Eideard

Forty years ago, Americans could expect to live slightly longer than Europeans. This has since reversed: in spite of similar levels of economic development, Americans now live about a year-and-a-half less, on average, than their Western European counterparts, and also less than people in most other developed nations. How did Americans fall behind?

A study in the July 2011 issue of Social Science and Medicine is the first to calculate the fiscal consequences of the growing life expectancy gap over the next few decades. The study also pinpoints the crucial age at which U.S. life expectancy starts to deteriorate.

Specifically, researchers from the University of Southern California and colleagues at RAND Corp. and Harvard School of Public Health find that health in middle-age – around the age of 50 – is overwhelmingly the main contributor to disparities in life expectancy between Americans and Europeans.

In the first half of the last century, average life expectancy increased by saving more babies, explains author Dana Goldman…”But now it is reduction in mortality among the elderly, rather than the young, that propels increases in life expectancy…”

Accounting for levels of socioeconomic diversity in the United States and predicted future demographic estimates, the researchers found much of the life expectancy gap would disappear if the United States lowered prevalence of middle-aged obesity and obesity-related chronic diseases such as diabetes and hypertension to European levels…

Released in January 2011, Crimmins’ research looked at life expectancy over the last 25 years and found that smoking – and to a lesser extent obesity – were the two major reasons why U.S. life expectancy has fallen short of other high-income nations in the past.

Improving American health during middle age in the future to increase life expectancy would increase later-life pension benefits. But this expenditure would be offset by a significant decrease in health care costs – at least $17,791 per person, the researchers estimate.

Though the transition to better health initially raises expenditures, the researchers estimate that by 2050 health care savings from gradual middle-age health improvements could total more than $1.1 trillion…

Learning about good nutrition, exercise, changing your lifestyle is going to do you more good and cost society less than passing more legislation.

The follow-on question, of course, is will our bureaucrats ever have enough confidence to let go of the nanny state? Will we ever get it together enough to justify less “management”?

Thinking about death can be frightening, no matter your age or medical condition. As we get older, the reality of our own mortality tends to come into clearer focus; this doesn’t make talking about death or life-sustaining treatments any less frightening though.

It was fear — stoked by certain politicians — that led to the inaccurate and misguided “death panel” rumors that surrounded health care reform proposals last year.

Beginning January 1, Medicare will reimburse physicians who advise patients, in voluntary discussions, about their preferences for end-of-life care treatment during their annual Medicare “wellness visit.” This is advance care planning, and it is a good thing for seniors, their families and health care professionals.

It’s not new. A law passed in 2008 allowed end-of-life planning to be part of a patient’s “welcome to Medicare” exam. Health care reform turned the welcome visit into an annual wellness visit. And now regulations clarify that these important discussions will be covered should the Medicare beneficiary wish to take advantage of this opportunity.

Advance care planning allows a person to make his or her wishes and care preferences known before being faced with a medical crisis. Advance care planning is simply smart life-planning.

RTFA. Many important details and suggestions about planning for the end of your future.

You can be smart. Or you can be stupid.

New research…takes a look at birth outcomes and maternal smoking, building urgency for more states and cities to join the nationwide smoke-free trend that has accelerated in recent years. According to the new data, strong smoke-free policies can improve fetal outcomes by significantly reducing the prevalence of maternal smoking.

The study…compared maternal smoking prevalence in one Colorado city where a smoking ban has already been implemented to that of a neighboring city where there is no ordinance.

Researchers from the University of Colorado School of Pharmacy collected data from mothers residing in Pueblo, Colo., before and after a citywide smoking ban took effect. Results show a 23 percent decrease in the odds of preterm births and a 37 percent decrease in the odds of maternal smoking in Pueblo following the ban. Birth outcomes in El Paso County, Colo., however, showed no such drop during the same time period. Findings in this first-ever study in United States reflect similar findings as national data from Dublin, Ireland.

The study suggests that smoking bans have a significant and immediate positive impact on the health of infants and mothers. Pre-term babies stand a greater likelihood of experiencing cardiovascular issues later in life.

“This research proves that smoking is an irrefutable risk factor for expectant mothers who are acutely more affected,” said Associate Professor Robert Page, PharmD, MSPH, at the University of Colorado Schools of Pharmacy and Medicine, and lead researcher on the study, who presented the findings. “The good news is that implementing strong tobacco control policy can protect even the most vulnerable from the deadly consequences of smoking.”

