This apparently is a risk, even if you have insurance because you are at the mercy of insurers not tossing you out over such whimsical reasons as pre-existing conditions or other bureaucratic tricks they use to kill their customers rather than getting them cured.
There are also these mafia extortion schemes that are completely legal where you have to pay through your nose for insurance in exchange for the privilege of not being charged tens of thousands of dollars for completely routine stuff like broken bones or other things that can and will go wrong for most people at some point. This is not a thing in most modern countries other than the US. Even many third world countries tend to get organized on this front to the best of their abilities.
Then there is the widespread obesity because of corn syrup being a heavily subsidized food ingredient (got to help those poor republican voting farmers). Also it seems there is a whole legislative game around shameless advertising on products where products that contain obscene amounts of corn syrup are advertised as "fat free" instead of "don eat this you stupid fat F*".
The reason for the drug overdoses is decades of shameless attempts by big pharma to coerce the US government on not cracking down on their quite successful attempts at selling heroine disguised as pain medication roughly at the same time when the war on drugs was a big thing. This too is much less of a thing outside of the US where pain medication tends to be very strictly regulated and not advertised every 10 minutes on TV.
In short, the above is the result of decades of misguided policies, failures to regulate, and greedy companies getting away with stuff they shouldn't get away with and lobbying successfully to get away with ever more.
I saw this when travelling in the US for work. (I am Canadian). Striking up conversations in restaurants I met staff that worked while sick because they couldn't afford to take sick days, or worked with chronic conditions because they couldn't afford a visit to a doctor.
Even worse are the major chronic diseases from our lifestyle (hypertension, diabetes, etc). These are largely preventable or manageable with early care. But, if folks don't see their doctor then the severity of the disease grows until treatment becomes something major like surgery or an ER trip (both much more expensive than preventive care).
In short. Yes, the US healthcare system is broken. Interestingly one political party's solution is to blame a past president and continue to undermine what you have, while the other party is content with the existing for profit model.
It’s the middle class who pays their huge bills. Insurance doesn’t cover why these days and deductibles are insanely high. The poor get treated and just skip out on the bill.
For 2018 the individual limit was $7350,
Which granted is a _LOT_ if your making $30k a year, but its not the instant bankruptcy many people discovered themselves in after situations like yours where the out of pocket for "good insurance" could easily go over $100k for fairly limited hospital says.
What's your proposed solution? Just murder the poor to balance the system? Which is, after all, what we already do, we just disguise it as "choice".
Most providers (outside of ERs and the mandate for emergency stabilization therein, and some free clinics operated as charities) won't provide treatment without proof of insurance and any required co-payment upfront, or, for private pay clients upfront payment or fairly strong proof that payment will be collectible.
Why? They're there to keep you healthy. Yeah, sure it can be uncomfortable talking to a doctor about personal health issues, but it's better than waiting until it's too late and finding out that "if only you'd come sooner, we could have helped".
Like Feynman said though, if you are deathly ill in the jungle you would rather go see a witchdoctor than some random person. At least they will have some experience caring for the sick.
>"Do you have a a Do Not Resuscitate order?"
>"Would you reject emergency surgery after being shot?"
I suspect the real problem here is with your reading comprehension though.
This is probably the issue under contention. I don't like doctors either (or really the entire medical establishment). Some part of that is a belief that they aren't in fact there to keep you healthy. No I'm not trying to argue something like profit motives or whatever driving an unethical effort to make you dependent instead of healthy, or say doctors shouldn't exist, or that I wouldn't go to one if I thought I needed medical care, just that I don't like doctors or the systems and methods they operate under (some by force). nonbel unpacks one aspect of the dislike, The Elephant in the Brain unpacks another aspect (e.g. by the finding that people who receive free healthcare consume a lot more medicine but aren't any healthier, which wasn't actually surprising for me to hear!), and there are other aspects for my dislike too.
Is there any evidence of this? I've seen malpractice litigation similarly cited as one of the reasons behind the the high cost of health care in the US (which is also frequently disputed )
Please, go to the doctor early and regularly. It's not worth it, trust me.
Your story could be helpful to others. According to the doctors:
1) What is the years survived estimate of this vs doing nothing in your fathers situation (age, stage, etc)?
2) What are the side effects (and in general the quality of life) after/during this treatment vs doing nothing?
Also, these should both be some sort of histograms or at least ranges.
Do you understand how insanely expensive healthcare in this country is, especially if you're making minimum wage and have dependents?
What do you suggest they do instead? Die? Let their kids die?
If you do, you (or at least your kids) likely qualify for Medicaid, so you do get treatment. Often preferentially. I have been to providers who have a 6-8 week lead time on appointments for new private insurance patients, but Medicaid patients get in almost immediately.
It's not a matter of forcing that decision on people, but rather having the same expectation of personal choice and responsibility for that choice that we have for other health matters (exercise, diet, smoking, alcohol use).
It's a biological drive so it's tough. But I think we could do better. We're too sensitve that we might be "poor shaming" or such nonsense to even discuss it these days.
That's mostly value indoctrination (both the what they deserve part and the “do not do X if you cannot do Y” part fairly directly,and also the “what they cost” if it focuses on what a preferred approach costs rather than the costs of a spectrum of choices), not education.
> It's a biological drive so it's tough
It's also an economic choice, which is why birthrate declines with strength of social safety nets.
(Which is also why strengthening the social safety net is probably a better approach than trying to shame people into not reproducing.)
Ah, yes. In the US, Twizzlers are a "Low fat snack":
In Canada, just candy:
It's sad how much this misunderstanding of fat being fattening has permeated the US population to this day. All the false/misleading information in product advertising has definitely played a significant role, it should be made illegal and enforced with stiff fines.
Do you want understand the cause behind the healthcare faillure in the US ?
Just take a look at the chart of the halthcare sector index of US Stock Market.
If I remember well, healthcare was once considered as defensive sector in bear market... Now, it beats, by far, even the financial sector in bull market.
To front-run the complaints, "same quality" does depend on specifics. The USA really does lead the world in breast cancer and diabetes treatment. It is in the middle or back of the pack at nearly everything else, though, including cost, which is >double, even for treatments without quality to match. Most people would not pay >double for this if they had a choice.
