In an eloquent and heartfelt essay, my former colleague Bob Dewey announced the birth of his granddaughter, commenting on how grateful he felt that the delivery was “routine and uneventful.” Indeed, modern medicine delivers infants with exquisite care and safety. Bob pointed out that childhood mortality in the US recently hit a new low – only 5 deaths per 1,000 live births, equivalent to a rate of 0.5%.
I, too, am grateful for safety. My grandson, Arden, recently turned 6.
But…
Hand-in-hand with progress come unanticipated consequences. Technology is a force of nature, interrelated with evolution, not totally within our control. Writing in the 1970s, Robert Pirsig called technology a “death force,” in the sense that it seems blind, unfeeling, and mechanical, follows a logic that is relentless and inhuman. He was thinking of industrial plants, surrounded by high barbed-wire fences, operated by invisible technologists – these “blind monsters” were eating the land and polluting the air and lakes – leaving ordinary people alienated and estranged, become strangers in their own land.[i]
Yet technology has produced miracles, of this there is no question. The rate of childhood mortality today is 10x lower than what prevailed in the US, Canada, and Europe during the 1950s, when 4-5% of children died before age 5. Back in 1800, childhood mortality rates were nearly 100x higher – death claimed nearly one-half of children before age 5.[ii] Death came from disease, violence, accidents. Famine took its toll, as did extremes of heat and cold, lack of clean water, toxic plants and fungi, venomous snakes, predatory animals, not to mention the trauma of birth itself. Much of this was random, but not all. On average, the stronger, quicker, healthier, sharper kids ran the gauntlet of early childhood and survived, emerging on the other end ready to face the demands of life in a time before modern safety nets.
Survival of the fittest is a tough system – merciless towards kids, heartrending for families. But “selection pressure” creates a population with robust physical and mental health, since these attributes are necessary for survival and reproduction. In past times childhood mortality served a necessary function, weeding out those whose genetic expression wasn’t suitable for the challenges of pre-industrial life.
Now, saving children is an unqualified good thing. Morally and pragmatically. Someone who might not have survived naked in the forest could make an important contribution in the modern world. Like Stephen Hawking – the brilliant physicist and cosmologist — crippled by ALS, confined to a wheelchair from the age of 21, yet thanks to modern medicine he lived to 76, sharing his brilliance with the world. How far would he have made it in 1800, when nearly half the kids perished before age five?
Nonetheless, when “selection pressure” is removed, things change. When the robust health attributes needed to survive early childhood no longer matter, those attributes stop being selected for. Instead, “genetic drift” takes place, resulting in greater genetic variation. With each passing generation, the population becomes weaker and sicklier.[iii]
Is this actually happening? Our lifespan today dramatically exceeds that of people in traditional hunter gatherer societies. But according to Dan Lieberman, evolutionary scientist at Harvard, this is due mostly to lower childhood mortality. Hunter-gatherers who survive early childhood typically live to 68-78 years old, similar to contemporary life expectancy in the US. What’s even more surprising – hunter-gatherers ae healthier than modern people.[iv] Due to their active lifestyles, hunter gatherers in their 60s and 70s are typically stronger and healthier than modern people in their 40s.[v]
Healthy life expectancy (or “health span”) is actually declining. According to the World Health Organization, the healthy life expectancy for Americans dropped from 65.3 years in 2000 to 63.9 years in 2021, with nearly 80% of those aged 60 and older having two chronic illnesses, such as diabetes, heart disease, or high blood pressure, and 53% of young adults aged 18-34 reporting at least one chronic illness.[vi] The trend is visually apparent in the epidemic of obesity, with more than 40% of people in America now considered obese[vii] and another 30% overweight.[viii]
How much of this is genetic drift vs. unhealthy lifestyle choices? It’s hard to say. Sedentary lifestyles, physical inactivity, smoking, and obesity are highly correlated with bad outcomes. Nonetheless, the conclusion is startling – but for improvements in childhood mortality, we are otherwise less healthy than our ancestors.
Call this a trade-off. We give up some of the robust physical health of our ancestors in exchange for safety and productivity. And to be fair, we don’t need to be as fit and wily as our ancestors, because we no longer need to outrun hungry bears. Or suffer extremes of heat and cold. If we get a cut, the strength of our immune system doesn’t matter as much as it used to, because today we have antibiotics. For the modern world, hunter-gatherer levels of fitness are frankly unnecessary — and in exchange we banish the sorrows of childhood mortality.
