Cradle Grave

INTELLIGENT DIALOGUE:

&
CRADLE
GRAVE

FALL 2008 Many Minds. Singular Results.

Cover photo: Creative Commons/pdam2

Many Minds.
Singular Results.

MESSAGE FROM THE CEO
“SOMEONE ALIVE TODAY will live to the ripe old
age of 150.” Agree or disagree? Two professors have
wagered $150 on this very question. No matter which
side you’re on, there’s no arguing that fundamental
shifts in health trends have us all rethinking long-held
beliefs about life and death. In our latest Intelligent
Dialogue white paper, “Cradle & Grave,” Porter Novelli
has examined emerging global trends in fertility and birth, health and death
that have profound implications for businesses, organizations and consumers
far beyond the health care industry.

Gaining a better understanding of these complex health issues means
getting out of your comfort zone. It means leaving behind preconceived notions
of the “right” age for a first-time mother. It means facing your own mortality
and examining whether you really want to live to be a centenarian, and then
honestly asking yourself, “Am I making the choices today that will allow me to
live 100 years?”

To prepare this paper, our health care industry specialists joined with our
public affairs, corporate affairs and marketing professionals to consider what’s
changing across the full arc of life, from conception to death. “Cradle & Grave”
identifies key trends in fertility, birth, health care advances, disease
prevention and treatment, aging and dying. The paper examines how families
(and populations) are changing, and how evolving health challenges like
diseases of affluence and the obesity crisis will affect modern society. It raises
questions about the advent of personalized drug therapies, the promise of
longer life expectancy and the threats posed by swelling ranks of elderly and
chronically ill people.

While some of the trends discussed in “Cradle & Grave” might not be news,
integrating the full scope of them into our lives and businesses is a
monumental challenge. This paper is intended to help map out the big picture
and prompt discussion.

At Porter Novelli, we believe ours is a learning culture, and that ongoing
dialogue is key. We challenge assumptions and cultivate creative questions,
and we invite you to join the dialogue by checking out our blog,
PNIntelligentDialogue.com. It’s your forum for discussing the issues raised in
“Cradle & Grave,” and for proposing your own questions.
Our goal with the Intelligent Dialogue series is to provide perspective and
stimulate conversation. This is an opportunity for individuals and organizations
to demonstrate thought leadership on issues that affect all of us.

—GARY STOCKMAN

TH E PRE S E NT SCREAM S
FOR ATTE NTION

AN D TH E FUTU RE WH I S PE RS .

No wonder more people than ever are falling
into the old trap of overestimating
Photo: Creative Commons/jonner

short-term change and
underestimating
long-term change.

4 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.

INTRODUCTION

IN THE CURRENT FRENZY of financial uncertainty, fast- most productive when it’s open and inquisitive. In particular,
talking pundits and finger-pointing politicians, can anyone afford this edition is driven by three overarching questions:
to think more than a year or so into the future?
1. What about life and death has changed?
Nobody knows what may happen between now and next
year in the economy, politics or technology, let alone other parts 2. Which long-standing assumptions about life and
of life. Thoughts about the longer term are crowded out by death no longer hold true?
urgent news of breakthroughs and breakdowns pumped out by
the media 24/7. 3. What are the emerging risks and opportunities
Businesses and consumers are so busy putting out the fires in for societies, businesses and consumers?
front of them, they are unable to focus on what’s further ahead.
With our background in social marketing, Porter Novelli
The present screams for attention and the future whispers. No
believes that now more than ever, when it comes to the life-and-
wonder more people than ever are falling into the old trap of
death issues covered in this paper, our communities need smart
overestimating short-term change and underestimating long-term
leadership through Intelligent Influence. During this period of
change. This paper is intended to shift the focus and look at
Photo: Creative Commons/A.M. Kuchling

worldwide financial change, we will be helping our clients take
some of the long-term changes slowly but surely reshaping the
the long view and keep their sights on these critical health issues
most important things in our world: literally the basics of our
as they make decisions on how they will move forward. This is
life as we know it. They’re gradual changes that we can all see
an ideal moment to foster serious consideration of the bigger
and feel but are too busy and too distracted to notice; they’re
health issues that affect everyone. For smart businesses and
eclipsed by breaking news or hot gossip.
brands in particular, life and death issues create opportunities to
In keeping with our guiding principles, this edition of provide the leadership employees and consumers need—
Intelligent Dialogue is driven by observation and open-ended opportunities that enhance both their reputation and their
curiosity. It raises a lot of questions, because we find dialogue is bottom line.

Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 5

BIG QUESTION 1

WHAT’S HAPPENING

TO NUCLEAR FAMILIES?
TO HAVE KIDS or not? Now or later? and effective contraception make for of 1.5, as do developed countries such as
How many? What will it cost? It used to smaller families. Russia (1.4), Japan (1.22) and Singapore

Photos (from top): Creative Commons/paristempo, Creative Commons/ShutterCat7
be that babies were the result of “doing (1.08), and newly developing countries
In the developed world, births in many
what comes naturally.” But now, having like China (1.77), Thailand (1.64) and
children isn’t inevitable, it’s a matter of countries are below an average of 2.1 per
South Korea (1.29).
choice. It’s a complex decision, woman, which is the crucial “replacement
and in the 21st century, deciding rate,” or number needed In all sorts of ways, traditional
to become a parent involves to maintain a population expectations of childbearing and family
considerations unknown to at a stable level. When relationships no longer apply.
previous generations. fertility rates are below

Though recent figures from
2.1, the population
shrinks. This is a radical
> WHY ARE WOMEN
the U.S. National Center for change from what has WAITING TO HAVE
Health Statistics show a record
number of babies born in the
happened throughout CHILDREN? It used to be that
most of history, when people married in their late teens or early
U.S. in 2007, birthrates are populations of prosperous 20s, had children and moved into a
trending downward worldwide. cultures continually grandparent role by middle age. Now,
The more prosperous people become, expanded. Today, with its recent baby growing numbers of people are starting
the fewer children they have. More years boomlet, the United States is running at this cycle much later, or they’re skipping
of education, higher quality-of-life replacement rate, but the European Union over the marriage step, or they’re
expectations, better career opportunities (EU) falls well below that, with a birthrate choosing to become single parents; some


necessarily mean it’s baby time. Women THE COST OF FERTILITY
may still be reluctant to take time out for
a child, either because they are unwilling
to sacrifice career goals or because they { MILLION
don’t feel financially prepared. Or the
delay may be beyond their control if they
DOLLAR BABY }
are having trouble conceiving.
The statistics tell the story of delayed
motherhood but Hollywood brings it to
life, writ large in the personal lives of
celebrities: Madonna famously gave birth
to her first child at 38 (fathered by a
boyfriend); her second at 41 (father was
second husband Guy Ritchie); and
then adopted a child at 49. “Desperate
are starting new families as they move on
Housewives” star Marcia Cross celebrated
to second marriages, and some are
her first marriage at 44, then gave birth
marrying relatively late and adopting.
to twins less than a year later. Actress
The average age for first marriages has Nicole Kidman recently gave birth to her
crept up, and it’s not surprising. Younger first child with second husband Keith
women are too absorbed in education and Urban at 41, having previously adopted
careers to focus on serious dating, and they two children in her 20s with first husband
tend to be financially self-sufficient. The Tom Cruise. And several stars chose to
women depicted in “Sex and the City” may be adoptive single moms despite their
have been TV-land creations but they busy careers—actress Angelina Jolie, In the U.K., child psychiatrist
struck a chord all over the world as women singer Sheryl Crow and actress Mary-
who enjoyed their independence and were Louise Parker. Patricia Rashbrook made headlines
Photos (clockwise from top): Creative Commons/SilentObserver, Creative Commons/Mahalie, Creative Commons/miss pupik

taking their time in finding a long-term in 2006 when she gave birth at age
partner until well into their late 30s or 40s.
Why should women hurry to have
> HOW OLD IS 62; she already had three grown
children when modern life is giving them TOO OLD TO HAVE A children from a previous marriage.
plenty of reasons and ample means to have BABY? Data across the EU and the She and her husband had spent
them in their own good time—or not at all? U.S. show the average age of first-time
Even settling with a steady partner doesn’t mothers is rising. More women at the $20,000 on fertility treatments with
Italian embryologist and fertility
specialist Dr. Severino Antinori, who
has become a controversial (and
wealthy) celebrity in the field.

According to the American Society
of Reproductive Medicine, the
average cost of an IVF cycle in the
U.S. is $12,400. Would-be parents
may try it two or three times,
although IVF is not successful for a
significant percentage of women. In
Europe the average cost is
estimated at $4,000 to $6,000.


