Class Matters More than Medicine
When compared to other developed countries, the U.S. ranks near the bottom on most standard measures of health. Many people assume that this is because the U.S. is more ethnically heterogeneous than the nations at the top of the rankings, such as Japan, Switzerland, and Iceland. But while it is true that within the U.S. there are enormous disparities by race and ethnic group, even when comparisons are limited to white Americans, our performance is “dismal” observes Dr. Steven Schroeder in a lecture published in the New England Journal of Medicine yesterday.
Why? It’s not the lack of universal access to healthcare, says Schroeder, though that’s important. And it’s not just that we don’t exercise enough and eat too much—though that is a major cause. But there is one factor undermining the nation’s health that we just don’t like to talk about in polite society: Class. When it comes to health, as in so many other areas of American life, class matters. In fact, it matters more than whether or not you have access to medical care.
Schroeder, who is the Distinguished Professor of Health and Health Care at the University of California San Francisco (UCSF) underlines how poorly even white Americans stack up when compared to the citizens of other countries by pointing to maternal mortality. When you look at “all races” you find that in the U.S. 9.9 out of 100,000 women die during childbirth. Focus solely on white women, and the number is still high—7.2 deaths out of 100,000 –especially when compared to Switzerland where only 1.4 women out of 100,000 die while giving birth.
Statistics on infant mortality and life expectancy reveal the same pattern. For example: white women in the U.S. can expect to live 80.5 years, only slightly longer than American women of all races (who average 80.1 years). Both groups lag far behind Japanese women (who, on average, clock 85.3 years). “How can this be?” asks Schroeder. After all, as everyone knows, the U.S. spends far more on health care than any other nation in the world.
The answer is a stunner: “the path to better health does not generally depend on better health care,” says Schroeder. “Health is influenced by factors in five domains — genetics, social circumstances, environmental exposures, behavioral patterns, and health care. When it comes to reducing early deaths, medical care has a relatively minor role. Even if the entire U.S. population had access to excellent medical care — which it does not — only a small fraction of premature deaths could be prevented.” [my emphasis]
Schroeder goes on to emphasize the importance of behavior, and talks about smoking and obesity—problems that most of us aware of. Then he turns to the causes of poor health that we tend to ignore: socioeconomic factors.
Here (and here and here) Schroeder points to an overwhelming amount of research which confirms that people living on the lower rungs of the socioeconomic ladder die earlier and suffer from more disabilities than those who are wealthier, better educated, have a better job and live in a better residential neighborhood (the four components that Schroeder uses to define “class”) . Moreover, he notes, “the pattern holds true in a stepwise fashion from the bottom of the ladder to the top.”
But isn’t the difference really a function of individual behavior? After all, as Schroeder acknowledges, “people in lower classes are more likely to have unhealthy behaviors, in part because of inadequate local food choices and recreational opportunities.” In poorer neighborhoods, fresh and organic foods are usually unavailable or exorbitantly expensive; public recreation is often nonexistent, and exercising outdoors can be dangerous.
"Yet," Schroeder points out, "even when behavior is held constant, people in lower classes are less healthy and die earlier than others." [my emphasis]. For example, a 1996 study published in the American Journal of Public Health which focuses on white American men –and takes smoking and other risk factors into account-- reveals that men earning less than $10,000 were 1.5 times as likely to die prematurely as were those earning $34,000 or more. A similar study of British civil servants shows that those with lower-middle class jobs were far more likely to die of heart attacks than those on higher rungs of the ladder.
Why? Schroeder points to a combination of “material deprivation” (in terms of housing, environmental pollution, acess to education, access to trasnportation and many of the other amenities of life) as well as “psychosocial stress.” Being poor generates terrible anxiety, not just about money, but about safety, your family’s safety, and the fact that catastrophe—in the form of losing your job and losing your home—is always just around the corner.
Within the world of medicine, while some attention has been given to racial disparities in health and health care, the importance of class, and “the wide differences in health between the haves and the have-nots are largely ignored,” Schroeder observed in a 2004 NEJM article that he co-authored with Stephen L. Isaacs J.D. Clearly, he stresses, addressing racism should be a priority. But he argues “concentrating mainly on race as a way of eliminating these problems of premature death, illness and disability among the poor downplays the importance of socioeconomic status on health.”
“Class disparities draw little attention” Schroeder suggests, “perhaps because they are seen as an inevitable consequence of market forces or the fact that life is unfair. As a nation, we are uncomfortable with the concept of class. Americans like to believe that they live in a society with such potential for upward mobility that every citizen's socioeconomic status is fluid. The concept of class smacks of Marxism and economic class warfare.” [my emphasis]
But how does class explain why the U.S. lags so far behind other developed countries when we look at the health of our citizens.? After all, the U.S. is not the only country where class matters. Here, Schroeder points to an uncomfortable fact: “nations differ greatly in their degree of social inequality.” [my emphasis] And in the U.S., in recent decades, the gap between the haves and the have nots has widened, to a point that we have become a divided nation.
Granted, inequality has been growing in most of the rest of the world, “but the United States led among the richer nations; and unlike most others that offset market inequality though government intervention, the United States has not done so,” observes William K. Tabb, author of Economic Governance in the Age of Globalization.
For a full discussion of class and health in America, how we spend our health care dollars, how class can trump race, and whether the status quo is, in fact, “an accurate expression of the national political will,” see my longer post on this topic on www.healthbeatblog.org.
Comments (73)
The culture of being poor affects the way you eat. When you are poor, you have to get the most bang for your buck, the most caloric intake per dollar, so poor people tend to frequent all-you-can-eat buffets, buy cheaper and fattier cuts of meat, prefer meat over vegetables and seafood, and dine heavily on carbohydrates and sugars. Poor children are taught to eat everything on their plate so that nothing goes to waste, and to "eat that meat down to the bone." Binge eating is encouraged, because the daily availability of food is not guaranteed. These are simple survival behaviors.
Wealthy individuals have a wider range of choices in eating habits. They don't have to eat what is put in front of them - they can be choosy and they can refuse to "clean their plates."
As a crude example, when given a choice between two pizzas of equal cost, they can afford to choose the all-veg pizza rather than the meat-lovers because cost is no longer the deciding factor in food choices. Taste and health factors begin to weigh more heavily.
And unfortunately, the eating habits learned growing up poor are not easy to overcome. Often they are passed from parent to child even though the conditions under which such survival patterns were learned no longer exist. The existence of the "Extra Value Meal" concept in fast food is sustained by our compulsive need to achieve the highest calorie per dollar ratio when making food decisions.
