The Streetlight Effect on Chronic Disease Prevention

 Once upon a time scientific thinking was a virtue…

But science as currently conceived  can also be like the tale of drunkard’s search also called the streetlight effect.

“Researchers tend to look for answers where the looking is good, rather than where the answers are likely to be hiding. (David H. Freedman, 2010)”

 Clearly it is not just science that can get stuck, but society as a whole, as the gap between scientific pursuits and their impact on societal progress  widens.  Could it be that as the gap between the rich and poor increases, so does the gap between what scientists are working on and what is truly beneficial for the common person?

The Streetlight Effect on Science

We have been ingrained with the virtues of science over the past few hundred years to the extent that many believe it can even supplant religion as the ultimate venue for seeking truth.

However, in spite of its many achievements, it’s becoming clear that science too is often like the emperor without clothing when practiced within our current economic framework.  In this framework, most scientists require funding in order to sustain themselves and their research.  Thus if the sources of funding are constrained by the wealth gap, and the motivation for research is to develop profitable products (i.e. marketable drugs and marketable behavioral interventions), we end up with a streetlight effect upon scientists that can limit the scope of the solutions they find (i.e. profitable solutions vs better but unprofitable solutions) .

Profitable vs Unprofitable Solutions to Problems

You may ask, “How can an unprofitable solution be good?”  It is all a matter of perspective.  For example, if I design a drug that a person with Alzheimer’s can take for life to reduce symptoms, I have a very profitable business.  I can patent the drug and people have to buy it from me.  There are barriers to keep people from getting the drug elsewhere or making it themselves at home.  However, if I work very hard to invent a behavioral intervention (i.e.  a lifestyle or multimodal stategy or perhaps a cognitively stimulating music / dance program) that completely prevents Alzheimer’s, and people can learn it on their own at home, I will be destined for the poor house.  Sure it is a better solution, but who in their right mind will work on it?  Who will spend good money on clinical trials and marketing for a superior but unprofitable product?

This is a huge dilemma for our society!

Unprofitable solutions are often the best for society as a whole but scientists may never seek them because of the streetlight effect.

Consider that the cost for the multi-center Diabetes Prevention Program (DPP) clinical trials has been estimated at $200 million over 10 years. This study showed that lifestyle intervention in the form of a 1 year program  consisting of 26 weekly sessions (20 sessions within the first 6 months and 6 sessions in the following 6 months) covering nutrition, weight loss, physical fitness and behavior modification was more effective than the drug Metformin, or the standard of care, for preventing pre-diabetics from becoming diabetics within 10 years.

Although it would seem that the results speak for themselves with 58% reduction in the incidence of diabetes ( up to 70% reduction for people over 60),  the justification for the DPP intervention comes not from the dramatic improvement in quality of life of the participants, but rather from demonstrated fact that insurers paying for the DPP can save on costs given the expenses associated with diabetes.

The effort to introduce prevention efforts for diabetes has been a very expensive 20 year battle that is still on going.  So where does that leave the future of prevention efforts for other chronic diseases such as heart disease, cancer, lower respiratory diseases, stroke, and Alzheimer’s?

Chronic Disease Prevention

Most people already accept that our economic system and it’s search for profitable solutions will result in the creation of environments where chronic diseases that could have been easily prevented flourish.  In this framework, things that exist in abundance become worthless. For example the air that we breathe is vital for healthy living but as of yet has little economic worth because of its abundance.

In the YouTube video, “Pay for the Air you Breathe,” the advertising agency Leavingstone in Tbilisi, Georgia  delivered the following message:  “If  we don’t care about the air we breathe, sooner or later we’ll have to pay for it.” 

What can we do to speed up the process of adopting prevention strategies as the gold standard for world health?

One thing seems certain,  we cannot afford to keep waiting for the scientific process trapped by the streetlight effect and  enormous costs / delays of RCT trials  to provide definitive answers.  Clearly health science is at a disadvantage when risk factors such as possible carcinogens, pollutants, pesticides, household chemicals, food additives, sources of stress, electromagnetic field exposure and sedentary work policies can be introduced into our environment at a much higher rate than the many years of RCTs that are needed to show definitive cause and effect.

These are some of our options:

  1. Become your own health detective.
  2. Become an expert on your own individual health.
  3. Find ways to unite with chronic disease prevention and health promotion advocates worldwide.
  4. Find ways to unite with world-wide economic change advocates.
  5. Vote for people who understand the importance of the above perspective for the future of world health.

As a health detective you will learn to monitor your health and environment more closely to detect symptoms earlier and effect environmental and lifestyle changes needed to correct problems before medical intervention becomes necessary.  The key strategy is development of personal agency (the ability to initiate actions that improve ones personal outcomes).

As an expert on your own individual health your doctor becomes your ally rather than your savior.  You are in a better position to keep yourself healthy than the doctor.  Of course the doctor is an essential part of restoring health if you are sick, but you must be the driver of your health.

There is strength in numbers and we must find more ways to unite with the specific goal of chronic disease prevention and health promotion at the community, national and world level.  The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) is a good place to begin the search for group involvement but must be greatly expanded upon in the years to come.  There are many groups already promoting multimodal chronic disease prevention strategies such as Sharp Again Naturally,  NEWSTART, AARP Global Council on Brain Health, etc.

Finally the elephant in the room must be addressed.  Human beings created our economic system and human beings can improve it. Sure it has been forged through suffering, sweat, tears and sacrifice throughout history largely through social structures based upon predatory-prey type relationships. But personal agency is our greatest asset and we must prevent our predatory-prey instincts from destroying the world and ourselves in the process.   Wealth inequality, slavery in the form of monetized debt and a profit driven economy that turns human beings into commodities are the greatest drivers of the world’s health problems.  The world needs a new vision of the future that includes health as the cornerstone.

Let’s begin building that vision.

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