They don't. They offer different services at lower overall cost. Cancer survival rates are the highest in the U.S., mostly because people don't like to die, and the U.S. is (by and large) stinking rich. Here in Ontario, I got a double ear infection (from swimming in lake Erie a few days before symptoms started), and was prescribed a combination eardrop. I'm under 25, and do not have private supplemental insurance, but I expected something like this to be covered by OHIP+; turns out they decide not to cover it unless you've been experiencing symptoms for almost a full month.
I ended up paying (it wasn't so bad, honestly) out of pocket for it, since my jaw was almost completely seized up at that point.
Now, you expect something like this to be covered, but these particular drops (I guess the doctor assumed I had supplemental insurance, or knew I would prefer this product [it worked very well and was easy to administer]) are not covered except as a last resort.
In the U.S. system, the majority of people pay for the privilege of at least partial coverage of more convenient/effective (but more expensive) medical products and services. The U.S. market produces high demand for medical products and services, and by-and-large has more disposable income, so prices can be higher.
Absolutely, I saw this when working in the US at age 23 (I'm Australian)
A good friend separated his shoulder while snowboarding and couldn't afford the surgery, so did nothing. To me this was staggering, and I had no idea people in "good" countries lived like that. Growing up in Australia this is unheard of.
His shoulder is still screwed, 15 years later.
I've never seen a commercial for a pain medication or opioid, they're usually for some heart/skin condition, ED, STD treatment, or something related to aging.
This paints a bit of a different picture ... I imagine somebody cracked down on this more recently.
You forgot to mention that the US Gov't also subsides the other side via food stamps, which poor folks use to purchase corn syrup and cheap grain foods, further exasperating the obesity epidemic. It's true insanity.
This is true. It is truly insane that public food benefits can be used to buy soft drinks, sugar cereals and candy:
"Soft drinks, candy, cookies, snack crackers, and ice cream are food items and are therefore eligible items"
Sometimes your kid will only eat sugary cereals for breakfast, because children can be fussy eaters. Or maybe you want to kick back with a can of Coke after a hard day at work (or need the caffeine to wake up for work in the morning, and coffee is too expensive). Or you want some Snickers bars to take on the train or bus to snack on. Policing what kind of food people spend their food stamps on seems like a pointless waste of time and government resources to me.
Obviously it's a bit nurture on both our parts, but sugar for breakfast is crazy, as is being taught that things like soda or snickers should ever be eaten except for in exceptional/celebratory circumstances.
One needs to be taught that those food stuffs are acceptable and gain a palette for them, because foreigners find your food sickly sweet. Clearly this is a policy/cultural thing...
> Obviously it's a bit nurture on both our parts, but sugar for breakfast is crazy, as is being taught that things like soda or snickers should ever be eaten except for in exceptional/celebratory circumstances.
There's always a gap between how things should be done and how they are actually done. I personally don't eat sugary cereals, or drink soda. I like sweets and candy and I'll admit it's a struggle to control sometimes, especially when I'm stressed out. I won't judge someone in far worse circumstances than I for indulging in sugar - it might be the only good thing in their life. And I don't approve of government resources being spent on checking what kind of food people eat - you can get far more bang for your buck elsewhere.
Present healthy food. Vary it day over day in case they really do have some strong dislike for something. If they don't eat it, they weren't very hungry. They will eat cereal every time you give it to them, no matter how hungry they are, which is part of the problem. Do not feed them crap because "that's all they'll eat".
Low-income parents may be hesitant to introduce new, healthy foods to kids because if the kid doesn't like it, it's time and money wasted (assuming the parent can't finish it). They're more likely to buy something the kid is sure to eat.
> If they don't eat it, they weren't very hungry
That's what I think to myself also whenever I see a parent running after a child trying to feed them. But parents can't seem to find peace unless the child finishes their meal. I've also heard children get cranky because they're hungry, but don't eat because they haven't learned that it will make them feel better. Being in that situation as a parent seems horrible. I'm willing to believe that stressed out low-income parents would rather that the kid eats anything, even crap, than face a meltdown.
> Do not feed them crap because "that's all they'll eat".
If I ever have children, this is my plan. But I have also heard that plans don't survive contact with the enemy...
I'm a little sensitive to this one because my wife and several of my friends are teachers and I gather it's really, really common for even fairly well-off kids' breakfast, every day, to be a couple pop-tarts. Which is a dessert, and isn't even on the healthier end of that category. As long as that continues to be as normal as it is, our obesity epidemic's going no-where.
Definitely don't blame low-income folks for doing what they need to do to get through the day, and yeah, food waste can really suck when you're not handing your kids hyper-palatable food for every meal, with the extra kick in the teeth that the hyper-palatable stuff's often easier to prepare. I mostly just weep for the future when I hear about the clearly-middle-class-or-higher folks doing that, or see them feeding their kids snacks (almost always crackers or similar) in the store to keep them docile, or whatever.
> If I ever have children, this is my plan. But I have also heard that plans don't survive contact with the enemy...
It's for sure harder to do it right. Snacks do shut them up, and in that weeks-to-months period when they just won't STFU at the store damn it, you do wanna just shove some crackers in their face so they'll quit making a scene. But if you do you'll have to keep doing it and then you're the parent with the six-year-old still snacking in the store. They will eat crap for any meal at all, or between meals, because it's crap and tastes freakin' amazing. That's the point of it. You just gotta suppress fear of judgement and keep in mind that the (medical) pros say skipping or picking at 50-60% of meals is totally normal for kids, and they will not starve themselves into ill health just because green beans don't trigger the same primal OMG-I-need-more-of-this responses as Doritos do.
The only place this is hard for us is with the grandparents. OMG there's no stopping them short of just cutting them off, which is too harsh for us to stomach. So much junk food. But that's how they eat too—they just don't get it, and that kind of deep cultural difficulty with food is why it's such a pain to do things right on an individual level. And school-provided lunches are pretty bad. The ones around here, at least, are clearly designed to shove as many calories as possible into the poorer kids, damn the nutrition and good eating habits.