It's also driven by our (in my belief) misguided belief in the nutritional superiority of eating three square meals a day. In my opinion, this is the equivalent of having three mini-binges a day, and it is not the way our bodies are designed to function nor the way we as a species evolved eating. We are, by nature, browsers who should eat small amounts of food throughout the day to sustain our energy level. Instead, because of our large communal society and localized availability of food, we tend to eat like large carnivores, consumming until we are stuffed, followed by a desire to sleep it off. This eating behavior is only appropriate only when food supplies fluctuate between feast and famine, as a great way to build up fat reserves to get you through the lean times.
Frankly, I don't know how we can begin to unlearn this.
September 21, 2007 2:08 PM | Reply | Permalink
I don't think we can ignore though the fact that class matters very much when it comes to access to medical care. No matter how poor a German or a Spaniard may be s/he has access to the same level of care that a middle class person in that country does. This is simply not true in the US, where the poor (and unisured) either have only minimal access (via ERs) or at best access via Medicaid whose stingey reimbursement schedule eliminate many of the better providers from the available pool.
September 21, 2007 2:13 PM | Reply | Permalink
Jeff C and JPF 311
JeffC-- First, your point that we are meant to be "browsers" and eat small amounts throughout the day is intriguing--and rings true.
Women I know whom have been most successful at losing weight long term --and generally feeling better, more energetic, etc. --have switched from "3 squares" to 7 or 8 mini-meals throughout the day. Unfortunately, this is very hard to do if you are married or have a family. Dinner, at least, is a ritual in most familiies in our society. So, as you say, it is extremely difficult to change these patterns.
JPF 311-- I completely agree that universal access to health care is crucial. I actually paused before writing this post, wondering if some people would use it to argue that health care reform really isn't that important.
Here I woudl emphasize the difference between preventing deaths and reducing suffering. Schroeder points out that access to medical care would save only a fraction of premature deaths --which I believe is true. Medicine, after all, is still an infant science,and just isn't that effective in treating many of the diseases that kill us: cancer, metnal health problems that lead to self-destructive behavior, and heart disease (particularly when the patient is not willing to exercise and change eating habits.)
In other words, having a good doctor and seeing him/her regularly is just not the miraculous ticket to longevity that many of us would like to think it is.
That said, access to healthcare can relieve a lot of suffering and prevent a great many diabilities. If a pregnant woman doesn't have access to heatlhcare, her child is much more likely to be born with problems. If you cut yourself, don't see a doctor and the cut becomes infected, you can wind up losing a foot. (This is a big problem for diabetics.) If you are diabetic and don't have regular eye exams, you are much more likely to go blind. Then there are all of those people who can't afford prescription pain-killers, can't afford to see a dentist, can't afford depression medications (or a doctor who would prescribe them) and so suffer extraordinary mental and physical pain that could be relieved.
Probably I should I have said this in my post. The next time I write about this topic I will-- thanks for bringing it up.
September 21, 2007 3:31 PM | Reply | Permalink
I'm afraid that I just had a flashback to a cartoon parody of "The Price is Right", as seen in Hell. Door #1 said "Damned if you do" while Door #2 read "Damned if you don't."
You correctly observe medicine is an infant science. For anyone who has not had the pleasure, do go read Lewis Thomas' The Youngest Science: Notes of a Medicine-Watcher.
We are just far enough out of infancy to start posing those difficult questions, the societal version, perhaps, of "mommy, where do babies come from?" [Notes 1,2]. Let us assume the existence of nanotechnology that can examine the telomeres of individual cells. If the nanodoctor decides the cells are bursting with microscopic health, and they show no evidence of being part of a tumor, it will take nanoglue and paste back a length of DNA at the end of the telomere. Conceptually, defeating the mechanism of apoptosis, or programmed cell death, if it can be done in a way that does not defeat natural protection against cancer, might stop the aging process.
If we have a problem now with universal access to healthcare, what would the problem be like if the question were access to extremely prolonged and vigorous life? An alternative interpretation might be that stopping apoptosis might not extend total life, but would stop the infirmities of aging, and, unchecked, mean that there would be a short but horrible period of accelerated decrepitude. If the latter, would it be ethical to offer euthanasia to those starting the irreversible process? Why? Why not?
In less general ways than telomere maintenance, we are starting to run into tradeoffs between cancer/infection defense and assorted autoimmune diseases. Tumor necrosis factor alpha (TNF-a) inhibitors such as Remicade and Embrel can stop or reverse rheumatoid arthritis, but it may increase vulnerability to infection. TNF-a seems more complex than first thought, as different means of blocking it seem to have different effects on autoimmune disease, such as thalidomide against leprosy or Behcet's Syndrome.
Much the same situation exists with agents that variously accelerate or inhibit angiogenesis. My heart recollateralized after failure of bypass grafts by angiogenesis, yet angiogenesis is the way many tumors grow quickly and reducing angiogenesis can starve the cancer.
It's never simple, is it?
--
Howard
[Note 1] One colleague shared her embarrassed blurting about birds, bees, mommies, daddies, etc., with her offspring, who irritably corrected her with "That's not what I meant. John said he came from Los Angeles. Where did I come from?"
[Note 2]When I asked my mother the question, she responded with an answer that was absolutely accurate and absolutely uninformative: "The male has the penis and the female is equipped to receive the penis." Had she lived longer, the ability to give answers like that would have made her a natural for software technical support.
September 21, 2007 9:07 PM | Reply | Permalink
Maggie
Steve Schroeder'article in NEJM was the most important health care policy article I've seen in years. Frankly I was surprised to see it appear in the prestigious but pretty mainstream-entrenched in organized medicine- New England Journal of Medicine. Kudos to the NEJM Editors!
Thanks for writing about this landmark article.
I am hopefull that every presidential candidate and their health plan advisors read Schroeder's article very carefully and takes his words and ideas to heart. Then and only then will real reform see the light of day.
Thanks again and
Be Well,
Dr. Rick Lippin
http://medicalcrises.blogspot.com
September 21, 2007 9:23 PM | Reply | Permalink
One never knows about NEJM. They are generally so staid that they can get away with an occasional stolen base, to mix a metaphor. Do you remember the letter to the editor, a "Case Report of Extreme Dehydration and Hypernatremia in a Young Woman of Mediterranean Origins," which turned out to be a postmortem report on Lot's Wife?
--
Howard
*equal opportunity offense to both extremes*
"Those who cannot remember the past are condemned to repeat it" [George Santayana]
September 21, 2007 9:27 PM | Reply | Permalink
Re: An alternative interpretation might be that stopping apoptosis might not extend total life, but would stop the infirmities of aging, and, unchecked, mean that there would be a short but horrible period of accelerated decrepitude. If the latter, would it be ethical to offer euthanasia to those starting the irreversible process?
