Sanjay Gupta is a country doctor — not in the sense of the old sawbones who traveled by horse or Model T, healing fevers and bone breaks, but a doctor who travels country by country, learning about best practices in the wide round world of health.
In his new series on CNN, “Chasing Life,” Dr. Gupta visits six very different nations to learn their success stories of diet, faith, lifestyle and medical care, from Bolivia, the poorest country per capita in South America, to northern Norway, a very cold Scandinavian success story. Each episode offers a contrast to the United States, where medical technology is top-notch, but both life expectancy and happiness are in decline. Dr. Gupta talks about why that’s the case, and what other medical perils — like measles — could be on our horizon.
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What does “chasing life” mean? Does that mean youth? Does it mean immortality? Does it mean health?
I think it’s in some ways chasing an optimized version of ourselves. When we think about health, we think of diagnosing and treating disease. If you’re slightly more evolved, you think about preventing disease.
But even that sort of feels like you’re swatting at flies, just trying to keep up. It doesn’t have to feel like some necessary evil. You [can] think about your health in a way where you feel good, you’re working at your optimal function mentally, physically.
And there’s a lot of places around the world where people live that life.
Other places practice lifestyles, eat foods — and have for centuries, if not millennia — that show us up a little bit as not exactly top of the heap.
I think this is one of the most startling things to me, and I say this as a doctor who thinks there’s a lot of great things about our healthcare system.
We’re spending trillions of dollars on healthcare in this country. Life expectancy is 23rd, 24th in the world. Life expectancy has dropped three years in a row in the United States. That hasn't happened in any other developed country in the world.
Clearly there are places around the world where they're living better, happier, healthier, longer lives than us. They’re doing it for a lot less in terms of their investments.
What do they know that we don’t know? What are they doing that we’re not doing? That was one of the very basic questions we were trying to ask.
One word that comes up again and again in the series is stress. You have to acknowledge that it’s there in your life, but it’s how you cope with it. What did you find that surprised you?
First of all, stress is one of these nebulous terms that people throw around; it’s very vague, means different things, probably, to different people.
But when you look at other countries that have lifestyles that maybe aren’t that different than the United States … they continue to go down in mortality and up in life expectancy. They're going in the right direction, whereas we're not. Why? What is it about the stress that’s so unique in the United States and why do other countries not suffer from it the way that we do?
And I think also there’s this really reductionist attitude sometimes towards these things: stress bad, let's get rid of all stress. Now I don't think anybody thinks that, certainly not in the medical world. We need stress. We survive and thrive in part because of stress.
The difference is when the stress never goes away, when it’s relentless, when you live in a world where you can never get a break from it. And you find that in many of these other developed societies, wealthy nations, similar lifestyles to what we have here — they have structures and systems in place to allow people to have reprieve from stress. They assign real value to it.
Instead, the rugged individualist society in the United States, where we take great pride in constantly being on the go, not getting a break from that stress — I think that’s part of the problem.
In Japan there's a word for that incredible overwork that drives people to suicide, but the Japanese at the same time acknowledge that they need to seek out some balance.
In Japan, there’s still a lot of stigma overall around mental illness. People don’t openly discuss depression, anxiety. They sort of power through it.
So when they acknowledged this new term, “karoshi,” it was pretty tectonic in Japan that we’re going to acknowledge that people can get sick from overwork, they can even die from overwork.
But we also see all these really novel and unique ways to try to prevent or address the stress, as well.
You also went to Norway, a developed country which always ranks high on the World Happiness Index, while the U.S. is slipping farther and farther down that ladder. What makes Norway healthier and happier? What insights do they have?
We were in a city that’s 270 miles north of the Arctic Circle, so it’s freezing cold and plunged into darkness for months out of the year. We were surprised that this is a country that’s continuously one of the happiest in the world. And there’s lots of different reasons:
Some obvious ones, it’s a wealthy country. They have a tremendous social safety net for people there in terms of healthcare, in terms of education, in terms of the elderly. And I think living in a society where you are pretty confident you’re going to be cared for, that you’re going to be given certain rights, does overall create a happier society.
But I think there’s something else too: This environment is harsh in Norway, and yet people every day overcome a significant challenge just in living in a harsh environment like that. It really got at this idea that many psychologists who study happiness talk about where, if you overcome some sort of challenge on a regular basis, your capacity for real joy becomes much higher.
So it’s not despite the environment that people are so happy in Norway. In some ways, it’s because of the environment that they’re so happy.
What have you adopted in your life, as you have traveled the world and seen the techniques and methods that other countries and other peoples use?
