Sunday, April 26, 2009

Comparing Cars and People

Some time ago I went to a talk at my local public library given by Dr. Walter Bortz, a professor of medicine at Stanford University (and many other active roles). He is also the author of many best-selling books including Dare to be 100: 99 Steps to a Long, Healthy Life, Living Longer for Dummies, and Diabetes Danger: What 200 Million Americans at Risk Need to Know.

He likened people’s health and longevity to that of a car, and said there were four key factors: Design, Accidents, Maintenance and Aging.

DESIGN: If a car isn’t well designed or well manufactured it’s going to fall apart quickly no matter what you do. Toyotas seem to last forever whereas the Yugo was derided as not being worth it at any price. For people, design basically means what we inherit in our genes. We have no choice in the matter, but Dr. Bortz noted that our genes influence only about 15% of our health.

ACCIDENTS: These are things that happen to you over which you have little-to-no control. If you car gets driven off a bridge, or some truck rams into it, there’s little your poor car can do about it and it’s “health” will suffer. Similarly for people there are accidents (get hit by lightning, tree falls on you, etc.) and also malignancies (nasty bugs, viruses, bacteria, chemicals, etc.) that you cannot avoid. Accidents used to be the major cause of death in times past, but advances in public health, medicine, and health care mean that today accidents are much more survivable.

MAINTENANCE: For cars this means changing the oil, tuning the engine, replacing worn parts, rotating tires, etc. – do these poorly and you may lower the lifetime of your car substantially. For people this means the food we eat, whether we abuse / overuse / underuse our bodies. Basically how well we take care of ourselves. Dr. Bortz stressed that this is the primary influence on our health & longevity today.

AGING: We’re eventually going to die no matter what we do. Same with our cars, although you could theoretically replace every single part with a new one and still think of it as the same car. But, how well we do maintenance can have a big impact on the rate of aging of our cars and our bodies.

Dr. Bortz is a man on a mission to get a good chunk of the trillions of dollars we spend on health care, mainly devoted to dealing with accidents and aging, to be devoted to maintenance instead.

I think this car analogy can be very useful especially in highlight how much we are unlike cars.

A recent personal example hammered this home. The front doors’ windows and door locks of my car stopped responding to the appropriate buttons. This seemed like a simple problem ... must just be a fuse or a loose wire somewhere! Little did I know. My local mechanic spent a day trying to fix it, taking apart both doors and the central control panel in the process. Things miraculously started working properly, but he had no explanation. A few weeks later the problem returned. This time I took it to the car dealer. They charge a higher rate, but since they should know what they’re doing at least it would get fixed properly. Their mechanic spent half a day, replaced some very expensive parts and charged me a lot of money. Next day the problem reappeared! Back to the car dealer. This time the mechanic and the foreman spent a good part of a day fixing things properly. It turned out that there was a malfunctioning component elsewhere in the car that was causing an electrical noise that in turn has resulted in the problems I was having. Now, my car comes from a firm renowned for its engineering and is that company’s most common model. It is designed to exacting specifications and manufactured in the millions. My car has never experienced anything particularly unusual (no significant accidents), and has generally been maintained on schedule by the dealer’s own service department. And yet they tell me they have never experienced such a problem and (obviously) it took a lot of experimentation and guesswork to figure it out.

If cars can be difficult to diagnose and maintain, what about people? Compared to a car our bodies are far more complex systems and experience much more complex lives. If such a well-designed, well-maintained car can be so difficult to diagnose and fix, is it reasonable to expect simple fixes for what ails our bodies?

No comments: