Wherever I look these days, across a wide expanse of trials and tribulations, I see one common malady: myopia.
Perhaps it’s just a problem with my vision, but I think the perception is accurate. Myopia, or near-sightedness, is pandemic, and it is a grave threat to nearly everything that matters.
Among what matters, of course, is the other pandemic you are apt to have heard of, COVID19. Myopia is much of the explanation for our current misfortunes there. Experts had long warned of the potential for new strains and recurring waves, for the pandemic to re-surge in areas not achieving herd immunity. There is a great uptick in vaccination rates again, but only now, after what was reliably foretold is a fait accompli.
At the level of the body politic, our collective action was to dispute and dismiss much of our expert intelligence until local hospitals were once again filling up with our personal friends and family members. That is classic myopia: you can’t see what is about to hit you in the face, so you only react after it has, in fact, hit you in the face.
Of course, the best sources of our “intelligence” were not immune to pandemic myopia either. They accepted a fragmented array of responses to the pandemic rather than recognizing that a global malady demanded a globally coordinated remedy from the start. We are hearing now that wide viral spread anywhere is a threat to pandemic control everywhere, but that is a lament, in retrospect. When that insight had the chance to guide our actions and avoid this current mess prospectively, we were too fractious and too myopic.
Myopia such as this, at the level of our individual bodies, is the bane of every Preventionist’s career. We know how to prevent most heart attacks, most strokes, much cancer, most cases of diabetes, and on it goes. All told, we know- and have long known- how to prevent 80% or more of all chronic disease and premature death in the modern world. But the parade of us into operating rooms and ICUs never shortens, because each of us waits until it happens to us to do much of anything about what predictably looms. Blame it on myopia.
The nearsightedness that seemingly plagues us all is compounded by distrust and a penchant for denial. We not only fail to see what is coming in hot - be it a new viral strain, a stroke or MI, climate devastation, the desiccation of Lake Mead, the failure of far-away nation building by means and methods that have always failed before, the dwindling flow of the Colorado River or rain where it ought to be snowing in Greenland – but we dispute and deny it when others who can see further tell us all about it.
Distrust is a rot at the very root of human prowess. What makes Homo sapiens so special, assuming anything really does, begins with these large brains we have, but extends to what we do with them- together. What we do that sets us apart from all other animals is our ability to tell and share stories not only about what is, but also about what might be. These “counterfactuals” – imagined alternatives to the current reality – are uniquely ours. They are a critical element in all attempts to emulate human intelligence artificially.
Interpreting portents about a threat that looms involves perceiving a “counterfactual.” We need to “imagine” what life would be like if we let things play out that way. If all we ever do is wait for what is going to happen and then react after, we renounce any claim to Homo sapiens exclusivities, and live out our fate much like deer in headlights. No other species, so far as we know, can deal in counterfactuals. But collective action based on what might be requires trust. Absent common cause predicated both on what is and what is coming, humans are a lot less special. Schools of bait fish swim into my vision.
Our truly great power never resided in any one of us being able to imagine what was coming; it resided in our ability to turn that into a story and share it. That way, each of us could benefit from the vision of all of us, and we could- by means of a common narrative- devise common action, in common cause, on common ground. If that sounds familiar to you these days, you are living in a very different reality than I.
The rampant propagation of distrust is eroding our capacity to move one another with stories. And the result is, we are ever more hapless. The looming threat of strains like Delta was a story denied by many who are now succumbing to it. So, too, the far greater devastation of environmental degradation.
Noting this liability while in a morass of concurrent messes may seem bleak, but my intention is the opposite. Any one of us can opt to turn this latent super-power back on, and use it to our personal benefit and that of those closest to us. Recognizing and addressing personal health risks proactively is, from this Preventive Medicine specialist’s point of view, a great place to start. As noted, we have the knowledge to reduce risk by 80% or more for all chronic disease and premature death; we squander the implied power if we don’t use it until we are already in the ICU.
Just as important, if enough of us individuals choose to see past the plague of myopia, an enhancement of our collective vision might ensue. We might once again exercise the power that made our kind special: the power of stories to imagine and predict how things might be, and the power to create the future we favor.
So, oh say, can we see? Not much past the ends of our noses, it seems. Myopia is a grave threat to us in myriad ways- and fixing it is thus prerequisite to fixing all that ails us most. One thing I can see: this looks to be an excellent time to go into ophthalmology.
David L. Katz, MD, MPH, FACPM, FACP, FACLM, is the Founding Director (1998) of Yale University’s Yale-Griffin Prevention Research Center, and current President of the American College of Lifestyle Medicine. He has published roughly 200 scientific articles and textbook chapters, and 15 books to date, including multiple editions of leading textbooks in both preventive medicine, and nutrition. He has made important contributions in the areas of lifestyle interventions for health promotion; nutrient profiling; behavior modification; holistic care; and evidence-based medicine. David earned his BA degree from Dartmouth College (1984); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He completed sequential residency training in Internal Medicine, and Preventive Medicine/Public Health. He is a two-time diplomate of the American Board of Internal Medicine, and a board-certified specialist in Preventive Medicine/Public Health. He has received two Honorary Doctorates.