Healthism: The New Puritanism

Here is a thought experiment. Assume that every hour you run you extend your life by an hour.

I have chosen a one-to-one ratio between the increase in longevity from running and the time running because higher ratios lead to the immortality paradox. Lazarus aside, the all-cause mortality for Homo sapiens is 100 % and will remain so for the foreseeable future.

This arithmetic means that at one point you will literally be running for your life: your life being extended precisely by the time spent running. But ignore this logical fallacy.

You run an hour every day for 40 years. Your life is extended by 1.67 years. Your costs are a new pair of running shoes every three months, which might even be covered at zero co-payment by insurance if USPSTF gave running a grade A or B recommendation.

A back of the envelope calculation, assuming the shoes cost $ 80, yields cost per life year of roughly $7664. There is, of course, more nuance. I am not including injuries that may result from running. I am not discounting time: I am assuming we value an hour now the same as an hour 40 years from now.

I am also not factoring the costs avoided of treating late stage cardiovascular disease, which must be balanced against the additional social security checks that the individual will draw because of living longer, not to mention the costs of treating diseases of extended longevity such as cognitive impairment, Alzheimer’s disease, recurrent falls.

But please continue to indulge my approximation. The point is not precision of economic calculations but a principle.

$7664 for an additional life year. Compared to the benchmark of $50, 000 per quality-adjusted life year that’s a bargain!

Was it worth it then?

You have spent 14,560 hours on treatment (running), time in which you could have read Moby Dick, listened to Mozart’s Requiem or watched re-runs of Breaking Bad.

Don’t get me wrong. I think running is its own good. It increases your endorphins and makes you feel good whilst you blissfully listen to the soundtrack from Chariots of Fire dreaming that you are an Olympian athlete (you might want to change tunes after the 501st hour).

The point is that healthy living consumes time. If enjoyed for its own sake it has value. If one obsesses over health (healthism) that obsession also costs. It can make people terribly unhappy as they stare at the shelf deciding between the 180 caloric scone and the decidedly deadlier 205 caloric carrot cake. It reduces their chances of getting dinner re-invitations for relentlessly questioning the host about the sugar content of the rice pudding.

Healthism is an avenue for subliminal narcissism. There is something seductively deterministic and morally appealing about eating like a cheese-fearing vegan rabbit and looking better, living longer and getting 50 % of the insurance premium back thanks to Affordable Care Act’s Zen-sounding Wellness provisions.

In short, healthism is the new puritanism. The old puritans worked for God’s glory with a famed work ethic which, according to Max Weber, might have been the chiefly responsible for the success of capitalism.

The righteous, mirthless, po-faced, lycra-clad new puritans are forever punching numbers in to risk calculators and obsessing over arbitrary thresholds of LDL-cholesterol whilst watching the Dr. Oz show with the fastidiousness with which the old puritans internalized Leviticus, lest they miss another opportunity for a miniscule relative risk reduction.

To slightly paraphrase an old saying: life is what happens when you are busy lowering your cholesterol.

Again don’t get me wrong. I am not advocating we eat double cheeseburger for breakfast and tea. There is nothing I enjoy more than two glasses of craft beer after an hour of receiving resounding thrashing playing squash, regardless of what that combination of activities does to my chylomicrons.

But between morbid obesity and a morbid obsession with health there surely must be a healthy middle ground.

Saurabh Jha, MD is an Assistant Professor of Radiology at the University of Pennsylvania. His scholarly interests include the value of imaging and dealing with uncertainty in clinical decision making. Jha views most problems in medicine as problems of imperfect information. He trained in the UK and migrated to USA for more predictable weather and a larger yard.

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6 replies »

  1. Let me tell you a true story, of my father that addresses the above from another angle:

    He was dying. Years of way too much drinking, smoking (4 packs a day), serious diabetes, the worst diet you can imagine and no exercise had taken the expected toll. He was 62, I was in grad school and came home to see him for the last time.

    He said the following as he lay on his death bed:

    “You know, when I first got diabetes (in his 30’s), your mother did everything right for me. Weighed the food and prepared it well. No sugar, lite on the fat. Got after me to quit drinking and smoking.

    Now I am old and sick. I do not feel good, and I am scared. I know I am going to die.

    But you know what? I;d rather die that eat the s**t. And I LIKE to drink and I LIKE to smoke.”

    Pretty well summed him up. And I know he is not unique.

  2. I am truly delighted to find a post like this in a health journal. I am a little more acerbic in my viewpoint and assert that not only is the health craze a new puritanism, but it has morphed rapidly into the new fascism. Sure, we all enjoy being healthy once we are and we need to be sensible in our dietary and general health habits but we do NOT have the right to impose our health philosophies on others! I am sick of being preached at by governments and self-righteous fools who insist I live my life their way as a matter of ethics – so now I’m off for an early morning gin and tonic!

  3. Indeed, BC.

    Et in Arcadia ego.

    No exceptions. Not even for American exceptionalism.

  4. Dr. Jha:

    Very well written and timely article. I agree with you.

    “Modus omnibus in rebus”

  5. Why run when walking a few miles a day is just as good, is more enjoyable, and doesn’t give you shin splints? Puritanism? I have distant relatives that came over on the Mayflower, and he was a real Puritan.

  6. Actually : footing the bill for running shoes is a not half bad idea …

    Why not pay for other types of sports / exercise related equipment as well?

    Can see all kinds of interesting opportunities for tie ins between equipment makers / wellness …