November 05, 2007
Americans Sicker Than Canadians Due To Lifestyle
Harvard economist Gregory Mankiw has an interesting article in the New York Times about medical spending. Differences in life expectancies between Americans and Canadians are not due to superior medical care under a socialist system.
The differences between the neighbors are indeed significant. Life expectancy at birth is 2.6 years greater for Canadian men than for American men, and 2.3 years greater for Canadian women than American women. Infant mortality in the United States is 6.8 per 1,000 live births, versus 5.3 in Canada.
These facts are often taken as evidence for the inadequacy of the American health system. But a recent study by June and Dave O’Neill, economists at Baruch College, from which these numbers come, shows that the difference in health outcomes has more to do with broader social forces.
For example, Americans are more likely than Canadians to die by accident or by homicide. For men in their 20s, mortality rates are more than 50 percent higher in the United States than in Canada, but the O’Neills show that accidents and homicides account for most of that gap.
Mankiw points out that Americans also have a higher incidence of obesity than Canadians. This makes Americans less healthy than Canadians. Mankiw wrote his article in order to make economic arguments about health care policy. But there's also a lesson here down below the level of national policy: The odds are that you can do far more for your health by improving your diet and lifestyle than you can by getting more health care. Think about that. Sure, there are people out there who would benefit from early detection of cancer or by taking statin drugs. But you probably could do more for your health by changing your diet and getting more exercise than by getting more medical care.
To put it another way: Medical treatments today have pretty severe limits on what they can accomplish. For many diseases we have no cures. For other diseases where cures are sometimes available the treatments have success rates well below 100%. You are better off adopting diet and lifestyle practices (more vegetables, more exercise) that will reduce your odds of getting sick in the first place. There's no magical place in the world (at least not yet) where either capitalism or socialism will supply you with cure-all health care.
U.S. obesity [BMI Greater than 30]
When you look at Michael Moore, you will say, kinda irony. And I support UHC too.
Well, since there is NO place on earth that is running free-markets in health care, it is unsurprising there is no magical place.
I repeat, get out of the way of me, my equivalents and betters and we will find cures. It is not possible to cure diseases if every turn of the screw has to go thru absurd FDA/NIH/name-your-regulation-agency/ethicspanels and inane byzantine dogmatic ritual laws, bylaws, regs and custom.
And it's becoming pathetically obvious that this is the case. Please see Grove's recent scathing indictments of the medical industry.
Cancer has some slow breakthroughs already. For example, bevaizumab and other targeted therapies such as sunitinib and erlotinib (both tyrosine kinase inhibitors), although not cures, are shown to increase the survivial of patients with certain advanced cancers and they were recently FDA approved. In addition, an aurora kinase inhibitor (MK-0457) and TroVax are waiting in the wings assuming they would be approved.
This paper argues that cancer is difficult to cure:
Regarding mouse models:
"Homer Pearce, who once ran cancer research and clinical investigation
at Eli Lilly and is now research fellow at the drug
company, agrees that mouse models are “woefully inadequate” for
determining whether a drug will work in humans. “If you look at
the millions and millions and millions of mice that have been cured,
and you compare that to the relative success, or lack thereof, that
we’ve achieved in the treatment of metastatic disease clinically,”
he says, “you realize that there just has to be something wrong with
Vishva Dixit, a vice president for research in molecular oncology
at Genentech in South San Francisco, is even more horrified that
“99% of investigators in industry and in academia use xenografts.”
Why is the mouse model so heavily used? Simple. “It is very convenient,
easily manipulated,” Dixit explains. “You can assess tumor
size just by looking at it."
Although drug companies clearly recognize the problem, they
haven’t fixed it. And they’d better, says Weinberg, “if for no other
reason than [that] hundreds of millions of dollars are being wasted
every year by drug companies using these models.”"
One reason why I am skeptical of "cures" reported in Mice on ScienceDaily and other sources like that.