Why would this be any more horrible than decline that many people already go through in the last period of their life? I'm OK with deathbed euthanasia (which we commonly prcatice by providing the dying with large narcotic doses which doesn't just ease their pain but eases them out of life). I see too many problems with euthanasia for the sick-but-still-functional. Ethical problems like the financial bias health plans (including public plans) might have on the subject, and the desire of impatient heirs to get rid of gramps so they can finally divvy up the estate.
September 22, 2007 4:35 AM | Reply | Permalink
I often think of Ship's Surgeon McCoy grumbling "This is the Dark Ages of medicine", when stuuck in the 20th century.
I thnk it is certain we will see more separation between elites and ordinaries, regarding medical/genetic intervention. Extending life is mainly an information problem---accumulated error or lost information. As such, it should be possible to store clean copies of a person's DNA when young, to use for restoring when older. The site-specific information created during development is tricker, but seems also possible to store/restore.
The worst future I can imagine would be Asimov's guess, that avoiding infections extends life, so social connections get set aside to preserve isolation. A life-extension technique would first be possible at high expense, since it would have be customized to an individual, but would get cheaper.
Large problems, socially, with extending life. It would slow innovation, skew male competition to activities suitable for youths, and create an overclass of those with more experience than others, and more insider connections than others. This would mean a permanent tyranny of the elders. Even if physically young, these people will have no incentive to raise proteges, replacements. They will become extremely cautious for themselves. They may live forever, but they may cause the cessation of social growth.
How can we make death respectable and desirable? Or should we resign ourselves to the distortions caused by immortality (for some)?.
September 22, 2007 6:24 AM | Reply | Permalink
Howard
Thanks
I gave up reading what I preceived as NEJMs obsession with bio-medical esoteria a long tme ago.
Maybe I re-subscribe?
Rick Lippin
http://medicalcrises.blogspot.com
September 22, 2007 7:42 AM | Reply | Permalink
That was great. I might not quite put it in terms of not access to univesal health care perhaps, though, since such a plan is also a kind of economic reform that addresses various aspects of income disparity, including anxiety over what one can afford.
John
http://www.haberarts.com/
September 22, 2007 7:47 AM | Reply | Permalink
Thanks to all. I don't expect access to longevity and immortality techniques to be an issue any time soon, and some of the best life extension techniques are things Rick describes as prevention.
Sir William Osler, one of the all-time great physicians and teachers, is supposed to have send, "the best way to have a long life is to get a chronic disease and take very good care of it." Especially if we age, we get chronic diseases, and getting maintenance therapy for them often avoids catastrophe.
--
Howard
*equal opportunity offense to both extremes*
"Those who cannot remember the past are condemned to repeat it" [George Santayana]
September 22, 2007 8:14 AM | Reply | Permalink
Tom Wright wrote:
" Large problems, socially, with extending life. It would . . . create an overclass of those with more experience than others, and more insider connections than others. This would mean a permanent tyranny of the elders. Even if physically young, these people will have no incentive to raise proteges, replacements. They will become extremely cautious for themselves. They may live forever, but they may cause the cessation of social growth."
To me that sounds like a fairly good description of the effect the white male power base has head over our society over the last 25 years.
When I rewfer to the white male power base I am thinking of a line that extends from Reagan and his supporters to people like Cheney and Rumsfeld- as ell as the elders running the mainstream media (including those that Dan Rather is suing, and those at the NYT who decided not to stand up and question the weapons of mass destruction mythology that sent us into Iraq. )
Then there are the corporate chieftains who refused, for years, to hear the message about global warming who have largely succeded in preventing any but the most docile women and minorities from gaining real power in our military-industrial complex (When I say "docile" I am thiking of people like Colin Powell). By taking over CNN, they also defeated Ted Turner.
For a long time, this white male establishment has been looking over its shoulder, anxiously watching the demographics of the country change. They realized, in the 1980s, that before long, they would be outnumbered. The radical feminism of the 1960s sent a message that terrified them--and they fought back. (See Susan Faludi's excellent book, "Backlash.) The black power movement had a similar effect, and brought a similiar reaction. (Count the number of black males now in prison.)
But the Rumsfelds and Cheneys are reaching the end of their careers. And the fact that a woman, a black man, and a white populist who has spent his career fighting corporate America and is now is running on a1960s platform (a war on poverty) suggests that the times may be changing. Though there is still the possibility that Republicans could win the election. I wouldn't count them out. They are driven by fear which is what makes them so nasty. (Think Guiliani).
Finally, Tom Wright asks: "How can we make death respectable and desirable? Or should we resign ourselves to the distortions caused by immortality (for some)?. "
I do think we need to make death "respectable and desirable." The whole notion of extending life, making 120 the new 80, etc. strikes me as repugnant. I can't help but think of the society that lived forever in "Gulliver's Travels." As human beings we are part of nature, and in nature, the cycle of birth and death is essential. "Death is the mother of beauty," as the poet Wallace Stevens puts it.
If we lived for generations what reason would we have to reproduce? The globe would be too crowded--babies would be seen an unncessary, a drain on resources. Who wants to live in a world without babies?
In my humble opinion, the goal of medicine should be to try to make the process of aging less painful--to help us live active and healthy lives into our 70s and 80s--even into our 90s. But prolonging life should not be the goal.
September 22, 2007 10:08 AM | Reply | Permalink
There's a very old epidemiological study of depression, done in England, I believe, which is consistent with the findings this post notes. People who are poor, especially women who lack a supportive partner, and who have young children tend to become depressed. Also, children who lose a parent before the age of 14 tend to become depressed. Add to that the idea that depressed people, who simply "give up" die sooner than others. Once you have a situation where families break up, poverty is rampant, people are very depressed and discouraged, have little energy to parent, or care for themselves, and then apply that to the children who grow up into similar circumstances. You have poverty, depression, deprivation of the psychosocial factors that support health and safety and wellness of every type. With the widening disparity in wealth in this country, and the "class" system which definitely operates, but which we tend to ignore - because we think of ourselves as egalitarian - yes, we have recipes for poor health, poor mental health, people who feel desperate and despairing and have little hope.
John Edwards' view of the two Americas. Yes. He's right! Whether you are for or against him, his message about that is hugely important in many ways.
Thanks for this excellent post!
September 22, 2007 10:17 AM | Reply | Permalink
On the always interesting subject of eating: I think the practice of eating three big meals a day became the custom because working people can't afford to take many breaks every day just to eat. I grew up in a farming community, although my family was not farmers, and the eating habits of the local farmers fascinated me. They ate a hearty breakfast, very early in the morning. Worked hard. Ate a hearty early "lunch". Worked hard. Ate a hearty mid-afternoon meal. Worked hard. Ate a hearty late dinner. Slept.
Those of us who were not farmers tended instead to eat a hearty breakfast, a hearty midday meal, called dinner, and a light evening meal, called supper. And, of course, we didn't "work hard" in the same context as the farmers did. Much healthier in that we didn't eat a late day hearty meal.
