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Major funding for Second Opinion is provided by the Blue Cross and Blue Shield Association; an Association of Independent Blue Plans committed to better knowledge leading to better, more affordable health care for consumers.
[clock ticking]
[music]
(Dr. Peter Salgo)
Welcome to Second Opinion, where each week we solve a real medical mystery. When we close this case file, in a half-an-hour from now, you'll not only know the outcome of this week's case, you'll be better able to take charge of your own healthcare. I'm your host, Dr. Peter Salgo. And our story today concerns Stephanie. Now you've already met our special guests who are joining our cast of regulars, primary care physician, Dr. Lou Papa, and health reporter, Christine Rogers. No one on this team knows the case, so let's get right to work. Let me tell you a little bit about Stephanie. Stephanie, Lou, is in her primary care physician's office. She likes her primary care physician.
(Dr. Lou Papa)
That's a good thing.
(Peter)
After some conversation with her doctor, she reveals to her doctor two significant events that are causing her concern. The first is she just had her 59th birthday, the big 5 9. And a few days before she came to see her doctor her best friend, about the same age, suffered a massive stroke that left her significantly disabled. Lou, what's going on here? What do you think?
(Lou)
Oh, well I mean, part of it is she's getting older and as you get older you have a better idea of what mortality is, it's a lot closer. So I think as she sees these events happening in friends and family it becomes more real to her. And makes her realize that could happen to her.
(Peter)
I'll tell you what she told her doctor, because her doctor was a good primary care physician and said what's bothering you? And she went on; she said that she's had a great deal of anxiety. And he writes in here about, "getting old". Those were the words she used. She's a very successful advertising agency executive but she worries about "losing her edge", another direct quote from the chart. And she increasingly finds herself, she says working with people half my age. And her friend's stroke, she said was both a great personal loss and a wake up call. What is this wake up call stuff?
(S. Jay Olshansky)
Well remember, once you get out into your 50s and 60s you start to see things go wrong that you didn't see in your 30s and 40s.
(Peter)
I mean we're dealing with a particular generation here. She's on a leading edge of the baby boom, right. And I got, this is the generation that thought nothing was going to happen, going to live forever, control the world. Isn't that right?
(Dr. William Hall)
I think it used to be that 50 was the big milestone, but I think 60 is now. And I think that as a sequence of people who are working is you suddenly look around the room and you say, my god I'm the oldest person sitting around this table. And the next day you come in and it's the same sort of thing. And then if by any chance somebody in your very same age range has a catastrophe, this is a real wake up call for most Americans.
(Peter)
Betty, what is she going through?
(Betty Perkins-Carpenter)
I would like to know what her friends are like. I would like to know what her social circle is like. Do most of her friends, are they having physical problems or are most of her friends pretty active. She's still working. That has a great impact.
(Christine Rogers)
I wonder if she's been experiencing any health problems herself that has prompted her to start having this.
(Dr. Lou Papa)
This is not like just; she could have that conversation anyway. She sought out her doctor and brought this up to her doctor as her major concern. And that's a little different then talking to somebody across the coffee table.
(Dr. Michael Gaziano)
Yeah. I think a little bit more about a health lifestyle.
(Peter)
I have more about what she told her doctor, in any event. She tells her doctor that she wants to do whatever it takes to live a long and healthy life. So my interpretation of this is she wants some medical advice for living longer. And she's a type A personality, so she came to her doctor and she said, I've got a goal. You know, this is my ad agency executive moment. I want to live to be a 100 and money is no object.
(Jay)
Well its sort of like saying, I want to be seven feet tall, money is no object. What can I do to be seven feet tall? Its just not, if it's not in the cards. If you haven't won the genetic lottery at birth, she has no chance of making it to a 100. If you're 59 female in the United States, you have about 23 years of life left.
(Dr. Peter Salgo)
The average age then, life expectancy for a woman in the United States is what?
(Jay)
Right now its 80.