"But not even Gleevec is what it seems. CML is not a complicated
cancer: In it, a single gene mutation causes a critical signaling
mechanism to go awry; Gleevec ingeniously interrupts that
deadly signal. Most common cancers have perhaps as many as five
to ten different things going wrong. Second, even “simple” cancers
get smarter: The malignant cells long exposed to the drug
(which must be taken forever) mutate their way around the molecular
signal that Gleevec blocks, building drug resistance.
No wonder cancer is so much more vexing than heart disease.
“You don’t get multiple swings,” says Bob Cohen, senior director
for commercial diagnostics at Genentech. Use a drug that does not
destroy the tumor completely and “the heterogeneity will evolve
from the [surviving] cells and say, ‘I don’t give a rat’s ass! You can’t
screw me up with this stuff.’ Suddenly you’re squaring and cubing
the complexity. That’s where we are.” And that’s why the only
chance is to attack the disease earlier—and on multiple fronts."
Gotta love that reference to "rat's ass".
And lastly about the competitive nature of the free-market:
"In the first attempt, the trial took so long that the biotech
startup with the promising agent went out of business. In the second
the lawyers haggled over liability concerns until both companies
pulled out. The third, however, was the worst. There were two
drugs that together seemed to jolt the immune system into doing a
better job of targeting malignant cells of osteosarcoma, a bone cancer
that occurs in children. “Working with the lawyers, it was just
impossible,” she says, “because each side wanted to own the rights
to the combination!”
Canada doesn't have more of a socialist system of health care than the United States.
Remeber, if you go to the emergency room of a hospital, they are required to care for you. This care is paid for by somebody, often subsidized by government. It is not a cost effective means to solve the sort of problems an emergency room is not designed for.
The term "socialist" or "socialized" has mainly a pejorative connotation. I hate it when it is used by Americans although democratic socialist in Europe doesn't evoke such strong sentiments.
Whatever, Randall's right; exercise and a healthy diet yield (currently) more QALYs than relying on the "advanced" medicine or a "socialized" or capitalistic system.
I am sure Randall Parker is familar with Linda Gottfredson. She argues that IQ is correlated with health. Also, IQ is correlated with income too. I do agree with Gottfredson that lower IQ people could not manage their health well if they have a chronic condition. But are they predisposed (environmentally) to have chronic diseases?
http://www.eurekalert.org/pub_releases/2007-08/uow-zca082807.php (A press release)
"Neighborhood property values predict local obesity rates better than education or incomes, according to a study from the University of Washington being published online this week by the journal Social Science and Medicine. For each additional $100,000 in the median price of homes, UW researchers found, obesity rates in a given ZIP code dropped by 2 percent.
The study, based on analyses of responses to a telephone survey conducted in King County by the local health department and the federal Centers for Disease Control, found six-fold disparities in obesity rates across the Seattle metropolitan area. Obesity rates reached 30 percent in the most deprived areas but were only around 5 percent in the most affluent ZIP codes.
"Obesity is an economic issue,” said Dr. Adam Drewnowski, director of the UW Center for Obesity Research and leader of the study. “Knowing more about the geography of obesity will allow us to identify the most vulnerable neighborhoods.”
[insert rant about the evils of capitalism exploiting animals and providing cheap unhealthy food with Peter Singer quotes]
Maybe providing cheap health food might control obesity. Maybe poor people rely on peanut butter and jelly on white bread as a staple. $1 USD cheeseburgers aren't helping the animals or lower income people too although such meals are cheap and provide satiety (which do exactly as advertised). High-fructose corn syrup doesn't help either, although it is cheaper than 100% juice products.
Maybe those with low IQs couldn't understand the benefits of eating healthy. Of course, it is intuitive to say that they have less health knowledge than those who are more intelligent. Of couse, Gottfredson supported this with data too. Well, I do not know about the government recommendations such as MyPyramid (haven't looked at it) if it would increase QALYs in painless way, but personally, I try to restrict calories, take fish oil (besides that I am vegetarian), eat about 30g of walnuts a day, consume lots of vegetables, oatmeal for breakfast, try to eat low glycemic index food (too bad most things in packages use "enriched wheat"), and the ultimate panacea: exercise.
I do know one thing: IQ does have a predictive value on health.
I hate to say this, but the differences between the US and Canada also boil down to one other statistic.