When I was employed, we had very brief coffee breaks, without time for real snacks, and a half hour lunch break. So, our eating habits were dictated by having to get our midday nourishment imbibed during that half hour. It was a light meal because of the time constraint. That left us hungry in the evening, so we had hearty evening meals, followed by sleep. That isn't a healthy eating pattern.
I would like to announce that on retirement I immediately switched to a healthy eating regimen. But, you know......
Hoppy in Sacramento
September 22, 2007 10:42 AM | Reply | Permalink
White males have only been a problem for the past twenty five years? Seems to me that white males have been a problem since the founding of this country.
Will this country really be better when white males have been eliminated or relegated to minority status? Or, are you assigning qualities you don’t like to people based on their skin color and/or gender? I do not want to think of you of a racist of sexist, so I am going to assume that is not what you meant.
September 22, 2007 12:51 PM | Reply | Permalink
When people rant about white males they are barking up the wrong tree and doing no little damage to the progressive cause. Most white males are not part of the elite that run the country and are in fact just as downtrodden as non-whites and non-males. Yet this rhetoric of blaming "white males" helps the real elite keep these folk on the rightwing side of the fence since they are made to feel decidedly unwelcome on the leftwing side. The real problem is not race or gender but social class: the problem is, in word, wealth. Better to rant about the "rich" than about "white males".
September 22, 2007 1:17 PM | Reply | Permalink
So will this country be better when all the “rich” have been eliminated? Are all “rich” people bad people? Or, are you assigning traits you don’t like to people based on their economic success? I guess there is no “ism” assigned to such beliefs.
September 22, 2007 1:41 PM | Reply | Permalink
Did you think it was equally repugnant to make sixty the new forty?
September 22, 2007 3:17 PM | Reply | Permalink
JPF 311--
I completely agree with you: that is why I talked about "the white male establishment"--i.e. the elite who run the coutnry--and not "most white mailes."
If you had read my post (rather than reacting after reading the first paragraph or two) you would have realized that I agree with you.
At one point, I draw a bright white line between Ted Turner (who is indeed white ,male rich and fairly old, but always a renegade and never part of the establishment elders) and the establishment people who took over CNN.
Too often, people react to a post or a comment online based on what they assume the poster is going to say--without bothering to read the whole post. It's very much like cuttring someone off midsentence (because you think you know where they are heading) and then shouting them down.
I like online threads because they can lead to very intersesting, thoughtful debate. But for that to happen, you really do have to read what the other person is saying.
September 22, 2007 4:10 PM | Reply | Permalink
Robert Brown--
Not at all. But we have made 60 the new 40 by eating healthier food, exercising more, and in general, paying attention to what our bodies were telling us (i.e. paying attention to nature).
And for for a very long time there have been people in this country who lived as if they were 40 when they were sixty. On one side of my family,my relatives were farmers and the men worked in the field, growing wheat and tending to the cows until they died. They ate healthy foods- eggs, milk, fresh vegetables grown on the farm, vegetables that their wives "put up" for the winter, apples and peaches grown on the farm, potatoes, chicken (raised on the farm) and meat.
Many were long-lived, their faces creased and browned by the sun, but they were still strong, energetic, able to pitch hay or climb a fence. I don't know why they didn't develop skin cancer (or any kind of cancer) but they didn't. Mostly, they died of strokes, sometimes in their sleep.
None of them smoked. Some of them drank, but not that much. A few binge drinkers, but not regular drinkers. (It's really hard to get up at 5 a.m. and work a 12 hour day if you drink. And they didn't eat that much meat because it was relatively expensive.
Making "120 the new 80" on the other hand, depends upon Silicon Valley finding a way around nature. I'm not saying it couldn't be done, just suggesting that we shouldn't do something just because we can do it. We need to think about possible consequences, and move very, very slowly. And, before we pour heatlhcare dollars into trying to prolong the lives of wealthy adults who have had full lives, I would like to see us spend that money on researching childhood diseases, and trying to help poor children whose lives are cut off because they have the bad luck to be born into a a dangerous, polluted environment.
Finally, (and this is just a personal opinion), I don't see what people hope to do with the extra 40 or 50 years. By the time I'm 80, I think I will have done, tried, experienced most of the things that I would like to do. At a certain point, it seems to me natural to be ready to die. I certainly hope I don't die in pain, or of some tortorous disease. But if most of us could live to 80 or so, feeling energetic and fairly healthy until the end, and then die peacefully in our sleep-- this would seem to me an ideal for medical science to strive for.
I'm afraid that the Silicon Valley people who want to extend life are primarily interested in the profits that they could make-- not in helping mankind.
September 22, 2007 4:31 PM | Reply | Permalink
Maggie, I agree with you completely on life extending "medicine". My father lived to age 94, and his final years were much affected by watching everyone he knew dieing around him. His first act of the day tended to be reading the obituaries to see whose funeral he would be attending next. He told me once that watching so many people he cared for die was very hard to do.
So, from a quality of life consideration I strongly believe that once you reach 90 it isn't likely that your life will be a positive experience. I know there are exceptions, just as there are to all generalities.
The out of control cost of health care is also negatively affected by the effort to keep the oldest of us breathing for the longest possible time. Far better, in my opinion to accept that the one thing we all will do is die, and when that time comes, acceptance is usually the best course of action. I say this as a 71 year old. My ambition is to get to 80.
Hoppy in Sacramento
September 22, 2007 4:48 PM | Reply | Permalink
Invent Heaven? Oh, wait...
Gee, Tom, you really set yourself up with that one. :-)
September 22, 2007 4:48 PM | Reply | Permalink
Riobert Briown--
I agree that white men with power and great wealth have been a problem since the founding of this country.
But at some point in the 20th century, we thought that was changing. Women got the vote. The civil right's movement and the women's movement gave many people (progressive white men among them) hope that whjite men were ready to share power. But the final two decades of the 20th century were disappointing.
Of course, when I talk about white men being the problem I'm not talking about all white males. Thjs is why I tried to make it clear that I was talking about the "white male establishment"-- men who did not want to see change, did not want to see freedoms extended to others. (See my reply to JPF 311.)
There is not doubt but that many women and minorities would have reacted the same way if the had been in the driver's seat. Power not only corrupts, it makes people rigid.
I'm not suggesting that white males should be "relegated to minority status" but that power should be shared. There should be no "minority status."
And I am certainly neither a sexist nor a racist. Both my husband and my son are white males, and I think they are both spectacular.
September 22, 2007 5:00 PM | Reply | Permalink
Re: By the time I'm 80, I think I will have done, tried, experienced most of the things that I would like to do.
