May 2, 2006

In Sickness and In Health

Hatched by Dafydd

I was surprised at the good job done by both Associated Press and Reuters reporting on the new British study showing that Americans tend to be a lot sicker than Brits -- even taking confounding factors into account (such as race, sex, rates of smoking and drinking, income, and education). The early and easy temptation is to leap to the conclusion that the British are healthier because their country is more socialist... but by and large, both articles pooh-poohed that knee-jerk "explanation."

First the bad news; from Reuters:

Considerably more middle-aged Americans suffer from chronic illnesses than their British counterparts, probably because more Americans are obese, researchers said on Tuesday.

"You don't expect the health of middle-aged people in these two countries to be too different, but we found that the Americans are a lot less healthy than the English," said James Smith, a RAND economist and one of the study's authors.

An analysis of health surveys showed the prevalence of diabetes and cancer were nearly twice as high among white American 55- to 64-year-olds than British in that age group.

Heart disease was 50 percent more common in the United States than in Britain, and rates of stroke, high blood pressure and lung disease were more common among middle-aged Americans as well....

Overall, 15 percent of middle-aged Americans suffered from heart disease compared to 10 percent of their British counterparts, diabetes afflicted 12.5 percent of Americans versus 7 percent of the British, and cancer hit 9.5 percent of the Americans compared to 5.4 percent of the British.

The surveys were conducted between 1999 and 2003.

AP adds:

The gap between the countries holds true for educated and uneducated, rich and poor.

"At every point in the social hierarchy there is more illness in the United States than in England and the differences are really dramatic," said study co-author Dr. Michael Marmot, an epidemiologist at University College London in England.

The study, appearing in Wednesday's Journal of the American Medical Association, adds context to the already-known fact that the United States spends more on health care than any other industrialized nation, yet trails in rankings of life expectancy.

The United States spends about $5,200 per person on health care while England spends about half that in adjusted dollars.

"Everybody should be discussing it: Why isn't the richest country in the world the healthiest country in the world?" Marmot said.

"It's something of a mystery," said Richard Suzman of the U.S. National Institutes of Health, which helped fund the study.

Now the good news: both AP and Reuters touched on the glib suggestion that the lack of socialized medicine (National Health Care) in the U.S. accounts for the health differences... but only to shoot it down. Reuters, for example:

"The less education and income people had the worse their health," study co-author Michael Marmot of University College London said.

"We cannot blame either bad lifestyle or inadequate medical care as the main culprits in these socioeconomic differences in health. We should look for explanation to the circumstances in which people live and work."

The AP article expands upon this, making clear the distinction between Britain's socialized medicine and America's (more or less) free-market system cannot explain the health differences:

However, Britain's universal health-care system shouldn't get credit for better health, Marmot and [Harvard School of Public Health Professor of Public Health Robert] Blendon agreed.

Both said it might explain better health for low-income citizens, but can't account for better health of England's more affluent residents.

Marmot cautioned against looking for explanations in the two countries' health-care systems.

"It's not just how we treat people when they get ill, but why they get ill in the first place," Marmot said.

So if it's not race, sex, age, economic strata, or the rate of smoking or drinking... then what does explain the differences? The major culprit may well be simple obesity. From Reuters:

In weighing the source of the health gap, the researchers said the answer most likely stemmed from higher U.S. rates of obesity and Americans' tendency to avoid exercise -- though the English were catching up.

The prevalence of obesity in the United States rose to 31 percent in 2003 from 16 percent in 1980, while U.K. obesity rates increased to 23 percent from 7 percent in the same period.

"It may be that America's longer history of obesity or differences in childhood experiences create the problems seen among middle-aged Americans," said study co-author James Banks, an economist at University College London.

"This may mean that over time the gap between England and the United States may begin to close."

If true, this is heartening, because obesity -- while not completely avoidable (genetics has a lot to do with it) -- is at least controllable. Even if one is "destined" to gain weight, one can gain it more slowly by watching diet and by exercising.

And the study points to the enormous influence obesity may have on a wide range of debilitating illnesses -- some of which have long been known to be related to obestity (diabetes, heart disease), but also others for which the connection is more obscure, like cancer.

This may spur research into the exact mechanism by which the body creates and maintains fat cells, which may lead to a pharmaceutical breakthrough in weight control and reduction: now that we know it's not just a cosmetic concern, perhaps more serious researchers will get involved in determining the actual cause of weight gain... something beyond the facile idea that people who gain weight must just be lazy pigs who eat too much and watch TV all day.

