In Chinese mythology, the Si Xiong or the Four Evils — Tao Tie, Hun Dun, Qiong Qi, and Tao Wu — represent formidable perils.
For us in the modern world, as we strive for longevity, I believe we face our own set of four deadly ‘evils’ in our golden years.
The ultimate aim of life is, arguably, to live long and well. While the fabled elixir of life sought by historical figures like Qin Shi Huang remains a fantasy, modern medicine offers a genuine path to a life of a hundred years or more.
As a physician, my goal is to help my patients achieve not just a long life, but a healthy one, ideally reaching the age of 100.
The harsh reality is that the moment we are born, the journey towards ageing and eventual death begins. For most people, this journey is prematurely ended by one of the following four medical ‘evils’:
- Ischemic heart disease (coronary heart disease).
- Stroke.
- Infection.
- Cancer.
Approximately 90 per cent of deaths in the elderly are attributable to complications from these four conditions. Preventing these ‘evils’ is the focus of countless medical studies and the basis for our recommended treatments.
The Conflict: Evidence Vs. Anecdote
A significant frustration is the alarming rate at which medical advice from professionals is ignored in favour of questionable information from social media, search engines (Dr Google), friends, relatives, or even fortune tellers.
Patients often dismiss proven, evidence-based medicine, preferring unproven herbal remedies, supplements, and direct-selling products prevalent in Malaysia, Singapore, and beyond.
It is critical to remember that only doctors will be there to care for you when you are frail and sick. We practise evidence-based medicine, offering advice based on scientific proof and established consensus.
Giving out irresponsible, non-professional medical advice is easy; taking responsibility for a patient’s outcome is not. As Dr Pearl Leong has pointed out, many people are eager to offer medical advice, essentially wanting to act as doctors, yet none are willing to assume any responsibility for that advice.
Remedial Measures Against The Four Evils
Ischemic Heart Disease: This condition is strongly linked to controllable factors like smoking, diabetes mellitus, hypertension, and high cholesterol, as well as non-controllable factors such as age, gender, and race. You can use risk calculators to assess your 10-year heart attack risk.
The key to prevention is managing the controllable risks. Yet, I constantly encounter misconceptions such as “Cholesterol medications will damage your liver and brain”, “Diabetes drugs are the ones causing kidney failure”, and “Doctors are just agents for drug companies”.
Every drug has potential side effects, but they are recommended because the overwhelming evidence shows that the benefits far outweigh the risks.
Fear of a rare side effect should not paralyse you into inaction, much like fearing car or motorcycle accidents shouldn’t stop you from travelling.
Stroke: Hypertension is the single greatest risk factor for stroke. This fact cannot be overstated.
Stroke, a leading cause of long-term disability and death worldwide, is highly preventable through the effective management of blood pressure.
A common and dangerous misconception among my older patients is that elevated blood pressure is a normal, inevitable, and therefore acceptable part of ageing.
This belief is profoundly dangerous because it leads to inaction and non-adherence to treatment.
While the prevalence of hypertension does dramatically increase with age — rising to approximately 50 per cent for those aged 60 to 69, and soaring to 60 to 70 per cent for those 70 and older — this statistic does not mean it is benign.
Rather, this age-related increase in prevalence is precisely what explains the alarmingly high incidence of stroke in the elderly population.
The sustained, high-pressure force damages the delicate inner lining of blood vessels, accelerating atherosclerosis and making blockages (ischemic stroke) or ruptures (hemorrhagic stroke) far more likely.
Crucially, hypertension is treatable, and treatment is essential for mitigating stroke risk. When assessing a patient’s risk profile, it is often the systolic pressure that poses the greatest and most immediate threat, particularly in older adults.
This is often due to the age-related stiffening of the major arteries, a condition known as isolated systolic hypertension.
Therefore, aggressive management of the systolic number is required, even if the diastolic pressure (the bottom number, representing pressure between heart beats) remains within a relatively low range.
Achieving and maintaining target blood pressure — typically less than 130/80 mmHg, but often individualised — is a cornerstone of stroke prevention.
Infection: Infectious diseases pose a formidable and often underestimated threat to the health and longevity of older adults, accounting for a staggering one-third of all deaths in individuals aged 65 and above.
This sobering statistic underscores a critical public health oversight: while we diligently ensure children receive vaccinations against common childhood diseases, the equally vital importance of adult and elderly immunisations is frequently neglected.
This oversight is particularly concerning given the availability of simple, highly effective, and affordable preventative measures.
Common and potentially deadly infections, such as bacterial pneumonia and influenza, have readily available vaccinations that can significantly reduce the risk of severe illness, hospitalisation, and death.
The financial calculus of vaccine hesitancy is profoundly flawed and short-sighted. The impulse to save a small, almost negligible amount — for example, RM200 to 300 — by foregoing a vaccination is nonsensical when weighed against the potential downstream costs.
A preventable infection can rapidly escalate into a life-threatening crisis, leading to emergency room visits, prolonged hospital stays, and exorbitant medical bills.
The true financial burden is often measured in thousands of dollars for inflated Intensive Care Unit (ICU) charges, powerful and expensive antibiotic regimens, and the long-term costs of rehabilitation or chronic disability.
Furthermore, the human cost, involving pain, suffering, loss of independence, and reduced quality of life for the individual and their family, is immeasurable.
Prioritising timely, routine adult vaccination is not merely a medical recommendation; it is an essential, economically sound investment in public and personal health.
Cancer: Cancer is the most unpredictable and cunning of the four evils. While there is no guaranteed way to avoid all types of cancer, a combination of a healthy lifestyle and proper vaccinations can significantly minimise your risk:
- Get a Hepatitis B vaccination (to prevent hepatitis-induced liver cirrhosis and subsequent cancer).
- Avoid smoking (the primary cause of lung cancer).
- Get the HPV vaccination (to prevent Human Papillomavirus-associated cervical cancer).
- Eat a healthy diet and protect yourself from the sun.
Since total avoidance is difficult, early detection is crucial. Talk to your doctor about screening for common cancers:
- Breast cancer.
- Cervical cancer.
- Colon and rectal cancer.
- Lung cancer.
- Prostate cancer.
Conclusion: Health Is The Ultimate Wealth
To make more money by working hard only to neglect your health is utterly self-defeating. All your years of hard work and savings will be wasted if you lack the healthy body to enjoy your golden years.
Taking regular, necessary medications and making healthy lifestyle choices is a long-term commitment, like running a marathon. You don’t see the immediate impact of skipping a dose, as chronic illnesses kill you slowly, not instantly.
My ultimate professional hope is that all my patients will outlive their peers with a sound mind, four fully functional limbs, and a big, fat pocket to enjoy their well-earned longevity!
Dr Goh Heong Keong is a consultant nephrologist and physician at Gleneagles Hospital Penang.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