(Peter)
Its 80.
(Jay)
Right. But if you've already made it 60, you can make it a little bit past 80, 82, 83 or so.
(Michael)
The biggest growing segment of the population by 2050 they'll be about 80 to 90 million people over the age of 65 in this country.
(Jay)
But just wanting to live to 100 to do everything you can to make it that long is actually the wrong thing to be searching for. Longevity should not be the goal. It's health. She should be asking the question, what could I do to be as healthy as long as I can and not set the goal of 100.
(Peter)
But I've stood here at this point, and heard doctors telling me that we're a nation drowning in fat, drowning in cholesterol, diabetes is epidemic in this country. How can I reconcile these? So I'm kind of confused where the epidemic of obesity and diabetes, for example, which means an epidemic of heart disease. How can people be living longer?
(Lou)
I think some of it is, you know, this obesity epidemic that we're seeing, we may not see the full fruition of that just yet. And we'll be seeing, and we may be seeing that valley where we're seeing the benefit of what we've done earlier and we're about to see the damage that we're about to do. That may be part of it.
(Peter)
But let me back this all up. Why do we die at all?
(laughter)
(Peter)
Why do human beings die?
(S. Jay Olshansky)
Well it's the same question of asking, why we age.
(Peter)
All right. Why do we age at all?
(Jay)
Or why aren't we immortal. And actually there's, believe it or not there's an answer to that question. There is a form of immortality that already exists. It's the DNA. The information contained within the DNA. And there's a fundamental tradeoff in biology between immortal DNA and mortal bodies. And as soon as that trade off came to pass many, many years ago, the inevitability of aging and death came to pass for humans and all other sexually reproducing species. The real question is why do we die when we do? Why don't we all die at 50? Or why not 150? Why is it at this particular age?
(Peter)
Is there a clock that simply says your time is up, goodbye. And isn't there this word, apoptosis, in the medical vocabulary, which means time to die?
(Jay)
Let me explain because your clock question is a really good one. There is a clock. The clock is for growth and for development and for reproduction. Everything is orchestrated up to that point. Aging is an inadvertent byproduct of clocks for growth, development, and reproduction. In other words, there's a clock for something that happens early in life and an accident of that clock is aging or synapses. So there is no genetic program for aging. There is no genetic program for death. Those cannot exist. But there is a genetic program that exists for something else that inevitably leads to that.
(Dr. Peter Salgo)
But supposing you look at folks. I mean we have several thousands people who have reached 100 years, which is Stephanie's goal. Have we done research on them? What do we know about these people?
(Bill)
We know a fair amount about them, I think, at the present time. Not as much as we should. One is we know that the impact in genetics has been a little bit overstated in some circles. By and large, the genetic sequences kind of play their way out at a much earlier age. So that basically that when someone lives to be 100, we have to look a lot at environment. How they've lived their lifestyle. Luck plays, certainly, a good role here.
(Michael)
It's a combination of the genetic hand you're dealt and the activities that you do. The behaviors like smoking and how much activity do you get? How much exercise?
(Peter)
Betty, what do you think of the idea of living to 100?
(Betty)
I think there's a lot of education needed for our physicians to look at wellness. I think we forget about wellness. You're dealing so much with the medical aspect.
(Michael)
I think she's absolutely right.
(Betty)
Of disease and death and dying. And I don't think they're taking enough interest in wellness. So there's so many things that physicians, I believe, in my humble opinion, have to be educated about on dealing with seniors.
(Peter)
All right. Let me interrupt just for a moment to sort of summarize where we are. We covered an awful lot of ground over here. There are better for treatments for healthcare in this country, and that can mean, and does mean we think, that Americans are leading longer lives. Any individual's prospect for longevity or combination, as you've heard of genes, and lifestyle. So let's go on a little bit, shall we. Stephanie, as you know, is on a quest. Lou, what do you want to know? Any history? Anything?
