Modern Medicine, Chronic Diseases, and Action Bias

Modern Medicine, Chronic Diseases, and Action Bias
Dr. Mukaila Kareem

Public sanitation, personal hygiene, and antibiotic therapy have contributed to the decrease in death from infectious diseases since 20th century. The efficacy and potency of modern medicine was demonstrated during the recent once in a century COVID-19 pandemic that hit its peak in 2021. For instance, according to the Centers for Disease Control and Prevention, approximately 460,000 Americans died of COVID-19 in 2021 and by 2023 that number was down by about 75,000. Modern medicine, operating under the germ theory of disease, has undoubtedly contributed significantly to improvement in human health but it is ill-fitted for the prevention of energy-oriented metabolic dysfunction such as hypertension, diabetes type 2 and heart disease.

While there are multiple antiviral and antibacterial drugs for infectious diseases, metabolic dysfunction has no pathogens and conventional medicine is constrained to manage or control metabolic derangement with medications, hence the term chronic diseases. However, in the last 30 years, I must add that I have been privileged to observe few surgical procedures and reviewed countless charts of mind boggling surgeries with no better words to describe other than medical miracles. In short, there is no better time to be alive, but this does not excuse the current failure to grasp the primary cause of chronic diseases.

The struggle to apply germ theory medicine to treat metabolic dysfunction has been ongoing since the advent of industrialization. Arguably the rising prevalence of chronic diseases such as hypertension, heart diseases, strokes, and diabetes type 2 are due in part to the fact that conventional medicine did not evolve in response to physical inactivity and excessive consumption which are the primary causes of these chronic diseases. On the contrary, modern medicine evolved to treat infectious diseases principally in situations that put the body in a physical inactivity state. However, a patient may live with hypertension, diabetes, and high cholesterol and may not show serious medical complications or physical impairments for decades.

To underscore the initial tension to treat non-microbial disease in the medical community, the term essential hypertension was coined by the minimalists who believed that hypertension needed not to be treated. A chapter in 1946 edition of Tice’s Practice of Medicine held the view that (essential) hypertension was necessary to protect multiple organs as we age by declaring that “may not the elevation of systemic blood pressure be a natural response to guarantee a more normal circulation to the heart, brain and kidneys” adding that “overzealous attempts to lower the pressure may do no good and often do harm.” This was in line with an article published in 1931 by cardiologist J. H. Hay with an admonition that “the greatest danger to a man with high blood pressure lies in its discovery, because then some fool is certain to try and reduce it.” We know better that hypertension needs to be treated to prevent organ failure. However, with more than one hundred anti-hypertensive drugs on the market, 48 percent of adult Americans have hypertension and only 25 percent of them have it under control despite 131 billion dollars being spent annually.

Additionally, a review of literature on type 2 diabetes is like reading a horror novel: Globally, the people with diabetes rose from 108 million in 1980 to a whopping 422 million in 2014.The prevalence of diabetes in China increased from less than one percent in the 1980s to almost eleven percent in 2013, which coincidentally was the year it spent the second highest amount on diabetes and its complications. With 110 million and 69.2 million, China and India respectively account for the most significant number of patients with diabetes in the world. As the success of declining prevalence of COVID-19 is being acknowledged and celebrated, a study in 2022 documented the increasing prevalence of diabetes in Mexico, with 7.5% in 2000, 9.2% in 2012, 13.7% in 2016, 14.7% in 2018, and 16.9% in 2021.

Permit me to digress a bit: In my household, I am one of five who drinks directly from the tap water as my family members put value on bottlers’ efforts, even though it has been shown that bottled water is not safer than water coming from a home faucet. In the United States, the Food and Drug Administration regulates the bottling companies, and they must test for coliform bacteria just once a week. The city tap is Federally regulated by the Environmental Protection Agency and they must test 100 or more times a month especially to screen for fecal coliform bacteria. However, according to a study, the packaging efforts steered people away from relatively free water faucets and rewarded the United States bottlers with18.5 billion dollars sales in 2017. The phenomenon to favor action (bottled water) over inaction (tap water) even when there is no credible indication that performing action is superior is called “action bias”.

Because the infectious diseases cause sudden death, even with spectacular global response to COVID-19 there was still significant pressure put on the governments and health systems to do more. However, for the past 40 years of chronic disease pandemic that has silently been killing millions of people annually and gulping billions of dollars every year the level of outrage is hardly palpable. The question is why? In soccer, it has been reported that the chance of saving a penalty kick is a slim 20% but the chance jumps to 33% if the goalkeeper stands in the middle of the goalpost instead jumping to the right or left before the ball is kicked. However, fans will not forgive a goalkeeper who played the odds by not moving either to the left or right while the ball went past him, but he might be excused for making an acrobatic dive to the left while the ball hit the net at the far right. As a writer put it: “We tend to think that doing something is better than doing nothing, even if the action is not the most effective or logical choice.”

As a physical therapist, I get frustrated reading “therapeutic target” for metabolic conditions.  Interestingly, the annual physical or wellness visit includes the so-called comprehensive metabolic panel and lipid profile which among others test for how the metabolic organs are coping with glucose, cholesterol, triglycerides, and nitrogenous wastes called blood urine nitrogen. These are metabolic molecules whose pathways can be rerouted or therapeutically targeted but certainly do not address the fact that energy cannot be created or destroyed. The code for therapeutic targets is designing a specific drug to block or stimulate a metabolic pathway that does nothing to address the energy embedded in the hydrocarbon macromolecules involved. Blood glucose levels can be controlled via medication, but this only stimulates the lipogenic enzymes to make more fats and cholesterol inside the cells.

We are the first generation of humans who lives on 3 meals plus snacks and the medical community has ceded the normal absorptive and post absorptive state or fast and fed cycle learned in medical training to the diet gurus who have appropriated normal experience of intermittent fasting over the millennial to some fad eating behavior. A drive during Winter in the Midwestern region of the USA may seem like a wasteland with no vegetation but a stop at the grocery store tells a different story of all kinds of fresh fruits. In natural environments, fruits are available seasonally in anticipation of winter or dry season, but these are in stock 365 days a year. Worse still, we have cheap man-made sugars from sodas, fruit juices, frosted breakfast cereals and desserts that are never available in natural environments. These are the main sources of high blood glucose, fats, and cholesterol and not the glucose derived from grains and tubers.

Modern medicine is showing a grave confusion between infectious diseases that provoke sickness behavior characterized by aversion for physical activity, food, and sex drive on one hand, and the energy flux metabolic dysfunction associated with excessive consumption and inactivity on the other hand. These two are not the same and just for the sake of taking action, conventional medicine therefore cannot be excused for primarily medicating metabolic diseases. The populations with best metabolic health who present with lifelong low blood pressure, excellent heart health and no diabetes are not found in New York City, Tokyo, London or Lagos.  They are found in small-scale populations who eat what is available and accumulate 5 to 7 miles on a daily basis.

For better or worse, to drive down the energy-flux metabolic molecules and effectively control chronic diseases, modern societies are poised for Ozempic living that would “force-starve” us by keeping our stomachs filled and trick our mind to “block” the appetite. As for the long-term side effects? Time will tell. Going back to the soccer goalkeeper guessing the direction of a ball yet to be kicked by preemptively diving left or right, when it comes to metabolic health, more medications are not optimally better.


Mukaila Kareem, a doctor of physiotherapy and physical activity advocate writes from the United States and can be reached via

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