wikipedia on smallpox:
"smallpox affected mainly children, with periodic epidemics that killed up to 30% of those infected. "
Such an epidemic would take an average of about 23 years off the life expectancy of the affected population compared to today's values (approximately (75 - 5 (age at death))*0.3 (for the 30%). Therefore, your number for the effects of preventive healthcare is way off: eradicating smallpox through vaccination was an act of preventive health care, your number for preventive health care should be around 30 years, maybe 40 years if you take into account all vaccinations and antibiotics plus isolation of infected individuals. Modern medicine has in fact been extremely successful. It's only that the really successful things are not glamorous: it's not heart transplants that save so many lifes, it's vaccinations, antibiotics and public health reactions to infectious diseases.

Fantastic article.

So Bob Marley had it right -- don't worry be happy.

L

A TED Talk on this very subject:

http://www.ted.com/talks/lang/eng/dan_buettner_how_to_live_to_be_100.html

If by some cosmic fluke I were to be appointed US Health Czar, here would be the priorities I would propose to govern our allocation of public expenditure:

1. Relief of pain and suffering. Opiates are a magnificent gift of nature, for which we should be genuinely thankful. They are (or could be) cheap, we are rich. There is no good reason why anyone should suffer agonizing pain when the means is at hand to offer relief. These are dangerous drugs, and a case can be made that access to them must be controlled, but to withhold them from those who genuinely need them in the name of withholding them from those who would abuse them is cruel and barbaric.

2. Prevention and control of infectious diseases. These can sweep through an entire population and cause a massive die-off, and now we have bioterrorism to worry about, so this is actually not just a health care issue but also a homeland security issue. It is absolutely, utterly stupid for people to go around unimmunized because they cannot afford the vaccination. It is also absolutely, utterly stupid to define and defend personal freedom in such an extreme way as to give contgeous people the absolute right to spread infections freely. We don't let people go around spraying machine gun fire at crowds, we shouldn't let infected people spray deadly germs at crowds either. Quarantine is an effective tool, let's use it if needed.

3. Minimize deaths from trauma, by prevention to the extent reasonably possible, and by prompt and effective care for those who are injured. Obviously, if someone is unconscious and bleeding to death you don't want to hold off with treatment until you can find an insurance card - you just get right on it. There is also a homeland security dimension to this: if there is an incident that results in massive casualties, you just need to be prepared to sweep in with as much emergency care as you can muster, do triage, and try to save as many lives as possible.

4. Maximize the productive working lives of children and working-aged adults. This priority is certain to be far more controversial, but it makes sense. An economy needs people who can work productively and contribute to it. Governments need revenue, and they are only going to get it from the economy and the people working it. The more an economy must invest resources in people who are not going to produce a return on that investment through productive working lives, the more of a drag that becomes on the economy. This priority is more difficult to work out, but in general medical interventions that are significantly likely to reduce mortality and morbidity rates in the population below 66 years of age (or whatever the standard retirement rate is) are going to be relevant. So are interventions that will prevent or reduce or minimize disability.

5. Maximize the ability of retirees and the permanently disabled to handle all or as many as possible of the Activities of Daily Living without assistance. It is stupid to deny a knee joint replacement to someone just because they are old and it won't extend their life expectancy, if getting the knee joint replacement will make the difference between their continuing to live independently or having to go into an assisted living center.

These are the only things where I can personally see much of a legitimate and compelling public purpose that justifies the expenditure of much public money. For things that fall outside of these priorities, I'm afraid that an economy that is over indebted and in long-term decline like the US simply can't afford them. If individuals are fortunate enough to have the financial resources to finance such above and beyond care on their own, then more power to them.

Great analysis. Just the facts. 17% of GDP {$2.1 trillion} for 2 months additional living based on population data. We in this Country always think we are smart. But in the universe, this has to be one of the worst bargains ever, on a population data basis, of course.

RC:

From Nate's introduction,
"As the healthcare sector makes up fully 17% of the GDP of the USA"

My impression is that we have a trickle down system in "the healthcare sector" in USA.
The health "insurance" sector collects money and passes on to the healthcare delivery
sector only a portion of what it collects. Somewhere in your many references there
must be data that would allow one to determine what fraction of GDP is retained by
health insurance sector. Do you know that number? How much?