(Lou)
Yeah. I mean what's going to be helpful is to know about her, you know, what does she do to stay fit? What's her diet like? Does she smoke? Does she drink?
(Peter)
She does not smoke. I have here, she drinks moderately, whatever that means. She has no family history of cancer. No family history, as far as I could tell, from the charts, of premature heart disease.
(Michael)
A little bit more information about.
(Peter)
Sure.
(Michael)
What's her base line? How active is she? What's her weight? Does she have diabetes? Does she have high cholesterol? There are many things that we can do to avoid chronic illnesses, which is one of the ways to help you get a little bit further.
(Peter)
Well you've asked some questions. I've got some answers for you in the chart. One of them, though, is a shocker. Because although her record gives her maternal ages at death and some of her relatives, she sheepishly looks up at her primary care physician and says, you know where, the information I gave you. I'm adopted.
(Dr. Michael Gaziano)
No matter what hand your dealt there are things that we do that can improve the likelihood of living a long and productive life.
(Bill)
There's good news and bad news there. The bad news is that you don't know who you parents were. The good news is it may not make all that much difference at age 59.
(Dr. Peter Salgo)
Well I got the information that you guys asked for. Her cholesterol, specifically her LDH is 104. Her HDL is 40. She is mildly hypertensive. Her BMH is, her BMI rather is 24. She does not smoke. She does not exercise. And she is postmenopausal. What do you make of all that?
(Lou)
Well a couple of things, one being postmenopausal has an impact in and of itself. Her blood pressure being a little high has me concerned. Having actual numbers would be helpful. The low HDL has me a little bit concerned, in and of itself, it's great that her LDL, her bad cholesterol is low but a low HDL has me concerned just for risk down the road.
(Peter)
Well I'll tell you the tests she's asked about. What about an MRI, can I have something that will tell me if I'm going to live to be 100?
(Michael)
Yeah. It's our job to tell her what the utility of some of those tests might be or lack of it technically.
(Peter)
But that's not going to tell her how long she has to live.
(Christine)
As a doctor.
(Michael)
And neither will any other test.
(Jay)
You have to be honest with her. There is no test that will predict how long you can live.
(Christine)
Shouldn't be a doctor's responsibility at this point to have a candid conversation with her, that her expectations were unrealistic.
(Peter)
Can I have a genetic test that's going to look at my genes and tell me of my risk of dying of old age at a specific time?
(Jay)
No. There is no test. There is no simple...no.
(Bill)
I think we're pretty much in agreement on this one.
(Christine)
And the reality for her is if she wants to find something there's somebody out there who will sell it.
(Jay)
She has to be cautious.
(Michael)
Right. There's no perfect test and there's no perfect pill.
(Jay)
But there are people who are willing to sell them tests and sell them pills.
(Lou)
And they do.
(Peter)
What's out there that are being sold?
(Lou)
This includes MRI facilities that are opened up in the mall. You can go and have your whole body MRI'd.
(Jay)
But there are tests that supposively measure your biological age. And there's no validity to.
(Peter)
Likewise. What are people hearing about?
(Jay)
Well actually it's a battery of tests. They measure your heart functioning, the functioning of your kidneys, your liver. They look at your skin elasticity, your mental functioning. They do a whole series of tests. And then they come up with a number. And they say, well your chronological age is 59 but your biological age is 75 or some other number. And its complete nonsense, unfortunately there isn't a way to measure accurately your biological age or predict how long your going to live.
(Dr. Peter Salgo)
Now you know what she says next? She says, all right. I hear what your saying about tests. Now I want that anti-aging diet. I've seen it on television. I've read about it on the web. What about it?
(Jay)
Well actually, once again, you have to be cautious here. There is evidence demonstrating that reducing your intake of calories does extend the duration of life of a wide variety of other species. It probably would make people live longer, if for no other reason then reducing our risk of diseases associated with carrying extra weight or being obese.
(Peter)
When you say reduce the amount of calories you eat, this is not one less mocha frap per week; it's a significant calorie reduction?