Some of the big basic things, in terms of how I eat, how I think about what I eat, why I am eating what I’m eating, how I exercise, how I move. I mean, human beings weren't designed to sit or lie for 23 hours a day and then get up and go to the gym for an hour a day. We were designed to be moving creatures, and natural movements all day long versus an intense one hour or 45-minute exercise makes a huge difference.
Something I did not expect was the stress that we inadvertently, unwittingly place on people around us, and in my case especially, children. The expectations that sometimes you put on the next generation can create a toxic level of stress that I think we don't even realize.
When you look at Japan as a cautionary tale, they’ve lost the Second World War, and then from that dust and ashes they built the miracle economy.
Just an expectation that that would continue into perpetuity, and an expectation that the next generation would pick up right where that generation left, the previous generation left off — there’s no way that you can maintain that pace of growth, and yet the next generation felt like they had disappointed, that they had not been able to live up to the expectations.
I’m trying to be very careful not to do that to my own children. So I think both physically and psychologically, lifestyle-wise, I’ve changed a lot as a result of this.
A reporter who’d be coming to the United States to do what you've been doing around the world would note a lot of things, including the disequilibrium in the healthcare system. We create the most advanced interventions and treatments in the world, and yet millions of people here can’t afford even the most basic of them.
It’s really illogical. It makes no sense. Friends of mine who are physicians are working the healthcare industry in other countries and they come spend time with us, and that’s always one of the first things that comes to mind, is that our healthcare system is wonderful in so many ways and yet some of the care that people really need isn't available to the people who need it.
It’s like if you looked at this 100 years from now and said, “So let me get this straight: You did all these wonderful things. You created all this medical technology and these new ways of caring for people, and then the people who needed it couldn't always have it?”
It’s in part reflective of the complicated medical complex that we are. It’s a hybrid system, half-public, half-private. You’ve got intermediary insurance companies, you’ve got intermediary pharmacy benefit managers, you’re not even sure how much things cost.
I was doing an operation Monday in my own hospital, a spinal fusion, and because I knew I was going to be spending time with you in talking about these issues, I asked, how much does this instrumentation that we’re using for the spinal fusion cost? And the answer that I got back was some variation of, “Well that's a difficult question to answer.”
The same hospital, the same instrumentation can have two different prices depending on whether it’s neurosurgery or orthopedic surgery, if it’s this doctor or that doctor.
It’s so opaque and we just have no idea what things really cost and where these costs are going up.
If you were to build a system from scratch, what would it look like?
I’ll give this answer and I want to preface by saying this is not a political answer, but I think when you look at single-payer systems around the world, such as in the Scandinavian countries and frankly most countries around the world, you recognize in some ways the advantages they have, and some of the problems they may solve with respect to our system.
Now people will say, well, should that single payer be the government? Is the government really the best arbiter of this sort of thing?
Those are fair questions. But I think once you start to eliminate or at least greatly reduce a lot of the third-party intervention into our system, it does become a more efficient system that I think would over time cost less — maybe not right away — and provide care for every American.
And people who need some of these wonderful technologies and interventions that we create in the United States, it would make it available to them in a way that’s not always right now.
Can you unpack this decline in life expectancy?
While heart disease and cancer remain the biggest cause of death, the big thing has changed over the last 20, 30 years has been this increase in deaths of despair. Death by suicide has gone up some 30%, 35% over the last 20 years. Everyone knows what’s been happening with drug overdoses and particularly opioids. And then there’s also liver cirrhosis due to alcoholism, which surprises a lot of people, that would be such a spike in those types of deaths as well.
What is also interesting is that if you look at the largest demographics within the United States — African Americans, whites, Hispanics — African Americans have higher mortality rates than whites. But those mortality rates continue to go down. Hispanics actually have lower mortality rates than whites.
It is primarily whites, and primarily white working class — which is defined as a high school education or less — that has had the most significant increase in mortality.
The last time we had three years of sustained life expectancy drop was 100 years ago. And what was happening 100 years ago? We had a global flu pandemic and we had a world war.
But why are so many people taking these medications in this country? Why is our perception of pain in the United States so much higher than other developed nations around the world? Why do we die by suicide so often? What is driving that, and why is it so concentrated primarily on the white working class in the United States?
A good doctor is going to go after the root cause of the problem because that’s the way to really take care of the problem itself, not just to continually treat the symptoms.
Something that emerged again and again in “Chasing Life” was how other cultures don’t first turn to the medicine cabinet or to the hospital when they have a problem. This seems to be as much cultural as medical.
With regard to pain, is a little bit of pain OK? Is it OK to not have to take narcotics for even a little bit of pain?
In the United States — and this is how I was trained as well in medical school — you ask everybody about their pain. They come in with a cold and [doctors] get this chart that basically has 10 faces, going from frowny face to smiley face, and the patient points at one, and based on that pointing, you get an idea of how much pain they have,
And they might get an opiate prescription because of where they pointed on that chart!
