The gorilla in the room
Update: In a peer-reviewed study in BMJ Public Health on July 16, researchers underlined the importance of cardiovascular fitness by reporting people who regularly commute by bicycle face a 51 percent lower chance of dying from cancer along with a 47 percent lower risk of death from any cause.
Original story: The American Cancer Society is out with a new study reporting nearly half of U.S. cancer deaths could be prevented by lifestyle changes, but the doctors involved in the study just couldn’t bring themselves to highlight the most needed change.
As with most of the medical community in this country, they chose to ignore the overwhelming data documenting “exercise is medicine” because, for whatever reason, few in the medical community want to admit to or confront the nation’s pandemic of sloth.
Instead, the report published in “CA: A Cancer Journal for Clinicians,” the self-proclaimed “flagship journal of the American Cancer Society,” played up the now well-known and easily identifiable causes of cancer and played down the giant confounder stalking the world of medicine.
But wait, what do we know about exercise, smoking and cancer? According to a study published five years ago in the peer-reviewed American Journal of Preventative Medicine, we know this:
The study suggested cancer deaths among smokers could be drastically reduced by improving the basic physical fitness of smokers.
Meanwhile, the connection between “excess body weight,” or what is commonly called obesity, and fitness has long been known. A study on the “Relationship Between Low Cardiorespiratory Fitness and Mortality in Normal-Weight, Overweight, and Obese Men” published by the JAMA Network 15 years ago spelled this out clearly:
That latter 44 percent would include many, if not most, of the “excess body weight” individuals identified in the latest cancer study.
And then there is alcohol. What do we know about alcohol and exercise? Well, in that case there was a peer-reviewed study published in the British Journal of Sports Medicine in 2017 reporting this result:
A mile walk to the office each morning at 3 to 4 mph coupled to a walk home after work would produce 200 to 150 minutes per week, but most Americans these days probably don’t walk 10 miles in a month.
How can this be missed?
The data pointing to the declines in American health due to lack of exercise and the ripple effects across the spectrum of medicine is so overwhelming it seems almost impossible to believe anyone could miss it, but the cancer study mentions “physical activity” only to rank it as “the sixth largest contributor to total cancer cases in men (1.8 percent) and the fourth largest contributor in women (3.7 percent).”
That is if you don’t consider the tens of thousands of smokers who’d have avoided or survived lung cancers if they’d been fit, and the likely well more than 100,000 cases of cancer in general that would have been avoided if Americans took their daily dose of exercise medicine.
The study does concede that “the population-attributable fraction (PAF) for a combination of excess body weight, alcohol consumption, dietary factors, and physical inactivity was 15.3 percent in men (second to a combination of cigarette and second-hand smoke, 23.1 percent) and 22.5 percent in women (followed by a combination of cigarette and second-hand smoke, 16.1 percent).”
The combination of excess body weight, alcohol consumption, dietary factors and physical activity would describe a significant share of American males sitting around watching National Football League (NFL) games on any given Sunday in this country from August to the start of February.
Why the percentage of women is so high is harder to determine, but ignore that. We can probably instead celebrate the ability of the mainstream media both right and left to agree upon the meaning of the latest study: alcohol has joined cigarettes as a cancer bogeyman.
They are to be excused. Most of the people described as journalists these days are stenographers who write down whatever they are told by someone who looks or sounds official, and many of them are scientifically illiterate.
Don’t get me wrong here either. This is not an endorsement of smoking or drinking. If you are seriously engaged in either, quit or at least scale it back. But the reality is that the risks of these lifestyle factors pale compared to the risks of the bigger issue the medical community refuses to confront.
Even if the country banned cigarettes, alcohol and unhealthy food, and then put all the overweight people on weight loss drugs, there would still be the “physical activity” deficit so well illustrated by the 21st Century pandemic of the unfit.
Some of this was because Covid-19 weighed so heavily on the elderly, who have immune systems starting to fade due to age among both the fit and unfit, but there is solid evidence that fitness can slow this process of what is called immunosenescence.