In the US, blacks have far higher obesity than whites.
Canada has a lot fewer black people than the US does, as a percentage of the total population.
If you take a white vs. white comparison, Canada and the US are virtually the same in obesity rates, life expectancy, etc.
The solution is to get black people to understand the links between lifestyle, obesity, and health. While we're at it, we can get them to also understand the linkage between education and income, but I digress.
If you can handle the political incorrectness, let me summarize your points even more simply.
1) Black people are the most obese (and least educated). Property values there are the lowest.
2) Asian people are the least obese (and most educated). Property values there are the highest (check out Cupertino, CA, Saratoga, CA, Los Gatos, CA, etc.).
Obesity and income both corelate to education. Education corelates to the cultural importance that different ethnicities give to education (even if genetically, Blacks and Asians have identical IQs).
I do not know, but what about the African-American/ hypertension correlation? Genetics or environment?
I do not want to talk about race and intelligence though. But I do think that lower IQ (and low income) gravitates people into making lifestyle choice that are inimical to health. If it is low income, it is one reason why we should fight poverty in the first world too.
No, I cannot handle the political incorrectness. I am saying this as a person who believes that the racial differences have a genetic etiology. I do not want to think about it as it might inhibit my utilitarian thinking which requires equal consideration of interests(discussed in Practical Ethics by Singer).
My main point: cheap foods, in general, are unhealthy. Poor people gravitate towards cheap food. Therefore, poor people are more likely to be unhealthy. Poor people also have low IQ too. This is one reason (most certainly not the only reason) why they are least likely to be health.
Here is another rub.
Healthy food IS actually CHEAPER than unhealthy food.
Go to any modest ethnic grocery store, or a place like Costco, etc. The mainstream fruits and vegetables are so cheap that I think most people will have trouble consuming more than $4/day. Note that this is a diet consisting of the staples like onions, potatos, carrots, celery, lettuce, cucumbers, apples, bananas, beets, etc. Sure, blueberries are expensive, but the mainstream fruits and vegetables listed above are so cheap that I think most people would have to really *try* to consume more than $4/day worth of these fruits and veggies at Costco/ethnic store prices.
Compare that with frozen dinners at $4/unit.
Yes, the healthy food is actually the cheaper food.
Tomatos : 80 cents/pound
Bananas : 50 cents/pound
Apples : 60 cents/pound
Potatos : 50 cents/pound
Sweet Potatos : $1/pound
Onions : 50 cents/pound
Carrots : 80 cents/pound
Mangos : 50-100 cents each, in season
Radishes : $1/pound, but a pound can last a long time
Beets : $3/pound, but a pound can last a long time
Garlic : 20 cents/unit
Lettuce : $1/head
Cabbage : 50 cents/head
Cauliflower : $1/head (a head is huge, BTW)
Broccoli : $1/head
Ginger : $1/piece (can last a month)
Turmeric : $1/piece (can last a month)
Corn on the Cob : 50 cents/unit
Pineapple : $3/unit
Kiwis : 50 cents/unit
Plums : 70 cents/pound
Avocados : $3/pound (a pound can last a long time)
Mushrooms : $1/pound
Green Beans : $1/pound
Green Bell Peppers : $1/pound
Truly, who can consume more than $3 or at the most $4/day? Go buy $20 worth of the above items and see how long it takes you to eat them, even if you eat only these items in each meal. I promise you, $3-$4/day max per person.
That healthy food is expensive is the biggest hoax of them all. The barrier is cooking skills (as you will quickly become bored with just salads), NOT cost. If anything, poverty should result in health, due to the very poor being limited to eating only these items!
HellKaiserRyo said :
"My main point: cheap foods, in general, are unhealthy. "
Wrong. You obviously have not bought fresh fruits and vegetables very often. The healthiest foods are the cheapest foods. McDonalds, etc. is far mroe expensive than buying fruits and vegetables from a grocery store.
The 'cheap foods are unhealthy' myth is just another lie that socialists use to try and mask their sinister agenda. I do suspect, however, that socialists are too lazy to learn how to cook, and thus don't know how to eat the cheapest and healthiest foods of all.
