When there is only one voice on an issue it dominates the narrative! We have a growing health crisis in the US and much of the world.
And, despite the catastrophic trends in individual and population health we continue to trust the stewards of the dominant health paradigm.
That same paradigm that has been the most dominant voice in healthcare for the past 116 years. I'm dating that from the 1910 Flexner Report which standardized American medical education around the biomedical model.
Yet, population health in the U.S. (and most industrialized nations) has been in measurable decline for 70-100 years. Noncommunicable diseases (NCD) now account for the overwhelming majority of deaths in high-income countries including the US, in contrast to the early 1900s.
Globally, NCDs are increasing each year, accounting for approximately 60% of all causes of death annually. Notably, approximately 25% of these deaths occur before the age of 60 years. Some studies estimate that approximately 52 million deaths occur around the world each year, with significant variations observed from region to region (1-3).
Lifestyle-related, environmental, and genetic factors are the major risk factors associated with NCDs. Additionally, changes in the population pyramid and globalization contribute to an increased prevalence of these risk factors across all regions (2, 4).
And, we march on, maintaining our failing medical system and the pharmaceutical companies, hospitals, and physicians in power as stewards of our collective health.
There is a tremendous amount of scientific evidence to the contrary of the standard procedures in medicine and health. Yet, we continue doing the same things that we have done on our journey to this crisis.
Here's what isn't often discussed...
- Regulatory Capture of our public health agencies - FDA, CDC, NIH - by the pharmaceutical industry is exerting tremendous bias into the decision-making process. The pharmaceutical industry has a stranglehold on the funding, trials and certification of the very substances they make huge profits on.
- Physicians are trained in a paradigm focused on the identification and management of disease that creates a bias independent of the outcomes of their therapeutics.
- Much of what is presented to us as incontrovertible evidence of safety and efficacy is countered by science that documents its weaknesses, failings, and dangers.
What if We Put the Focus on Health and Not Disease?
Medicine's best efforts toward health really have little to do with health. They have put their "eggs" into early detection and as you will learn this has significant risks and carries with it much error.
Why not put some emphasis on prevention?
After all it would seem rather logical and beneficial to prevent a health challenge from developing than it would to treat it once it arrives.
My belief is that the most appropriate way to prevent disease would be to promote health.
But, that is not part of our current paradigm.
First, medicine is not really equipped to prevent major chronic health challenges. To a great degree this is because there is little effort at asking the question of "why" our most common challenges develop. If we asked that maybe we would get some answers.
And, those answers would likely direct us to fundamental changes in how we live.
Even if we put greater emphasis on prevention the focus is still on disease. I'm in complete support of prevention and...
I believe we need to shift more of our attention to the promotion of health.
Let's pull apart three things that are often used for one another.
Early detection finds a disease that already exists. Prevention stops a disease from starting. Health promotion builds a body less likely to allow a disease to start.
Almost everything doctors do is focused on early detection and treatment. Pretty much everything they call "prevention" is simply early detection.
The focus in our system is more on early detection than it is on prevention. I believe that is partly due to the myopic focus of our system on disease and
early detection is still focused on disease.
Also, for a profit driven system early detection entails often expensive screening tests and procedures and should something be detected it is followed by often expensive courses of treatment.
The Problems of the Early Detection Model
Medicine's emphasis on early detection via screening has led to substantial overdiagnosis—detecting cancers or pre-cancers that would never progress to cause symptoms or death—resulting in unnecessary treatments, anxiety, and costs without proportional mortality reductions.
Let's be clear right now. Nothing in this issue is advice to skip a screening your physician is recommending. That's not a decision to be made because of a newsletter.
And overdiagnosis does not mean misdiagnosis. The cancers these studies found were real cancers under a microscope. The problem is that some of them would never have progressed to harming the person and we have no reliable way to differentiate them.
What I am arguing is that early detection has been marketed to us as prevention, that it involves real costs and risks and that it contributes
absolutely nothing about why the disease showed up.
The early detection model has little to do with prevention and carries with it significant downsides and risks that might not be apparent upfront. In this issue I am going to give you more links to studies so you can look yourself at the science and not trust my word or interpretation.
So, what are the risks, downsides, and inaccuracies that come with this focus on early detection?
What if the effort at early detection is largely misplaced?
Certainly there is value in detecting disease processes earlier but what we haven't considered is whether the benefits outweigh the costs. My focus is more on the human costs rather than the financial ones.