IVF TURNS 30

{ ONE PLUS ONE EQUALS ME }
The world’s first test tube baby, Louise Brown, has just turned 30, and the IVF (in
vitro fertilization) technique used to make her birth possible has spawned an industry
now worth $3 billion in the United States alone. The process used at the time has
been superseded by ICSI (intracytoplasmic sperm injection), where a single sperm is
injected directly into an egg.

upper range of childbearing ability are Professor Bill Ledger of England’s and “gender bending” (endocrine-
becoming mothers. Sheffield University is one of the fertility disrupting) chemicals in the environment.
specialists warning that obesity and
The average age of EU women giving
birth to their first child rose from 23 to 25
sexually transmitted diseases are causing a
growing number of fertility problems.
> WHAT ARE THE
between 1990 and 2002. In the bigger FINANCIAL ISSUES OF
Currently, one in seven couples has
countries, first-timers were older than
that: 28 in France (as of 2001)
trouble conceiving naturally, and Ledger OLDER PARENTHOOD?
warns this could rise to one in three. First-time parents who are older than the
and 29 in Germany (2003).
He advises couples to start trying to “traditional” age tend to do a lot of soul-
According to the U.K.’s
conceive younger than 35. searching. Whether their later parenthood
Office for National Statistics,
more of Britain’s first-time Older parenthood is not just a is deliberate, or due to circumstances such
mothers now fall in the 30 to 34 age female issue; men have their own as marriage or fertility problems, they are
group than in the 25 to 29 age group; fertility problems. There is clear more likely to feel the need to rationalize
and there has been an almost 50 percent evidence that sperm quality and justify their situation to themselves
increase from 10 years ago in women over deteriorates with age and around and/or to others. The Internet is proving
40 having babies. In the U.S., the most a quarter of men of reproductive to be an ideal medium for them to
recent census figures show the average age at age are subfertile (they produce compare notes and examine the issues.

Photos (clockwise from top): Creative Commons/moyix, Creative Commons/salimfadhley, Creative Commons/paristempo
an all-time high of 25.2, with more than sperm but not at maximum One clear advantage of older new
100,000 births in 2003 to women 40 or older. fertility). There are indications that male
parents is financial stability—a factor that
fertility is decreasing due to several
Fertility treatments and improved health seems to be widely accepted and valued in
possible causes, notably stress, weight
care are certainly pushing up the age at discussions on the issue. Parents in their 30s
issues and diabetes. Researchers are
which it’s possible to have children. and 40s tend to be educated and established
looking into other possible causes such as
However, “possible” is not the same as in the workplace. They’re more likely than
electromagnetic radiation from cell phones
probable, advisable or desirable. younger parents to have achieved a certain
standard of living, along with higher
expectations of service, comfort and quality.
Older prospective parents may have to
be prepared to invest significant amounts
of money and time in fertility treatments
or adoption.
On the other hand, these parents may
find themselves needing to fund their
children’s teenage pursuits and college
education at a time when their peers are
beginning to draw pensions. As AARP the
Magazine put it: “Midlife parents face
another challenge: how to stay financially
healthy as well [as physically healthy].
Many may find themselves working well
beyond the traditional retirement age just
so they can send their kids to college.”
Current assumptions about maternity-
planning patterns and family structures are
increasingly out of step with reality.


TH E MORE PROS PE ROU S
PEOPLE B ECOM E, TH E FEWE R CH I LDRE N

TH EY HAVE. MORE YEARS OF E DUCATION, higher

quality-of-life expectations, better career opportunities and

effective contraception make for smaller families.


SURROGACY IN INDIA

{ CARRYING THE WEIGHT OF THE WORLD }
Thanks to globalization, India has emerged as an option for surrogacy. Centers are
springing up in which local women carry the babies of Westerners who don’t want to pay
the high costs generally associated with such a proposition in their home countries.

India’s sophisticated medical capabilities and low costs make outsourced surrogacy a
viable industry, but one that’s prompting outrage from critics who charge that it exploits
poor people and is a crass commercialization of an intimate matter. Dr. Nayna Patel, who
works at a surrogacy clinic in Anand, India, defends the practice as a win-win
arrangement, telling the Associated Press, “There is a woman who desperately needs a
baby and cannot have her own child without the help of a surrogate. At the other end there is a woman who badly
wants to help her [own] family. If this female wants to help the other one, why not allow that? It’s not for any bad
cause. They’re helping one another to have a new life in this world.”