Also, it is often claimed that medical malpractice insurance and malpractice tort, and
physician ordering of 'unnecessary' tests to protect against malpractice tort are major
costs. Is this supported, or not, by what you have seen of the data?

As you can easily see, I incline toward trying to find some evil people whom I can blame
for our situation. But your presentation points to environmental problems as a likely
cause of our poor life expectancy. Would you support pulling money out of healthcare
and putting it into environmental remediation? I think I would support pulling money out
of health insurance and putting it into some better delivery channel.

Yes, we have a problem.

So much to say...

First of all, I myself am (was?) an internist, graduated from an elite US medical school. I also have been an member of the academy of anti-aging (or ageing for writers of international English) medicine for several years. However, as longtime posters know, I bugged out to a small remote nation a few years ago. I practiced full time as GP for a couple of years. Now I work part time as the mood strikes and try to enjoy whatever years of BAU might remain.

Pretty much agree with all of the above paper. The truth has always been out there, and my medical school professors taught me the same.

High incomes allow better sanitation and vaccinations. However they also mean unlimited access to cheap unhealthy foods, advertising of the same, and the ability to earn a living without any physical labor. So less infectious diseases, but more obesity and diabetes. So gastric bypass surgery gets added to the GDP, but longevity is a zero sum game.

Now thank goodness for the (relative) anonymity of the internet ...

The details are much too involved to go into online, but to some extent the genetic mechanisms controlling the caloric restriction longevity pathway are being puzzled out. Some people already are taking sirtuin activators, and TOR agents are in the pipeline. If BAU were to continue, it is quite reasonable to expect that many well informed affluent middle aged people alive today could live to be around 120.

Ah, but how much happiness can be obtained by extended health and longevity in a declining world? There's the rub.

Personally, I am childless and in my mid 50s, but appear to be in my 30s. I earned an age group world title in an Olympic sport a few years ago and am now taking up another Olympic sport as a challenge. My parents are both still living approaching 90. One of my ancestors lived to be 97 in the era before electricity without any modern medical care. Minus misadventure, I could expect to live to 2050 in good form, even without considering any theoretical benefit from anti-aging agents. But in the world TOD readers expect, why should I want to?

Conclusion, collapse is here already. Both economic and environmental. The first half of this decade will see Great Depression levels of economic decline (pretty much already here). The second half of this decade will be worse. Most of the shallow water coral in the Caribbean died in 2005 due to the hot water. Ocean acidification with kill the Great Barrier Reef by 2050. Why should one wish to outlive the oceans?

Personally, I have decided to party like it is 1999. In the past few months, I have fully embraced hedonism as the personal solution. Why not? As long as I am having fun with family and friends, I will go on. But I see no reason to continue indefinitely when living conditions become unacceptable. Then it will be time for pills and leaving a good looking corpse.

I find the 20th century focus on general population health as a desirable goal to be ironic. All of the problems facing the world are exacerbated by overpopulation. Even the economic crisis is made worse by the need to support the long lived unemployed, disabled, prisoners, and pensioners. Declining fertility, increased infant mortality, and shorter lifespans are not problems. They are solutions. In fact they are the only solutions humanity is willing to adopt.

The Russian experience post the 1991 collapse is instructive. They turned to alcohol, violent crime, and abortion and are decreasing their population as their resources dwindle. The entire world can and will do the same. We might wish that our loved ones enjoy health and longevity, but should not wish for strangers (competitors for scarce resources) to similarly succeed.

Perhaps post collapse, the world's average life expectancy will drop below 40 again. That would be TEOTWAWKI, but not the end of the world. Da Vinci, Shakespeare, Mozart, and Newton lived in such an environment. Love and life will go on. In the meantime, the whole idea of public health as a social goal will become antiquated.

My information is about a decade old but may still be valid. In Denmark they have neighborhood paramedics/nurses who you see before going to the doctor. This eliminates a lot of unnecessary visits to the doctor and gives doctors more time to serve those who need them the most.

