Grim Reaper comes later and slower

Killers of past ages may not get us now, but chronic disease still waits for a cure

Health & Fitness

May 19, 2002|By William Hathaway | By William Hathaway,HARTFORD COURANT

In the last century in the developed world, death's face has become wrinkled.

In 1900, one of death's most common visages was that of a 5-year-old child struggling for breath, trying to clear his or her lungs of fluids caused by the sudden assault of pneumonia or perhaps influenza.

Today, death's favorite weapon is a lethal blockage in one of the arteries of the heart, caused by plaques that form gradually during 70 years or more of life.

So, what dramatic changes in the Grim Reaper's handiwork can we expect in the next 50 years? Not as many as you might think.

Despite the promise of biomedical research, many doctors say that most people in the future will die from the same causes as today -- chronic and complex diseases such as heart disease and cancer, often caused or complicated by poor lifestyle choices.

"We will positively see incremental improvements, but not necessarily miracles," said Dr. Andrew Spielman, professor of tropical public health at Harvard University. "The vision that there will be some endless chain of new drugs that will be with us from here until eternity requires a great deal of skepticism."

While each one of today's major killers may claim a slightly lower percentage of lives, experts predict there will be a compensating increase in fatalities from diseases associated with age -- such as Alzheimer's or infections that prey on the weakened immune systems of the elderly.

If new killers emerge to take a position on the Top 10 list, they are likely to be infectious diseases -- perhaps new pathogens such as Ebola or ancient scourges such as tuberculosis retooled by nature to resist antibiotic treatments.

In 1900, pneumonia and influenza, tuberculosis, and diarrhea and enteritis caused three out of every 10 deaths. Four out of 10 victims of those infectious diseases were under age 5.

Today, those infectious diseases, for millenniums a source of terror, rarely trouble the dreams of parents.

The invention of antibiotics and the advent of childhood vaccinations were two of the great medical successes of the century. However, many epidemiologists say that public health initiatives -- such as the introduction of sanitation systems, the increased emphasis on personal hygiene, better nutrition, and maternal and infant care for the poor -- did much more than new treatments to reduce high rates of childhood mortality.

The battles won over infectious diseases in the past century have left medical science to deal with ailments that are much more complex than those that could be traced to a single bacteria or virus.

"Look in any old New England graveyard, and you find children who died of whooping cough or other infectious diseases," said Benjamin Druss, assistant professor of psychiatry and public health at Yale University. "That doesn't happen anymore. As you become better at treating acute diseases, you are left with chronic diseases."

Today's top two killers, heart disease and cancer, which account for nearly 60 percent of all fatalities in the United States, strike the elderly with by far the highest frequency.

Age-adjusted deaths from cancer have begun to inch down in the last five years, but that is because smoking rates have gone down over the last two decades, not because of technological advances, according to Dr. Andrew Salner, director of the cancer program at Hartford Hospital in Hartford, Conn.

While an array of risk factors has been identified for heart disease, few other than tobacco have been conclusively linked to the onset of various cancers.

Medical science will continue to make improvements in treatments of certain types of cancer, Salner said, "but human beings are complex. I don't think we're going to see home runs. There's not going to be a magic bullet."

And as cancer or heart disease deaths decline or the diseases claim people at later ages, deaths from degenerative diseases such as Alzheimer's will inevitably increase, some epidemiologists say.

S. Jay Olshansky, author of The Quest for Immortality: Science at the Frontiers of Aging, said that the developed world is moving from an era in which most people die from "chronic man-made disease" to delayed degenerative diseases.

Others argue that infectious diseases will reclaim positions as major killers in the developed world. New diseases such as Ebola could emerge as deadly worldwide health threats, as AIDS did in the past half-century. Older afflictions such as tuberculosis that have developed resistance to antibiotics could take a higher toll.

"We are essentially swimming in a sea of potentially dangerous pathogens," said Harvard's Spielman.

William Hathaway is a reporter for the Hartford Courant, a Tribune Publishing newspaper.

The changing face of death

Life expectancy -- newborns who live to age 65

1900

Boys 39 percent

Girls 43 percent

1997

Boys 77 percent

Girls 86 percent

Leading causes of death in the United States (as a percentage of all deaths)

1900

Pneumonia, influenza 11.7 percent

Tuberculosis 11.3 percent

Diarrhea and enteritis 8.3 percent

Heart disease 8 percent

Stroke 6.2 percent

Liver disease 6.1 percent

Injuries 4.2 percent

Cancer 3.7 percent

Senility 2.9 percent

Diphtheria 2.3 percent

1997

Heart disease 31.4 percent

Cancer 23.3 percent

Stroke 6.9 percent

Chronic lung disease 4.7 percent

Unintentional injury 4.1 percent

Pneumonia, influenza 3.7 percent

Diabetes 2.7 percent

Suicide 1.3 percent

Kidney disease 1.1 percent

Chronic liver disease 1.1 percent

Sources: Hartford Courant; Centers for Disease Control and Prevention

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