Can employers afford to have valuable,
talented staff absorbed in a baby chase?
> WHAT’S WRONG frustration through violence, crime and
political extremism, and that rising
What are the opportunities for businesses WITH GETTING A SNEAK demand for sex workers could fuel the
to offer fertility counseling and assistance PEEK? Fertility treatments and practice of human trafficking and the
as part of occupational health care, in prenatal screening have given would-be spread of HIV/AIDS.
order to attract and retain top-notch mid- parents the option of knowing the sex of Although prenatal gender screening

Photos (clockwise from top): Creative Commons/jenaynay, Creative Commons/Michael_Chavarria, Creative Commons/The LeCrones
to-senior level professionals? their baby before it’s born. In some involves the relatively simple technology
Are employers that foster a maternity- cultures where males have a higher status of ultrasound, its wider social effects are
friendly, postpartum-friendly, family- than women (such as India and China), proving to be far-reaching. The effects
friendly culture getting ahead of the curve this has resulted in a dangerously skewed of more sophisticated genetic-based
in recruitment, retention and reputation? gender balance. prenatal screening are likely to be even
Or are they merely picking up the tab for In China, the one-child policy has meant more radical.
more ruthless, lean-and-mean competitors? that many parents aren’t willing to let
The biological limitations of parenthood nature take its course. China will have 30
have changed, and so have the social million more men of marriageable age
limitations. Parents no longer need to be than women in the next decade and a half.
in a traditional couple—some are single The ratio for newborn babies in 2005
women, others are same-sex couples. was 118 boys vs. 100 girls, up from
110/100 in 2000. In some regions the
There’s a greater willingness to talk ratio is as high as 130/100, compared
about fertility problems and options. with an average of between 104 and
Still, there’s a risk of social backlash when 107 boys for every 100 girls in
people opt for non-traditional choices. industrialized countries.
For businesses, how tightly they want to
embrace non-traditional choices is not just In 1994, the Indian government banned
a matter of inner-focused company policy— medical practitioners from revealing the
it’s a part of brand positioning and identity. gender results of fetal scans. Yet the
gender imbalance has only further
tipped. In 1991 there were 945
women for every 1,000 men, and
the gap widened to 927/1,000
by 2001.
These unintended
consequences of simple
screening are likely to be
felt for decades to come.
There are concerns that
millions of restless young
men could vent their


WHY S HOU LD

WOM E N H U RRY TO

HAVE CH I LDRE N…

WH E N MODE RN LI FE is giving them plenty of reasons and
Photo: Creative Commons/wilf2

ample means to have them in their own good time—or not at all?


BIG QUESTION 2

WHAT’S THE BEST WAY
TO DELIVER BABIES?

CHILDBIRTH IS AN EXPERIENCE it happens.” But in fact, it doesn’t happen How much of this is due to the
traditionally surrounded by folklore and the same everywhere. precautionary principle, with the fear of
mystery. Historically it has been one of the malpractice suits informing medical
Now, as in other parts of medicine,
riskiest moments in life. It still is. And procedures? How much is due to the
globalization has enabled interested parties
while medical science has helped alleviate medical profession seeking business
to compare practices in terms of medical
the risk and pain involved, there are still opportunities? How much is due to the
outcome as well as emotional outcome and
major open issues. “mission creep” of technology, as implied
cost. This has encouraged challenges to
the highly medicalized approach to in the polemical 2007 movie “The Business
> IS A HOSPITAL pregnancy and childbirth that is at its most of Being Born”?
BIRTH THE ONLY SAFE pronounced in the United States.
Photo: Creative Commons/premus

OPTION? There’s a growing In the U.S., home births account for just > WHO REALLY WANTS
tendency for developed countries to treat 1 percent of deliveries, and the American
pregnancy and childbirth as medical College of Obstetricians and Gynecologists
BIRTH BY CESAREAN
issues, requiring highly sophisticated has repeatedly stated its opposition to home SECTION? One of the most hotly
medical care and hospitalization. For a births, emphasizing that “the safest setting contested issues is the trend to deliver
long time this trend was accepted by for labor, delivery and the immediate babies by cesarean section. Although it’s
parents-to-be and the wider society as postpartum period is in the hospital, or a still a serious surgical procedure, it’s no
“doctor knows best” and “this is the way birthing center within a hospital complex.” longer a last-resort rarity.