Somehow we let nurses do triage in an expensive emergency ward but won't let them come to our homes and do the same thing.
What we have in America are paramedics and nurses afraid to say you don't need a doctor and tell you to just stay home and rest until you fell better. We also have doctors afraid not to pursue the most aggressive treatments for people very likely to die from cancer or heart disease within the next year. We have doctors like those my 89 year old step father saw last year who urged him to get a cornea transplant because his insurance and medicare would cover all the cost. We need to get rid of fee for service payments for our doctors and just give them a decent salary and a cadre of nurses and paramedics to call first.

An excellent article, and confirms many of my own thoughts on the matter.

Ultimately, as long as a country has 1) a basic vaccination program and obstetrics and 2) no particular social ills such as AIDS (sub-Saharan Africa) or prevalent alcoholism (Russia / Ukraine), then it is virtually guaranteed a life expectancy in the 70's. Even the best healthcare would only barely nudge it into the low 80's.

This means that as long as we don't get huge wars or Malthusian crises in the post-industrial age (something I'm not too sure about), the humanitarian consequences need not be too severe.

Interesting article and great post by MicroHydro. I'm an internist myself, though a bit fresher...finished residency in 2008, right as the crash was unfolding. Been lurking here since then, but this is my first post.

One of the many overlooked parts of our system that is collapsing-we just don't know it yet-is healthcare. Sure, everybody talks or comments about a healthcare crisis, or about this or that plan being announced or scrapped by our politicians, etc., most of which is nothing but random noise. At the same time, healthcare constitutes 17-18% of our GDP and is one of the only sectors growing jobs. So is healthcare in crisis, or is it booming? The moment we ask this question is the moment we can see how bipolar the whole discussion is. Once we put on our handy post-peak, oildrum looking glasses, we can see what's really going on-that modern healthcare constitutes one of the last bubbles of the pre-peak oil age. At some point, the costs of all of it, for the technology, the workers, to keep the whole thing going...all the hospitals, ER's, offices, clinics, ambulances, drugs and devices based on plastics...will overwhelm the flow of the money/energy from the remainder of the productive economy to service it, and then healthcare will deflate...then all of our young people can look forward to being drummed into the military.

To some extent, we see this happening already. The cuts in Medicare rates that are always one more year into the future are soon to happen...and when salaries of middle class profession people go down (and there are millions of them), take a guess as to what will happen to the econony. I've worked at hospitals, which happen to run beautifully, where the surrounding neighborhoods look like a second world country. How long can these hospitals operate? I suspect they won't be around 20 years from now.

At first, the decline of modern healthcare won't do much to alter population health or life expectancies...for all the reasons mentioned in the article. But what happens when there are no longer antibiotics or vaccines? That's a whole different ballgame than going without gastric bypass or hip replacements. And it's coming...we just don't know when.

I too, for the moment, am working part time and, day by day, drying to make sense of things and come up with a game plan for survival. Good luck to everyone, and I'll definitely post more in the future!

I'm perfectly acceptive to the message, about rather minimal effects, however I suspect some of the stuff that we take as pretty routine actually helps a great deal -perhaps these are not included in your two month figure:

(1) Childbirth: this used to be pretty dangerous. Even for the well to do a couple hundred years ago, getting pregnant at age forty was considered to be a death sentence. So I suspect this area of medicine contributes substantially to average longevity.

(2) Antibiotics, bacterial infections either from injuries, or because in our modern organized societies the ability of diseases to become widespread is so much greater than in low density hunter gatherer societies.

(3) Basic public health, sanitation mainly.

(4) Vaccines, which have eliminated or controlled a lot of the diseases we've picked up since transitioning to high density societies.

(5) Trama treatment in the case of serious accidents.

I completely agree with the author, and remember a surgeon-general quote from 20 years ago where he estimated that medical care accounts for 10% of health outcomes. I spent 20 years both doing individual medical care, studying public health and child abuse prevention, and reflecting on the life circumstances of my homeless patients.