(Jay)
It's roughly a 20% reduction in calories below maintenance levels.
(Peter)
That other two that we keep hearing about are stress and community involvement. Does this really have a demonstrable statistically provable effect on longevity?
(Jay)
I would say about the only control, this may sound controversial.
(Peter)
Oh go ahead.
(S. Jay Olshansky)
Yeah. I know. The only control we have over our duration of life is to shorten it. And we exercise that control all the time by eating too much and not exercising. And so there are plenty of things that we can do to push us out to our body's ability. That's what we can control, is going beyond that where there's difficulty. Where there are people making promises that you can go beyond your bodies' own ability for a specific duration of life, and that, there isn't any evidence for that now.
(Peter)
But you know, we've all read this and I'm sure that she's read this as well. There is the vitamin salesman out there promising if you just take our product that's it.
(Dr. Lou Papa)
But unfortunately, that's people taking advantage of the, you know, the science of the medical community. Its no different if someone came and knocked at your door and tried to sell you a broom you don't need. You're not going to buy it. And I mean, if its, once they hear that it has, you know that there's some medical research or has some medical implications or that it's a doctor that's pushing it. And I hear that from patients, but it was a doctor who was selling it. I'm like, but that doesn't make any difference.
(Peter)
But what's real, what's snake oil? Let me just run down a few. Vitamin pills.
(Michael)
Well there aren't any that are going to prolong your life with certainty for certain. We're studying some of them to see what their effect on chronic diseases are.
(Jay)
Look we may have the most expensive urine anywhere in the world, here in the United States.
(Lou)
Exactly.
(Jay)
And that's where most of these vitamins get flushed out.
(Christine)
And then maybe the argument though, I mean if its not doing harm in somebody like our patient who money is no object. If they're willing to spend that money and it does make them feel better in some way.
(Lou)
How do you know that? And see that's what I try to tell patients. They assume it's not doing any harm because they don't feel anything or its not hurting them at the moment. We don't know that.
(Dr. Peter Salgo)
Well let me tell you about Stephanie. Stephanie leaves her doctor's office and here's what she leaves with, Lou. Her prescriptions include, from her primary care physician, a statin because obviously her primary care physician was concerned about her cholesterol. And some friendly advice to take a daily aspirin, exercise more, and stop worrying because stress is bad for your life. Do you think she's satisfied?
(Lou)
I don't think she got the right treatment. I mean.
(Peter)
What do you mean?
(Lou)
Well a statin, well the first, the concern I have is her HDLs are already low. Her LDL is low. I'm not sure what your goal is treating that, the statins can lower HDL and I think before I would jump to that and say, okay. Well here's some sort of a pill I can give you for your treatment. I would really reinforce the importance of the lifestyle.
(Peter)
But do you think she's happy? In other words, you're unhappy.
(Michael)
I don't think she is.
(Peter)
Right.
(Dr. Michael Gaziano)
And I think it's our job. The medical model doesn't deal with this kind of issue. The medical model is I have a complaint, let's solve that problem. I have a chief complaint, is the word that we use. William Osafer gave us this model that we use. But we're talking about long-term wellness and prevention here. And I think it's our job to empower her to make choices in her life on a daily basis.
(Peter)
If she left your office with diet advice, exercise advice and maybe two pills, my guess is, if you guys weighed in this, that she'd be not all together more happy then she was here. So you know what happened. She wasn't happy. And she went to a cocktail party and at a cocktail party she met a professor at a major American university. And this major American university was a well-known expert in the field of life extension. Jay, what kind of a conversation do you think that was?
(Jay)
Well I'm trying to think of who it is that might have expertise in life extension.
(Lou)
I think he parted the Red Sea.
(Betty)
Yes he is.