CE SAREAN S ECTION

HAS B ECOM E SO NORMAL
THAT I N SOM E I N STANCE S, IT I S

REGARDE D AS

A WAY OF

S LOTTI NG

CH I LDB I RTH

B U SY SCH E DU LE .
Photo: Creative Commons/wilf2

I NTO A


In the United States, figures for 2007 According to a survey of American As childbirth becomes a less frequent
are expected to show around one in three women conducted on behalf of the U.S. occurrence in developed societies, will each
births by cesarean, compared with fewer nonprofit Childbirth Connection, 98 pregnancy and birth become more
than one in 20 in 1965. Cesareans are percent of women with primary (planned) expensive? Will the medical profession
increasingly common in Canada too, even cesareans believed there was a medical become ever-more intensively involved?
though the health system is significantly reason for the surgery. The most common Childbirth has become a lot less risky
different: 26.3 percent of women concerns cited were fetal distress, position than it used to be in many parts of the
delivered by cesarean in 2005–2006, up of baby, size of baby and prolonged labor. world. But is the complete medicalization
from 23 percent in 2001–2002. In the However, 42 percent of respondents also of childbirth in the best interest of all
U.K., cesarean sections are also felt that due to fear of lawsuits, the concerned? Are health care and insurance
increasing and currently stand at around current health care system leads to providers missing an opportunity to offer
20 percent. unnecessary cesareans. alternatives that cost less and satisfy more?

IN-HOME DELIVERY

{ SHOULD WE ALL BE GOING DUTCH? }

Among major developed countries, childbirth in the Netherlands is an anomaly. In fact, the attitude of the Dutch
toward childbirth has been called medieval. Pain is regarded as a normal part of childbirth, and pain relief is the
exception rather than the rule. Indeed, unless there are medical complications, maternity care is a determinedly low-
tech affair left in the hands of midwives; a home birth is the default choice. The rate for cesarean sections is less
than 10 percent, which is significantly out of line with the modern trend. Likewise, few countries have the
Photo: Creative Commons/eyeliam

equivalent of the kraamzorg, a program in which a maternity nurse provides after-birth care in the home for a week.
It’s standard after all births in the Netherlands and is on the policy list of Britain’s Conservative Party.
However, the Dutch example may not be so easy for other countries to emulate. In the small, densely populated
Netherlands, most homes are within 10 to 15 minutes of a hospital. If an in-home delivery suddenly turns difficult,
medical facilities are within easy reach.


BIG QUESTION 3

WHAT NEW
HEALTH THREATS
MUST BE DEFEATED,
AND HOW?

PEOPLE ARE ALREADY experiencing > ARE THE MAJOR HIV/AIDS and the virulent staph
infection MRSA are relatively new to the
longer, healthier lives than ever before
and there’s the prospect of more good
CONTAGIOUS DISEASES roster of communicable diseases. One
GONE FOR GOOD? Time
Photo: Creative Commons/Andrew Ciscel

third of the world’s population is infected
news to come. But that doesn’t mean it’s
was when contagious diseases were the with the bacteria that causes tuberculosis.
all smooth sailing from here on. For one
Meningitis continues to lurk and malaria
thing, microorganisms (bacteria, viruses, big killers: plague, smallpox, cholera, etc.
may yet spread further as global warming
etc.) have a way of evolving to exploit Thanks to public sanitation, hygiene,
makes temperate zones more congenial for
new opportunities, which could trigger a vaccination and antibiotics, their impact mosquitoes. Meanwhile, health authorities
major pandemic. For another thing, we has been hugely reduced. But they have are keeping an eye out for the likes of
are facing diseases arising from new not been completely eliminated, and they SARS and avian flu, and whatever might
lifestyles and from living older. still hold some nasty surprises. yet emerge from tropical jungles.


E A R LY P R E V E N T I O N F O R A H E A LT H Y F U T U R E

{ WHAT A GIRL WANTS }
According to the U.S. Centers for Disease Control and Prevention, the
vaccine Gardasil® prevents
the types of genital human
papillomavirus (HPV) that
cause most cases of cervical cancer and genital warts. The vaccine is given in
three shots over six months and is routinely recommended for 11- and 12-year-old girls. It is also recommended for
girls and women ages 13 through 26 who have not yet been vaccinated or completed the vaccine series.

Communicable-disease specialists warn that of Montpellier in France. The systematic
there’s a strong chance of more superbugs; monitoring of bush-meat hunters may also
microbes and even cancers are developing help prevent future AIDS-like epidemics.
immunity to the drugs that have been used
against them. Although communicable diseases are not
killing huge numbers of people in the old
HIV/AIDS is typical of what health familiar ways—sickness, fever, swelling and
professionals fear from cunning superbugs. pain within weeks or months—they may be
By the time the Centers for Disease Control wreaking havoc over a longer period,
and Prevention (CDC) in the U.S. working in the background. Some viruses
recognized HIV/AIDS as a distinct can cause changes in cells that may lead to
syndrome in 1981, it was already on its cancer. There are clear links between
way to becoming a devastating epidemic. cervical cancer and the genital wart virus from behaviors or environments of wealthier
According to a 2006 report from the United HPV, between primary liver cancer and societies. This is uncharted territory in
Nations Joint Program on HIV/AIDS, over the hepatitis B virus, and between various human history and raises new challenges.
the last quarter-century, nearly 65 million cancers and the Epstein-Barr virus.
people were infected with HIV and an We are seeking medication to tackle the