Anyone who has been paying attention should by now be well familiar with the importance of T cells in helping the body fight off the SARS-CoV-2 virus. And fit people have T cells that are in better shape than those of the unfit.
T cells also help fight cancer, and their “fitness” has become a serious focus of scientific researchers in recent years.
Anyone can get cancer, and anyone who has cancer can end up with exhausted T cells. But the researchers said there are “metabolic factors” involved, and we have learned a lot about “metabolic factors” over the course of the last two decades thanks to a lot of research into the health problems associated with the obese.
“The obesity epidemic has forced us to evaluate the role of inflammation in the health complications of obesity,” according to the Journal of Clinical Investigation. “This has led to a convergence of the fields of immunology and nutrient physiology and the understanding that they are inextricably linked. The reframing of obesity as an inflammatory condition has had a wide impact on our conceptualization of obesity-associated diseases.
“The burden of obesity on health extends across multiple organ systems and diseases. While its impact on tissues involved in nutrient regulation is manifest in the development of insulin resistance and type 2 diabetes, there are also unexpected connections between obesity and the risk of cancer and pulmonary diseases.”
Real world
But let’s now emerge from down in the weeds of human physiology and look at what has been happening with cancer in this country in the past 50 years. The good news, the very good news, is that the death rate has fallen steadily since the early-1990s and remarkably so.
Nearly all of this, however, can be attributed to better treatments rather than lifestyle changes because the rate of new cases has remained almost steady throughout this period and remains higher than in 1975 when it stood at 400.32 per 100,000.
The rate was 448.95 in 2021, the last year for which the Institute reports it. The 10-year average is 441.47, but it is dragged down by the rate of 404.41 per 100,000 in the pandemic year of 2020 when a lot of people avoided the doctor’s office. Going back to see doctors would also account for a slight uptick to a rate of 447.49 in 2021.
If you go back to the 10 years immediately preceding the pandemic, you get an average rate of 451.25, which is close to the 2021 rate and well above that of 1975. There is, unfortunately, no good data for the number of cases before 1975.
The data tracking website Statista does, however, report the per capita cancer death rate for 1960 at 193.9, the same as for 1950. That is well above the 142 per 100,000 today, but then doctors didn’t really know much about how to battle cancer in the ’50s and ’60s and treatments remained limited into the mid-1970s as reflected by five-year survival rates.
The Institute data puts the five-year survival rate at just a little under 50 percent in 1975. It had risen to 71.75 percent by 2016, the last year for which a five-year rate from 2021 could be tracked. This marks an improvement of about 31 percent.
Good records for overall cancer rates prior to 1975 are lacking. Cancer News, a publication of Cancer Research UK, in 2015 reported scientists had calculated that “the lifetime risk of developing cancer for someone who was born in 1930 is around 1 in 3. But, by 1960, for those born in that year, lifetime risk had risen to the new figure of 1 in 2.”
This generally tracks with other reports indicating a steady increase in cancer rates from the 1930s on. So the rates were likely higher in 1975 than in 1960. If you assume there was little improvement in treatment in this time frame, something else the historical record appears to indicate, a 1960 death rate of 193.9 per 100,000 would indicate an incidence rate of something near or under 400 per 100,000 based on 50 percent survival.
Most of these people were older Americans, too, as historical been the case with cancer. But that is changing as well.
“…Cancer is occurring in more adults at younger ages, before they turn 40 or 50 and sometimes even earlier,” as Yale Medicine noted in April. “These are called ‘early-onset’ cancers, which are diagnosed in adults between the ages of 18 and 49. Because advancing age is the top risk factor for cancer in general, the recent rise in early-onset cancers is worrisome.”
Why is this? No one really knows for sure, but increased exposure to carcinogenic chemicals; obesity and faster rates of aging; something tied to immunosesence and lack of exercise have been suggested; diet and lifestyle changes.