Reducing food deserts, increasing healthy food programs for children, and eliminating market distorting subsidies are less paternalistic and more effective.
The winning localities and companies offered $2 billion in rebates to amazon over 10 years, conditional upon job and revenue targets that guarantee the localities and companies are getting multiple times the rebate amount. https://en.wikipedia.org/wiki/Amazon_HQ2
Marketwatch put the local economic contribution at up to $17 billion per year (not per 10 years like the $2 billion). https://www.marketwatch.com/story/amazons-hq2-could-bring-lo...
Sounds like an amazing ROI.
My only question is, how can I give Bezos money for that kind of guaranteed return?
Can you imagine the additional bureaucracy needed to classify (and enforce) the use of food stamps on a more granular level?
And there are "low carb" products that contain an obscene amount of fat.
If people can't count calories, that's their tough luck. It's not rocket science.
High fiber carbs and protein make you feel full too.
> The real problem is they started pairing sugar and corn syrup and grains in general with high fat food.
aka: calorie dense foods. Also, it's the type of grains they use - low fiber, high GI - not grains in general.
Individual bodies' responses to fat/carb ratios, while different, are marginal, and orders of magnitude less important than total calorie consumption - especially when overeating.
If you're eating 3,000 more calories a day than me, it really doesn't matter that your body, for example, stores 10% more fat from carbs than mine does.
Yet there’s no reliable research that proves how all of that works in most people nor how the situation can be solved at large scale. I think it’s a way harder problem than flying rockets.
Educating people, modifying their behavior, and increasing their willpower and persistence is what's difficult - that's a sociological problem and I agree, a hard one. The actual physical mechanism is simple.
Sure. Running faster is also just increasing the power to weight ratio.
You are technically right, but nobody doubts the high level physics of it, it’s the biology part that is complex.
Even leaving aside socio-economic factors and pure behavior issues, it’s not just a “throw things in and you can predict what goes out”. Knowing how different bodies manage food intake, food processing and retention, then come up with a calory burning budget is damn hard. We’re not pipes, a lot of things happen in the body.
I know it’s so much more comfortable to think it’s simple, but I think we need the courage to accept it’s not as straightforward as motivational poster would want us to believe.
Corn syrup isn't really any better or worse for you than cane sugar, it's just a lot cheaper.
"Earlier this century, the steady and robust decline in heart-disease deaths more than offset the rising number from drugs and suicide, Dr. Anderson said. Now, “those declines aren’t there anymore,” he said, and the drug and suicide deaths account for many years of life lost because they occur mostly in young to middle-aged adults.
While progress against deaths from heart disease has stalled, cancer deaths—the nation’s No. 2 killer—are continuing a steady decline that began in the 1990s, Dr. Anderson said. “That’s kind of our saving grace,” he said. “Without those declines, we’d see a much bigger drop in life expectancy.”
Drug-overdose deaths skyrocketed between 2015 and 2017,
particularly for adults between ages 25 and 54. The main culprit was fentanyl and other synthetic opioids that became pervasive in illicit drug supplies in the U.S. around that time.
Deaths from synthetic opioids rose 45% in 2017, while the death rate from heroin, which had risen sharply after 2010, was flat."
The US is pretty much also the only country where suicides are increasing.
When it comes to spending on social welfare, the U.S. is at the low end of the spectrum relative to Western Europe. For example, only 18.8 percent of the U.S. GDP is spent on social welfare, while most of the OECD nations spend at least 25 percent of their GDP. Our rates of suicide are increasing while their rates fall.
of course it's way more complicated and nuanced than my one example.
edit - no? is this wrong?
Suicide rates in order per 100k: South Korea 20.2, Belgium 15.7, Japan 14.3, Finland 13.8, US 13.3, Iceland 13.3, France 12.1, Sweden 11.7, Australia 11.7, New Zealand 11.6, Switzerland 11.3, Ireland 10.9, Canada 10.4, Norway 10.1
Others in Europe: Russia 26, Lithuania 25.7, Belarus 21.4, Ukraine 18.5, Latvia 17.2, Estonia 14.4, Hungary 13.6, Moldova 13.4, Poland 13.4, Slovenia 13.3, Austria 11.4
Why are Europeans killing themselves at such high rates?
So the initial assertion was not compelling.
> it is rate of change which has people concerned.
Do you have any source about people being concerned (what people?) for the new goalpost?
The elephant(s) in the room is(are) of course Russia and within the EU - Poland(population: 38mln) - but in these cases the explanation as to why it happens is pretty obvious.
Honest question, I really dont know.
Having a terminal illness at age 90 and being clinically depressed at age 18 are very different things (obviously).
All the other European ones you mention other than Finland (where the suicide rate is believed to be linked to being dark for half the year) are Eastern european former communist states. There's still a lag in healthcare modernisation there.
CDC wonder has data from 1999-2016, when I plotted the appropriate ICD-10 codes I found this is a misleading way of describing the data: https://i.ibb.co/N9Fqmxd/CDCmort.png
You can clearly see that deaths attributed to these codes in those age groups have been increasing since well before 2015, basically since the data became available.
Honestly, somebody should make a Kony2012 style video about it. It was a sham but I can still remember how viral that thing went, because it hit all the buttons of human psychology.
> The US has 330 million people. Do we really care if a bunch self-select out of the gene pool?
While some people do choose to use drugs with their own free will, this epidemic isn't about that. Many people getting addicted have been initially prescribed the pain killers by a doctor for medical reasons and then got addicted. They didn't use recreationally.
It's thanks to these ignorant comments that make them fearful of seeking help with the addiction.
The was on drugs and the stigma it brings continues it's devastation...
> The only way I would care is if I found out that a foreign power was behind this, i.e. getting people addicted to deadly substances in order to undermine our country. If it's just jackass flunkies doing it because they're jackass flunkies, then I'm just glad they aren't on the highways.
It's not a foreign power, it's our own pharmaceutical companies attacking our citizens.
From lobbying against medical marijuana as an alternative pain killer to pushing false information on doctors and patients about the addictive nature of their drugs.
But pharmaceutical companies don't fit your typical stereotype of a villain and they flood our politics with cash, so they are getting away with murder.