I pay 50 cents/lb for cabbage and eat half a head a day.
I agree that price isn't the biggest obstacle. People don't like the taste of vegetables all that much. They like meat and potatoes and butter and bread a whole lot more.
This makes sense. Calorie malnutrition was our biggest killer in history. Even a substantial fraction of those who died from infectious diseases only succumbed because they were malnourished due to lack of food. So we have a strong desire for higher calorie foods and less a desire for vegetables.
Have you read Gary Taubes newly released book "Good Calories, Bad Calories"? There is a bit about it at this link http://tierneylab.blogs.nytimes.com/2007/11/01/is-nutrition-science-not-really-science/. I have read it and I'm rethinking my diet and exercise goals based on it. Vegetables good, exercise good but also fat and protein are very important and the big no-no is any carbohydrates that cause a release of insulin. Insulin looks like the problem in many things including cancer. I highly recommend the book and I look forward to your comments about it and a following discussion in comments.
Randall said :
"I agree that price isn't the biggest obstacle. People don't like the taste of vegetables all that much. They like meat and potatoes and butter and bread a whole lot more."
YES. It is because they don't know how to COOK. The 20+ items I listed above can all be combined turned into literally hundreds of various dishes, with the sophisticated use of spices.
Indian, Meditteranean, Thai, etc. cuisine has been doing this for centuries.
Learn to cook about 10 dishes you really like, from the fruits and vegetables above, and a person will be both healthy and wealthy (and thus wise).
I'm glad you agree that $3/day can do it for someone who confines their diet to the 20-30 fruits and veggies I listed above (I'll also add Oranges, Lemons, Celery, Grapefruits, Plantains, Scallions, Honeydew Melons, and Watermelons to the above list).
There you go, 30 specific fruits/veggies, from which to make 500+ tasty dishes, for those who can make the effort to learn how to cook.
Ok, I will concede that my argument about the alleged high cost of food is untenable.
Also I do not know how to cook too. I normally put about a two cups of broccoli, sundried tomatos, and about two ounces of spinach with some enriched wheat pasta (which is bad) about everyday. I also learned something: broccoli tastes horrible if you overcook it. Tabasco is practically augments everything, also black pepper, parsley, and oregano.
At the very least one should lower the glycemic index of one's diet. How much of the harm from carbohydrates comes from their percentage of total calories versus the speed with which they enter the blood stream?
Maybe the answer to that question is clear and I'm just not up on the relevant diet research. But I suspect that the optimal ratio of fat to protein to carbo depends heavily on which kinds of fats, which kinds of protein, and which kinds of carbos. So the research that compares diets with different ratios has a fair amount of noise in it.
I agree that insulin is a big problem. That part of the argument I buy. I keep hyping on glycemic index and have linked to glycemic index food tables many times.
Personally, I've stopped eating bread, cut way back on potatoes, reduced rice and shifted to lower glycemic index rice. By contrast, I cook up a lot of small red beans in a crockpot every week and use them in various dishes. That's all due to looking at glycemic index tables for foods.
The problem is that cooking veggies takes more thought and effort. People don't want to think that much about it.
Also, my argument isn't health foods are prohibitably expensive, simply more expensive than other alternatives.
If one considers salmon a health food, it would be more expensive than other meat. Also, I eat walnuts (about an ounce a day). It is not that expensive, simply many other unhealthy foods exist that are cheaper.
Regarding rice, basamati rice is much more expensive.
Improving access to America's broken medical system is not the solution to our health woes. Cancer rates have soared from 1 in 8000 to nearly 1 in 2 in one industrial century. Aside from emergent care, medical care used to be rarely necessary. It is only in the advent of chronic diseases due a society that promotes poor lifestyles and the industrial pollution of our nation that medical costs have exploded into the trillions and we have been herded like cattle into a medical system that cannot cure these chronic diseases and afflictions.
Throughout history, medical epidemics have frequently been associated with social problems and this era of chronic diseases is no different. Medications are not the solution.
If America wishes to cure its healthcare crisis it has to: STOP TREATING! START PREVENTING!
Teresa Holler (www.holler4health.com)