Overdiagnosis Rates from Screening Trials
- Breast cancer mammography: 24–31% of screen-detected cases overdiagnosed.
- Lung cancer (chest X-ray/sputum): ~51% overdiagnosis in screen-detected cases.
- Prostate cancer (PSA): 50–60% overdiagnosis risk for screen-detected tumors.
- Lung CT screening: 13–67% overdiagnosis depending on trial/follow-up.
Here's something interesting. Colonoscopy is missing from that list. Why?
Because it has good evidence and it really isn't a screening test. It's more of a detection test. When the GI doctor finds a polyp, he removes it. The cancer that polyp might have become never happens.
That is closer to prevention than early detection.
The screening that functions best is actually the one that leans more toward prevention. All the other tests confuse the two.
Those are some pretty significant percentages of overdiagnosis. Diagnosis is followed often by aggressive treatment.
And, the treatment for cancers is rarely a walk in the park, consisting of chemotherapy and radiation. Not something you want to undergo unnecessarily.
Population Trends vs. Mortality
If early detection were effective we might expect to see a rising survival rate or reduced mortality rate. But, that's not what many of the studies reveal.
It's worth looking at the word "survival" because this is one way the numbers can be made to look better than they are.
When you hear a reference to the five-year survival rate that is measured from the date of diagnosis. If a screening finds evidence of cancer three years earlier than the arrival of symptoms would have, the five-year survival improves even if the person dies on the exact same day they would have without the screening.
They didn't live any longer. They simply lived with the diagnosis for longer.
Incidence rises dramatically with screening adoption, but mortality stays flat, indicating detection of slowly progressing disease:
- U.S. SEER data: Thyroid, breast, prostate, melanoma, kidney cancers show soaring diagnoses without death decreases.
Abstract
This article summarizes the phenomenon of cancer overdiagnosis—the diagnosis of a "cancer" that would otherwise not go on to cause symptoms or death. We describe the two prerequisites for cancer overdiagnosis to occur: the existence of a silent disease reservoir and activities leading to its detection (particularly cancer screening). We estimated the magnitude of overdiagnosis from randomized trials: about 25% of mammographically detected breast cancers, 50% of chest x-ray and/or sputum-detected lung cancers, and 60% of prostate-specific antigen—detected prostate cancers. We also review data from
- No offsetting drop in late-stage cancers despite early-stage surges (e.g., breast DCIS up but invasive rates unchanged). More evidence of overdiagnosis without a significant improvement in outcomes.
Harms and Methodological Flaws
- Ecological/cohort studies best quantify overdiagnosis but face confounders; RCTs show persistent excess diagnoses. This paper reviewed 52 studies.
- Leads to overtreatment: surgery, chemo, radiation for non-lethal lesions, with risks like incontinence, lymphedema, secondary cancers. This is perhaps the biggest risk in screening or early detection, receiving dangerous treatment unnecessarily.
Much of the data shows that screening both results in overdiagnosis and consequent unnecessary treatment. And, just as importantly overall it isn't changing outcomes as one might expect.
Where to Go From Here
Our system to a great degree has focused on the treatment or management of
disease. Based on population health statistics this approach is not making a dent in the occurrence of noncommunicable chronic degenerative diseases.
That's because these diseases are arising secondary to changes in our environment or how we live. All the early detection in the world is never going to change the impact of our environment.
And, we continue to manipulate and change our environment from lighting to food to our exposure to EMF frequencies and a reduced time spent outside.
So, what do you actually do with all this?
I suggest you ask four questions before agreeing to a screening test.
- Does this test identify disease or does it interrupt it? Most tests find, colonoscopy can be argued to interrupt.
- What's the absolute risk reduction, not the relative risk reduction? A drop in deaths from two in a thousand to one is a 50% reduction but keep in mind it is one person in a thousand.
- What is the overdiagnosis rate for this test? If they don't know, that is telling.
- If something turns up, what is the next step - and what happens if we watch it instead?
Four questions that can change your entire approach and at the very least provide you with valuable information.
The missing piece to this puzzle is an exploration into the environmental causes of this rising epidemic of chronic degenerative disease. How much suffering would we avoid if we eliminated or greatly delayed the onset of these diseases?
The diseases robbing the majority of people of their health prematurely are not based on genetics.