Finally, people regurgitating the garbage like "self-select out of the gene pool" are also a major part of the problem. How someone got addicted to drugs shouldn't be important. Whether It was due to recreational use or by a prescription, they need help and should not be ostracized.
Our public funds should go to recovery centers, not law enforcement for victimless drug use.
There are plenty of laws on the books to arrest someone who harms another, whether on drugs or not. We don't need laws specifically for drug use. Those people need medical help, not jail.
As another user pointed out below:
> "Drug-overdose deaths skyrocketed between 2015 and 2017, particularly for adults between ages 25 and 54. The main culprit was fentanyl and other synthetic opioids that became pervasive in illicit drug supplies in the U.S. around that time."
> "Deaths from synthetic opioids rose 45% in 2017, while the death rate from heroin, which had risen sharply after 2010, was flat."
Synthetic opioid overdoses: https://www.drugabuse.gov/related-topics/trends-statistics/i...
People end up ingesting shit they don't even know about that's in their drugs (like chinese fentanyl) and then accidentally OD. It's still bad to overprescribe drugs, and this shows more legalization/regulation of drugs would be better to not have supplies randomly cut with whatever products some dealer has laying around.
1. Doctors over prescribe opioids and poorly monitor patient addiction.
2. Eventually, doctor cuts off patient.
3. Addicted patients turn to street drugs, like Chinese fentanyl.
4. Street drugs have unreliable dosage and ingredients, making it easy to accidentally overdose.
I'm not sure the comments are made out of ignorance as much as desperation.
Imagine an audience member telling a DJ: "Hey, I liked your stuff. But I kept hearing a bunch of pops and clicks in the music. Was there something wrong with your system?"
And the DJ says, "No, my system was just discarding the samples that self-selected to miss realtime deadlines. Good riddance, I say!"
We need a name for this fallacy: perhaps the "Unsampling Fallacy?" That is, morally attacking samples in an attempt to characterize the very system for which you were supposed to analyze those samples to gain insights into it.
It's glaring with the DSP example but insidious when it's humans being sampled.
To me this all boils down to what you’re saying, but I’d like to just add mention that i think the bigger disease in the US that enables situations like this is the acceptance of misinformation. As you pointed out, many many many of these cases are started by a medically issued prescription, and it kills multiple times more people than recent wars or terrorist related acts, yet anyone who drives action here is often labeled as “helping junkies that don’t deserve help”.
In the very near future when climate change has destroyed our way of life, and one of the few nations that was capable of doing something is finally and certifiably recognized as having sat by and done nothing, i hope the world takes note. These are the kinds of acts of neglect that make Nero famous, and while i don’t want their names remember, i do want the world to move on from the US being seen as the worlds police and freedom fighters. If Kama is real, the US should be concerned, and as someone that is a close neighbour, it terrifying to think how that will flow on to impact the rest of us.
It's amazing how many Americans are actually proud of their ignorance.
It's also amazing how many Europeans think they're somehow different.
But to take it seriously, what fraction of opioid deaths started from a prescription?
Maybe people are killing themselves because they are addicted to the fear porn spread by mainstream/social media regarding "climate change". I don't mean this as a joke, I was addicted to financial/economic fear porn for a bit and it did have a negative effect on my outlook.
Herbert's quip that "Fear is the mind killer" is apt.
Research (has hit the HN front page several times) bears out the fact that constant exposure to stress decreases IQ.
Ergo, the first step to most effectively combating anything is to accept it, but NOT give in to fear and despair.
Climate change is real. We are not doing enough to counteract it. But we can.
You can go through my recent post history to find it.
People dying from their addiction aren't killing themselves, they are struggling to survive.
Back on topic, the "messaging" here that directly relates, as far as the opioid epidemic goes, is the opposite: the lax regulation of the marketing for prescription drugs. Purdue Pharmaceutical was allowed to engage in a lot of aggressive marketing courting physicians with plenty of symposiums and swag. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/) The marketing hugely downplayed the addiction potential of Oxycontin, over-promoting the use cases and underplaying risk. (Along the way you get some IMHO absurd swag like an Oxycontin-sponsored 50s swing music compilation -- https://www.reddit.com/r/SwingDancing/comments/593xof/til_th... -- I mean, what?) This helped contribute to the opioid over-prescription problem.
Sober, fact based analysis -- present in neither of the above scenarios -- unfortunately is in short supply these days.
Personally, I haven't seen the sort of aggressive marketing you see in America for prescription drugs in any other country -- at least, I don't recall seeing the sort of direct-to-consumer prescription ads anywhere else, (I was able to find articles that said DTCA is quite restricted in Europe --https://www.pharmafield.co.uk/in_depth/pharmaceutical-direct...). I think pharmacy-to-physician marketing is still allowed in most places, but the above shows that work needs to be done to ensure that this marketing also is sober and fact based. Even physicians can be persuaded by "marketing swag". (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623540/)
But what causes far greater deaths than even opioids, is avoidable medical errors. It's quite difficult to stop a highly addictive class of drugs which is backed by big business (legal or illegal). But that many avoidable medical errors in 2018, despite the high barriers to become a doctor?
Maybe we shouldn't be treating this opioid problem so gravely after all. The more serious, more deadly, more costly problem of avoidable medical errors could be even the root cause of the addiction epidemic.
I spent the better part of my adult life as an addict, and yet not one doctor out of the many that I saw acknowledged or noticed. Furthermore, on the occasions I did muster enough courage to ask them if the drugs were causing harm (three different non-opioid drugs at different periods of my life), I was shrugged off, the doctors saying that my symptoms do not match up, or otherwise downplaying the situation. I needed hard evidence that what I was doing was actually harming me or I saw no incentive to quit. By the time one does enough chronic use to be at risk of death, I imagine the addiction and habit is far too strong to easily break. So I'm of the opinion that the root cause is with the medical profession's apparent limitations.
It's often very hard to get medical help in general until something is plain and obvious, highly common, or literally killing you, with the evidence needing to show up on examination or test. This is something that I could be vastly improved with AI doctors and open access to anonymized health data. But given how much of a fight the taxi cab driver union puts up (with self driving cars and even Uber), I won't hold my breath for the AMA to get behind the idea.