There was really little attention given to the idea that these medications could be addictive, that they don’t work long term, that they can cause overdose deaths.
That was an American-made problem. There are other countries around the world where they have trauma. They do heart surgery. They do things that can be painful to people, and yet they don’t use these medications.
Turkey is a country that is the largest producer of legal opium in the world. They export almost all of it, most of it to the United States, which raises two questions: Why do they do that, and how do they control pain then?
They’re a developed country that does many of the same procedures.
I was in intensive care units where patients were coming out of open-heart surgery — no narcotics. Are they going to have a little bit of pain? Yes. Are they going to recover just fine? Yes.
They were doing things that you might find surprising. Surgeons playing instruments for their patients as they wake up from anesthesia. And I said, “Does that really work? If you’ve got pain, how is music therapy going to work?”
And they gave me some answer like, “Look, you need to change how you think about this. It’s not that the music is a narcotic medicine. It’s more that we’re changing how someone perceives pain. If you can change how one perceives pain, you can make a big dent in their need or requirement for narcotics.”
Paralleling the big divide in income in this country, we see almost a parallel divide with healthcare.
Probably one of the great tragedies of the healthcare system is that when you have a hybrid system like this, when not everyone has access, you find that the people oftentimes who need it the most are the ones who suffer the most.
This always surprises people: Our healthcare system is expensive, but 5% of the population oftentimes accounts for about 50% of the healthcare costs.
They’re people who are defined by illness, not by health. They take multiple medications. They’ve been in and out of hospitals. They are the quote unquote frequent fliers of the medical system.
When you hear this, you say, “OK, how do I feel about that 5%?” Do I say, “Well, look, if we hyper-target this 5%, help them with home visits, ensure compliance of medications, nutritional counseling, things like that that we know can work — should we be doing that? Or should we say, “Hey, look, you know what? They drank too much, they ate too much, they smoked too much. Why should I be responsible for them?”
And depending on how you answer that question will probably give you tremendous insight into how you think about healthcare overall.
We know that if you hyper-target that 5% and provide the sort of care that they need, not only will you help them, but you will dramatically lower healthcare costs overall.
One of the other metrics that’s alarmingly on the rise is measles. Why is that happening?
It’s a complicated question. Sometimes we have a feeling of equivalency with regard to those who choose to vaccinate and those who choose not to vaccinate. And the numbers of people who choose not to vaccinate, thankfully, are still small.
But they’re large enough — especially in certain more insular communities — that you can see true outbreaks of measles.
I think there is a distrust to some extent of the mainstream medical establishment. There was this incorrect theory that was put forth many years ago that there was an association between these vaccines and autism. That is not the case. That has been discredited.
Measles was eliminated in this country in 2000. So the fact that we have any numbers at all is unnecessary.
You talked about the flu pandemic in 1918, 1919. Since then, we have virtually eradicated polio. We’ve eradicated smallpox. We thought we had measles under control. What are the chances that, especially in this age of global travel, that we could see something take us unawares again?
What we saw in 1918, we saw again in 1968, 50 years later, and people worry about it happening again now, if the flu virus mutates to a form that makes it not only easily transmissible, but also highly lethal.
Then you really have the makings of another global flu pandemic. It takes several months to create a vaccine after you’ve identified the virus that is causing the problem. If it takes a few months, millions of people can die in that time period.
Out of all the big health threats out there, all the things that we talk about, a global flu pandemic is probably right at the top of the list, because it could come out of nowhere, because of a reassortment of genes in a tiny little virus that all of a sudden turns it into a highly transmissible killer.
And that’s what the virus hunters are constantly on the lookout for.
“Chasing Life.” The title is compelling. Do we ever catch it, or does it just catch us?
To the extent that that means we will achieve any kind of immortality, I don't think so. If I say to you, how long do you want to live, the answer usually comes back to some version of, “It depends. What would my body be like? What would my mind be like?”
Not to sound too simplistic, but it’s not how many years of life, it’s the life in your years.
That’s what I found so inspiring around the world. Even in places like Bolivia, where you find in this tribe that while their life is not any longer than ours, up until the day they die they are healthy.
That’s not something we can count on in this country. We expect near the end of our lives that we’re going to spend time in hospitals, that we may spend time in extended care facilities, that we may have difficulty getting around, require multiple medications, maybe even operations, whatever it may be.
In Japan, they talk about the fact that you want to live your life like an incandescent light bulb: Burn brightly your whole life, and then one day just go out. You don’t want to live like a fluorescent light bulb, with a bunch of flickering near the end of your life.
That made a lot of sense to me. That’s how I’d like to live my life.
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