Thomas Carroll, MD, PhDView all authors and affiliationsVolume 93, Issue 2https://doi.org/10.1177/00243639261426053View article versionsContentsPDF/EPUB

There have been a variety of changes I have seen in the past twenty years or so, since I started my training in internal medicine. What I’ve come to see as a fundamental aspect of these changes is the profound interplay between the advance of medical science and larger societal trends. This stands in contrast to some claims in recent years that science is something that we should Follow. Far from science leading the way in some (at least near) absolute sense, it seems to me rather that societal trends inform not only the direction of scientific research itself but also, importantly, the interpretation of the results thereof.

These results, and their interpretation, in turn feed back, influencing old and creating new trends in society, and so the cycle continues. I realize that once it’s written down, this may seem painfully obvious. At the same time, it seems to me that this bidirectional interplay has a tendency to get lost in the shuffle of our day-to-day lives, not to mention the noise of our modern online discourse.While I have many soapboxes and axes to grind, my purpose here is not to bemoan change itself or any specific set of changes in the world of healthcare, but rather to point to one trend that has been catching my attention recently, namely what I have come to think of as The Worship of Health.

My point here is to ask whether the pendulum has swung too far, with the rightly ordered prevention of disease drifting into setting up Health as something of an idol. It seems to me that this idol of Health is part of a larger societal trend that sees only the risk side of the equation, having lost sight of the benefits of risky undertakings. Furthermore, and in some sense more disturbingly, this risk-averse trend has not simply sought to eliminate risk but is being accompanied by an increasing (or at least ongoing) willingness to transfer that risk onto others, whether for our needs, wants, or even just for our entertainment.I think the end of this story is, in essence, that this is a result in our society of a loss of faith.

When we lose Faith in God and Hope for eternal life, what we have left is to maximize our time here on Earth in hopes of holding off for as long as possible—according to this worldview—the annihilation that is death itself. However, as we will see below, the innate human desire for risk does not go away; it simply gets transferred. Ultimately, the response to this, which I hope is painfully obvious, is to rekindle that lost Faith and Hope (not to mention Charity!) in our world today. However, even to the extent this rekindling might be accomplished, I would suggest that in order to truly Flourish, we need to accept, acknowledge, and perhaps even embrace some amount of personal risk.In thinking about this, a scene comes to mind from the Civil War-era epic, The Outlaw Josey Wales.

Toward the end of the film, the title character (played by the steely-eyed Clint Eastwood) rides out to protect his adopted family, meeting Chief Ten Bears (played by Will Sampson) and his warriors. His goal is either to make peace or, “… to kill Ten Bears and as many of the men as he can,”1 certainly dying in the effort. In response to Josey’s offer of a choice between peace and battle, the Chief responds,There is iron in your words of death for all Comanche to see and so there is iron in your words of life. No signed paper can hold the iron. It must come from men. The words of Ten Bears carries the same iron of life and death. It is good that warriors such as we meet in the struggle of life…or death. It shall be life.2

I am not here arguing in favor of needless bravado or excessive risk-taking, nor against bike helmets, seat belts, and the like. Modern safety measures have saved many lives, which is in itself a good thing. Even more importantly, my life is a gift from God, one that should not be given away needlessly. At the same time, to the extent that attempts at assuring personal safety have excised the iron from our “words of death,” I fear they have done likewise to our “words of life.” Indeed, I would venture to posit that without the risk of failure (up to and including possibly even death!), there can be no true success (up to and including possibly even life!) in this world.To take this one step further, the sentence above would be more accurate if amended to, “… without the risk of personal failure (up to and including even mydeath!) …”

While I believe it is true that we have become risk-averse, the human appetite for risk, even risk of death, has not abated, but only transferred. This transfer of risk is not new; from antiquity, there have been those who perform risky jobs and those who live in luxury. There is, however, an important difference between the risks to various social groups then versus now. Namely, the slave, warrior, sailor, or even the gladiator in ancient times was certainly at increased personal risk compared to their noble counterparts. However, the baseline personal risk (of disease, disability, and/or death) was much greater for everyone, regardless of social status, than it is today.

Indeed, Warren Buffett was onto something when he suggested that the poorest 2% in the US today live better than John D. Rockefeller did around the turn of the twentieth century.3This decrease in personal risk of (unexpected) death has been driven largely by a decrease in deaths from infection and trauma, replaced by chronic diseases (e.g., sequelae of hypertension, diabetes, cancer, etc.). As we have become more secure and longer-lived, we have also become further removed from the struggles that have typified all of human history and indeed continue to typify the lives of many people around the world today. Essentially, in so-called developed countries, calories have never been cheaper and safer, and even those who do dangerous jobs are generally not worried about their families starving due to hailstorms ruining their crops.In this regard, things have changed rapidly over the past century since the days of the original American robber barons.