There are sufficient self-detructive so-called adults who consider this a libertarian issue. The silly part is they uniformly deny one’s right to legal suicide. But, it’s OK to kill yourself, your family, children and co-workers because of your addiction. One with no redeeming social value whatsoever.

Washington State University researchers have discovered a way to help cancer cells age and die, creating a promising avenue for slowing and even stopping the growth of tumors.

“Hopefully, we can make cancer cells die like normal cells,” said Weihang Chai…Basically, you make the cancer cell go from immortal to mortal.”

Normal cells lose a little bit of their DNA every time they reproduce as the molecule’s strands lose part of their protective tips, called telomeres. Eventually, the telomeres become too short, signaling to the cell to stop replicating and growing.

But cancer cells have a mechanism to keep their DNA strands from shortening, giving them a near eternal life. This is because the enzyme telomerase extends one strand of the cancer cell’s DNA while other proteins help extend the second strand.

Chai and her colleagues, writing in the current issue of The EMBO Journal, say they have found a regulatory protein that controls the production of that second strand. They have also found a protein required to synthesize it.

If that second strand of DNA cannot be lengthened, says Chai, it behaves like a normal cell and dies a normal death. She says her team will now focus on developing a strategy to block the regulatory protein’s function.

People wonder why I have such a short fuse over questions of science vs. superstition? Time after time, our culture, our economy, the compass of our cultural direction is distorted and misdirected by the ignorance offered as the only “choice” to reason.

Living longer – as we do as a result of modern science and medicine – we encounter disease unknown in the Good Old Days of the Stone Age? Praise and thanks is owed to those who labor in the vineyard of these exciting new citadels of life.

The squirrels littering your lawn with acorns as they bound overhead will live to plague your yard longer than the ones that aerate it with their burrows, according to a University of Illinois study.

Scientists know from previous studies that flying birds and bats live longer than earthbound animals of the same size. Milena Shattuck and Scott Williams, doctoral candidates in anthropology, decided to take a closer look at the relationship between habitat and lifespan in mammals, comparing terrestrial and treetop life. They published their findings in the Proceedings of the National Academy of Sciences.

The two hypothesized that, like flight, treetop or arboreal dwelling reduces a species’ extrinsic mortality – death from predation, disease and environmental hazards; that is, causes other than age.

“One of the predictions of the evolutionary theory of aging is that if you can reduce sources of extrinsic mortality, you’ll end up exposing some of the late-acting mutations to natural selection, and therefore evolve longer lifespans,” Williams said.

Williams and Shattuck found that for arboreality, the theory holds. Mammals who spend the majority of their time up a tree enjoy longevity over those who scurry along the ground. The pattern holds consistent both on the large scale among all mammals, and also in specific classes the pair studied, such as tree squirrels versus ground squirrels…

This arboreal ancestry may partially explain why humans have such a long lifespan relative to other mammals. As primates descended from the trees, they had to develop new strategies for survival on the ground. Terrestrial primates, including humans, tend to be larger and more social, providing some security from predators and environmental obstacles.

We learned to make better weapons.

While lower intelligence scores — as reflected by low results on written or oral tests of IQ — have been associated with a raised risk of cardiovascular disease, no study has so far compared the relative strength of this association with other established risk factors such as obesity, smoking and high blood pressure.

Now, a large study funded by Britain’s Medical Research Council, which set out to gauge the relative importance of IQ alongside other risk factors, has found that lower intelligence scores were associated with higher rates of cardiovascular disease and total mortality at a greater level of magnitude than found with any other risk factor except smoking…

When the data were applied to a statistical model to quantify the associations of nine risk factors with cardiovascular mortality, results showed that the most important was cigarette smoking, followed by low IQ. Similar results were apparent when the health outcome was total mortality.

I wonder if inclusion of firearms worship could determine the eventual date of the Darwinian disappearance of the Republican Party?

The risk of infant death following planned home birth attended by a registered midwife does not differ from that of a planned hospital birth, found a study published in CMAJ (Canadian Medical Association Journal).

The study looked at 2889 home births attended by regulated midwives in British Columbia, Canada, and 4752 planned hospital births attended by the same cohort of midwives compared with 5331 physician-attended births in hospital. Women who planned a home birth had a significantly lower risk of obstetric interventions and adverse outcomes, including augmentation of labour, electronic fetal monitoring, epidural analgesia, assisted vaginal delivery, cesarean section, hemorrhage, and infection.

