In an exclusive conversation with India Today, world-renowned doctor, Professor Shitij Kapur busts myths around longevity and points to the importance of lifestyle in improving outcomes.
He speaks about how mental health problems have a stigma attached not just in India but also in the West, and how solving crossword puzzles will not help prevent dementia but working on your heart health would.
He also spoke about how living healthy is more important than focussing on living longer, precision medicine and if predictive health is the future of healthcare.
Here are the excerpts:
Q: What is your opinion on precision medicine?
A: Earlier we were making a diagnosis and treating it. That was evidence-based medicine. In precision medicine, a diagnosis like breast cancer gets broken into different entities. Treatment gets targeted. When you do the genetics of what you have found you realise there are four types of breast cancer. When you study this further, you realise that either the person’s genetics or the cancer’s genetics are different. The treatment is targeted based on that.
The point of doing that is that you get better outcomes. This, however, is not available for everything. It is available for certain cancers. The hope is the principle of using your genetics to guide your treatment will lead to better outcomes.
Q: Affordability is a big concern when it comes to precision medicine.
A: Can I give you a scary figure? The latest medicine that has come for a brain disease called metachromatic leukodystrophy and a single treatment for that disease for one person costs $4.5 million. It is ridiculous. No person can afford it. In the US too, where this is being offered, it is only being offered in the context of insurance.
Insurance companies can afford it because it is a very rare disease. The number of patients for whom that drug can be used is smaller. The economics for the drug company would mean that their drug be used only by a small number of people. It makes them automatically increase the cost to make the research and development worth it.
Q: Do you see predictive health as the future of healthcare?
A: Can we, based on your genetics, based on knowledge of your lifestyle, make predictions about your health? Yes, we can, absolutely.
Now we are doing detailed genetics, our ability to predict has gone up. Can you change the outcome of our findings? We cannot change your genes. What we can change is lifestyle factors. What is being questioned is the modifiability of those things. Do people actually go and modify their diet for any length of time? They may follow these things for a week or two but not for a longer period. That may or may not change the outcomes.
Q: Is the early onset of dementia a huge concern now? Are more and more people getting dementia early in their lives?
A: Early onset of dementia is a reality. But there is a small subset of people who in their 50s and 60s get dementia. There is not much evidence that dementia is creeping in earlier. Our detection systems are getting better now. As systems are improving, better tests are coming up, and MRI is becoming widely available.
We do not know just yet what can we do to delay dementia. There are modifiable risk factors. Dementia that is related to blood pressure and strokes can be prevented. Taking good care of your cardiovascular health will help decrease the chance of your developing vascular dementia.
Crossword puzzles and two cups of coffee a day will not delay the risk of dementia. What will help a person is no smoking, minimal alcohol, diet, as per the usual dietary guidelines, and social connectedness, not just with the family but also within the community.
Exercise, good sleep and connectedness are important, these are lifestyle essentials.
Taking care of your mental health is also important. People who have depression in their 50s and 60s stand a risk of developing dementia.
Q: You spoke about depression. In India, there is very little conversation and also little awareness of mental health.
A: This is not just in India. It is a misconception. The idea is that in India no one talks about mental health. So, I think the first thing, there is a sense that, oh, you know, in India, we don’t talk about it, but the rest of the world, everyone talks about it.
This is just a matter of time. I’ve had the privilege of being a psychiatrist in several continents, I’ve seen it in different ways, in the 1980s, even in the West, people did not talk about it.
This issue of stigma was alive and well.
The way it changed is some very high-profile politicians, and journalists came out and talked about their depression and that’s what gave people the license to talk about depression outside of the family, and to call it that. Previously, people gave it all sorts of different names. So the first thing is that the stigma to this has been universal. In the West, I would say the change has been much greater, but not entirely gone.
But there have been some high-profile incidents, politicians, you know, sports stars, who’ve owned up to their mental illness.
But people, when they see that, yes, these people had a mental illness, but they still went on to perform. So I hope that that journey will happen in India too, but it’ll take time.
The young people everywhere around the world, are more connected to an international dialogue than the generation who are now in their 40s, 50s and 60s.
Because while we got social media, we didn’t get it while we were formative. For young people, the language they speak is pretty international about issues of mental health and they are much more open to it.
So I think this will change, particularly amongst the educated class, particularly amongst the class that is linked to the world’s social media.
And then, of course, the real challenge will be that when we start understanding, appreciating, and exposing the scale of these issues, then we need interventions and treatments.
Q: Is it normal to want to live beyond 100? And in India, while we have an ageing population, the concern is about the quality of life once they are past 70. That’s also a big concern because living long is not enough, living healthy years is more important.
A: So let’s put this in perspective. The average life expectancy around the 1950s used to be 50. In India, probably even slightly lower than that. The world has seen huge increases in life expectancy. In the West, after the Second World War, in the 1950s, life expectancy just kept increasing every decade. It just kept increasing to where it got to about 80 and for the last seven, or eight years, now, it is stuck.
Life expectancy in the United States is decreasing, modestly, but it’s going down.
In the UK it has plateaued and slightly decreasing, in Australia it’s the same. This is despite all the developments in precision medicine, all the developments in cancer treatments. In the West, where life expectancy is now plateauing, this idea that we will all move to live to 100 is becoming a little tricky. The second thing that’s becoming clear is that spending more and more money on precision medicine is not going to change the life expectancy of populations.
Obviously, for a single person, it makes a difference. But no one has found anything that can through these medical interventions in a disease dramatically change life expectancy.
The things that dramatically change life expectancy through medical interventions are public health interventions. Ideally done at the younger stage, when you’re a child, and has to do with vaccinations, nutrition, etc. Once you’re past 40, what can make you live longer?
Now, many studies have followed people from the age of 40 and tried to figure out what’s the secret to living longer. And the secrets were in some sense what I just told you. Some people call them longevity essentials eight.
But those are very simple, no smoking, minimal amount of alcohol, and regular exercise. If you’re taking care of those life essentials eight, this is important for your listeners to understand the magnitude of the impact.
So let’s say someone gets all of those eight right, and someone gets all of those eight wrong. In other words, they don’t, I’m not saying they’re alcoholic, but they drink a lot of alcohol, they smoke a reasonable number of cigarettes, and the life expectancy difference is 24 years.
So these eight simple things can have a dramatic impact.
Claims that some nutraceuticals and some vitamins can change your telomeres, or it can change your chromosomes, and you will live to be 105 are not going to help.
And I think people should be very cautious because I do see ads of this kind, particularly on the Internet. And I’m particularly bothered by that because I could see vulnerable people could end up spending a lot of time there. I mean, most of these things I would say would be wasteful rather than dangerous. But at the moment, there is no claim that other than these sensible things that we’ve talked about, there is anything that you could take with the express purpose of just living longer, that works.
