Resurrecting Democracy

White Men Dying

            Robert A. Levine   December 2, 2015

White men in America are dying in droves. Not all of them. The increase in mortality is being seen among middle-aged white men, unlike other age groups, women, men of other ethnicities, and men in other developed Western countries, all of whom are actually living longer lives. The sad thing is that most of these men are killing themselves in one way or another. Unlike the usual drivers of mortality like cancer and heart disease, the major causes of death in this group are drug overdoses of heroin and other opioids, methamphetamines, cirrhosis of the liver secondary to alcohol abuse, and suicides.

Interestingly, the increase in the death rates in middle-aged white men appears to be restricted to those who are poorly educated. But because their mortality rates are so excessive, they have raised the rate for all middle-aged Caucasian Americans. Men with a high school education or less had an increase of 134 deaths per 100,000 over a fifteen year period ending in 2014. This is an amazing and unheard of statistic when medical advances in diagnosis and treatment of major diseases have enhanced life expectancy in every other group and age range. Mortality rates of middle-aged Hispanic and black men decreased during this same interval (though the latter still have higher rates than white men).

The pattern seen is similar to an increase in mortality that occurred among Russian men, both the young and middle-aged, since the 1960s, but particularly during the 1980s and 1990s. They were also dying of drug overdoses, alcohol related conditions, suicides, and AIDS, the latter brought on mainly by using infected needles when injecting drugs. But there was also a significant rise in violent deaths, homicides and automobile accidents in these men.

When AIDS initially hit the developed world and affected mainly gays and drug users, mortality also increased until drugs were developed that could arrest the disease. But that mortality was offset by improved survival in the general population because of better diagnosis and treatment of cardiovascular conditions and cancer.

The question is why was there an epidemic of substance abuse and suicides in America among poorly educated white middle-aged men that increased their death rate, while college graduates had a reduced mortality. Obviously, the incidence of depression and feelings of hopelessness captured many of these men for them to turn to drug and alcohol use or commit suicide. However, it is likely the problem for these men started much earlier in life before taking its toll in middle age. Many of them probably started abusing drugs or alcohol when they were younger. This may have been an escape because they were performing poorly in school or may have been related to their home situations, lack of support in their lives and lack of success in their endeavors and relationships.

What many high school graduates or drop outs did not understand was that blue collar jobs that paid well were disappearing in America and to find reasonable work one had to have a higher education or mastery of some new technology. Their inability to get an advanced education or specialized training targeted them for failure at an early age. (A history of mental illness, difficulty socializing, poor physical condition, increased reports of pain, trouble managing the ordinary tasks of daily living, were all found to be more prevalent in this cohort of men when they reached middle age.)

In the meantime, women were increasingly independent and successful, able to earn enough to support themselves and raise a family, with or without men. Girls did better in school than boys and often continued their educations past high school. And many women did not want to live with men who were less educated than they were and unable to earn decent livings.  Men were no longer necessarily the primary breadwinners and the dominant figures in their families. It was not that woman’s lib had changed the relationships between men and women, but that women had adapted better to the new technological world than men, and were better able to perform the jobs that were available.

Lack of a suitable income and a dependency on drugs or alcohol also reinforced the odds against these men having a stable and happy marriage and family life, or even sustainable relationships. And by the time they reached middle-age, the chances of changing the paths they had taken were increasingly slim, and there was little for them to look forward to. So why not continue to escape with drugs or alcohol or choose to end it all by suicide. These statistics support the concept that education is the key to a fulfilling and lengthy life in the new technological age.

Resurrecting Democracy

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Science Denied

            Robert A. Levine   11-11-15

One of the foundations of Western civilization has been a belief in science and the ability to utilize new discoveries in practical ways to improve and extend human life. Yet currently, the citizens of many Western nations are rejecting scientific information and recommended responses as being valid, spurning behavior changes on the basis of this knowledge. Scientific data is being endorsed or denied in different nations because of long held biases, religious beliefs, economic incentives, and so forth. And evidence does not seem to make a difference. Two major areas of global importance where science has been disregarded are climate change and the safety of genetically modified crops (GMOs- genetically modified organisms).