I'm only half way there but assuming I had both my health and enough $$ I can think of all kinds of things I'd be able to do which I havenlt had the tiem for yet. There are sorst of new things I'd like to learn. Languages, how to play the guitar, evemn how to snowboard (well, maybe not at 80! Isuspect bones will still be a bit brittle). And places I'd like to travel to. And causes to support. I could probably fill up a couple centuries with life if I had the vigor and the cash to do so.
September 22, 2007 5:18 PM | Reply | Permalink
Ok, to explain it a bit further, let me state that I find the balkanizing indentity politics of the Left quite objectionable-- and a big part of the reason that the Right has prospered so well. And while Marx may have been very wrong in his predictions I do think his social analysis based on class is far closer to the mark than one based on race or gender. Class conditions a person to think and act and vote in certain ways that race and gender do not. (I will allow that gender may have a bit more influence than race here, since gender is at least a biological reality whereas race is at most skin-deep, and at least a social construct). And this also explains people like Clarence Thomas, Condi Rice and Nancy Reagan: they identify with the overclass because they are part of it.
Though to be sure let me also say that the GOP has gone so far off the deep right end that even class does not explain them very well these days. Indeed, in some ways GOP policy acts against the economic interests of the upper classes too nowadays. It's very hard to see how Bushism in foreign policy or Christianism in domestic policy benefits the wealthy, or for that matter benefits either white people or males. We are probably seeing a classic (and quite extravagant) case of Folly, as Barbara Tuchmann once described it.
September 22, 2007 5:27 PM | Reply | Permalink
John--
I agree that universal health care is very important, even if medicine can't do as much as we hope it could (in terms of savings your lives) it can relieve pain, and anxiety --and, a the end of life, provide "care" if not "cure."
See my reply to Jeff C and JPF 311 above --the section of that reply addressed to JPF 311.
Thanks for your comment.
September 22, 2007 7:31 PM | Reply | Permalink
John--
I agree that universal health care is very important, even if medicine can't do as much as we hope it could (in terms of savings our lives) it can relieve pain, and anxiety --and, a the end of life, provide "care" if not "cure."
See my reply to Jeff C and JPF 311 above, and the section of that reply addressed to JPF 311.
Thanks for your comment.
September 22, 2007 9:03 PM | Reply | Permalink
TPM's servers often bog down (the ads, maybe?). Sometimes a very slow and deliberate mouse click helps. In any case, wait and see, if response is slow.
September 23, 2007 5:12 AM | Reply | Permalink
JPF: "The real problem is not race or gender but social class." I can't agree with that. Class is sadly one of those great unmentionables in American politics. But, just as sadly, so is racism, and it's real. We're not going to put class back on the table any faster either by denying it.
Pointing to the powerlessness of many white males is only fair, but it doesn't get them or racism off the hook either. When they keep voting GOP, like fundamentalists, they're allowing themselves to be manipulated by the powerful. And that manipulation has a lot to do with racism. Powerlessness, the sense that we're falling off the ladder and need to distinguish ourselves from the truly powerless in the gutter, is quite compatible with that kind of dynamic.
John
http://www.haberarts.com/
September 23, 2007 6:06 AM | Reply | Permalink
Gee, thanks, Tom. I now have a vision of a very slow and deliberate mouse along with the official house rodent, a hyperactive young squirrel. I have never tried to click Waffles, the squirrel, but perhaps that is appropriate when he and one of the cats are rubbing noses.
--
Howard
*equal opportunity offense to both extremes*
"Those who cannot remember the past are condemned to repeat it" [George Santayana]
September 23, 2007 6:26 AM | Reply | Permalink
Squirrels may be on the road to incidental domestication, like cats did starting about a hundred thousand years ago. If they find enough to like by hanging around humans, and don't get "selected" out (killed or transported), our descendants might reliably enjoy them as friends instead of pests. (As long as they don't nest in the ceiling or attic.)
By comparison, the only good mouse is the one that stays put on the pad and doesn't leave a trail of droppings.
September 23, 2007 6:48 AM | Reply | Permalink
Perhaps this is not completely off-topic, given the Medscape editorial on how veterinary medicine has efficiency and care lessons to give to human medicine. The general rule is that orphaned squirrels should go to wildlife rehabilitators, but the ones we contacted couldn't take another.
Since one of the cats had very carefully carried the wee squirrel to my housemate, and acted exactly as when she brought her kittens to him for assistance, he felt obligated to act. It was amusing that we had to go off for several days' trucking of some of my household goods, and Waffles went along with us so he could get his frequent feeding.
The books warn that adult squirrels can get aggressive, but we now have the problem not just that he trusts humans, but trusts a fair number of cats (and vice versa). For his own safety, we are thinking that he may eventually be in a very large private enclosure on the deck. Our cats do not seem to regard him as prey, but that's inside the house -- and there are other cats outside.
One fascinating aside is that he's quite communicative. Oh, I had heard general squirrel chattering outside, which mostly seemed territorial warnings. Now, however, Waffles has taught us there are sounds that mean "Mommy, feed me", "I'm content and happy", "Please play with me," etc. We have fed him his first acorns, and, as opposed to cashews and sunflower seed, seem to be the equivalent of crystal meth for squirrels -- he gets hyperactive.
--
Howard
*equal opportunity offense to both extremes*
"Those who cannot remember the past are condemned to repeat it" [George Santayana]
September 23, 2007 8:27 AM | Reply | Permalink
In general the dirtier and riskier the job the less it pays. So those doing these jobs tend to be the ones in the lowest economic classes. These people are subject to more environmental hazards (think agricultural chemicals or even the artificial butter used in microwave popcorn). They also are subject to more on-the-job physical injury and their harder work means they "wear out" younger.
People in the US also work more hours each year and tend to work further into old age then in other developed countries.
One of my favorite Utopian books is "Looking Backward" by Edward Bellamy. In his society everyone was paid the same amount, but the number of hours you had to work was inversely proportional to the distastefulness of the job. So a sewer cleaner might only work three hours per week, while a doctor might work twenty. The number of hours worked was set by competitive bidding.
It's interesting that Walmart has just put such a plan in place, but they inverted it. Each worker gets to state how many hours they wish to work and when they are available, those who are willing to take the worst assignments get more hours.
It is popular to talk about bad nutrition, but I don't think this can be only blamed on the consumer. I stopped at a highway rest stop yesterday and looked at all the menus from the various fast food sellers. There wasn't one item that wasn't deep fat fried or high in cholesterol (hamburgers, fried chicken, french fries, etc.). There was the token salad listed, but that is hardly a comparable meal. The corporate food industry has focused on efficiency and this means a lack of variety. The reduction in variety has been accompanied by a relentless advertising effort which promotes bad nutrition. Where are the ads for milk and spinach? Instead we get TV dinners and "sports" drinks.