(Jay)
I mean I can only imagine what goes on. It happens all the time in the United States. You got individuals who are going to these life extension clinics or other types of clinics where they make all kinds of promises at a, and you know, they charge very large sums of money to do all these tests to measure your so call biological age. And usually, of course, in order to sell their products your biological age has to be higher then your chronological age. And then they could say, well we can make. We can bring them back.
(Peter)
Stephanie wants a fix. You know what she's asking. All right. If you won't give me that special diet that I suspect you have but are keeping a secret from me, or this special pill, at least tell me, Jay what's on the horizon? Where's the research going? When, if I just live long enough, will they have the pill ready for me? Is there research out there?
(Jay)
Well actually, believe it or not, and you may find this surprising coming from me. She has something to look forward to. I think scientists in the field of aging are on the verge of discovering the means by which we can slow the process of aging. I don't know if it will be in enough time for her, at the age of 59. It would have to, you know, come within the next 10 to 20 years and even then she's going to age over those next 10 to 20 years. But there is reason for generations beyond her to be optimistic. We can slow this process.
(Michael)
I think there's reason for her to be optimistic. We've done an enormous good for society in getting larger numbers of people to older ages with a high quality of life. And there are a lot of things that she can do.
(S. Jay Olshansky)
But that's not the same. The slowing, the biological process of aging versus attacking the diseases that is associated with it.
(Dr. Peter Salgo)
Is it fair to view what he's doing, as holding the fort, keeping them alive until your pill that you know about comes along. If you can just keep her going another 20 years and keep her healthy then that's pill's going to help.
(Jay)
Absolutely. The approach should be to extend duration of healthy life as long as possible regardless of whether a pill comes or not.
(Peter)
If we do everything right. And all the cosmic tumblers hit the right numbers, what is the absolute limit on a human life?
(Jay)
Well remember, it will be, for an entire population it will be greatly diverse. I think the basic answer to your question is that if everyone did the right thing. If we all exercise, ate right, we probably would get a life expectancy up to about 85 or 90 for men and women combined.
(Peter)
Let me sort of sum up what we discussed today. We covered a lot of ground. I think its clear we are living in fascinating times with regard to research and life extension. For the time being, I think the most you can say, the most significant steps that you can take in terms of longevity are the old standbys. You know these. Sensible diet, regular exercise, learning how to handle stress, seems like a good idea. But it's not necessarily all-inclusive and we're still waiting for you. But in the meantime let me tell you a little bit more about Stephanie. We're going to be leaving her soon because Stephanie said that this is what I got. This is what I got. So she went out there. She's got a healthier diet. She's exercising daily, Lou. She took her PCP's advice to heart, so to speak. If it's true that the older we get the sicker we get. Are we looking at an aging sick population? What are the costs to society of people living out to 100 if they're ill? Can society afford oh 100,000, 200,000 people living to 100 and beyond? What's the answer here? Anybody have?
(Lou)
Well I think, and we talk about these individuals that are 105 and you know, 100 years old and they're bungee cord jumping or whatever they're doing. And that's great. But what we don't talk about are the patients that are in their 90s and close to 100 that are not communicative and are in a nursing home and requiring a great deal of care.
(Peter)
Isn't it true. Isn't it true that there's a large population of people, large by the standards of the people of that age group, who are doing just fine in their 90s.
(Dr. Lou Papa)
Oh yeah.
(Michael)
Absolutely.
(Peter)
They're active. They go to your classes and that in fact they're not using a lot of health resources at all and that in fact when they have a terminal illness its rather quick and that they don't deplete the healthcare resources of this country.
(Michael)
Quality of life is improving in old age, as we age. We are pushing certain disease to an older and older age.
(Peter)
The buzzword that I hear is successful aging.
(Christine)
Yes.
(Dr. Peter Salgo)
Betty what does that mean to you?
(Betty)
I just want to be able to do what I want to do, do it as well as I can do it, be as physically fit as I am capable. And mentally alert.
(Peter)
What is the benefit to society in having all of these older people around? Is there one?
(Betty Perkins-Carpenter)
We learn more from them.