Photos (clockwise from top): Creative Commons/Mel B., Creative Commons/Jaye_Elle, Creative Commons/Andy McLeod
Fortunately medical science evolves fast
estimated 25 million have died of AIDS- effects of too little physical activity and too
too and a range of new vaccines such as
related illnesses. About 33 million—almost much food; we are expecting cures for
Gardasil has been introduced in recent
half are women—live with HIV today, the diseases that were barely encountered a
years that seem to be effective at reducing
vast majority unaware of their status. century ago. And they can’t be found soon
the incidence of such cancers.
enough. By some accounts, half the
Scientists are looking for ways to spot Many of the major historical advances American population is living with some
other emerging diseases before they in disease control and life expectancy have form of chronic illness.
become equally—if not more—devastating. come from preventing diseases rather than
About three-quarters of emerging human Diabetes is a case in point. About 124
curing them. Vaccination, sanitation,
diseases are “zoonoses,” or pathogens that, million people worldwide had diabetes in
education and nutrition have together
like HIV/AIDS, originate in animals and 1997, compared with a projected 221
done more to save lives from disease than
cross into human populations. A number million by 2010. The rate is rising in
have feats of medical wizardry as seen in
of projects are focused on gathering front- parallel with obesity, a major cause of type
“ER” and “House.”
line blood samples across equatorial 2 diabetes; the coupling of a severe weight
jungles, watching for changes in behavior The specific illnesses have changed but problem with type 2 diabetes is being
and mortality, and coordinating findings the principle holds; cures are needed but referred to as “diabesity.”
through specialists such as the CDC and prevention will continue to be the most
While death from heart disease in the
the virology laboratory at the University effective and the most cost-effective
U.S. has fallen by 26 percent and death
strategy.
from stroke by 24 percent since 1999, they
are still the first and third causes of death,
> WHAT ARE THE respectively. And the American Heart
PROSPECTS FOR Association has warned that the
improvement could be short-lived if risk
TREATING CHRONIC factors aren’t reduced.
AND TERMINAL It’s not just the U.S. that’s grappling
CONDITIONS? People in with the big killers. The World Health
developed countries are much less apt to Organization reports that cardiovascular
die from contagious diseases anymore. disease is the top cause of death globally,
Rather, they tend to succumb to old age or and it’s projected to remain so. An
to “diseases of affluence”—those stemming estimated 17.5 million people died from


CH RON IC
TH E U PS I DE OF
DI S EAS E TREATM E NT
I S THAT PEOPLE ARE S U RVIVI NG
AN D EVE NTUALLY DYI NG
with the disease rather than from it.
The downside is that it can be
expensive and debilitating to live
life on the tightrope of
daily disease management.
Photo: Creative Commons/Jimee, Jackie, Tom & Asha


through basic research and improvements developing, heavily populated regions such
in treatment and care. as China, India and Latin America.
The longer people live, the more likely it Like battlefield weapons designed to
is they will experience any one of about 80 wound rather than kill, the chronic
autoimmune disorders that can make life illnesses of today can be more devastating
miserable. These disorders involve the than acute, sudden-death conditions.
immune system mistakenly attacking and People suffering from chronic disease over
destroying healthy body tissue—“friendly fire,” several years represent major costs, both
so to speak. Well-known conditions include: financially and emotionally.
type 1 diabetes, thyroiditis, pernicious anemia,
The prospect of many millions more
rheumatoid arthritis, lupus, multiple sclerosis
people suffering from chronic illnesses and
and Graves’ disease. According to the
millions having to look after them is a real
American Autoimmune Related Diseases
and unprecedented threat likely to eclipse
Association, it’s estimated that
the dangers of terrorists and road traffic
cardiovascular disease and strokes in 2005, approximately 50 million Americans suffer
accidents and violent criminals combined.
accounting for 30 percent of global deaths. from an autoimmune disease.
How can governments, insurers and
In 2003, the World Health Degenerative conditions are another individuals be adequately prepared for it?
Organization’s “World Cancer Report” prospect, especially dementia—the umbrella
forecast an increase in cancer from 10 name for progressive degenerative brain
million new cases globally in 2000 to 15 syndromes that affect memory, thinking,
million by 2020, mainly due to steadily behavior and emotion.
aging populations in both developed and Alzheimer’s disease is the most common
developing countries, as well as rising form of dementia. According to Johns
trends in smoking and the growing Hopkins researchers, an estimated 26.6
adoption of unhealthy lifestyles. The million people worldwide suffer from
report says cancer poses major challenges Alzheimer’s, a number that’s forecast to
for health care systems worldwide, but that rise to more than 106.8 million by 2050.
it can be prevented and its impact reduced Much of this increase will be in rapidly