--- Policies not Politics
Daily Landscape
September 23, 2007 8:43 AM | Reply | Permalink
Don't know what it is, but I think there's a mushroom squirrels get off on. My sister described watching one eating some and then jumping and thrashing around. I've seen the second part, but not noticed what inspired it.
If animals indulge in fermented fruit and mysterious mushrooms is it drug abuse? I had one cat that got hot over celery greens, as well as green peppers, and leaf lettuce. Kind of strange to see her rubbing her face with the salad, held tenderly between her front paws.
September 23, 2007 12:32 PM | Reply | Permalink
"The culture of being poor affects the way you eat." (JeffC) (I assume you're referring to Americans only.)
Besides what you talk about, high sugar and high fat content foods supposedly satisfy us (physically, mentally, emotionally it has been suggested) more than foods low in sugar and/or fat. Women in prison and homeless women, certainly low in spirit, crave the high caloric foods - particularly sweets. Likewise, poor women (and men) use food to assuage their despair and broccoli and lettuce just don't cut it.
(A study done a number of years ago on why young, poor and unmarried girls were having babies more frequently than their young, unmarried but not poor sisters revealed something quite interesting. A very common reason given was that they wanted something 'brand new' and solely theirs. Again, poverty determining behavior.)
Eating unhealthful foods (and having babies before one is emotionally able to cope) are pretty widespread among the American poor. It's safe to assume that the behavior that poverty can determine may ultimately result in a shorter life.
September 23, 2007 1:20 PM | Reply | Permalink
At Mass today the homily made a nice distinction. Wealth is not bad unless acquiring it or using it is done at the expense of the powerless or for immoral purposes. The deacon did a nice job of using the SCHIP bill as an example.
Denying health care to children in the interests of protecting the wealthy is not a moral act.
September 23, 2007 2:45 PM | Reply | Permalink
Studies such as Schroeder's should be welcome, and hopefully there will be many to come that will go beyond correlations to specific causes of higher morbidity and shortened longevity. Misinterpretation of study results, however, and assumptions that result, are risky. We live and die as individuals. The statistical results of a study of a large group, such as a defined socioeconomic class or all socioeconomic classes compared, do not support valid predictive values for any individual in the group. Situations vary from person to person. Aggregate statistics and measures of central tendency obscure distinctions among individual situations. Big deal? Yes. Some who would benefit from health care might tend to forego that care (if there's a choice) if a fatalistic the-poor-die-younger mindset takes hold.
Those who would benefit from health care, for events and diseases the medical treatment of which would make likely years more of sentient life, number in the tens of thousands every year; however they may rank in the study results, the individuals composing this “small fraction” are not insignificant individually or statistically. For them, class is not necessarily more important than medicine.
We should not only be concerned that a misunderstanding of risk factors will influence some to not seek needed medical care or to not make life changes conducive to good health. Some public policy makers and politicians are likely to seize upon study results that state or suggest that socioeconomic class is more important than medical care. I can almost hear some campaigning politician saying something like, “We don't need the government raising taxes while saying they'll take care of your health needs. We need to let you keep your hard-earned money and improve your financial situation. After all, prosperity and good health go hand in hand.”
September 23, 2007 4:28 PM | Reply | Permalink
If the race of the person didn't cause the problem, why did you bring up race? I think that is just as repulsive as those who always happen to notice that some one on welfare is black.
Yeah, yeah, I suppose some of your best friends are black too.
September 24, 2007 6:53 AM | Reply | Permalink
A lot of the longevity increase from forty to sixty was due to the "silicon Valley" ot the day discovering cures for diseases. Do you favor limiting research on cancer treatments, better treatment for heart disease, or other ailments that tend to afflict older people?
September 24, 2007 7:09 AM | Reply | Permalink
You bring up what is a current controversy in medical journals: is "race" merely a surrogate for socioeconomic status (i.e., "class"), or is it meaningful in a biological, genetic sense? Should the only such categorization be made on verifiable genetic differences?
The simple answer is that it isn't simple. On the one hand, I consider race a social construct. On the other hand, there is some evidence to support that salt retention is more common in American blacks who develop high blood pressure, so the first-choice treatment should be a diuretic to get rid of excess sodium.
If someone else will lend be a third hand, or help me take off a shoe, on the third appendage, we have a smaller body of evidence saying that hypertension in recent immigrants from West Africa don't have the predisposition to salt retention, and a different first drug should be chosen. While the thiazide diuretics used to be a first choice for most patients, it's now recognized that they may predispose for diabetes in a susceptible patient, and also increase the risk of dehydration and heat injury.
No one can prove it, but there is a suspicion the difference may be one of the human genetic differentiations that became significant faster than almost anything in history. It is argued that in the hells of the holds of slave ships, where the prisoners got inadequate water, those that had the genes to conserve salt, and, as a consequence, water, had a better chance of survival.
If the slave ship hypothesis is correct, then the population of blacks that came to the US with slave ancestors has a genetic difference than even darker blacks who came directly to the modern US. While I can't call it a scientific example, I have, as extended family, a clan of people that trace their sometimes recent immigrant roots to Sierra Leone. Those that have developed hypertension in middle years appear to do better on non-diuretics if they were immigrants, where the first generation born here, many of whom married blacks of American slave ancestry, do better on diuretics.
So, the simple answer to a non-simple problem is that we don't have a good answer. Still, we can point to associations between ethnicity and disease. Tay-Sachs disease is associated primarily with Ashkenazi Jews. Behcet's Syndrome originally and mysteriously seemed to be common only to Turks and Japanese, but it now has been found along the old Silk Road, suggesting that it may have originated in China, from which carriers moved west to Turkey and east to Japan.
--
Howard
*equal opportunity offense to both extremes*
"Those who cannot remember the past are condemned to repeat it" [George Santayana]
September 24, 2007 7:40 AM | Reply | Permalink
There are differences among people that are genetic. I don’t think there any doubt about that. Did society divide people up by an obvious difference, skin color, and call it “race” when some other more subtle differences could have been used. I thing the answer is probably yes. In fact we invented a “Hispanic” “race” which really has nothing to do with genetics.
Of course the correlation between disease and “race” would make sense in many case. Take the susceptibility of people with black skin to sickle cell anemia. Dark skin is a defense against the sun and sickle cells defend against malaria, which thrives in the tropics. So, it seems the same traits would evolve in the same individuals.
I do not find the rapid evolution hypothesis very compelling. Why would not those same traits select out just as rapidly?
September 24, 2007 8:24 AM | Reply | Permalink
Unless it's coupled with other mechanisms -- and I do note that the genes have not been identified -- there may not have been an evolutionary reason for it to select out, given the different ages of reproduction and death from cardiac disease or stroke.