TRhere have been some noticeable lifestyle changes in the U.S. in the new millennium, but the most talked about of those in regards to cancer should have helped drive overall rates down significantly,
Up in smoke
Nearly everyone seemed to be smoking in the 1960s, and the data reflects that. Per capita cigarette consumption in the U.S. peaked at 4,171 cigarettes per person in 1960 but thanks to anti-smoking campaigns and taxes on cigarettes that had fallen to 1,078 by 2015, according to Statista.
This easily explains the steady, decades-long drop in lung cancer rates and deaths in the U.S., but does nothing to explain the uptick in other cancers. Could drinking be the problem? Probably not.
Over the course of the last 35 years, the alcohol consumption rate has varied relatively little with the low at 2.15 and the high at 2.53, a difference of less than 18 percent. One could only wish the dollar had been as stable. It has lost 58 percent of its value since 1990, according to the CPI Inflation Calculator.
Obesity is another matter. It has gone from relatively uncommon in the 1960s, according to the CDC, to all too common today. In a 2020 report, the CDC put the 1960 rate of obesity for American men at around 10 percent with their rate of “severe obesity” near zero.
Or, to put it another way, the average American male now looks more like a sumo wrestler than our homo sapien ancestors who chased wildlife across the plains of Africa or first followed big game into Alaska.
The average American female, meanwhile, is 5-foot, 3 inches tall, weighs 170.8 pounds (four and half pounds more on average than the American male circa 1960, according to the CDC) , and has a 38.7-inch waistline, about 18 inches more than in 1960.
Given the connection between obesity, metabolic disease and all the complications that come with the latter, it’s hard to avoid the conclusion that obesity is helping to drive up the cancer rate, but then there’s the matter of fitness which ties directly back to obesity and the lack of which exacerbates metabolic issues.
And it’s impossible to ignore the by far largest lifestyle change in America between the 1950s/1960s, which is connected to the electronic gadget on which you are reading this and to our asses. Americans today spend more time sitting on their asses than they do moving.
And it isn’t just in offices where daily exercise has fallen. The exercise levels on all job have only gone down since the ’60s. The nail gun has replaced the hammer on construction projects. Lawn maintenance personnel ride their lawnmowers instead of push them and nobody rakes or sweeps anymore; they use a power blower.
As for the country’s techies, they don’t even get up from a computer to recreate; they just switch to e-games. And few walk or bicycle to get around anymore; they drive. Americans now drive everywhere.
This is especially striking in rural Alaska where if there isn’t a truck in the village to drive someone a few blocks to another person’s home, there is a four-wheeler to do so. And any research that downplays how much this lifestyle change is wreaking havoc with American health can only be described as flawed.
Driving to our deaths
A comparison that is revealing here is that between Italy, where Statista reports a daily step count of 5,296 and America with a count of 4,774 steps. According to World Population Review, 22.4 percent of Italians were smoking in 2022 compared to 24.3 percent in the U.S.
The World Health Organization put the Italian rate of alcohol consumption below that of the U.S. as well at 7.0 liters per capita in 2020 versus 9.9 liters in the U.S. in the same year. The difference is explained in large part by Italian men drinking almost four times as much as Italian women. The U.S. differential is about three to one.
The nearly four-and-a-half-year difference between the average, Italian lifespan of 84.2 years compared to that of the U.S. lifespan of 79.74 should, however, more than offset the smoking and alcohol factors given that cancer rates increase dramatically with age. In the U.S., the median age of a cancer diagnosis is 67 and the median age of death is 73, according to the Cancer Institute.
Given this difference, Italy’s death rate should be at least close to that of the U.S. despite somewhat lower substance uses, but it isn’t. The Global Cancer Observatory reports the rate in Italy at 284.5 cases per 100,000 with a 27.7 chance of developing cancer before age 75.
Rates for men are higher than those for women in both countries. But the rate for Italian men, who on average drink about three times as much as American women, is 312.1 per 100,000 versus 341.7 per 100,000 with American women also facing a 31.7 percent chance of cancer before age 75 compared to the 30.6 chance for Italian males.
World Population Review also reports 25.7 percent of Italian men smoking compared to only 18.7 percent of American women. If the differences here were about smoking and drinking, the cancer rate for Italian men and their risks of cancer before age 75 should be well higher for them than for American women.
