RealAge: Are You As Young As You Can Be? Book

As a doctor, I have often felt I was fighting an uphill battle. My job is to cure people after they are already sick. But preventing illness in the first place is always the best cure. Practicing my specialty of cardiovascular anesthesiology has meant that I have spent much of my working life with patients who are among the sickest of the sick, people who need bypass surgery or emergency operations to fix potentially fatal aneurysms. After spending so much time in the operating room with patients who were so severely sick, I was frustrated by not being able to do more for them. I was grateful that I really could save lives, but at the same time, I was mad as heck. So many of these patients were sick because they had mistreated their bodies over time. Moreover, every single one of them knew better. They knew that they should exercise more, eat healthier foods, and take care of themselves, but they just weren't doing it. That seemed to me a true tragedy, not to mention a national health care crisis. Why were so many people--smart, educated, thoughtful people--not paying attention to the reports of studies that correlated good health behaviors with long, healthy lives? It would have been easy to blame it on the patients. But it wasn't their fault. Clearly, the medical community was failing to communicate its message effectively.

In my internal medicine practice and my anesthesia preoperative clinic, I told my patients again and again how they could live healthier. I told them how they could lengthen--and strengthen--their lives and how they could increase the quantity and the quality of their years. But the tide of patients coming into my office and into the operating room with entirely preventable illnesses did not stem. I felt as if all my talk was for nothing. Why did they persist in habits that were harmful to their health, even though they knew better? What could I do--what could all doctors do--to explain health better? Good health is an attainable goal, but my patients weren't listening.

One day, a friend said to me, "Health is so confusing. One day the papers are telling you to do one thing, and the next day they're telling you to do the opposite. There's just so much information. I don't know what to do with it all." I empathized, but I didn't know exactly how to change things. How could people measure one alternative against another?

When another friend, Simon Z., developed a severe illness, it all came together. For some reason, stepping out of my role as a doctor and into my role as a friend made the idea flash in my head: Health is like money. It has an exchange value. Health decisions and behavioral choices that you make today are capital toward living younger tomorrow. What we were missing was a common currency for health.

Simon, who was forty-nine, was afflicted with severe arterial disease. He had a terrible circulatory problem that made it nearly impossible for him to walk more than a quarter of a block without terrible pain, and he needed a major operation. His lifelong smoking habit wasn't helping any. Even though he was relatively young, his body was in the condition of someone much older. I was afraid that he might not be my friend for much longer.

Simon was a tough cookie--and an even tougher patient. A self-made man, he had a drive and determination that was hard to match. He had worked hard for everything he had ever gotten in his life, and, with a wonderful family, good friends, and a booming career, his was an American success story. Yet he was a heart attack away from losing it all. As a doctor, I wanted to cure him. As a friend, I didn't want to lose him. For all Simon's attention to detail in his job, family, and friendships, he had overlooked the one thing that made it all possible: himself.

Telling him to quit smoking didn't work. (Quite literally, I called him every single day for years to ask him if he had quit yet. The answer was always "no.")

"Simon," I said one day when he was in for a checkup, "how old are you?"

"Mike, please," he grumbled. "You know I'm forty-nine."

"Simon, this isn't a joke," I replied. "How old are you really?"

"What are you getting at?" he said, eyeing me suspiciously.

"Did you know that all that smoking has made you older?" I asked him.

"Eight years older. Right now, you may be forty-nine. But your body is as old as someone who is fifty-seven, maybe more. For all practical purposes, your age is fifty-seven."

"I can't be fifty-seven," he said.

"Why not?" I asked.

"Because no man in my family has ever lived to the age of fifty-eight."

The message hit home. Simon quit smoking. He began exercising and eating right. He reduced his RealAge and began celebrating "year-younger" parties, rather than his usual "one-more-year-over-the-hill" birthday parties. Over time, he became younger.

Fundamental to economics is the concept of "net present value." Net present value is used by economists to determine the current value of investments that have future payoffs. The RealAge concept allows us to calculate the value of different types of health behaviors and choices. In biologic terms, the difference between your calendar age and your RealAge is a calculation of the net present value of your health behaviors; it is the estimate of what age you are physiologically when compared with the rest of the population.