It's reasonable have more sympathy for a conscripted soldier killed in a foreign war he had no desire to fight in than an opioid addict that died from a result of choosing to do drugs.
Finally, it may be hard for those of us who were never addicted to opioids to understand. It no longer becomes a simple choice when your body is extremely sick if you don't get your dose. This is one reason why a drug addict might steal from those they love, their illness is literally the most important physical sensation at any moment, overcoming familial and societal norms. It's a scourge and illness, not merely a choice.
The permanent war has long term casualties.
It's so strange how prevalent it has become in the past few years to talk of human beings in terms of productivity. Growing up in the 90s, all the talk was about how we were mindless consumers. Now, all I hear is people talking of others and themselves as producers and productivity. How they feel about themselves and their worth depends on whether they had a 'productive day'. What does that really even mean? It's amazing how quickly the vernacular changes.
Never in a million years would I have ever thought of someone dying and juxtaposing that with productivity. Why even bring it up? Are we here just to produce for society or the wealthy or the government? 20 years ago, would we have been upset at all the consumers or consumption being lost through suicide and death? We are talking of others and ourselves like farmers talk about produce and livestock. Maybe that's what modern society has reduced us to. Livestock that needs to produce.
We've recently seen a lot of coverage of the forecast that climate change could cause a 10% reduction in GDP by 2100. Your objections apply to this measure equally. But by quantifying the magnitude we can compare it to things like the cost of remediation.
Quantifying an effect also has the benefit of exposing the estimate to more effective refutation. The more numerate debate we subject policy preferences to, the stronger they'll be.
People used to think that heroin or other substances were inherently addictive in and of themselves. This was because of experiments on mice in Skinner boxes. But that is not how addiction works. Addiction is, in great measure, the result of animals being unhappy and trying to do something about it.
This has been proven both in humans and in mice. Mice, and humans, generally don't get addicted when they have good things to do.
To focus on the opioid side of our social dysfunction is just as useless as focusing on any other SYMPTOM of dysfunction.
When I hear people talking about how horrible the epidemic is, I can't stop helping thinking of a flu analogy:
This sniffling epidemic is really terrible. We should ban sniffling because sniffling people suffer, we need to protect them* if they sniffle. But let's not worry about people washing their hands... that's unrelated.
* Generally implied is that by protecting people it means putting people in cages if they disobey our social commands.
The well intentioned scientist (June Dahl) who championed the widespread adoption of the pain scale recalls that when she was giving talks about it and it started to get a little traction, the pharma industry started pouring money into her campaign. At the time she thought it was just unbiased grant money without an agenda, but she later realized the intent was to sell more drugs.
I've heard people casually refer to criminals/addicts as animals, it's ridiculous.
People who behave cruelly aren't animals, they're people who behave cruelly and we should seek to minimize/stop their cruelty and ability to inflict it.
Drug users, willing or no, also aren't animals. Drug users who want to stop should be given all the tools necessary to kick their habits. Drug users who don't want to stop should be given the tools necessary to reduce the harm to themselves and to society.
Anything else is barbaric.
If you are enjoying someone else's tourment, especially after you inflicted that tourment onto them, then you are a psychopath.
People who take drugs aren't taking it for the hangover, they are taking it for the high. If you remove the tormenting hangover, 100% of users would be fine with that.
You should seek psychiatric help and I'd be happy if my tax dollars were used to help you with your mental problems.
I actually work in helping abusers control their addiction. I have all the access to mental health services I need, thanks.
You can play this game all day. This isn't the point. They're all people — they have families, wants and needs, they dream at night. They're all just trying to get by one way or another. They're no more discardable than you or me.
If you say it's "not so big a leap", make the argument? After all it doesn't matter if a leap is big or not, that's always related to the gap it needs to cross. If argument holds and you end up on the other side, it wasn't so big a leap. But it's pointless to talk how a leap is feasible instead of simply making it, leaving that as some sort of exercise for the reader.
I guess it would be actually two arguments, 1.) calling sociopaths animals 2.) the equating of injecting others with something for the purpose of torturing them with injecting oneself with drugs, for the reasons and purposes people actually do that.
Not sure how you would funnel the wide variety of reasons people end up addicted to drugs into something that could be compared with a single situation and motivation like that hypothetical torturer, but then again you haven't made the argument yet, so maybe you know something I overlooked.
I'd bet many people share my differentiation. I don't think it's primarily a 'visual' difference.
[Kind of off-topic] I'm guessing you mean by 'than Vietnam', 'than Americans died in the Vietnam war"? (Well I think so. Apologies if not.) That's a pretty macabre unit. Can you imagine how a Vietnamese person would feel reading that? Maybe in Vietnam they say 'More people die from [something] every year than America' - meaning what they call the American War. Wouldn't that sound super-weird. That's something like how what you said sounds to me. Only for them it would mean 1-3 million.
 or the Resistance War Against America.
edit: Downvoter, care to explain how I can improve my comment? Thanks.
ps. You could also use car deaths per year (somewhat similar number) but then anyone who has lost relatives in car accidents might get offended by using these macabre numbers.
Imagine you're sitting in Canada and say "The opiod epidemic kills more people annually than WW II", and then when confronted, you say "Of course I mean Canadian lives in WW II!"
Americans may only see 55000 deaths in Vietnam. The rest of the world (and HN is international in audience) sees a lot more.
A similar bit of misfocus shows up in comments about the Holocaust, which technically refers to the 6 million Jewish dead rather than the estimated 17 million total.
A general feeling of disconnectedness? Perhaps some existential dread in there. The United States (by and large) used to be lashed to religious moorings, which provided some sense of purpose and moral grounding, as well as fending off pesky questions like "what happens to me when I die?"
The statistics that claim the US is still largely religious are hallow. People wear labels of their religion as a means to exclude or silently signal 'better-than-you', when the purpose and message of those religions has nothing to do with that.
I don't mean to say lack of religion is the primary cause of our opioid epidemic, rather a significant contributing factor.