Surely, net net, we are better off.
Yes. Probably. But.
There are other indicators of decline. As the health of a population wanes, people become more dependent. They need care providers. Access to clinics or hospitals for medical procedures. Prescriptions for pharmaceuticals. And while helpful and in some cases life-saving, these services also carry risks. For example, estimates of deaths among US patients attributable to preventable medical error range as high as 410,000 victims per year.[ix] The tally from diagnostic errors has been estimated at 800,000 victims per year, including both death and permanent disability.[x] Nonoptimized drug use (including both overprescription and patient nonadherence), leading to treatment failures and new medical problems, results in over $500 billion per year in mortality and morbidity.[xi] One study found that for adults over 65, 34% of patients were given potentially inappropriate prescriptions.[xii]
As people become weaker and more dependent, they may also become more fearful. They may clamor for something, anything — even if it doesn’t work. For example, a recent article in the Wall Street Journal points out that popular anti-depressant medications provide benefits indistinguishable from placebos for 85% of patients, yet carry significant side effects.[xiii] During the COVID pandemic, people clamored for lockdowns, remote schooling, and experimental vaccine mandates – measures which in hindsight may have made things worse.[xiv]
We stand at an interesting point in time
Over the last 150 years, life expectancy has more than doubled. But in the US, after peaking at 78.9 years in 2014, it declined sharply to 76.1 years in 2021 (due to the COVID pandemic), before rebounding to 78.4 years in 2023 which is similar to the level last seen in 2008 and incidentally 4.1 years below other developed nations, despite the fact that healthcare spending per capital in the US is considerably higher.[xv] Americans boast of having the most advanced economy in the world, yet it seems that economic progress is not necessarily consistent with the best health. Meanwhile, in the last 20 years the physical and mental health of young people has started deteriorating, too.[xvi]
Perhaps we’ve hit a speed bump. Maybe progress will resume shortly. That’s possible, of course, but we should be mindful that there are limits to what modern medical care can do. Many procedures offer relief for symptoms, without addressing the underlying root causes. This is because our understanding of how the body works is limited. The body is, after all, the product of billions of years of evolution, which is an entropic (random) process. Trying to unpack this complexity is a daunting task. For example, anti-depressants were originally conceived as drugs that would help patients by limiting the uptake of serotonin. However, subsequent reviews found no relationship between serotonin levels and depression.[xvii] In other words, to the extent that these drugs work, we do not know how or why.
You’d think that with the advances in modern science, there would be more understanding and less controversy. But maybe not. Nassim Taleb argues that “an abundance of data is extremely harmful to knowledge.” What he describes as “the tragedy of big data” refers to the risk that with more data, unscrupulous researchers can more easily find spurious correlations, which they can use to market drugs and procedures of questionable efficacy.[xviii] On a global basis, pharmaceuticals represent a $1.7 trillion market. Surveys indicate that 60% of Americans take at least one prescription, with 25% reporting four or more.[xix] Whatever the quality of research may be, there is no question about the marketing.
So let’s ask the question – to what extent should we trust modern medicine? John P. A. Ioannidis, Stanford University professor of medicine, epidemiology, population health, and biomedical data science, and one of the world’s most influential researchers (h-index of 274[xx]) famously argued in a 2005 paper that the majority of medical studies are false.[xxi] His work calls into doubt the body of research supporting much of the products and services of the modern medical-industrial complex in such fields as evidence-based medicine, genetic and molecular epidemiology, nutrition, psychiatry, neuroscience, and economics.
Now, nothing in life is perfect – the skeptic can always find something to criticize. Bad research and questionable products notwithstanding, life expectancy today is still much higher than in the past due to a host of improvements: better sanitation, safer workplaces, more plentiful food, cleaner water, reduced rates of crime and war, more advanced medical services. Although, as noted above, the biggest difference between today and our hunter-gatherer past lies in childhood mortality, because otherwise they seem to have lived healthier lives.
The causes of bad health are complex and multi-factored, yet there is a single, simple, fundamental root cause for good physical and mental health – for organisms to live in the natural environment for which they are genetically adapted.[xxii] For people, that means living active outdoors lives in the way that our ancestors used to do, when only the children who were hardy (and lucky) survived.