(Dr. William Hall)
There's an enormous benefit.
(Betty)
We've learned so much from them.
(Bill)
One benefit in the early stages of advanced aging, say from 70 to age 85 is that these are often very, very productive individuals in society. Many of them are still partially in the workforce. Many of them are having a tremendous impact in terms of legacy, in terms of the, of the next generation. There's like an accumulated wisdom that a successful society has to be able to transmit. We can't put that in a bottle. We can't necessarily put it in a book. And that's what this society represents.
(Peter)
Jay, what does longevity dividends stuff that I've been hearing about?
(Jay)
Well the way in which you live you life can actually, you know, very heavily influence the way in which things are expressed at later age. Your ability to enjoy life can actually improve. Believe it or not for some people their sex life actually gets better at one level when they get older. There's just, you know, levels of control that they can exercise when they are older then either when they're younger. So there are a number of dividends, a number of benefits associated with growing older that you need to begin recognizing. You need to take advantage of this huge resource of older individuals who are healthy, who are wise, who are intelligent, and these are going to be a huge segment of the population in the next couple of decades.
(Peter)
Is there an advantage to these people of maintaining social integration? Is there any data?
(Bill)
Successful aging kind of was crystallized about a decade ago by a study funded by the MacArthur Foundation. And they found three aspects that were associated with successful aging. One is good medical care for most of their lives. I think we all agreed on that. The other was continuing physical and mental activity, we've all agreed on that. But the third one that really kinds of just smashed home that these are, were people who remained engaged in society. That this was not, was both a squally of the other two but also was a very essential component to being able to adjust to a lot of the difficulties with aging. So it's very, very important. I'd almost put it, Peter, at the top of the list.
(Peter)
Let's stop for just a moment and sum up what we've been talking about. Successful aging is more then longevity. Staying engaged physically and emotionally and intellectually benefits you, benefits all of us. It's nice to have older folks around who have some memory of what's gone before. Betty, we have very little time left. I'm going to give you the last word here.
(Betty)
Oh oh. Seniors are suffering a lot of losses. They're dealing with it on a daily basis. And I think we have to give them the tools. When I was studying for my PhD, which I just got at age 74, a year ago.
(Peter)
Can we stop and say congratulations for the PhD.
(Betty)
Thank you.
(applause)
(Betty)
Thank you. I dealt with seven deaths in two years of the four years that I was in school. And I think thanks to studying and having something, a goal, I think it kept my sanity. So I think it's staying involved. Doing the best that you can do with what you have. Keeping it positive. Being an optimistic versus a pessimist. There's a wonderful saying. An optimist goes to the window every morning and says good morning god. A pessimist goes to the window and says, good god, morning. And I think there's a correlation there to wellness. I really do.
(Dr. Peter Salgo)
You've used this quote before, haven't you? I think its fair to say you're an inspiration to all of us.
(Michael)
Could you have a better example of successful aging?
(Peter) I don't think so. I mean there's a reason you're here, Betty. Thank you so much again. I want to.
(Betty)
Thank you for having me.
(Peter)
Before we go, just sum up some of the things we've been talking about. Better treatments for healthcare mean that more Americans are leading longer lives. Any individual's prospect for longevity is a combination of genes and of lifestyle. There are important steps that you can take in terms of your own aging, and they're the old standbys. You know them. Right now its sensible diet, regular exercise, learning to manage stress. Yes, I know it sounds boring. You've heard it before but it works. And successful aging is more then longevity. Staying engaged physically and emotionally, it intellectually benefits you. It benefits all of us. And of course, our final message is this. Taking charge of your health means being informed and having honest communication with your doctor. I'm Dr. Peter Salgo, and I'll see you next time for another Second Opinion.
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(Announcer)
Major funding for Second Opinion is provided by the Blue Cross and Blue Shield Association; an Association of Independent Blue Plans committed to better knowledge leading to better, more affordable health care for consumers.
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