--
Howard
*equal opportunity offense to both extremes*
"Those who cannot remember the past are condemned to repeat it" [George Santayana]
September 24, 2007 9:12 AM | Reply | Permalink
I have been experimenting with changing my eating habits for a few months. It is extremely difficult to maintain, as you say, because our entire food culture is geared to preparing and eating big meals. The big meal scenario grew out of the agrarian culture, in large part, when there wasn't time or proper facilities for multiple small feedings. Farmers couldn't afford to break off work and eat several times times per day, so large meals were required to sustain them through the long hours of toil. Two of those meals occured before and after the day's work. Industrialization reinforced this eating behavior with the introduction of the time clock. The daily school schedule sets children firmly in this pattern at an early age.
I have young children and I do most of the food preparation in my house. It is difficult for me, as a cook, to not prepare a big meal. But even though I still cook like my mother, I try not to eat the way she taught me. Frequent small snacks helps curb my desire to gorge at meal time. But it is nigh impossible to completely switch over to a browser diet without alienating yourself. Food is a defining element of culture.
September 24, 2007 10:21 AM | Reply | Permalink
O.K. you have a point.
Something like the argument that blacks today are better athletes because of the selective breeding of their ancestors as slaves. There is no evolutionary reason that I can think of that athletic ability should be deselected once it exists
September 24, 2007 12:51 PM | Reply | Permalink
Robert Brown wrote:
" the race of the person didn't cause the problem, why did you bring up race? I think that is just as repulsive as those who always happen to notice that some one on welfare is black.Yeah, yeah, I suppose some of your best friends are black too."
Robert, I don't quite know how to break this to you, but my daughter's husband is black. (I was happy to see them get together, and like him very much.) So no, I'm not a racist.
But I do think that being black (or Latino or Arab) changes how you are treated in our society. It can be much harder to get a job, which makes it harder to live in a good neighborhood, which makes it less likely that your children will get a good education and more likely that they will be exposed to environmental conditions that cause asthma, etc.
Even if you are a middle-class African-American, there is quite a bit of research showing that you are likely to be treated differently in an ER (just as you are likely to be treated differently when trying to hail a taxi in N.Y.) You also are likely to be treated differently by an ambulance (that will take you to a poorer hospital, while taking a white person to a better hospital, even if it's a bit further away. (There was a story about this in the New York Times a year or so ago.)
If you are found unconscious on the street, there is a greater chance that EMS workers won't realized that you've had a stroke, and will instead assume that you are drunk and have passed out. (Here, probably a lot depends on how well you are dressed.)
There are also biological differences between not only races, but ethnic groups. I'm Irish, so I'm more vulnerable to skin cancer. African-American males are more vulnerable to prostate cancer.
Robert, I also agree that racedis in some ways a "social construct": You are absolutely right that "Hispanic" covers a large number of people coming from very different cultures and gene pools.
Finally, I think that class and race both matter when it comes to getting healthcare, and that while being poor, and a person of color is a subset of class, people of color alos have separate problems.
If you are an upper-middle-class African-American woman, I think you are likely to get much better pre-natal care than a very poor white woman--because you are more likely to have insurance, and also, because you are better educated, you are more likely to know where to go to get good care.
But if you are an upper-middle class African-American woman you still run the risk of bumping into health care "professionals" (nurses, doctors, the admissions nurse at an ER) who are simply bigoted against people of color. It's one think when a taxi won't pick you up, something else altogether when a nurse doesn't answer your call when you are in pain.
September 24, 2007 4:00 PM | Reply | Permalink
Effusion--
I couldn't agree more. We are born and die as individuals, so when it comes to making an individual choice for myself, I realize that aggregate data may not be compelling.
And while, in some sense "Class" may be more important than "Medicine" I do not in any way mean to suggest that universal health care is any less important. I realize that someone could use this post to make that argument, and worried about that before I wrote it. (On the other hand, I think people on this thread know better.)
Please see my response to JPF 311 in a respone headed "John C and and JPF 311--scroll up nearly to the top of this page.)
And thanks very much for your comment.
September 24, 2007 4:11 PM | Reply | Permalink
So if non-whites were running the power structure in this country, you would have no problem with it? If you would, why do you associate the power structure you don't like with skin color? Or am I to imply that you think that only people with white skin would implement an oppresive pawer structure?
By the way I cannot tell you how tired I am of racists starting the conversation out by pointing out that they have black friends.
September 24, 2007 6:00 PM | Reply | Permalink
Never one to be politically correct, I don't have any black friends, or white ones either. I have quite a few that have their own unique shades, from a purplish brown to a very pale pink.
I do miss my black friend Clifford most terribly. OTOH, the last inch of his tail was snow-white, so should he not have been considered black? How does the taint theory apply to the tails of incredibly wise and charismatic felines?
--
Howard
*equal opportunity offense to both extremes*
"Those who cannot remember the past are condemned to repeat it" [George Santayana]
September 24, 2007 6:26 PM | Reply | Permalink
Athletic talent and height among African-Americans are not different from other populations. What differs is variability. The extremes are more extreme or more represented. It isn't that selection made for more athletic blacks, but that the population has a wider range from which the contemporary sport can select.
Non-African populations show less variability.
September 24, 2007 10:57 PM | Reply | Permalink
Ms Mahar
Thanks for the initial post. It was one of the most interesting and thought provoking articles -- and backed up by data -- that I have read in a while.
On the other hand, I was appalled by the deplorable commentary in which you joined making negative assertions regarding "white males". Those ad hominem arguments are grotesque overgeneralizations - as your various later posts in the thread essentially concede by continually drawing distinctions between white males you deem acceptable and those you don't - that are wholly counterproductive to your policy goals and morally offensive in that they do not differ in any logical fashion from the racism and sexism that we and the vast majority of the country condemn. While policy in a country of 300 million people needs to be done on a large scale that requires consideration of group characteristics to be efficient, whether any human being is good or bad in a moral sense cannot be assessed by skin color, gender, net worth, membership in a statistical category, amount of power they hold or any other status, but solely from their oonduct vis a vis the rest of society.
September 25, 2007 6:45 AM | Reply | Permalink
Excellent comment. I was thinking along the same lines. The foundation of our medical (and, for that matter, many other societal parameters) is built upon the notion that a 5'10", 180 pound white male is the "norm". The vast majority of clinical and pharmaceutical trials have been conducted within this population. When minorities including women and people of color have been included, they are still a subset of the study and may not represent sufficient statistical power to alter results from the majority group. It is far less common to see studies performed only with women or minorites and criticism abounds when such trials are conducted (the A-HeFT trial, for example).