I would venture a guess that things like easy access and over-prescription also play a role.
I lived in northern Europe for a couple of years and it seems to me northern/western Europe is also much less religious than US, without a opioid epidemic.
There surely are more examples where the docs seem to be a lot less careful about giving out these drugs. Also I think, and that's not only regarding the US, but all of the world, people should be getting way more education about what these drugs are, what they cause, how they should be taken and how you should stop taking them / what risks it bears if you don't.
My experience is that it's too complicated for people. My parents can just about understand don't take more than 8 paracetamol/tylenol per day, or don't take advil if you've got high blood pressure, but any more complex than that and they just can't really understand it.
They can't (or don't want to) understand that certain antibiotics mix poorly with alcohol (Don't drink on antibioitics) or that some painkillers are _not_ suitable for hangovers (headache == tylenol). They don't understand how statistics of side effects work (10% of people have one or more of the following side effects means "It won't happen to me"), or that some supplements can interfere with medication (warfarin and St Johns wort), and that this is bad, even though they're not medicines.
Among people younger than about 60 or so I've noticed the reverse being far more true. People don't broadcast how religious they are. People are much more likely to broadcast things like what you're saying which is fairly insulting. You're message basically boils down to "most people who believe they are religious are just in it for the virtue signaling and therefore are doing religion wrong" which is pretty insulting to anyone even remotely religions.
I personally don't think religion has a large effect on opioid use or suicide but if it does have one it's a positive one. Nobody ever got hooked on drugs or attempted suicide because their life was fulfilling and on a track to get better. People do drugs and kill themselves because they are in despair and feel like there is no way out of their situation. If anything religion would act as a positive outlet for those feelings.
That was my point.
As for insulting people, that isn't my intent. I have only my own observations to go on, and I don't know other people's situations or story, especially religion. My personal experience has been rather shallow. No one asks hard questions, no one talks about God unless they're forced into it, especially at church.
Part of my (rather sad) interpretation of my experiences is that I have questions that are hard, that no one wants to answer. And I'm not able to ask those questions and get a useful answer. So, my interpretation is stained.
That's unfortunate. However, there are people who are not at all afraid of the hard questions.
I see from your profile that you're at UW Madison. As it happens, I know such a person there. (He's almost certainly going to become my son in law.) If you want someone to deal seriously with the hard questions, contact me at mikestimpson (at) yahoo (dot) com.
I think those questions are best answered by religion, but religion is being attacked, or at the very least, excluded in most thought-provoking venues.
Take for example the school that reject have Chick-fil-A on campus because of its (Chick-fil-A's) religious leanings. Or the fact discussing religion on this very website is generally frowned upon - though that seems to be a reaction to people's recent animosity towards religion.
That said, I think religion can have a very real effect on opioid use/suicide, depending on the religion. See for example Utah, where the opiod rates, suicide rates and pornography rates are above average. I think that's a result of a complex interplay of factors. I think the gist of what's going on is that the "mormon" culture has squashed many visible vices - smoking, alcohol consumption and physical infidelity. Combine that with a streak of being judgmental / people trying to fit in (TGF, not in all places), and you get an over expression of harder to see negative effects: pornography consumption (though maybe Utahns just pay more for it... being more honest about it?), opioid use, and depression leading to suicide.
With all that said, (disclaimer: I'm a member) I think the Church of Jesus Christ of Latter-Day Saints has plenty of missionaries who love to talk about (and answer) the hard questions (if I'm interpreting your post right). And I'm willing to talk about them too (my username as a gmail account). I'm not sure the answers will be satisfactory to you, but I've found them useful.
That article you linked seems to suggest that the school doesn't like Chick-fil-A's leanings towards gay rights. Do you tie gay rights into a religious ideals?
Is it animosity towards religion, or is it animosity towards anti-gay forces? I for one have certainly met militant atheists, so I'm not going to pretend that militant atheism doesn't exist, but they're a very small minority of people.
Most atheists I've seen are willing to listen to me talk to them about religion. They're curious, growing up with a life without religion, and they are interested in what growing up in a religious family is like. But where the line is drawn is when rights of others are trampled upon.
> The extent of my knowledge there was the christian underpinnings of Chick-fil-A's founder and the statements made in the article.
In the majority of these cases, people usually don't care about religion, as much as political views. IE: They may be pro-choice (while religious are typically pro-life), and that's what they're really annoyed about.
Or in this case, the Chick-Fil-A situation is 100% a gay rights issue more so than anything else.
Even the "Satanic Temple" is really just a bunch of trolls / a political group who are mostly concerned about separation of church-and-state issues. The "Satanic Temple" just uses the same tactics as right-wingnuts do: "Trigger the snowflakes". In any case, the entire strategy is to try to make the other side look bad by trolling and acting worse. I severely doubt that anyone in the Satanic Temple actually worships Satan, they seem to be atheists / secularists for the most part.
Again, militant atheists who look down upon religion certainly exist. But they aren't commonly in major positions of power in my experience. So I'm always weary when any group blames things as a "War on Christians".
I don't buy this for a second. There is a notable, consistent correlation with economic viability (lack thereof) and perceived/real economic inequality and the negative effects these have on a population. Drug use, mental illness, even infant mortality.
This is what is happening. People don't have good jobs, they don't have a good education (and in some cases their education doesn't net anything), and they don't have a "purpose." You don't need to invoke whimsical images of non-sense to guess at why people feel useless and/or are seeking drugs.
We are actively wasting multiple nations' resources and people's own personal lives over absurd policies and to cater to a very tiny portion of the population who is already rich beyond anyone's dreams.
I guess I didn't state my case clearly. My point was (in part) that religion can provide purpose if people lean into it the right way, and that having a purpose can stave off the desire to be numb - emotionally and physically.
There isn't evidence that being involved in a religion alleviates or negates any of the effects/correlations that were presented earlier.
It might seem reasonable to suggest that religion gives people purpose, but again, it actually doesn't really affect what we're talking about. There are extremely religious communities who have extremely high drug use and mental issues per capita. There are extremely religious communities who do not have those issues in the same significant manner. The main factor setting them apart is the economic environment.