But they’re not. They’re actually lower.
So obviously, other things must be going on here, and there are. For one, Italians are a lot less sedentary than Americans with that Italian step count likely undercounting how much so given that old people walk less than young people and Italians are older.
The median age of 47 in Italy is nine years greater than the median of 38 for the U.S., according to World Economics. The Italian obesity rate, which is now reported to be about a quarter of that in the U.S. is also a likely reflection of Italians spending more time on their feet than on their asses and eating differently.
The Italians eat a lot less processed food than Americans do. This is no doubt healthier, but it’s doubtful this aspect of American behavior could be easily changed. Let’s face it; Cheetos are tasty as are a lot of those other unhealthy snacks Americans find themselves munching.
Better by design
It is, however, conceivable that exercise could be reinjected into the American lifestyle by altering urban and suburban design to make it easier to walk and bicycle and by slowing motor vehicle speeds down to make it safe to do so while at the same time altering the decisions on whether it is faster to walk or to drive.
This, of course, would also require a change in zoning in many places to allow the development of shops, restaurants and even bars within walking or cycling distances of where people live.
The MAGA – Make America Great Again – crowd should be all over this because these are the things that made America great in the 1960s and into the 1970s when most kids were still walking or bicycling to school, and a fair number of adults were getting around under their own power.
When at the University of Minnesota at the start of the 1970s and working in the seed lab at Northrup King, which is now somewhat ironically a Minneapolis art space, my main form of transportation was a bicycle, which was not usual at the time. The country was then in the midst of an environmentally driven bike boom.
Urban designers in their never-ending quest to make urban travel by motor vehicle ever easier and faster managed to kill that boom, but they could still fix it today if most of them weren’t – excuse my plain language here but I am forced to be honest – stupid, f—— a–h—s.
Suburban walking paths in upscale suburbs are nice, but why not connect them to the places people want to reach to make using them for travel easy? But better urban planning isn’t all this country needs.
It possibly even more needs a serious, national campaign to bring home the message that “Exercise is Medicine.”
Imagine a short public service ad regularly popping onto the TV screen with the words “Exercise is Medicine” from behind which emerges a star athlete running, cycling, emerging from the pool, dropping a dumbell, taking off the gloves or whatever to say simply, “It’s time to take your medicine. Get up. Get out. And move!”
Hell, I can see cyclist Arnold Schwarzenneger taking part here as he pedals up behind that slogan to mutter the phrase “take your medicine” as old Arnold could. Who knows who all else would want to get involved in this effort to get America moving again.
Other celebrities. Surely some fit politicians or former politicians like Alaska polebrity Sarah Palin, a longtime and regular runner. Maybe even a fit-looking NFL football coach like Minnesota’s Kevin O’Connell who as a player scorched the track at the 2008 NFL combine and still contends he can outrun any NLF coach in a 40-yard dash.
One would think the American medical community would be all over an idea like this, but the American medical community doesn’t seem nearly as interested in telling Americans what they should do to get healthy as telling them what they shouldn’t do and selling them drugs or procedures to fix anything and everything when they don’t listen.
It’s depressing to think that this could be because so many of people in medicine are now in it for the money. Such a thought strikes too close to the old accusation that used to be lobbed at newspaper reporters that “you’re only doing this to sell papers!”
That was sometimes a tiny part of the motivation, but it didn’t carry the weight it does now with news organizations doing anything they can to sell online news. But at least news organizatoin can are argue that they’re fighting for their lives.
I can’t begrudge them that. A neurosurgeon who fixed my back eons ago basically made me a new man. And doctors lose a big chunk of that salary to taxes which help support the country.
One can’t ignore the power of the dollar in a capitalist economy either. But one can still hope for people to rise above monetary greed. Everyone would benefit if American’s medical community would get behind the idea of helping people get healthy instead of just treating them or lecturing them on how to behave.
Unfortunately, the chances of that happening appear slim.
Categories: Commentary, News