For my own example, I eat less than my occasional collaborator, Brad Linaweaver; and I certainly exercise far more than he; yet I outweigh him by quite a margin. Like many genetically lucky people, Brad simply does not gain much weight, no matter what he does. Similarly, many Asians gain less weight than Westerners, even when they eat and exercise just as much as their counterparts.

Taken together, these two science articles -- only AP identifies the authors, Carla K. Johnson from Chicago and Mike Stobbe from Atlanta -- are well written, factual, and without any of the usual political bias of the two wire services. Great job, everyone!

Hatched by Dafydd on this day, May 2, 2006, at the time of 1:37 PM

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The following hissed in response by: Nuclear Siafu

So, this report is going to spur the scientific community into doing some serious research into fat, eh? I submit that this report was unecessary for this point since there's already a huge tub of money waiting for the scientists who figure out.

I mean, look what people are willing to spend on the bull crap diet products that are already available. Just imagine that clamoring that'll result from finding the "real thing." The market gives all the incentive businessmen and scientists need for this issue.

The above hissed in response by: Nuclear Siafu [TypeKey Profile Page] at May 2, 2006 6:40 PM

The following hissed in response by: Dafydd ab Hugh

Nuclear Siafu:

Believe it or not, there are a powerful lot of scientists, and many of them the best, who are in the gig for pure knowledge and understanding and don't particularly seek a bunch of money.

Those folks may be shying away from obesity research, since it bores them... just like a lot plastic surgeons specialize in reconstructive surgery and won't touch breast implants with a ten-foot pole.

If so, then the prospect of actually curing cancer may be a tremendously greater lure than helping housewives look like Hollywood stars.


The above hissed in response by: Dafydd ab Hugh [TypeKey Profile Page] at May 2, 2006 10:17 PM

The following hissed in response by: Nuclear Siafu

I didn't mean to sound that cynical. I work with, read about, and count myself as among the people who eat and breathe science for the fun of figuring things out (being trained up to be a chemist, actually).

It's just been my observation that scientists are not immune from supply and demand, even if they manage to balance the "demanded" science with their own investigations. They need time and money, and potential "cures" for obesity have already shown that they have no trouble garnering either even when the science isn't solid. The nature of obesity itself touches upon so many subsets of chemistry and biology that said scientists wouldn't even have to work on significant aspects of it with finding a cure in mind.

I suppose I should clarify that market forces are no good for predicting the behavior of individual scientists, but an excellent bellwether for the community as a whole. Brilliant individuals are important in advancement, but equally so is the community that provides the environment. In most sciences, it has never been the norm through modern history for major advancements to be done by individuals in a vacuum.

So, the time and funding is already available to support the community, and that’s what’s important. Breast implants do not make a good comparison since it’s a very limited field. Brilliant individuals who do work with breast implants are pretty much limited to work involving breast implants. Obesity, as I said before, touches on a lot of scientific fields, and it’s not too improbable that the scientist who finds the cure will not have been looking for it specifically in the first place.

The above hissed in response by: Nuclear Siafu [TypeKey Profile Page] at May 3, 2006 3:20 AM

The following hissed in response by: RRRoark

I do have to wonder how much of the difference might lie in "reported diagnoses." With wait times and the general pain-in-the-rump process and government-employee doctors in Britain versus the "I have to test you every conceivable thing due to malpractice protection" US standard, might part of it be that if you look for more, you find more? What about mortality rates?
I'm not saying the study is wrong, but quite possibly the reporting standards are not really comparable.

The above hissed in response by: RRRoark [TypeKey Profile Page] at May 3, 2006 6:29 AM

The following hissed in response by: cdquarles


They aren't comparable, simply because the US uses the ICD9CM/ICD10 and the socialists, er, British use something else. Not only that, obesity in the US has been defined downward. Obesity is *not* measured by % body fat, but the "BMI", which is weight(kg)/ height*height (m). By the BMI, a 110kg, 1.7 m 2% bodybuilder is obese BMI=38, but an 70kg, 1.7m with 25% body fat isn't BMI=24.

Even given that, it is my very educated opinion that for the average Joe that isn't diabetic, the label of obesity matters little (as does reasonable diet and exercise, since atherosclerosis begins in your teens and if vascular disease doesn't get you, you can be sure something else will). For a diabetic, diet and exercise are crucial because of the effects of insulin resistance and high blood levels of insulin and related peptide hormones. IOW, like far too much in today's world, the risks of smaller interventions are overblown and the rewards of major interventions are also overblown.

We do NOT have an obesity epidemic in America today. We have a "State of Fear" and Hyperbole (and socialist hubris) epidemic in America today.

The above hissed in response by: cdquarles [TypeKey Profile Page] at May 18, 2006 2:25 AM

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