The only things (relevant to the current discussion and context) that help out with these issues tends to be economic stability and viability.
Also see anomie 
The decrease in life expectancy observed is being largely driven by people on the middle to lower portion of the income spectrum. It's very unfortunate that it is happening and so many people are struggling. Hopefully our country can come up with solutions to help out people who are struggling with addiction and poor health.
But, it's important to remember that if you are not in that demographic, you are still likely to live a very long life and need to plan for that.
My grandfather died in his early 70's a few years ago. By any other measure, he should have lived well into his 80's. He had a comfortable middle-class life and was quite healthy when he was younger. But he spent the last decades of his life in rural Maryland with very little social contact. My family rarely visited him. For reasons I'm still unsure, my dad didn't talk to him for almost 2 decades. His physical and mental health really disintegrated.
My wife is from India, and I'm convinced that this sort of thing is more rare there. There is a strong, almost sacred connection between family members. If your parent is sick or unwell, you bring them into your house and take care of them. No questions asked. For the most part, the culture in (white, middle-class) America looks at things very differently, and I'm not really sure what the solution could be.
Native Americans on reservations have free health care from IHS https://www.ihs.gov/ https://www.ihs.gov/forpatients/faq/
Add to this the statistical factors like the anti smoking and healthy living campaigns hitting their peak effect a few decades after improvents in modern science hit their peak effectiveness.
To me, it seems like life exectancy will improve again as the economy improves and governments find ways to fight fentynal.
Improving life expectancy maked great advancements in healthcare and sanitaion and lifestyle in the past. As these improvements seem to have peaked I dont know that life expectany is still a good indicator of progress in rich nations
I find this exceedingly difficult to believe in the rural areas of the US. The current expansion is almost the longest on record, going on since 2009. The structural forces that have hollowed out the economies of rural areas (widening inequality, e-commerce, globalization, etc.) are only increasing, not decreasing. The drug overdoses may be caused by powerful opiates like fentanyl, but the drug use is mainly a symptom, not cause, of despair.
then the blame would shift from China to the new country.
maybe instead of blaming others, we should fix ourselves. stop buying cheap dangerous drugs and decriminalize the drugs we do have
Anabolic Steroids are one example, Fentanyl is another, I'm sure there are many more.
For example I wouldn't be surprised if there's a black market for agricultural chemicals that are banned in the US but you can get them from China.
It's definitely intellectual fraud. This is a life expectancy projection for babies born in 2017 and it's assuming the opioid overdoses (the recent scale of which didn't exist ten years ago) continue unabated for seven or eight more decades.
>the drug and suicide deaths account for many years of life lost because they occur mostly in young to middle-aged adults.
Hence their large effect on life expectancy.
Of course healthcare effects life expectancy but the net effect on overall life expectancy has been small because half-assed legislation has ensured that recent gains for the poor and sick have come at the expense of the middle class and healthy.
Depending on how the data breaks down that could just be a narrative they are pushing for whatever reason. The "overdoses" include poisoning by pretty much any drug.
Also, public heath care plays a massive role in opioids treatment and suicide prevention, at least in developed countries.
What seems to be clear is, unless the issue if acknowledged, the US will continue to slide literally to developing countries life expectancy levels.
Some strains of the flu are believed to be more deadly to the "strong" patients, due to a phenomena known as "cytokine storm" - where the strong immune system response directly contributes to death.
>"In February 1919…Edward's fever kept getting higher and higher…aspirin…was given to him by the 1/2-handful over and over…Edward sweated through his mattress…Dr.…could not save his patient.
A confluence of events created a “perfect storm” for widespread salicylate toxicity. The loss of Bayer's patent on aspirin in February 1917 allowed many manufacturers into the lucrative aspirin market. Official recommendations for aspirin therapy at toxic doses were preceded by ignorance of the unusual nonlinear kinetics of salicylate (unknown until the 1960s), which predispose to accumulation and toxicity; tins and bottles that contained no warnings and few instructions; and fear of “Spanish” influenza, an illness that had been spreading like wildfire."
Also, basically no-one works in a sterile environment. There's a reason that so many places have hand sanitiser dispensers.
I grew up muddy and dirty, eating anything I found in nature that was mostly edible (apples, ground cherries, berries, chewing bark and grass), as well as organic beef and pork (before we knew what that meant) and garden vegetables. That was closer to historical experience.
From personal experience, I have a strong suspicion that much of this "care" is actually harming people. In particular I am concerned about over-prescription of anti-pain/anxiety/depressant medications and incorrect dietary modifications (eg, to eat a low-fat/salt/cholesterol diet).
Very roughly, there is a link to "obamacare". From TFA:
>"The U.S. has lost three-tenths of a year in life expectancy since 2014, a stunning reversal for a developed nation, and lags far behind other wealthy nations."
>"The ACA's major provisions came into force in 2014. By 2016, the uninsured share of the population had roughly halved, with estimates ranging from 20 to 24 million additional people covered during 2016."
This is either incompetence or maliciousness on behalf of the CDC, WSJ, or both. Life expectancy in the US is falling, but it's only falling due to Simpson's Paradox .
The CDC's own data  shows life expectancy increasing for all genders and races except black men, which decreased marginally over the last few years.
The primary reason life expectancy is falling is due to changes in the racial composition of the population, not because of opioids or suicide.
: https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_05.pdf (see Figure 5)
• In 2016 compared with 2015, life expectancy decreased for
non-Hispanic white males (0.2 year), non-Hispanic black
males (0.4), non-Hispanic black females (0.2), Hispanic
males (0.2), and Hispanic females (0.1). Life expectancy for
non-Hispanic white females remained unchanged
So, no, it's not just Simpson's paradox.
If lack of awareness isn't the problem, then what is? What drives people to end their lives? Is it the way we live our lives? The people around us and our inner demons telling us it's the only way to stop the pain? And would projects involving life extension work and make them not go through their plan of taking their own lives?
The data on life expectancy from 5 years old is remarkably consistent... mid to upper 70's.
It's even more consistent when one looks at life expectancy from 21 years.
I do not have links to the charts showing this. But, last time I checked, I was quite surprised at how a sensational story about life-expectancy from birth loses much of its significance when one disregards the deaths that occur in the first 5 years of life.