Republican conservative politicians in the United States deny that climate change is real and doubt whether mankind could be responsible if global warming is indeed occurring. Because of this, they have refused to pass laws to address this critical issue. This is in spite of the fact that climate scientists have repeatedly shown that global warming is real and caused by human activity, particularly the burning of coal and oil which releases carbon dioxide into the atmosphere. Methane and nitrous oxide are also “greenhouse” gases like carbon dioxide that trap the earth’s heat and result in the warming of the planet. Backed by the fossil fuel lobby and the Koch brothers, Republicans claim that controlling carbon emissions to cut down on carbon dioxide in the atmosphere would damage the American economy and that there is not enough evidence to warrant this action.

Fortunately, rational Americans like President Obama accept the veracity of global warming and his administration has taken steps to reduce greenhouse gases, in conjunction with China and Europe. The majority of Americans, including those who deny global warming, appear to believe that GMOs are not dangerous and are willing to eat foods containing ingredients from GMO crops. A significant minority, however, including environmentalists who want to stop global warming, are afraid of GMOs and refuse to ingest them, ignoring the scientific evidence of their safety.

For the most part, Europeans feel that global warming is a real threat and have taken steps to cut down on the production of greenhouse gases. (Interestingly, their testing for automobile emissions has not been as stringent as in the U. S, allowing Volkswagon and other automobile companies to game the system.) But Europeans are almost uniformly against GMOs, calling them “frankenfoods” and believing the lies and propaganda against them. This false information has been generated mainly by environmentalists in groups like Greenpeace. Seventeen countries have recently banned GMO cultivation on the basis of the popular belief that they are dangerous. Many farmers as well as scientists have argued against this ban, realizing that GMOs increase crop yields and are safe to eat. Instead, farmers have to use pesticides and chemicals that may leach into the local water supply to control insects and crop diseases to produce foods for European consumption.

This ban on GMO cultivation will check development in this promising area of biotech science in European universities and corporations. The Scientific Advisory Council of the European Academy of Science had previously warned that European countries were lagging other nations internationally in agricultural and biotech innovation and new technologies such as genetic research. This could have future economic ramifications for the European Union.

But even more importantly, African countries have followed the European lead in not cultivating crops that are genetically modified, concerned about potential side effects that are non-existent. There are worries that GMOs can produce sexual dysfunction or homosexuality, which is of course ridiculous. This means, however, that drought-resistant, insect-resistant, and disease-resistant crops will not be grown in sub-Saharan Africa, though these could enhance crop yields dramatically and provide foods that would alleviate hunger and famine, reducing the number of malnourished children.

A number of people in the U.S. and Europe (particularly those afraid of GMOs) are also resistant to having their children vaccinated, believing this increases the chances of autism or other developmental problems. Again, the scientific evidence has disproved this theory and vaccinations are necessary for the safety of all children. And there are other instances as well, where people disregard scientific evidence that should shape their beliefs, reinforced perhaps by what children are taught in some schools (creationism, intelligent design, and non-acceptance of evolution).

Science has provided data that clearly shows global warming is real, foods containing GMOs are safe, and vaccinations are safe and necessary. Yet many people choose to think otherwise, ignoring the evidence that is available and acting in unacceptable ways. And at times the leaders of democratic nations acquiesce and pass laws that are unreasonable in light of the scientific data, or refuse to pass other laws that are necessary. Citizens and legislators need to accept scientific evidence to guide their behavior, but obviously this is often disregarded. A problem for democracy and the world.

Resurrecting Democracy

www.robertlevinebooks.com

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V.A. Physicians Are Not the Problem

                        Robert A. Levine    6-4-14

What has been seen as a serious problem with the care given at our Veterans Administration hospitals is not really a V.A. problem, although the Veterans Administration is being battered by the media and politicians seeking publicity. The vast majority of veterans are quite content with the care they receive at the V.A. and the quality of the physicians. Their main gripe is the time they have to wait in order to get to see their physicians.

I am a Vietnam veteran who developed lymphoma. I am being followed by a primary care physician and oncologist at the West Haven V.A. in addition to being in an experimental trial being conducted at Weill Cornell Hospital in New York that has arrested my disease. My local oncologist also participates in my care. However, the care I have received at the V.A. is top-notch and I have obtained all my medications (16 different pills) from the V.A. in a timely fashion over a number of years.

There seems to be little question that some data regarding appointments and waiting times were falsified by administrators (and possibly some physicians) at certain V.A. facilities to hide the inadequacies at these hospitals and bolster their standings. However, the vast majority of V.A. physicians were not involved in this deception.