Photos (clockwise from top): Creative Commons/Subewl, Creative Commons/Sam Blackman, Creative Commons/brykmantra


U P TO TH E AG E OF 65,

DE M E NTIA
DEVE LOPS I N ABOUT ON E PE RSON I N 1,000.

Its incidence rises sharply with
age to one person in 20 over age
65. The big threat is to people over
the age of 80, when the incidence of
dementia increases to one in five.
That’s riskier than the one in six of
Russian roulette.
Photo: Creative Commons/lanuiop


> IS OBESITY THE (defined as a body mass index
greater than 30) increases the
of public and private
concerns, ranging
NEXT FRONTIER? Obesity risks of developing diabetes, from governments
and its complications will cause the high blood pressure, angina, to nonprofits to
untimely deaths of hundreds of thousands heart attacks, high the food industry.
of people every year for the foreseeable cholesterol, urinary Perhaps a faster,
future. In 2006, U.S. Surgeon General incontinence, infertility, fail-safe solution
Richard Carmona called obesity “the osteoarthritis, asthma, sleep will come from
terror within” and warned that, “Unless apnea and cancer. science.
we do something about it, the magnitude
of the dilemma will dwarf 9/11 or any These illnesses represent A lot of people
other terrorist attempt.” Are such dire huge costs in terms of human are aiming for a
proclamations just the nanny state at suffering, not to mention medical “cure” for obesity—
work? After all, if obesity is such a big and insurance costs as well as lost miracle foods, pills,
productivity and earnings. Obesity is set injections, surgery, gene therapy
threat, why are people living longer?
to become the most critical health issue and more. Whoever comes up with a safe and
There’s no getting around the health shaping life and death in the first half of effective treatment that fulfills the classic
implications of extra pounds. According to the 21st century. Turning the tide will marketing imperatives—quick, easy, convenient,
U.K. private hospital group BMI, obesity require the commitment and collaboration affordable—will be sitting on a goldmine.
Might microbes come to the rescue?
THE OBESITY EPIDEMIC Researchers at the EU’s Metagenomics of

{ NO ROOM TO GROW } the Human Intestinal Tract project
(MetaHIT) have found a sharp contrast in
the bacteria population in the guts of
overweight and thin people. And when
heavy people dieted and lost up to a
quarter of their body weight, their gut flora
changed too, becoming more like those of
the lean group. So it may be that certain
types of probiotics can help reduce weight.
Might genetics solve the problem? In
2007, scientists analyzing a large-scale
study of diabetics found a correlation
between the FTO gene and obesity.
Researchers at Cambridge University in
the U.K. have discovered that the gene
codes for an enzyme that modifies DNA
could be activated or inhibited by
pharmaceuticals. This opens the prospect
of drug therapies for obesity.
For the moment, many people are pinning
their hopes on surgery. Restrictive surgery
covers procedures that make the stomach
smaller, so that the patient eats less.

Photo: Creative Commons/gotplaid?. Creative Commons/memekode
World Health Organization figures for 2005 show that approximately 1.6 Malabsorptive surgery changes the body’s
billion adults worldwide were overweight and 400 million were obese; the ability to absorb calories from food. The
two most commonly performed operations
WHO forecasts as many as 2.3 billion overweight adults in the world by are laparoscopic adjustable gastric banding
2015, more than 700 million of whom will be obese. (LAGB), also known as lap banding or
gastric banding, and gastric bypass.
Just how much have our waistlines expanded over the decades? In 1951, Weight problems are no longer simply
aesthetic issues; they represent a major
a survey found that the average British woman’s waist measured 27.5
threat to public health, although public
inches. By contrast, the U.K.’s 2004 National Sizing Survey (SizeUK) found perception of the real threat is far short
of reality.
that the average waist had increased to 34 inches. While there was no
comparative data for men in 1951, the SizeUK data found an average male What will it take for obesity to be
treated seriously as a modern medical
waist of 37 inches in 2004. condition with major public health


TH E FOOD AN D DRI N KS
I N DU STRI E S
HAVEG ROWN
TH E I R MARKETS
S PECTACU LARLY.
While they may not be blamed for
consumers’ obesity, they are clearly
a crucial part of the problem.
How can the health of
these industries align more
effectively with the interests
of public health?
Photo: Creative Commons/moyix


ACCORDI NG TO TH E
MAYO CLI N IC, EACH YEAR
AN E STI MATE D

100,000
AM E RICAN S DI E
from adverse reactions to medications and
more than 2 million are hospitalized.