One thing to remember is that we are stuck. We do in fact have more medical conditions, which then result in more medical expenditures. These expenditures are not just a waste. Without them, I would guess our health status would be worse yet. For example, the premature babies that so affect our life expectancy numbers would just die.

When I was researching a paper on "Health, Wealth and Medical Care", I came across someone's PhD thesis, where he correlated states' health expenditures and health status measures. Of course, the more states spent on health care, the worse the health status. And that's NOT because most doctors make most people sicker.

This means that in order to fix the problem, we have to adopt public policies that address income inequality, neighborhood incentives to smoke and eat fried GMO-fed sick animal parts, whatever drives pregnant women to use drugs, whatever causes so many babies to be born premature (the drugs only account for some of it), whatever causes so many young men to try to murder each other, etc, etc...

How we would do this in a society so entrenched in spending 17% of the GDP on medical procedures and expensive medications is unclear.

Collapse offers hope for complete restructuring.

Of course die-off will be worse than voluntary restructuring ever would have been.

i'm a trained geriatrician and would like to clarify a few things that i learned recently to my surprise. human life span has not changed a single bit for atleast in the last 100,000 years. its fixed at 85 yrs. animals studies have confirmed the same observation. note that life span of a species is not the same thing as its 'life expectancy'.

secondly, vaccinations provide no gaurantee of immunity against any disease. they are over rated. on the contrary they are all neurotoxic (especially in infants) and can potentially lead to autoimmune diseases later in life. the only reason docs recommend is because industry says so.

in my opinion, the key to health is to eat less, mostly plants (as michael pollan says) cleanliness and stay away from pharmaceuticals.

I am also a medical doctor, an eye surgeon. I completely agree that life expectancy of a population depends much more upon lifestyle than health care expenditures. I would also add that dependence upon cheap fossil fuels in some ways reduces population health. How?

Humans require about an hour a day of vigorous activity for good health. Fossil fuel replacement of muscle power has enabled most Americans to eliminate vigorous activity. SUVS replaced walking to work or school, blowers displaced rakes and snow shovels, elevators quieted stairs. And when Americans do get exercise, it is usually on a FF powered machine in a FF powered gym.

Cheap FF have also given us cheap sugar and meat. FFs are processed into synthetic pesticides and fertilizers to produce cheap corn which yields cheap sugar (high fructose corn syrup) and cheap meat (from corn fed to penned up cattle). The combination of inactivity with cheap sugar and meat, produces obesity, diabetes, cardiovascular diseases, and cancers. And also raises debt by increasing disability and health costs.

So, many choices that make us healthier, also reduce FF consumption and climate change.

Great post and supporting visuals. I have a major disagreement, however, with the following sentiments expressed in the article:

"Like everything else in our artificial modern world, healthcare and energy problems are really economic and social policy issues."
"Science is the most powerful way to look at the world."
"Obesity is a social problem, and especially affects poor and minority people inside rich countries."
"It would be cheaper and more effective to treat many diseases as the social problems they really are. Good societal living conditions are the ultimate preventive medicines. Teach girls to read, thus saving the world."

I would wager that all of the above are moral/psychological issues that become social issues. Science is only one way of looking at the world and just because it is the most destructive way, does not mean it is the most powerful. Many illiterate cultures, dying off not due to self-implosion, but rather to encroachment of the "civilized", lead happy lives. This 'happy' part, so damn difficult to quantify or qualify, gets dropped so often since it clearly is easier to discuss "mortality rates". The fact that so many follow-up posts focussed on adult, infant, childbirth, etc. mortality rates simply illuminates a cultural phobia with death. The concept of death in our culture is not shared by all and could be something that needs work along with other aspects of healthcare. As an addendum to the literature citations for the article, Google the Center for Disease Control links to the Adverse Childhood Experience study indicating the association between such experiences and later mental and physical health problems (Kaiser Permanente study by Anda and Felliti).