 The problem being seen at the V.A. regarding appointments is actually systemic in origin involving medical care in general and has been going on for years. There are just not enough primary care physicians to service the American population (as well as veterans) and they are not being paid adequately. Because of this, the number of primary care physicians will continue to decrease relative to the population in the future. And the Affordable Care Act will only exacerbate the situation as more Americans who were previously uninsured will now have coverage and can seek medical care.

A survey on medical compensation conducted by Medscape in 2013 showed orthopedists at the top of the heap with an average annual salary of $413,000. Other well-paid specialties near the top included cardiologists, urologists, gastro-enterologists, radiologists, and dermatologists. Primary care physicians, who work long hours as the main caregivers and are the bulwark of the system, are among the most poorly paid physicians. The average annual pay for an internist is $188,000 and for a family medicine doctor is $176,000. Not surprisingly, a large number of these physicians feel they are not being fairly compensated.

57% of internists spend more than forty hours per week in patients care and another 5-9 hours or more in paperwork and administrative tasks. The majority of PCPs spend 13-20 minutes with each patient they see.

So the problem is not because there are not enough primary care physicians at the V.A. but because the nation does not have enough of them overall. And the situation will only deteriorate further unless profound changes are made is the system of remuneration for physicians. There is no reason why orthopedists and other subspecialists should be making more than twice as much as primary care physicians when the latter provide just as valuable a service (if not more so) in the medical care which they provide.

Interestingly, when asked whether they would choose medicine again as a career, internists were at the top with 68% saying they would make this choice. However, they were at the bottom in saying they would choose a different specialty than internal medicine and were also near the bottom in affirming their overall career satisfaction.

While compensation may not be the main reason medical students choose internal medicine as a career, they have families to raise, loans to pay off, college costs for their children to consider, and so forth. If America wants to guarantee a steady supply of primary care physicians in the future for general care as well as for the V.A., the way we pay our doctors must be transformed dramatically.

So don’t blame the long waits for care at the V.A. on the physicians there. There just aren’t enough of them. (Congress could fix this situation quickly by increasing PCP pay at the V.A. and allotting funding to recruit more doctors. Don’t hold your breath waiting for this to happen.)

 Resurrecting Democracy

www.robertlevinebooks.com

AIDS Prevention- A New Recommendation

            Robert A. Levine      May 21, 2014

The lead article in the New York Times on May 14 noted that Federal Health officials are recommending that Americans who are at risk for AIDS take a pill daily to prevent infection. The medication is called Truvada and less than 10,000 individuals currently are on the drug. Federal recommendations would increase this to 500,000 people taking the medication.

This is an example of officials reinforcing the lack of responsibility among patients with various illnesses. The recommendation for the use of this drug includes gay men who have sex without using condoms, heterosexuals at risk because of intravenous drugs use or sharing needles, male bisexuals who engage in unprotected sex, and patients who have sex with individuals with known infections. All of these individuals could protect their partners by using condoms when they have sex, but obviously do not do so. Thus, instead of using condoms, they are told to take Truvada which costs $13,000 a year. Though taking Truvada daily is very effective in preventing HIV infections, it would add $6.5 billion to the nation’s health care costs.

Having unprotected sex can also lead to STDs- sexually transmitted diseases such as syphilis and gonorrhea for both partners if condoms are not used. Should our health care bills be increasing because at risk patients believe they will derive more pleasure having sex without condoms and so do not use them. And aren't we condoning their actions by our willingness to pay the bills for their medications. Of course, those high-risk patients who are irresponsible enough not to use condoms when they have sex may also neglect taking their pills daily, decreasing the effectiveness of Truvada. In fact, a number of organizations and individuals involved in the prevention of AIDS, doubt whether suggesting a daily pill will have a significant impact on prevention.

To me, the recommendation to prescribe Truvada for those who do not use condoms makes no sense. Though officials at the Centers for Disease Control and Prevention may be upset that the number of HIV infections has remained steady at 50,000 per year over the last decade because condoms are not being used by at risk patients, paying for them to have unprotected sex is not the way to go.

If people are unwilling to take responsibility for their sexual habits and put other people at risk, perhaps legal avenues should be explored, to fine them or institute some kind of punishment. I don’t want my health care dollars going to support at-risk individuals having unprotected sex.

Resurrecting Democracy

www.robertlevinebooks.com