This is a result of the fact that more women are smoking than ever before. I do understand it when, for example, people who have to deal with considerable stress find relief in smoking: Besides smoking’s innumerable negative effects on the body, there are also positive effects. It reduces the experience of stress, strengthens cardiovascular activity, makes one more alert, lifts one’s spirits, and encourages communication. We would have to invent something that has the same positive effects as smoking without at the same time harming the body. The connection between smoking and the increased risk of cancer, not only of the lung, has been proven beyond any doubt by the cancer research of recent decades.

Nonetheless, far fewer people die of cancer than of cardiovascular disease, which results from the high frequency of hypertension, high levels of blood fats, and overweight. Another reason for the difference lies in the progress made in cancer treatments. In a number of forms of cancer it has been possible to find a cure or to transform the cancer from a fatal to a chronic illness.

We expect further rapid progress, to which the correction of defects in the steering mechanism of cancer cells as well as immunotherapy and cell therapy will contribute. This rapid progress will, in addition, be supported by the new quality of data processing, which can be summed up in the concept of big-data mining.

Still, the question of what each and every one of us can do personally to stay healthy is of major relevance. Certainly, there are factors in all illnesses on which we have little or no influence, as, for example, our genetic makeup or environmental factors, which I will go into in the course of the book. There are also factors, however, that we can very well influence. We have available to us a range of actions we can take, and we would do well to take them. It sometimes depresses me to see how people irresponsibly do without the knowledge that is available, either because they haven’t made the effort to look for it or because they ignore it when they do have it.

I started thinking in a more systematic fashion about the actions that are available to us, because patients frequently asked me what they themselves could do beyond the proposed treatment. It became clear to me that there were, in fact, different things they could do to support the medical treatment and thereby improve their prognosis and their quality of life. At that point, I started looking at the scientific basis for the different activities that came under consideration. And right then and at the very top of the list of meaningful activities I wrote the word »Love«. Inspired by cases such as those of Martha Allen and Robert Tucker, I mean not only love between two persons but rather the entire scope of our interpersonal relationships and our social integration, and in addition, our love of and devotion to a given task, to our work, or to a hobby.

In the course of time, my list of sensible activities grew, without at the same time getting out of hand. That is because the list can basically be reduced to five elements that I not only warmly recommend to my patients but also suggest to healthy individuals as life maxims. The things that patients can do to regain their health or at least to improve their prognosis are the same as those that the healthy can do to stay healthy.

These five activities can be deduced from many scientific studies that are often very comprehensive, carried out by physicians all over the world. Their results are in conformity with my own observations and insights. Therefore, these five activities mirror the current state of scientific knowledge as well as my personal experiences in patient treatment, from which I have for a long time been continually and systematically drawing my conclusions.

I have always asked myself what it is that makes us the persons we are. How important are our genetic makeup, our life experiences, our surroundings?

When I was studying, immunology was considered the most promising medical research area, comparable today to molecular biology or modern genetics. I wanted then to know more about the biological and biochemical fundamentals of our bodily defenses against pathogens such as bacteria, viruses and fungi. I was also particularly interested in the so-called autoimmune diseases, in which our own bodily defense system turns against components of our organism. How does this system, whose central task it is to keep us healthy, function? What strengthens it and what weakens it?

At the time, these fundamental questions were an enormous field that was barely researched. That spoke to my ambitions and my curiosity. I therefore applied for a research assistantship at the Vienna Institute of Immunology, which had shortly before been founded as the first German-language institute in this field.

I was accepted. After having familiarized myself thoroughly with the scientific method, I was very soon given projects of my own. Three years later I was ready to start my clinical training in internal medicine. At the time there were two university departments for internal medicine that were in competition with each other. That can be good, of course, since competition is stimulating.

A question at the time was whether type-1 diabetes (the form in which little or no insulin is produced and which usually develops in childhood) was the result of a viral infection with a subsequent autoimmune reaction. Having learned at the Institute of Immunology a variety of then modern research techniques, I was of interest to both departments. In consequence, I had the privilege at the age of 27 of being able to make the choice myself.

Because it is directly connected with the message of this book, I describe in the following how I made my decision. Before my interview in the first of the two departments, the secretary of the department head asked me, »How much time do you need? Five minutes… or ten?« That bothered me rather a lot. But in the conversation itself I sensed that the department worked very efficiently and professionally. That impressed me. But because I wanted to be able to compare, I also applied to the other department. The physician responsible for recruitment of medical staff greeted me in friendly fashion. He explained his research area and also touched on the organization of the department. In the end, he gave me half an hour of his time.

Both departments were very promising. But I made my decision not on the basis of the scientific activities and clinical successes of either department – and in any event, I didn’t know what they were in detail. Rather, and without having thought the issue through to the end, it seemed to me even then that the interpersonal aspect, which will be covered more fully later in this book, was more important. The head of the first department might have been the better scientist, but the conversation in the second department, which I experienced as friendly and interested, motivated my choice.

That was the beginning of my clinical career, in which I later specialized in oncology and hematology while doing cancer research. Since then I have been able to accompany, treat, and support many patients like Martha Allen and Robert Tucker with cancer and other serious illnesses. I have experienced how individual patients deal with the cancer diagnosis and the burdens associated with it, how they fight to regain their health, or how they come out of it healed but with the fear of relapse or of late consequences as unloved companions, or how they lose the fight and die of the disease.

On my list of recommendations for patients there were originally four entries. I made a point of having them all start with the letter »L« as in »Love«, so they might be easily remembered.

Loving

Laughter

Learning

Lifelong fitness

The list was well received just on the basis of the speech rhythm, but it clearly compressed the recommendations for which the words stood. In »Love« I include, as I have mentioned, the entire area of social integration and passion for a given task. With »Laughter« I mean the entire range of humor, a positive view of life, and contentment. With »Learning« I mean the conscious use of and training of our cognitive abilities. And with »Lifelong fitness« physical activity altogether.

Finally, my four L-concepts were joined by a fifth, of which I had long assumed that it was surely already sufficiently anchored in the heads of most people – until I realized that particularly in this case there were quite a lot of misunderstandings. The issue is how we nourish ourselves, and I had to make a bit of an effort to get this point into an L-concept. What resulted was:

Lighter eating

So – Loving, Laughter, Learning, Lifelong fitness, Lighter eating. Those are the five things we can practice in order to stay healthy. They are fundamental to our humanity, they pervade our entire life, and they influence our physical as well as our mental health, as I will show in the following chapters. I am writing these chapters not with the purpose of producing a book of advice that will guarantee a healthy life to everyone who follows it blindly. That, of course, is impossible because we do not have an unlimited range of action in our efforts to stay healthy. Additionally, I believe that the success of such books depends importantly on their readers and their ability actually to integrate the respective recommendations into their lives. I myself bought a book of advice once. Its title was Don’t Say Yes When You Want to Say No.² It was meant for people like me who have problems with refusing someone a favor. I’m not entirely sure that I succeed in the meanwhile in saying »No« when I really ought to, and, if I do, what role this book of advice played in that success. I would say that I have in any event been made more aware of the problem and possible solutions.

Should I succeed with this book in making the reader more aware of the problems and possible solutions in matters of health, then I would be satisfied for a start. The five things that we can do in order to stay healthy basically constitute a plan for a fulfilled life – a plan that we possibly already have at the back of our minds, but the realization of which is all too often sabotaged by our habits, our going along thoughtlessly with the mainstream, or simply our inherent laziness. But it is a plan that can only do us good when followed even for a short distance.