With regards to a few other follow-up posts:

From WNC Observer;
"Prevention and control of infectious diseases. These can sweep through an entire population and cause a massive die-off, and now we have bioterrorism to worry about, so this is actually not just a health care issue but also a homeland security issue. It is absolutely, utterly stupid for people to go around unimmunized because they cannot afford the vaccination. It is also absolutely, utterly stupid to define and defend personal freedom in such an extreme way as to give contgeous people the absolute right to spread infections freely. We don't let people go around spraying machine gun fire at crowds, we shouldn't let infected people spray deadly germs at crowds either. Quarantine is an effective tool, let's use it if needed."

I'm a healthy, PhD virologist and you know what??? I'M not getting any of the friggin H1N1 vaccine or any other at this point. Although I don't do this as a wish to become the next "Typhoid Billy", I also don't feel that maintenence of the precious human population to be top priority right now. We spend so much time worrying about this and that health for humans while the planet croaks. On another point, we may not "...let people go around spraying machine gun fire at crowds", but we also don't blink when, in the name of the economy, we crowd millions into unfit work places that reduce their health as well.

and Paranoid added: "Of course die-off will be worse than voluntary restructuring ever would have been."

As I indicated above, I can think of several restructuring scenarios that would be far worst than die off.....

BWB

I thought this press article was interesting. An excerpt,

We found that all five Blue Zones possessed the same nine lifestyle characteristics. Among them: a low-meat, plant-based diet (all of them ate a lot of beans) and a ritual of "downshifting" each day. They experience the same stresses we do -- kids, health, finances -- but they managed it through daily prayer, meditation, ancestor veneration or city-wide happy hours (like the Sardinians).

The secret to longevity, as I see it, has less to do with diet, or even exercise, and more to do with the environment in which a person lives: social and physical. What do I mean by this? They live rewardingly inconvenient lives. They walk to the store and to their friends' homes and they live in houses set up with opportunities to move mindlessly. They do their own yard work, hand-knead their own bread dough, and, in the case of Okinawa, get up and down off the floor several dozen times a day.

Something I thought equally interesting was the suggestion of a connection between soil fertility and health in an online publication by Steve Solomon. At the link, scroll down to the section Lessons From Nutritional Anthropology.

At least twice in your article, you said, "The bad health of Americans isn’t doctors' fault."

Yes, yes it is.

And just to be clear: The bad health of Americans IS doctors' fault, first and foremost.

The medico-industrial complex has become nothing more than another wealth extraction mechanism in our hypercapitalist society. The premise may be health care, but the reality of the situation is that you're extracting a hell of a lot of money from our society, and as you described in your own article, we're not getting much of anything to show for it.

A person who takes money in return for promises that in reality go unfulfilled is generally considered to be a con man, isn't he?

How on earth can this NOT be your (collective) fault? Because so many Americans are so gullible that they let you do it? That may mean that you can get away with it, but it doesn't make it right.

Psychologically you may be able to talk yourself into believing that "the problem" lies elsewhere, but seriously, it doesn't. If you want to see where the problem with American medicine lies, go to an AMA meeting... or look in the mirror.

And if the system is to be reformed, who do we look to for guidance on how to fix it? Doctors. A classic fox-guarding-the-henhouse situation.

Meanwhile, just about all doctors, including you, continue to deny responsibility. "Oh, it's not *our* fault!" Yes, it *is* your fault.

America's dismal medical industry will NOT be reformed until the patients realize that doctors' motives are not as pristine as they think they are, even if doctors themselves believe that their intentions are good. Society should be making demands of the medical industry, not the other way round.

I'm also convinced that we're putting the wrong people through our medical schools, though that argument is probably too long for this comment. But, a short thought experiment: if putting straight A students through med school gave a population an average lifespan of 75 years, but putting B students through med school gave a population an average lifespan of 85 years, what grade would *you* want your doctor to have gotten in calculus? The best doctor who I *cannot* see because the system is broken or because he has 3000 patients and the HMO wants to minimize its loss rate by limiting patient visits to 15 minutes (and since the doctor is already running late, that translates to *five* minutes) is not as effective as one who bucks the system and condescends to spend some time with his patients and find out what their actual medical issues are so he can address them. Grades are a poor proxy for ultimate career effectiveness. (Disclaimer: I work around a lot of premed students. Observing them... explains a lot.)

