“Half a million people are dead who should not be dead.”

In November 2015, two Princeton economists, Anne Case and Angus Deaton, published a report analyzing mortality rates among Americans from 1999 to 2013. Their findings violently overturned our fundamental expectations for life expectancy in 21st-century America: For 14 years, the mortality rate among white Americans age 45 to 54 rose, half a percent every year. According to Case and Deaton, if mortality rates had simply held steady at their 1998 number, there would have been 96,000 fewer deaths from 1999 to 2013. Further, if the mortality rates had continued to steadily decline as they had in the second half of the 20th century—and as is typical of industrialized countries—488,500 deaths could have been prevented over that 14-year period. As Deaton told The Washington Post, “Half a million people are dead who should not be dead.”

In a commentary on the study, Dartmouth economists Jonathan Skinner and Ellen Meara observed that “it is difficult to find modern settings with survival losses of this magnitude.” Skinner says the U.S. mortality figures are unique even among other epidemiological crises: Compared with, say, the crack cocaine epidemic of the 1980s, the HIV crisis, and even the mass deaths of Russian men in the 1990s, the current trend is unprecedented in its abrupt and unforeseen arrival. “There were a few studies that kind of hinted at it, but to find this rise in mortality where people didn’t even know why, there’s nothing that you can point to where you can say, ‘Oh my gosh, this is why this is happening,’” he says.

When Case and Deaton’s study was published in Proceedings of the National Academy of Sciences in early November, the intelligentsia slipped into a kind of paranoid rapture. Journalists, pundits and op-ed potentates came out in droves to offer their takes on the dismaying statistics. There are some clear hints as to what was going on: The data show that the uptick in deaths was primarily from drug and alcohol poisonings and suicides, with liver disease a somewhat distant third culprit. But there was no clear explanation for why middle-age white Americans were overdosing and killing themselves at such unprecedented rates. So many treated the study as a canvas upon which any and all of the popular American end-of-days narratives could be painted: loss of religion; decline in marriages; disintegration of good middle-class jobs; the end of the blue collar–led household due to wage stagnation; even, more quixotically, the broken promise of the American dream.

But many of the factors pointed to—especially economic considerations like frozen wages, unemployment and the disappearance of well-paying jobs that didn’t require a college degree—affected blacks and Hispanics in the U.S. even worse than they did whites. Yet mortality rates in those demographic groups have continued to fall. White middle-age Americans still have a lower mortality rate than, for example, middle-age blacks—415 per 100,000, compared with 581. But that difference is significantly smaller than it was 15 years ago, as black mortality in the 45-to-54 age group has fallen 2.6 percent per year since 1999, while that of their white counterparts rose. And European countries were racked by arguably even worse economic hardship than the U.S. in the past decade—but their mortality rates have likewise declined, in keeping with historical trends. Middle-age white Americans’ mortality now lags well behind both Hispanics in the U.S. and corresponding age groups in France, Germany, Canada, the U.K. and other industrialized countries. Apply a bit of analytical rigor and the economics argument doesn’t hold up.

Speculators were also quick to interpret the mortality figures as specifically a white man’s problem—all the better to suit journalists’ characterization of disillusioned former breadwinners made impotent by growing income inequality.  But the numbers undercut that argument: Columbia statistics professor Andrew Gelman sifted Case and Deaton’s data to separate the mortality rates for gender, and he found that women have been dying at a higher rate than men ages 45 to 54 since 1999, with the most pronounced spike coming after 2006. This data crunch sabotaged the neat and widely popularized idea that the dying were grievously disaffected middle-age white men, broken by the revelation that the American dream was a lie.

 

There is, however, something that does make white men and women in the U.S. unique compared with other demographics around the world: their consumption of prescription opioids. Although the U.S. constitutes only 4.6 percent of the world’s population, Americans use 80 percent of the world’s opioids. As Skinner and Meara point out in their study, a disproportionate amount of these opioid users are white, and past studies have shown that doctors are much more willing to treat pain in white patients than in blacks...

Today, drug overdose deaths from both prescription opioids and heroin continue their sharp climb in every age group. But the OxyContin Wild West of the 2000s was not just about skyrocketing overdoses—the overprescription of OxyContin, Vicodin and Percocet also spread the intractable disease of addiction. As Case and Deaton point out in their study, for every fatal painkiller overdose, there are 130 people addicted to prescription opioids.

“Mortality is the canary in the coal mine,” says Skinner. The fact that heroin overdoses nationwide increased 28 percent from 2013 to 2014 (with an accompanying 16 percent hike in prescription painkiller deaths) means there are hundreds of thousands of addicts behind those fatalities, who are not only one wrong fix from death but are also saddled with addiction for life. And heroin addiction taken as a whole, Skinner says, is arguably even more pernicious than the deaths it can cause: It can tear families and communities apart, harming many more people than just the actual addicts.

Efforts are underway to fight the onslaught of prescription drugs and the sprawling heroin epidemic. Michael Botticelli, director of the Office of National Drug Control Policy in Washington, says his office has led an aggressive expansion of state-based prescription drug monitoring systems, allowing health care providers to identify potential abusers jumping from doctor to doctor to feed their addiction. The office focuses on educating prescribers about the perils of opioids. Botticelli has also led efforts to improve access to treatment for addicts, including bolstering distribution of naloxone, which reverses the effects of an opioid overdose. But perhaps most promising are the recently drafted CDC guidelines for opioid prescribers, urging doctors to weigh the risks of dependency and abuse whenever prescribing opioids. The CDC recommends “three or fewer days” of opioid treatment under most circumstances—a long way from the 30- and even 90-day supplies patients have been able to obtain. While CDC guidelines are not binding, they are oft-cited and widely followed in the medical community.

Of course, while there is always a place for both triage and more stringent prescriber guidelines, such efforts won’t cut off these drugs at the source. And pharmaceutical companies like Purdue, Endo, Johnson & Johnson and Abbott Labs have little incentive to reduce the sales of their pain pills: They’ve been lavishly profiting from the opioid epidemic for nearly two decades. It’s also too early to tell how the opioid epidemic is affecting the livelihoods of men and women in their 20s and 40s. It may take years for us to fully comprehend the scope of its devastation. And there’s a good chance it’ll get worse before it gets better: In August, the FDA approved the use of OxyContin for children ages 11 to 16.

http://www.newsweek.com/2016/01/08/big-pharma-heroin-white-american-mortality-rates-408354.html
Courtesy of:  http://www.aish.com/ci/ss/Why-are-White-Middle-Aged-Men-Dying-More.html?s=mm