My grandfather, for example, grew up without seat belts or bike helmets. At the time of his birth (mid-1920s), the maternal mortality rate in the US was 6–9 per 1,000 live births, perhaps 10%–30% of infants died before their first birthday,4 and I suspect he also knew more than a few kids his age who died of various infections, trauma, etc. before they reached adulthood. In his early twenties, he drove a tank across Europe in the 778th Tank Battalion, survived, came home, and started a family and a business, the latter of which he ran successfully until he retired. I, on the other hand, was born at a time when the maternal mortality rate was 0.14 per 1,000 live births, and there were universal seat belt laws (though bike helmets were still not prevalent).

I spent my twenties and early thirties studying, working in the lab, later in various hospitals, and now have a very stable position working as an academic physician for the largest employer in town.Given all of this, perhaps it makes sense that we have become ever more risk-averse. After all, the less struggle, pain, suffering, and death I see in my day-to-day life, the less comfortable I am with being close to it. The problem is, as we have become more comfortable, we have transferred ever more risk, discomfort, etc. onto others for our needs, wants, and entertainment.For our needs and wants, we have migrant farm workers living a difficult and dangerous life to provide us, for example, in the Northeast with strawberries in February, and employees of the world’s largest online retailer working under what can only be described as unpleasant conditions in warehouses across the country.

While the latter’s conditions are perhaps not on par with those of children working in factories during the Industrial Revolution, these are not easy or safe jobs.5All of this seems both true and so universally accepted as to be almost unrecognized. Yet there is more when it comes to our demand for entertainment. As I write this, the National Football League (NFL) season is coming to a close, with only The Big Game left to be played. Despite the NFL’s well-publicized (by the NFL) efforts in recent years to improve player safety, this has been made necessary largely due to demand for more and more extreme “entertainment value.”

As a result, players have gotten bigger and faster, with resulting violence (and, predictably, increased risk of serious injuries) than was ever imaginable in the early years of professional football.Beyond this, something else caught my attention during this football season. Commercials during football games sell many things, among which are two that are of interest here—online gambling and ultimate fighting. These two, I think, further highlight the point I’m trying to make. Online gambling provides a type of personal, though non-physical, risk (though certainly financially risky!) while ultimate fighting takes our desire for (the feeling of) risk to the next level, all from the comfort of our homes.What, you might ask, does all of this have to do with bioethics? Simply this, that The Worship of Health is both a cause and effect of our increasingly (personal) risk-averse culture. This manifests in a variety of ways in the medical world, whether changes in preventative health recommendations toward “doing more” in the absence of new data6 or the new temperance (aka “sober curious”7) movement.

In themselves, any such changes might be good or bad. The point here is that these changes and movements are not simply Science, they are part of the larger human story, with all of the attendant values—whether implicit or explicit—baked in at every stage.In the end, my recommendation is that we all need to listen (and read) carefully. Whenever we hear someone in the medical/public health/wellness/random online world use words such as, “have to,” “should,” or “must,” it is incumbent upon us to ask, “why?” and “says who?” Screening for various cancers, recommending (or requiring) particular vaccinations, or ingesting one volume of alcohol or another are issues about which reasonable people can disagree. One thing I hope we do not disagree about is that we cannot afford to blindly follow the trends of the Society/Science, worshiping that fleeting thing we call Health while ignoring the other side of the equation and all of the attendant values baked into these high-level decisions.

To do so is, I fear, neither life … nor death … but only a lukewarm existence unworthy of our dignity as humans made to Flourish in the image and likeness of God.In Christ and through our Blessed Mother,Thomas Carroll, MD, PhDEditor-in-ChiefProfessor of MedicineUniversity of Rochester Medical Center,Rochester, NY, USA

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

Footnotes

1. https://movie-sounds.org/western-movie-quotes/quotes-with-sound-clips-from-the-outlaw-josey-wales/he-s-a-guerrilla-fighter-he-figures-he-can-carry-the-fight-to-the-enemyReturn To Text2. https://www.imdb.com/title/tt0075029/quotes/?item=qt0176144&ref_=ext_shr_lnkReturn To Text3. “Warren Buffett Says The Poorest 2% Of Earners Live Better than John D. Rockefeller—Richest Man In The World: ‘People Have More Money Now,” Yahoo! Finance, https://finance.yahoo.com/news/warren-buffett-says-poorest-2-163018261.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAL0wtU-EMM56EFZA4IbAVCmT7BZHCZdZuXYD7WT3lmFwCwriSz0DhbDwFZKzE2I1KrPOJtkB2_qKysqa0rFrMrpSgbOQj8hBqyRklzr9EYR2enQwQcIyXnKiI7KL9eotjwgnxsw_ZGGRFWeUfNRvw00Wvhd7SYAZPp-U5CjsPxu2Return To Text4. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htmReturn To Text5. https://www.dol.gov/newsroom/releases/osha/osha20230201-0Return To Text6. Ebell, M.H., and K.W. Lin, “Evidence Considerations for Recent USPSTF Recommendations,” Am Fam Physician 111, no. 2 (2025): 110–112.Return To Text7. https://www.apa.org/monitor/2025/01/sober-curious-alcohol-moderationReturn To Text