Excess deaths in the United States

According to an article in the Journal of the American Medical Association, the term “excess deaths” refers to the “difference between observed deaths and deaths expected if US death rates equaled the rates of other high-income countries.” In fact, the US has higher mortality rates than other high-income countries. In 2023, life expectancy in the US ranked 50^th among other countries across the globe.

The causes of our excess mortality vary according to age groups. For ages 25 to 55, half of the excess deaths were caused by drug poisoning, alcohol, and suicide. For people 55 to 64, circulatory diseases and metabolic conditions, such as diabetes, account for nearly half of the excess deaths; for ages 64 to 84 those conditions account for more than half. For people 85 and older, mental and nervous system disorders, such as Alzheimer’s disease, were the leading cause of excess deaths. According to the Journal, “many of these excess US deaths could likely be avoided by adopting health and social policies that have benefitted other high-income countries.”

The most rapid increase in excess US deaths is the result of drug poisonings, alcohol-related causes, and suicide—“deaths of despair”—and were most common among males.  Deaths of despair accounted for 24 percent of the increase in US deaths from 1999 to 2022. The Journal noted that deaths of despair are closely associated with social disadvantage, the loss of manufacturing jobs, automation, and worsened opportunities for less-educated workers. It also noted that “US regions with less-protective safety net and health coverage policies have higher and worsening mortality than other regions, as do those where majorities voted for Donald Trump in 2016.”  Whaddaya know!  

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Why acupuncture works—sometimes

I tried acupuncture for my sciatica. It didn’t work. Surgery did. Nevertheless, studies have proven that acupuncture does work for some ills, such as migraines and chronic pain. Recently, researchers have theorized that the interstitium may be the conduit that facilitates the effects of acupuncture.

The interstitium was discovered about ten years ago (see my 2016 blog post).  It’s a large, fluid-filled, interconnected network—a “highway of moving fluid”—that allows fluids, cells and molecules to move between tissues and organs before re-entering the lymphatic and cardiovascular systems. Interstitital spaces exist throughout the body. (The full implications of this interconnectedness haven’t fully been grasped. For example, both healthy and cancerous cells can pass through it.)

More recently, when researchers examined the skin of people with tattoos, they found that ink particles had traveled deeper into the body than they expected. The particles had traveled from the skin into the interstitum, then into the fascia.

In later experiments, researchers injected dye into acupuncture points on the forearms of volunteers. They found that the dye slowly migrated up their arms along the same meridian as acupuncture points, flowing through the interstitium between the muscles. It appears that acupuncture points, located along 12 main meridians, are within the same areas of connective tissues where fluid flows through the interstitium.

As far as I know, the researchers made no comments about acupuncture balancing your flow of energy (chi), as asserted by traditional Chinese medicine. I don't know how you can tell if your energy is balanced. 

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Food noise and set points

Obese people report having incessant thoughts about food. It’s called “food noise.” For example, one woman talks about being plagued by internal voices saying things such as “Don’t you want the cake in the kitchen?” or “You don’t want the salad.” Oprah Winfrey writes that she has suffered from food noise, and that the new weight loss drugs, such as Ozempic or Wegovy, silence that noise. As she writes, “The single biggest surprise of taking the medications was waking up and not thinking about the very first thing I wanted to eat.”

As to set points, scientists have long observed that we have a weight that our bodies naturally gravitate toward. If you try to get your weight below that set point, your body’s metabolism slows such that you’d need less food than would be expected to maintain your weight. You regain the weight you lost.

The weight loss drugs seem to reset the set point to a lower level, but only so long as you continue taking the drugs. What’s more, when you quit taking the drugs, the food noise comes back. Again: You regain the weight you lost.

The question now is, if the new obesity drugs reset the set point, how do they do it? As one researcher notes, “What’s the thing that’s set and what’s reading that as set?” In other words, what is the mechanism that controls the set point? Maybe if they figure that out, they’ll find new ways of lowering it. I suppose the solution, if they find one, would require more drugs.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Hospitals to blame for high costs of health care

According to a professor at Yale’s School of Public Health, hospital prices are responsible for the high costs of health care, including the 320 percent increase in insurance premiums over the last 25 years. (Premiums for a family health plan can exceed $27,000 a year.) Prices at hospitals have grown three times as fast as inflation and twice as fast as prescription drugs and doctor visits.

In the U.S., hospitals earn $29,000 on average for hip replacements that are covered by private insurance and $16,000 for those covered by Medicare. In Germany, where 90 percent of the population is covered by a public system of nonprofit insurers, hospitals receive $9,400 for a hip replacement.

The reason for excessively high hospital costs is the hospitals’ “accumulation of market power, which brings them more bargaining heft when they negotiate prices with insurers.” Their market power is a result of mergers: Since 2000, more than 1,300 out of 5,000 hospitals have merged. When hospitals that were once competitors merge, prices go up. Now, 21 percent of hospitals are effectively monopolies.

Because hospitals are the largest or second-largest employer in many counties in America and spend more than $100 million on lobbying, politicians who represent places with dominant hospital systems are not eager to fight with these institutions. Moreover, chronic underfunding of the Federal Trade Commission inhibits their ability to regulate the hospital monopolies. According to the professor, the costs of  fighting hospital mergers “would potentially exceed the agency’s entire budget for antitrust enforcement across all sectors of the economy.”

The professor says we should push back on mergers and “scrutinize an industry in which 25 years of price increases have left care unaffordable.” Pushing back and scrutinizing don’t strike me as very powerful weapons.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.