The safety of home births is under debate. American, Australian and New Zealand Colleges of Obstetricians and Gynecologists oppose home births while the United Kingdom’s Royal College of Obstetrics and Gynecology and the Royal College of Midwives are supportive, as are midwife organizations in Canada, Australia and New Zealand. Canada’s Society of Obstetricians and Gynecologists has encouraged further research into the safety of home birth, and this study addresses that directive.

“Women planning birth at home experienced reduced risk for all obstetric interventions measured, and similar or reduced risk for adverse maternal outcomes,” writes Dr. Patricia Janssen from the University of British Columbia and coauthors. Newborns born after planned home births were at similar or reduced risk of death, although the likelihood of admission to hospital was higher.

Factors in the home environment that decrease risks are not well-understood and could be due to sample bias. “We do not underestimate the degree of self-selection that takes place in a population of women choosing home birth. This self-selection may be an important component of risk management for home birth.” They write that the eligibility screening by registered midwives safely supports a policy
of choice in birth setting.

“Our population rate of less than 1 perinatal death per 1000 births may serve as a benchmark to other jurisdictions as they evaluate their home birth programs,” the authors conclude (.pdf).

Terrific study. Designed for comparison and peer review.

Nowhere near as political as some author [me] tried to make it with the headline.

Daylife/AP Photo by Tom Mihalek

Rapid and widespread privatization in several former states of the Soviet Union and post-Communist East European countries in the early 1990s contributed to rising mortality rates, particularly in Russia, according to a study.

The report…vary from country to country, depending on the pace of privatization, the official response to unemployment and the level of support from social organizations.

They wrote that “rapid mass privatization as an economic transition strategy was a crucial determinant of differences in adult mortality trends in post-communist societies.” The effect of privatization, they added, was “reduced if social capital was high. These findings might be relevant to other countries in which similar policies are being considered.”

The report asserts that in the early to mid-1990s in countries undergoing post-Soviet transformation, there were more than three million premature deaths and the region lost at least 10 million adult males. Even though the governmental and economic transitions occurred nearly two decades ago, “only a little over half of the ex-communist countries have regained their pre-transition life-expectancy levels.”

The contrast between Russia and other countries – notably the Czech Republic and Poland – is striking because Poland was one of first East European countries to introduce the “shock therapy” model, which aimed to speed up the transition from a centralized state-run economy to a capitalist one. Despite the immense upheaval, it did not lead to higher mortality rates, possibly because of strong social institutions but also because Poles could emigrate or rely on the large Polish diaspora to support them.

In the Czech Republic, mass privatization was handled on an enterprise-by-enterprise basis and in a more measured way than in Russia, which underwent sweeping, nontransparent privatization. The impacts were entirely different.

I saved this one for the weekend. You may have a bit more time to reflect upon history and politics.

I think Russians would have been better served if Gorbachev listened to peers like Deng Xiaoping instead of Esalen Institute dreamweavers and rote cowboys like Aganbegyan. The former certainly understood the fragility of a war-level transition. The latter two still are stuck into John Wayne politics and magic bullets.

RTFA. Track down the original report [I haven't - yet] and read that and wander through the details. It’s certainly hard, though, to deny mortality statistics.

The widely-held perception that the influenza vaccination reduces overall mortality risk in the elderly does not withstand careful scrutiny, according to researchers in Alberta. The vaccine does confer protection against specific strains of influenza, but its overall benefit appears to have been exaggerated by a number of observational studies that found a very large reduction in all-cause mortality among elderly patients who had been vaccinated.

The study included more than 700 matched elderly subjects, half of whom had taken the vaccine and half of whom had not. After controlling for a wealth of variables that were largely not considered or simply not available in previous studies that reported the mortality benefit, the researchers concluded that any such benefit “if present at all, was very small and statistically non-significant and may simply be a healthy-user artifact that they were unable to identify…”

“The healthy-user effect is seen in what doctors often refer to as their ‘good’ patients— patients who are well-informed about their health, who exercise regularly, do not smoke or have quit, drink only in moderation, watch what they eat, come in regularly for health maintenance visits and disease screenings, take their medications exactly as prescribed— and quite religiously get vaccinated each year so as to stay healthy. Such attributes are almost impossible to capture in large scale studies using administrative databases,” said principal investigator Sumit Majumdar, M.D., M.P.H..

The finding has broad implications for patients, vaccine developers and for policy makers. You just may not need a flu vaccination unless there’s a specific flavor headed your way.

I’m one of those pain-in-the-butt healthy-user artifacts. Except for weight, I fit all the parameters. I usually get the flu shot each autumn.

And I probably will continue doing so. That’s what healthy users do.