Over the past several decades, Americans have become increasingly health conscious. Because cardiovascular diseases (heart disease, high blood pressure, strokes, and related ailments) have been, as a group, by far the most frequent cause of death, it is not surprising that health-conscious Americans have made substantial life-style changes in order to reduce the likelihood of developing a cardiovascular disease (hereinafter "CVD").

Thus we see that many, perhaps most, Americans have either increased the amount of exercise that they do, decreased their intake of certain fatty foods, increased their intake of certain supplemental vitamins and herbs, or taken other measures recommended by health professionals to reduce the risk of CVD.

Here we have an exemplary instance of "suboptimizing". In this case, by reducing their respective probabilities of dying from CVD, people are increasing their respective probabilities of dying from one or more other causes, without diminishing the probability that they will die at all. In fact, just the opposite is true. According to the U.S. Centers for Disease Control's National Center For Health Statistics, during the two decades between 1979 and 1998 (inclusive) - decades during which the words "fat-free" and "good cholesterol" became household terms, and the "fitness" industry has prospered as never before -, the annual death rate in the United States actually increased by 1.5%, from 852 deaths to 865 deaths per 100,000 population.

Meanwhile, the anti-CVD program has been enormously successful. During the period 1979 - 1998, the death rate from CVD dropped by more than 18%, and the fraction of deaths nationwide caused by CVD dropped from about 50% to little more than 40% of the total.

Were you to deduce from the aforementioned two facts that the U.S. death rates due to causes other than CVD increased substantially during these two decades, you would most certainly be correct. Specifically, while the death rate from CVD was falling by less than 19%:

• Deaths due to cancer increased by 12%
• Deaths due to renal failure increased by 36%
• Deaths due to diabetes increased by 61%
• Deaths due to pneumonia & influenza increased by 69%
• Deaths due to obstructive pulmonary diseases increased by 88%
, and
• Deaths due to viral hepatitis increased by 500%

With this knowledge in hand, the rational American might stop and have a conversation with himself not unlike the following:

Since my efforts to reduce my chances of dying from CVD have served only to increase my probability of dying from some other disease without improving my overall chances of survival, I need to ask myself: "Would I rather die from CVD or one of these other causes?"

The answer to that question will, of course, depend on a combination of the personal values and fears of the aforementioned rational individual, and the probabilities of dying from specific types of each of the various categories of disease. For example, deaths from CVD include deaths from heart attacks and strokes, among others; while deaths from cancer include death from leukemia and brain cancer, among others. The rational person could examine these detailed mortality data (1.1 meg PDF file) and then make his decision.

Here, for the curious among you, is my own answer to the question:

Given that a substantial fraction of CVD-related diseases result in quick, if not instantaneous, deaths (e.g., heart attack, major stroke); and given that all, count them 100%, of the other major diseases (cancer, pulmonary diseases, diabetes, etc.) result in prolonged, difficult and painful dying, I would much prefer to die by way of CVD than any of these alternatives. Accordingly, I drink heavily, eat loads of cheese and perform no cardiovascular exercise whatsoever.

I can dream can't I?

Note 1: According to the US. Centers For Disease Control, over 40% of Americans that die each year do so as as a result of cardiovascular diseases. This is twice as many as die from the next most frequent cause, cancer. Back



Note 2: "Suboptimizing" is defined as the act of optimizing only a portion of a system, or whole, as distinguished from optimizing the entire system. In the example discussed in this article, the health-conscious American is "optimizing" his chances of dying from CVD (a portion of the whole) without concern for the larger, system-wide issue, i.e.,: when and how to die.