Photo: Creative Commons/subewl


implications rather than as a lifestyle issue? before doctors find one that more focused therapy, greater
The risk is that the cumulative effects of works. emphasis on preventive
obesity will overwhelm the capacity of medicine and cost
In the meantime the
communities to deal with the financial and reduction. The PMC
side effects of this
health care consequences. also believes when
trial-and-error process
used in research,
can be distressing for
pharmacogenomics
patients and risky
could reduce the
for their health, not
length, cost and failure
to mention a serious
rate of clinical trials, and
waste of health care
even revive drugs that
resources.
failed clinical trials or were
To reduce the potluck withdrawn from the market.
element of drugs, health care
A lot depends on technology
professionals are looking to
being developed to read (or
personalized medicine, or
“sequence”) genes fast and affordably. In
pharmacogenomics. With this approach,
> WHEN WILL CURES before medication is prescribed, genetic
the U.S., the National Institutes of Health
has set a goal for sequencing an entire
BECOME LESS LIFE- analysis will be carried out to check for
personal genome at a cost of just $1,000 by
relevant genetic variations—single
THREATENING? For all the nucleotide polymorphisms, or SNPs. This
2014 (currently, one firm is charging
amazing progress in pharmaceuticals, $350,000 to anyone who wants a complete
will enable doctors to better predict
prescribing drugs is still hit-or-miss. Drugs personal genome sequencing). In a parallel
whether a drug will provoke an adverse
have been developed to deal with initiative, the X Prize Foundation in the
reaction or will be likely to do the job.
conditions, not individuals; they take a United States has put up a prize of $10
one-size-fits-all approach that can’t account According to the Personalized Medicine million for the first private team that can
for individual body chemistry. Patients Coalition, this approach has the potential decode 100 complete human genomes
may be subjected to a range of treatments to offer benefits such as early detection, within 10 days for less than $10,000 each.
Photos (clockwise from top): Creative Commons/SMercury98, Creative Commons/MASH DnArt, Creative Commons/jurvetson


BIG QUESTION 4

HOW OLD DO WE

REALLY WANT TO BE?
HOW ABOUT LIVING FOREVER? In most developed countries, life spans that damage and weaken the body. There
Mythology, legend, religion and popular have been steadily increasing for a long are fewer accidents and better treatments
culture are full of quests to find ways of time and look set to continue upward. for injuries such as fractures and lesions.
beating the Grim Reaper: the fountain of Consider that in 1850, life expectancy at Better nutrition is more widely available,
youth, the elixir of life, the philosopher’s stone. birth averaged just 38.3 years for helping bodies stay resilient.
But the human body hasn’t evolved to live American Caucasian men and 40.5 years
The big imponderable is whether the
indefinitely; parts of it go wrong (including the for women; by 2004 it was 75.7 for men
trend for gradually increasing life spans
repair systems), and an accumulation of faults and 80.8 for women. In the U.K., for
can be projected indefinitely into the
eventually leads to one part of the system every million born alive in the 1880s, just
future. What are the limits? Steve Austad,
failing, with fatal consequences. 309,020 were still alive at 65 and only
a professor of cellular and structural
161,164 at age 75; by the 1990s, a
biology at the University of Texas, is
majority could expect to reach both 65
> WHAT ARE THE (830,990) and 75 (612,740).
convinced that somebody alive today will
reach the age of 150. S. Jay Olshansky, an
LIMITS OF LIFE People are living longer largely because epidemiology professor at the University
EXPECTANCY? Although

they are staying well longer. They are now of Illinois at Chicago, disagrees strongly.
there are a few areas of the world where in better shape as they age—one reason for They each wagered $150 on the question,
life expectancy is still poor, in general it proclamations such as “50 is the new 30.” and Olshansky invested the money in a
has increased steadily. Globally, life And while it’s true that less healthy fund. If a 150-year-old is alive in the year
expectancy at birth was just 30 years in lifestyles and the rise of obesity mean 2150—someone of sound mind and body—
1900; it had more than doubled, to 62, by many people are not in great condition, Austad’s descendants will get the pot;
1985 and currently stands at around 64. they are less beset by infectious diseases otherwise, Olshansky’s offspring will win.


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