My cousin OD'ed on heroin in 2016. My old classmate, 2 weeks after him - same church for the funeral.
One of my best friends killed himself in 2015.
One of the most disturbing trends in American healthcare, IMHO, is that the suicide rate has been steadily rising since 2000. It's now back to where it was in the 1980s before SSRIs.
The amount of anger the healthcare system can cause in the US is unbelievable. Example, I had a surgery that was pre-approved. Then, I received a bill for $20k. I called the insurance and they said the company wanted to charge them to much and they could not come to an agreement, therefore, they are not paying. So, I call the surgery place and told them there is no way I am paying that bill.
I kept getting bills for 4-5 years, till they settled with insurance company and send me a bill for $500. At that point, I decided just not to pay it, because it angered me so much.
Doctors are under pressure now too. There is pressure to see many patients in a day. Push drugs, vaccinations and so on. It is terrible for everyone involved except companies who benefit financially from it.
Oh, sure, that's likely what makes it inefficient.
I think a better conclusion would be that life expectancy can be hardly increased with further spending in the current healthcare system.
It's the short, statistical version of a thousand thousand tragic individual tales.
I remember clearly nurses saying hospitals are full of elderly and obese people.
Life expectancy for Americans fell again last year, despite growing recognition of the problems driving the decline and federal and local funds invested in stemming them.
Data the Centers for Disease Control and Prevention released on Thursday show life expectancy fell by one-tenth of a year, to 78.6 years, pushed down by the sharpest annual increase in suicides in nearly a decade and a continued rise in deaths from powerful opioid drugs like fentanyl. Influenza, pneumonia and diabetes also factored into last year’s increase.
Economists and public-health experts consider life expectancy to be an important measure of a nation’s prosperity. The 2017 data paint a dark picture of health and well-being in the U.S., reflecting the effects of addiction and despair, particularly among young and middle-aged adults, as well as diseases plaguing an aging population and people with lower access to health care.
“The continuation of this trend is a warning for all of us that our country has not found a way of addressing the profound needs of the people who are dying,” said Eric Caine, professor of psychiatry and director of the Injury Control Research Center for Suicide Prevention at the University of Rochester Medical Center. “While the economy may be recovering at the macro level, it’s very uncertain whether it’s affecting the lives of these people.”
The U.S. has lost three-tenths of a year in life expectancy since 2014, a stunning reversal for a developed nation, and lags far behind other wealthy nations.
Life expectancy is 84.1 years in Japan and 83.7 years in Switzerland, first and second in the most-recent ranking by the Organization for Economic Cooperation and Development. The U.S. ranks 29th.
“It’s significant,” Bob Anderson, chief of the mortality-statistics branch of the CDC’s National Center for Health Statistics, said in an interview. “It doesn’t seem like a lot, but in terms of human cost you’ve got a lot of life that’s not being lived.”
White men and women fared the worst, along with black men, all of whom experienced increases in death rates. Death rates rose in particular for adults ages 25 to 44, and suicide rates are highest among people in the nation’s most rural areas. On the other hand, deaths declined for black and Hispanic women, and remained the same for Hispanic men.
“These sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable,” said CDC Director Robert Redfield.
As drug and suicide mortality has risen, deaths from heart disease, the nation’s leading killer, went down only slightly, failing to offset the increases in mortality from other causes and prolonging another worrisome trend. A decadeslong decline in deaths from heart disease—brought about by antismoking and other public-health campaigns, along with medications to control blood pressure and cholesterol—has stalled in recent years, with heart-disease deaths even increasing slightly in 2015.
Earlier this century, the steady and robust decline in heart-disease deaths more than offset the rising number from drugs and suicide, Dr. Anderson said. Now, “those declines aren’t there anymore,” he said, and the drug and suicide deaths account for many years of life lost because they occur mostly in young to middle-aged adults.
Drug-overdose deaths skyrocketed between 2015 and 2017, particularly for adults between ages 25 and 54. The main culprit was fentanyl and other synthetic opioids that became pervasive in illicit drug supplies in the U.S. around that time.
Deaths from synthetic opioids rose 45% in 2017, while the death rate from heroin, which had risen sharply after 2010, was flat.
Methamphetamine and cocaine use is on the rise in the U.S., but deaths from those drugs weren’t broken out from the total. Those statistics will be released in mid-December, in a separate report, said Holly Hedegaard, a medical epidemiologist at the CDC and lead author of the reports released Thursday on drug overdoses and suicide.
There is some hope the decline in life expectancy won’t be prolonged. The rise in drug-overdose deaths was slower in 2017 than the previous year. Total overdose deaths for the preceding 12 months dropped slightly between late last year and April, though they remain high.
“We may have reached a peak in regards to the drug-overdose epidemic,” Dr. Anderson said. “I’m hopeful, given what we’ve seen in recent months.“ But, he cautioned, “This might just be a lull.”
More federal and local resources have been devoted to the opioid crisis. States began accessing nearly $1 billion in federal grants in 2017 to combat the opioid crisis. In addition, opioid prescriptions are monitored more tightly, and medication to reverse opioid overdoses has become more available, among other factors possibly behind the tentative improvement.
Suicides rose 3.7% in 2017, accelerating an increase in rates since 1999, the CDC said. The gap in deaths by suicide widened starkly between cities and the most rural areas between 1999 and 2017, the data show. The rate is now far higher in rural areas. “There’s a much wider spread,” Dr. Hedegaard said.
“This is extremely discouraging,” Christine Moutier, chief medical officer of the American Foundation for Suicide Prevention, said of the suicide-rate increase. Studies show that traumas such as economic difficulties or natural disasters, along with access to lethal means including guns and opioid drugs, and lack of access to care can affect suicide rates, she said. More accurate recording of deaths may also have added to the numbers, she said.
Scientific understanding of suicide and its risk factors is improving, Dr. Moutier said, and new prevention programs are being implemented. But their effects have yet to be felt, because they haven’t been scaled up yet, she said.
“The science is growing tremendously,” she said. “We now have answers about how to prevent suicide.”