It is a fasicnating question - and increasing relevant one, as well - to consider the impact of designing our medical system around essentially one subset of the society. There is now strong evidence to challenge the notion that if a drug works in a typical white male, it will work equally well in a black male or a woman. Consequently, we are very likely treating a large swatch of society with therapies that may not be optimal for them. And we have most likely overlooked better treatments because they were ineffective on the white male treatment group.
This is one way in which America differs substantially from many other industrialized nations whose populations are far more homogeneous. And it might exaplain some portion of racial/class differences in outcomes.
September 25, 2007 10:34 AM | Reply | Permalink
I am rapidly getting above my pay grade here, but it is unclear to me that a relatively short period of selective breeding or survival of the most physically fit during slavery would not manifest itself an increase in variability in physical ability in future generations of African Americans.
September 25, 2007 10:48 AM | Reply | Permalink
I think your points are well-considered, but want to suggest that there are even simplier connections between poverty and poor nutrition. 2 liters of generic soda costs $.99 while a gallon of milk is $4. The cheapest bread on the isle is a completely processed, white loaf for about $.75-$1.5 while the whole grain variety is consistenty 2-3 times as much. Lean meat (chicken, pork, turkey) is more expensive per pound that beef. High-fat beef is more expensive than lean beef. A bag of chips costs half as much as a bag of brocolli.
"Frankly, I don't know how we can begin to unlearn this"
There is something very wrong with our priorities when the botique grocers is where you go to get organic, whole grain, non-antibiotic-fed food while junk food is vailable on literally every city corner. We need a fundamental realilgnment so that a typical corner grocery store is stocked entirely with low-priced fruits, vegetables, lean meats, whole grains, etc. And less common, speciality food stores carry the more expensive items like Twinkies, soft drinks, ice creams, and other treats.
September 25, 2007 10:49 AM | Reply | Permalink
Don't be too hard on Maggie.
I think she is just parroting talking points that she has heard in her travels and has not really thought them through very much.
She doesn't realize that she sounds like a sexist and a racist and I sincerely doubt that she is one.
September 25, 2007 10:58 AM | Reply | Permalink
In regards to the "survival of the fittest" under slavery I think we need to remember that most people, especially rural peoples, were subjected to pretty much the same physical stresses in that era: they labored hard and long, were subject to malnutrition when harvests were poor, and suffered the same sorts of parasites. Selective breeding may have occured among slaves, but the environmental pressures were the same for everyone.
September 25, 2007 11:33 AM | Reply | Permalink
I would be very surprised if selective breeding among slaves, once arrived, would make a significant genetic difference in today's population. If -- and I emphasize if -- the salt/water retention genotype made a major survival difference on the hellish slave ships, there might have been enough people that were selected for a single characteristic.
--
Howard
*equal opportunity offense to both extremes*
"Those who cannot remember the past are condemned to repeat it" [George Santayana]
September 25, 2007 12:30 PM | Reply | Permalink
lizmom--
You're absolutely right. I haven't thought this out, but there should be a way that "greenmarkets" selling local produce (which exist even in Manhattan) could distribute to grocery stores in low-income neighborhoods.
Presumably, the people growing fresh produce who now sell it at the greenmarket at Manhattan's Union Square would need to get together to do this as a group (with one distributor to low-income neighborhoods) but I'm sure they could do that. (They now distribute to upscale restaruants all over N.Y.--so why not to individual grocery stores, where the total volume could be much higher?)
Thank you very much for your comment.
September 25, 2007 4:41 PM | Reply | Permalink
For a parallel argument made with regard to education, see Richard Rothstein's somewhat confusingly titled 2004 book Class and Schools: Using Social, Economic and Education Reform to Close the Black-White Achievement Gap.
Better educational outcomes tend to be associated with better health outcomes, and vice versa. Effective education policy tends to be effective health care policy and vice versa, although only as a generalization and therefore not predictably the case in any individual's situation.
September 26, 2007 2:36 AM | Reply | Permalink
But you know what is interesting? If you look back through recorded history (excluding the bible for the moment), the outer ends of human life-span have been about the same - 120 years. The oldest-lived persons 100 years ago and the oldest-lived persons today are still....about 120. So while medical care and modern society have produced large increases in lifespan (meaning the average age to which people live), we don't see a corresponding increase of the maximum lifespan of humans. Even efforts to "extend life" like caloric restriction experiments still only amount to increasing how many people (or animals) reach the maximum life span and are not necessarily increasing what that maximum is.
So your premise that more people may make it to 80 wihtout debilitating physical or menal diseases is, for the moment, quite realistic.
September 26, 2007 6:45 AM | Reply | Permalink
I agree that much of this discussion is more accurately about power and the advantages it can acquire. Generally speaking, power is concentrated along with wealth in the white, male segment of our population.
However, one does not have to be wealthy or powerful to derrive a benefit from having been born white or male in this country. An example I mentioned in another response is the evolution of our healthcare system with the while male as the "norm". Every medicfal procedure and pharmaceutical product that has been tested and approved in this country has been evaluated under the assumption that the white male is the physiological standard. That confers an advantage irrespective of wealth or power. Another example for which I take personal offense are airbags. Wonderful devises that they are, they were developed and continue to be implemented as if every vehicle occupant is 180pound and 5'10. Which means that both myself and my children are subjected to increased *risk* because of this assumption that offsets the benefit of the devise. And you do not have to be wealthy (or even white in this case) to earn this relative benefit. You simply have to fall within what is considered to be "the norm". White males fall into this "norm" at an overwhelmingly higher rate than do women and people of color.
To put it more succintly, I will quote a friend of mine who described a white male student thus - He was born on third base but thinks he hit a triple.
September 26, 2007 6:57 AM | Reply | Permalink
We made a lot of progress with heart disease from 1986 to 1996--mainly by learning to use medication (thrombolytics, aspirin . . .) Since 1996, however, we really haven't made iany progress in treating victims of heart attacks and some technological progress (use of stents and coasted stents in angioplasties) has turned out to be harmful than helfpul. (The general consenus is that we have been doing way too many angioplasties
See the abstract below form a 2006 Health Affairs article. Is Technological Change In Medicine Always Worth It? The Case Of Acute Myocardial Infarction
Jonathan S. Skinner, Douglas O. Staiger and Elliott S. Fisher
We examine Medicare costs and survival gains for acute myocardial infarction (AMI) during 1986–2002. As David Cutler and Mark McClellan did in earlier work, we find that overall gains in post-AMI survival more than justified the increases in costs during this period. Since 1996, however, survival gains have stagnated, while spending has continued to increase. We also consider changes in spending and outcomes at the regional level. Regions experiencing the largest spending gains were not those realizing the greatest improvements in survival. Factors yielding the greatest benefits to health were not the factors that drove up costs, and vice versa. "
As for cancer, oncologists will tell you that in recent years we h