28/05/2026
I worked with a woman late last year. Early sixties, just finished treatment for an aggressive cancer. She'd been a runner since her thirties, vegetarian since her twenties, alcohol-free for fifteen years. She looked at me on our first appointment and asked the question every clinician dreads.
"What did I do wrong?"
I want to sit with that question, because it touches something the wellness industry has spent twenty years actively obscuring.
The simple equations have always grated against what clinicians actually see.
Eat well, exercise, don't drink, don't smoke, follow the rules — and you'll be fine.
Eat badly, sit around, drink, smoke, ignore the rules — and you'll get what's coming to you.
This is the moral grammar of modern wellness. Good habits get rewarded. Bad habits get punished. Health becomes a measure of character. Illness becomes a verdict.
It doesn't work like that.
You know people with type 2 diabetes who have never had cancer, who eat fast food and smoke and drink and somehow keep going. You know people who ran marathons in their fifties and died of pancreatic cancer at sixty-two. You know smokers who lived to ninety. You know thirty-five-year-old vegans who collapsed without warning. You know women who did everything they were told and got sick anyway, and women who broke every rule and stayed well.
The internet hates this. Algorithms reward certainty. Headlines reward formulas. Influencers reward people who promise that the right diet, the right supplement, the right protocol will keep them safe.
Biology has never agreed.
I've spent the last fifteen years working clinically with bodies under physiological stress. The longer I do this work, the less interested I am in blaming people for their illnesses. Most people are carrying more guilt about their bodies than any clinician needs to add to.
Here's what the evidence actually shows.
Your behaviours matter. They shift risk. They improve odds. They make some outcomes more likely and others less likely across populations of millions of people.
What they don't do is guarantee anything. They don't make you exempt. They don't earn you a particular ending. The same five behaviours that produce a healthy seventy-year-old in one person produce nothing visible at all in someone else, who dies at forty of something nobody could have predicted.
This is not nihilism. It's just physiology meeting genetics meeting environment meeting time. Sometimes the loaded factors line up in someone's favour for decades. Sometimes they don't. Sometimes the loading itself doesn't become visible until the body has already lived a long time around it.
I read a comment online recently from a woman writing about her grandparents. Her grandmother ate clean, never drank, never smoked, never touched sugar. She died of multiple cancers. Her grandfather drank a beer at lunch and a beer at dinner, ate sweets occasionally, never worried about anything. He died at almost a hundred, in his sleep.
The woman noticed something specific. The one who lived to a hundred wasn't healthier in food. He was healthier in nervous system. He didn't carry his stress in his body for sixty years.
That's a real biological variable. Chronic stress changes immune function, alters inflammatory signalling, accelerates cellular ageing, and reshapes cardiovascular risk in ways that no amount of clean eating can compensate for. The grandfather didn't outlive his wife because he drank a beer at lunch. He outlived her because his nervous system was somehow held differently by life.
Which is to say — even when we do understand variables, we have to be careful with what we attribute them to. We do not get to know in advance who will live to a hundred and who won't. Anyone who tells you otherwise is selling something.
What we can do is stop using illness as evidence of moral failure.
The marathon runner who got sick was not careless. The smoker who lived forever was not virtuous. The woman doing everything right and watching her body still change is not failing. The woman who hasn't been doing everything right is not deserving of what comes.
The patient I started this post with — the runner, the vegetarian, the careful woman with the aggressive cancer — was not asking me a clinical question. She was asking me a moral one. And the honest answer is the one almost no clinician is given permission to give.
She did nothing wrong.
Sometimes biology is just biology. Sometimes the body does what the body does, in directions we cannot fully predict, regardless of what we did with our days.
Health is not a morality system.
It never was.
