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Squaring the Mortality Curve

I have been practicing emergency medicine for nearly 23 years (26 if you count my EM residency time). And now I am pivoting to the care and treatment of more chronic health problems. What gives? If you've met someone who works in emergency medicine, you'd note most of us are adrenaline junkies, living for the next medical catastrophe:  sepsis, multi-system organ trauma, diabetic ketoacidosis. Our current medical system excels at taking care of these acute disasters, and in that moment in the ER resuscitation bay, we save lives.  


Overall, our current medical system has also extended lifespan significantly compared to 120 years ago, mostly from interventions like antibiotics.  For example, the death rate from infectious disease fell by 90% from 1900 to 1950, accounting for the majority of the overall reduction in mortality during that period. Since that nearly doubling of life span in the 20th century, we’ve plateaued (and even gone backwards). Why?  One reason is our failure to prevent chronic disease, and I would argue we need a seminal change in our mindset.  Instead of focusing on living longer WITH disease, we need to figure out how to live longer WITHOUT disease.  I feel passionate about helping people do just that: improve their health span alongside their lifespan, sometimes called squaring the mortality curve.  


What is health span vs lifespan?  Health span is the length of time you live as a healthy person—this feels slightly different for every person, but most people would identify markers of good physical and cognitive health as being able to play on the floor with their grandkids, travel without significant assistance, walk three miles, pay their bills, carry groceries in from the car, mow the lawn, play pickle ball, you get the idea.  Lifespan is the time you’re alive, no matter how good or bad your health is.  Unfortunately, most Americans live poorly the last decade or so of their lives; their health span and lifespan diverge in that final decade. 


I’d like to help people change that trajectory—whether you’re early in your life or later, it’s never too late to make changes to improve your health span.  We have data on people in their 70s improving their quality of life with lifestyle interventions alone!  There are five main areas in which we can intervene to improve people’s health span:  sleep, exercise, nutrition, emotional health/resilience, and medications & supplements.  This is one of the key pillars in functional medicine—concentrating on these modifiable facets of people’s lives and in doing so, profoundly impacting their health.  I have also trained in obesity medicine, as the diseases of obesity and overweight are common drivers of many of our chronic diseases (including cancer, dementia, heart disease, etc). 


Making changes to your sleep or way of eating or adding movement to your life isn’t easy, but the payoff is enormous.  For example, everyone recognizes that smoking is detrimental to your health. If you smoke and then quit, your all-cause mortality (in other words, death from any cause) decreases by 2.5-fold compared to someone who continues to smoke.  Let’s compare that mortality decrease to the mortality decrease with regular exercise.  There is a monotonic relationship between cardiovascular fitness and decreased mortality—increases in fitness increase not only lifespan, but health span.  One large study of more than 100,000 people measured cardiovascular fitness (via VO2 max measurement) and followed them for a decade.  Even going from the least fit to just below average fitness level netted someone a whopping 50% reduction in mortality, and the benefits continued to grow from there.  Very few other interventions impact all-cause mortality in such a profound manner.


I have so much more to share!  Interested in learning more? Come see me!  Make a meet ‘n greet appointment on my website at

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