They are lifestyle related.
The incredible rise in chronic illness over the past 100 years cannot be traced to genes. This is an epigenetic phenomenon.
Our system is focused on identifying disease processes and treating them. That is never going to identify factors that promote health. Early detection on the surface sounds wonderful, and maybe we can retool it to reduce the issues of overdiagnosis and unnecessary treatment.
Prevention is also a wonderful concept and I'm supportive of that as well. But, here again the focus is still on the disease process.
The Biological Truth
Our health challenges are environmental and lifestyle related.
The healthcare (that's an oxymoron) system is focused on the identification and treatment of illness and disease. It's clear that they are outside of their area of excellence when it comes to the management of chronic lifestyle related disease.
Simply looking at the public health trends and the typical course of these diseases is confirmation.
Early detection has its problems and even if we resolve the issues of overdiagnosis and unnecessary treatment the focus remains on identifying and treating disease processes.
There is value in early detection and it still misses the mark if you desire to optimize health.
The concept of prevention is a move in the right direction but here again the focus is on the disease process and not on optimal health. Prevention is certainly an improvement over developing the disease but my contention is it is still missing the mark.
The absence of a disease process is not equivalent to the presence of robust health.
It is time to take back our autonomy over our biology and our health.
We each have the power to greatly impact our level of health.
We have many options when it comes to the treatment of illness and disease but health is an individual responsibility.
Change Your Environment
Unless you are living differently than the majority of other people you are exposed to the same environmental challenges that are allowing if not promoting the chronic illnesses that are impacting most people.
When the disease process shows up, which disease, and how it progresses are all related to a number of factors, some of which we have little control over.
But, there are fundamental conditions that we have control over that have a profound impact on our health and wellbeing.
These are the conditions that humanity has made drastic and wholesale changes in, mostly in an effort to make life easier.
And, in the process we have changed the conditions in which humans have lived for thousands of generations.
Many of the environmental conditions that are vital to consider will have individual issues devoted to their exploration. I suggest looking at these through what I call an ancestral lens. Look at how you live in comparison to how humans have historically lived until the last few hundred years.
You don't have to go back in time but you might consider how out of balance you might be.
Our ancestors demonstrated robust health and if you eliminate deaths from childbirth, infection, and trauma they experienced comparable lifespans. And, they didn't spend their last decades in nursing homes.
Consider these environmental factors
- Lighting: both the amount and frequency of natural light exposure and the amount and nature of your artificial indoor lighting.
- Daily Rhythms: this involves the occurrence and timing of sleep, waking, light exposure, food.
- Manmade EMF Exposure: this is everything from wifi to 4G to 5G to Fluorescent and LED lighting and more.
- Outdoors and Nature: we have largely moved indoors to climate controlled spaces and experience fresh air, natural sunlight, and nature with less frequency.
- Food: this has dramatically changed. Processed food is hyperpalatable and lacks nutrition. We eat food out of season with the light cycles in which we live. We eat food laden with chemicals. And, we eat sugar and vegetable oils that promote inflammation.
As I've said before and will continue to repeat this from a wise mentor...
"You can't get well in the same environment in which you got ill"
I suggest you broaden that quote.
You might be thinking that you aren't ill so you don't have to change anything.
Fair enough.
But, are you living significantly differently than the majority of people experiencing the typical metabolic decline?
If You Want Different You Have to Do Different!
This issue pointed out the shortcomings of the early detection model and offered mainstream scientific evidence to support this.
There is a tremendously growing body of evidence that supports the positive impact of the environmental conditions I outlined above.
The best part of this approach is it is largely under your control.
You get to decide the environment in which you live. And, when it is out of your control there are still actions you can take to mitigate the biological cost.
At a time in history when we seem to have less control over the conditions in which we live, you have the power to shape your environment and control your health.
The course of chronic degenerative disease impacting the vast majority of people does not have to be your path. You can choose to experience greater energy, improved metabolic health, lowered inflammation, greater mental
clarity, reduced stress, and more.
You first need to decide if this is a priority for you. It really isn't complicated but change is rarely easy.
Make sure to read past and future issues of Biology Reclaimed as I dive into the natural stimuli and environment that support robust human health.
Next issue I'm going to look at the trend of the cycle of emerging health trends, many of which are denied that they exist by the mainstream paradigm.
To Your Health Sovereignty,
Bill MetabolicResilience.com