The reason medical care doesn't help society more than it does is that we have a medical industry filled with very smart, very ineffective doctors who have been culturally programmed by their medical industry to maintain the status quo, and not question any of their basic assumptions about the "healing" profession.

And you should all be ashamed of yourselves for that... but you have been selected and bred for large egos to prevent that from happening.

And your patients have been culturally programmed to trust your profession. Trust which is, when the evidence is looked at objectively, probably not well deserved.

If you, personally, Dr. Rock Climber, want this state of affairs to change, the *first* thing you need to do is to start accepting responsibility for your own industry's flaws. And learn to see past the blinders that were installed on you in medical school.

The blindness you describe in your article... is your own blindness, I think. The dark matter is nothing more than a deeply flawed but thoroughly entrenched culture in a medical industry that fails too see that fact... but profits anyway.

And, really, in a hypercapitalist world, why try to change things when you're still making money hand over fist?

I generally agree with the message of this post.
The average life expectancy in England and France was about 32 years in 1700, with two thirds of the children in London dying before their 16th birthday. This was attributed to hunger and malnutrition (weakened immune system) and to infectious disease.

http://www.amazon.com/Escape-Hunger-Premature-Death-1700-2100/dp/0521808...

The living conditions and lack of sanitation of the factory workers in industrial England were horrible beyond our imagination:

http://www.fordham.edu/halsall/mod/1844engels.html

The germ theory of disease was not proven until the mid to late 1800’s (Pasteur and later Koch).

The use of chlorine to treat municipal water in the early 1900’s led to dramatic declines in the death rates form water borne diseases. Tuberculosis, another major killer, was greatly reduced by antibiotics. Smallpox was eradicated and diphtheria, Pertussis (whooping cough), polio and other diseases were greatly reduced by vaccines.

All that being said, my own life was extended many years by gall bladder surgery , my bile duct having been blocked by sludge from gall stones, resulting in pancreatitis, which almost killed me. The pancreatitis was discovered by an MRI and I underwent laparoscopic surgery after which I was walking around 24 hours later. Eight years later I am still healthy, bicycling 10 miles at a time a couple of days a week, doing yard work, lifting weights and building houses for Habitat for Humanity. By life expectancy tables I should be around at least another 20-25 years.

1. On the whole medical care has little effect on average lifespan.

Oh really? So when I got strep throat and couldn't fight it off, somehow the antibiotics that did fight it off weren't actually necessary? Or the antibiotics to get rid of a uninary tract infection. Gees, I hate to admit it but I'd be long gone in this life without medical assistance.

Man Adapting by Rene Dubos is a good book that deals with this larger picture of health of individuals in a society and the world at large.

How much of the increased average life expectancy in the top countries can be atributed to superior law enforcement and lower birth rates?

Rock Climber writes:

Poverty inside rich countries also harms health.

The chain of causality is not quite as simple as that. The independent variable is not poverty as such, but cognitive ability or information processing capacity. People with low IQs tend to get poorly paid jobs (on average) or to be unemployed / unemployable. Because the poor are less educated and less educable, they also tend to be less well informed and thus less concerned about the adverse health effects of smoking, alcoholism, and overeating.

Poverty inside rich countries, in other words, correlates with poor health. It may be a proximate cause insofar as poor people's low social status makes them more prone to addiction as an escape from the frustrations of their everyday lives. But the ultimate cause is that people are poor because they are cognitively disadvantaged. And because they are cognitively disadvantaged, the 'just don't get' when it comes to understanding the importance of a healthy lifestyle as a determinant of longevity and, well, of good health in general.

Rock Climber writes:

Optimists take heart: the global human lifespan probably grew 35 years last century. US life expectancy is also growing slowly, and in 20 years may be where Sweden’s is today (they hit 78 years in 1989). Healthcare does little, but global human living conditions (outside Africa) are improving rapidly, and world population growth is slowing. I believe humans overall will do just fine.