Maybe we could have the best of both worlds. We could exercise and eat whole foods, like our ancestors did, while availing ourselves of modern healthcare. As a runner, I’d like to believe this is possible. Harvard’s Lieberman comments on a study which tracked aging runners over a twenty-year period, comparing outcomes to a control group of healthy but sedentary people. After 20 years, the runners had a 20% higher survival rate and 50% lower rate of disability.[xxiii]
Source: Lieberman, “Exercised”
Unfortunately, the study does not prove causation. It may be the case that the voluntary decision to engage in running produced more favorable outcomes. But we cannot rule out the possibility that this is genetic drift at work. Maybe the non-runners were born with physical and mental health issues which would have been selected against in primitive times – issues that make it difficult to run, or not fun, or maybe they just don’t have the energy. This is a creepy possibility, because genetic drift has only been operating for a handful of generations (8-10 since 1800). How far we will drift from health towards morbidity remains to be seen.
Maybe one day childhood mortality won’t matter at all, because people will no longer have children. That’s the premise of the 2006 dystopian thriller, Children of Men, directed and co-written by Alfonso Cuarón, and based on the 1992 novel by P.D. James of the same name. Obviously, this is Hollywood, not science, but looking around the world, aging populations and plunging birthrates are leading to forecasts of population decline in many places, including China, Japan, South Korea, Russia, Ukraine, Italy, Spain and Greece.
Advice for the Next Generation
For people born today, 99.5% will make it through the gauntlet of childhood mortality and live to make a contribution to the world. Most likely, they’ll live in comfort and with conveniences unimaginable to past generations. But they’ll face the specter of chronic disease, and with it the possibility that they won’t achieve the typical 70-year health span of hunter-gatherers, but maybe something closer to 50 if they smoke, are obese, or physically inactive and develop diabetes or become depressed. Even if they are spared these ailments, they may go through life without enjoying the robust physical and mental strength of our ancestors or the resulting confidence and sense of agency. Badgered by constant marketing and propaganda, they may become anxious about health matters or depressed.
Here’s what I hope for Arden and Bob Dewey’s granddaughter — that they’ll take ownership of their health. Maybe they’ll learn in school the words attributed to the Roman poet Virgil, “the greatest wealth is health.” Hopefully they’ll develop a healthy level of skepticism, learn to do research, decline to outsource judgment to the medical-industrial complex. Hopefully they’ll discover the ancient Greek philosopher Hippocrates’ advice to walk, eat carefully, seek independence, and live in harmony. Maybe they’ll take up running.
We grandparents want the young to lead long and vibrant lives, just like we’ve tried to do. And it’s our job to worry about the risks. Like the grandfather in Peter and the Wolf, we shake a finger and scold the kids – “What if a wolf came out of the forest? Then what would you do?”
[i] Rober Pirsig, “Zen and the Art of Motorcycle Maintenance: An Inquiry Into Values,” 1974.
[ii] Max Roser (2023) – “Mortality in the past: every second child died” Published online at OurWorldinData.org. Retrieved from: ‘https://ourworldindata.org/child-mortality-in-the-past’ [Online Resource]
[iii] Vasseur E, Quintana-Murci L. The impact of natural selection on health and disease: uses of the population genetics approach in humans. Evol Appl. 2013 Jun;6(4):596-607. doi: 10.1111/eva.12045. Epub 2013 Jan 21. PMID: 23789027; PMCID: PMC3684741.
[iv] Pontzer H, Wood BM, Raichlen DA. Hunter-gatherers as models in public health. Obes Rev. 2018 Dec;19 Suppl 1:24-35. doi: 10.1111/obr.12785. PMID: 30511505.
[v] Gurven, M., and Kaplan, H. (2007), Hunter-gatherer longevity: Cross-cultural perspectives, Population and Development Review 33:321–65. Cited in Lieberman, Daniel E.. Exercised: Why Something We Never Evolved to Do Is Healthy and Rewarding (p. 392). Knopf Doubleday Publishing Group.
[vi] https://www.heart.org/en/news/2025/01/14/what-is-healthspan-and-how-can-you-maximize-yours#:~:text=Meanwhile%2C%20according%20to%20the%20World,more%20years%20of%20better%20health.
[vii] Emmerich SD, Fryar CD, Stierman B, Ogden CL. Obesity and severe obesity prevalence in adults: United States, August 2021–August 2023. NCHS Data Brief, no 508. Hyattsville, MD: National Center for Health Statistics. 2024. DOI: https://dx.doi.org/10.15620/cdc/159281.