Hmmm ... sounds as though the Cornucopians, under the banner of St Julian Simon and Blessed Bjorn Lomborg, are at the gates of TOD.

Time for Rock Climber to do some further reading:

http://www.garretthardinsociety.org/

This is a brilliant post by a brilliant doctor. IMO it is the best post I have ever read on TOD. It is obvious that he put a lot of work and thought into it. I can find nothing to pick on except I think he is overly modest about doctors saving lives.

Doctors have saved my life at least 3 times. It appears the doctor is counting a life saved as one per person. In my case and no doubt in many other cases, doctors save one person multiple times.

As a boy I fell and broke my arm. Seems minor but I might have died or been maimed for life had a doctor not set it and put it in a cast.

In 1964 as a draftee in basic training I slipped on the overhead bars and fell breaking my left elbow. Army doctors operated, put in a stainless steel screw and set it, then promptly lost by medical records.

But they saved my life for sure not so much by fixing my broken elbow but by getting me separated from my unit which was mostly sent to Viet Nam. I was later sent to much safer Germany.

In the early '70's I could have been killed in a car crash at a rural intersection when another car hit me on the driver's side door. My knee was sore for weeks. I did not see a doctor, but clearly could have been killed if the crash has happened at a higher speed.

I didn't see a doctor again for many years until 1999 when I noticed by feet were numb. My sister had purchased a blood glucose meter and my blood sugar tested 300. I went to the doctor who found that my A1c tested 13. I count this as the second time doctors saved my life.

One year later after losing a lot of weight and drinking a lot of diet drinks (aspartame) I had a sharp pain in my right side. I went to the doctor who ordered a CT scan which found a renal cell carcinoma
tumor about the size of a quarter in my left kidney.

I had a nephrectomy of my left kidney. This is the third time doctors saved my life.

Since being diagnosed diabetic, I am one of the "frequent fliers" as the doctor points out in his post. But with out intervention of doctors I would have died at least 3 times.

I am being treated for hypertension and high cholesterol too. So it may be that doctors have saved my life up to 5 times so far.

In longevity statistics you only die once. But in the real world people face death multiple times and survive, but statistics ignore it except for a small blip in life expectancy which is averaged out with all the other medical successes/failures and societal failures as the article points out.

These multiple life savings are undervalued in the statistics but are highly valued by the beneficiaries.

Quality and Quantity of Life from TOD and bicycling

People that bicycle to work live 10 years longer than those that do not. +12 for improved health, -2 for accidents. Increased bicycling keeps the overall fatalities steady or reduces the #. So the rate drops dramatically and x10 the bicycling will bankrupt Social Security because of increased life span.

Walking also does a lot of good for health, especially if it is part of a lifestyle and is done several times/day instead of "going to the gym". Depending on Urban rail just naturally creates walkable neighborhoods over time.

Best Hopes,

Alan

Stress will kill you. I never went to a doctor until fifteen years ago. My son was killed in a car accident and the stress almost killed me. After that my health went down hill. Kidney stones, gout, high blood pressure, diabetes, back problems, allergies, gallstones, and cancer are things I recall off the top of my head that I developed. I went from a very healthy man to a person who is disabled in a few short years. Stress will kill you even if your not a baboon.
hotrod

Wow, quite a discussion here. That was an excellent article posted by Rock Climber and I am in substantial agreement. I have long believed that our health is mostly determined by external factors as opposed to what our health care system dictates, provides, etc. It is primarily a result of our own actions or lack of actions throughout our lives, many of which our society collectively decides are best and are served up as "cultural norms." Our natural tendency is to go along with these cultural norms even if scientific realities may point us in a different direction. Given this fact, I do question what percentage of our decisions can actually be attributed to not understanding the "dark matter." I would argue that many people are aware of at least some of this dark matter but still do not act on it because it is not congruent with their long held cultural norms and beliefs.

When people are confronted with scientific realities that may be different from established cultural frameworks this often causes cognititve dissonance. Once this happens we usually ignore the science and go with cultural norms even to our detriment. If you point out these conflicting scientific realities to people they will either ignore you, think you are crazy or forget about what you said. Anyone who has tried to explain peak oil to people knows exactly what I mean. This type of behavior has been going on throughout history. I believe it is why so many people are ignoring: peak oil and other resource depletion, our reliance on excessive debt, our need to change a broken health care system, to redesign our communities, etc., etc.