[viii] https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity#prevalence
[ix] James, John T. PhD. A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care. Journal of Patient Safety 9(3):p 122-128, September 2013. | DOI: 10.1097/PTS.0b013e3182948a69
[x] Newman-Toker DE, Nassery N, Schaffer AC, et al Burden of serious harms from diagnostic error in the USA BMJ Quality & Safety 2024;33:109-120.
[xi] Watanabe JH, McInnis T, Hirsch JD. Cost of Prescription Drug-Related Morbidity and Mortality. Ann Pharmacother. 2018 Sep;52(9):829-837. doi: 10.1177/1060028018765159. Epub 2018 Mar 26. PMID: 29577766.
[xii] Clark CM, Shaver AL, Aurelio LA, Feuerstein S, Wahler RG Jr, Daly CJ, Jacobs DM. Potentially Inappropriate Medications Are Associated with Increased Healthcare Utilization and Costs. J Am Geriatr Soc. 2020 Nov;68(11):2542-2550. doi: 10.1111/jgs.16743. Epub 2020 Aug 5. PMID: 32757494; PMCID: PMC8235922.
[xiii] Cited in ‘Girl, Take Your Crazy Pills!’ Antidepressants Recast as a Hot Lifestyle Accessory’ Wall Street Journal, October 18, 2025 — Stone M B, Yaseen Z S, Miller B J, Richardville K, Kalaria S N, Kirsch I et al. Response to acute monotherapy for major depressive disorder in randomized, placebo controlled trials submitted to the US Food and Drug Administration: individual participant data analysis BMJ 2022; 378 :e067606 doi:10.1136/bmj-2021-067606
[xiv] Joffe AR. COVID-19: Rethinking the Lockdown Groupthink. Front Public Health. 2021 Feb 26;9:625778. doi: 10.3389/fpubh.2021.625778. PMID: 33718322; PMCID: PMC7952324. Bardosh K, de Figueiredo A, Gur-Arie R, Jamrozik E, Doidge J, Lemmens T, Keshavjee S, Graham JE, Baral S. The unintended consequences of COVID-19 vaccine policy: why mandates, passports and restrictions may cause more harm than good. BMJ Glob Health. 2022 May;7(5):e008684. doi: 10.1136/bmjgh-2022-008684. PMID: 35618306; PMCID: PMC9136690. Alessandria M, Malatesta G, Di Palmo G et al. All-cause mortality according to COVID-19 vaccination status: An analysis of the UK office for National statistics public data [version 2; peer review: 2 approved]. F1000Research 2025, 13:886 (https://doi.org/10.12688/f1000research.154058.2)
[xv] https://www.healthsystemtracker.org/chart-collection/u-s-life-expectancy-compare-countries/
[xvi] Forrest CB, Koenigsberg LJ, Eddy Harvey F, Maltenfort MG, Halfon N. Trends in US Children’s Mortality, Chronic Conditions, Obesity, Functional Status, and Symptoms. JAMA. 2025;334(6):509–516. doi:10.1001/jama.2025.9855. Also see Jonathan Haidt, “The Anxious Generation,” 2024 for evidence of rising rates of depression and self harm.
[xvii] Moncrieff, J., Cooper, R.E., Stockmann, T. et al. The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry 28, 3243–3256 (2023). https://doi.org/10.1038/s41380-022-01661-0
[xviii] Nassim Taleb, “Antifragile: Things That Gain From Disorder,” 2012.
[xix] https://www.kff.org/health-costs/public-opinion-on-prescription-drugs-and-their-prices/
[xx] https://scholar.google.com/citations?user=JiiMY_wAAAAJ&hl=en
[xxi] Ioannidis JPA (2005) Why Most Published Research Findings Are False. PLoS Med 2(8): e124. https://doi.org/10.1371/journal.pmed.0020124 with reference in https://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/308269/
[xxii] Cardiovascular Disease Resulting From a Diet and Lifestyle at Odds With Our Paleolithic Genome: How to Become a 21st-Century Hunter-Gatherer, O’Keefe, James H. et al. Mayo Clinic Proceedings, Volume 79, Issue 1, 101 – 108
[xxiii] Modified with permission from Chakravarty, E. F., et al. [2008], Reduced disability and mortality among aging runners: a 21-year longitudinal study. Archives of Internal Medicine 168:1638–46). Lieberman, Daniel E.. Exercised: Why Something We Never Evolved to Do Is Healthy and Rewarding (p. 249). Knopf Doubleday Publishing Group.
Chasing the Grid is available on Amazon!
The Long Brown Path 