Ecological economist, William Rees, from UBC has recommended several books on this subject including:
-Don't think of an Elephant by George Lakeoff;
-Brain and Culture: Neurobiology, Ideology, and Social Change by Bruce Wexler;
-The Crowd: A Study of the Popular Mind by Gustav Le Bon

I am also a fan of Sapolsky and have enjoyed reading his books "Why Zebra's Don't Get Ulsers" and "Monkeyluv : And Other Essays on Our Lives as Animals." In addition to being a brilliant neurobiologist he is a hoot.

I liked very much the article.

Speaking about medical dark matter, I believe that in human health there is an energetic component. I am talking about a kind of energy unknown to conventional medecine, vital energy or something like that. I am a practitioner of energetic therapies in Spain, and I wouldn't say that those kind of therapies can cure cancer, parkinson or alzheimer, but, if you are lucky enough to find a professional that actually knows what he is doing, they can cure your backache, headache or many functional troubles in +/- 80% of the cases. As we have read here that stress is one of the main causes that reduces lifespan, and it is clear that having headache for 30+ years should stress you, how can those therapies not contribute to prolong your life?

As always, not everything is true in complementary and energetic therapies, but also not everything is true in conventional western medecine.

I speak about vital energy being the dark matter because, at least in my country, what conventional medical doctors can do for your cronic musculoesqueletal pain is to give you analgesics and anti-inflammatories, that probably are good for acute problems but don't cure cronic cases, and certainly should not be ingested for years on end.

TOD is a cultural treasure. Great articles like this one and so many more here.

Regarding the medical 'dark matter'. I recently came across some web sites discussing sit vs squat toilets and potential health effects of the former. I have seen many studies comparing diet, but had never even considered the possibility that the 'sit' toilet could lead to health problems by itself. Perhaps this could account for a little of 'dark matter' affecting so many.

Fantastic article, with really well presented data. Rock Climber actually does a great job invalidating his own metaphor. "Dark matter" and "dark energy" are terms physicists use to mean they haven't got a clue as to why some observations don't support some of their theories. No one has actually found "dark matter" or "dark energy". However, RC has found and listed the most important factors affecting longevity - and they are not what most people in this country would think. Thanks for posting this Nate.

Thank you for a very fine article, Rock Climber.

Some great discussion in comments also.

Rock Climber -- I live in the Central neighborhood of Minneapolis -- maybe 10 blocks south of Abbott Northwestern Hospital.

If you are in the Twin Cities or nearby, it would be great to have coffee. I can show you my Organic Engines Sensible Utility Vehicle, talk EV's, Peak Oil, or related topics.

My guess is that I will be in the heart of the city here for at least a few more years -- maybe more.

At any rate, thanks again. Feel free to contact me at

gmghoover (at) comcast (dot) net

My mother died when I was four. With four siblings, and an alcoholic native american father, we were all placed in foster homes. I personally had 14 different families that I lived with growing up. I'm 57 years young now. My youner brother died in Germany while in the army. My middle older sister died too early at the age ofg 52 from cancer that spread rapidly through her body. I have been blessed with a healthy family, two children, and a wonderful wife.

I'm a social gerontologist who develops and operates assisted living centers....currently with 270 residents in various communities of care...as I call them. I employ about 180 people, hearts and minds I tend to refer them as. Building communities of care is rewarding. We see the "health care system" generally improving regarding end of life issues, and "futile medicine", as it's called. Hospice has been a key player in this evolution, bringing acceptance and a saner view to the process of end of life. Blessing to hospice workers everywhere.

A good book....The Denial of Death...The Denial of Death is a work of psychology and philosophy written by Ernest Becker and published in 1973. It was awarded the Pulitzer prize for general non-fiction in 1974. THere is much in our culture that is f***** up regarding the issues of health, happiness, death and dying. That said, we continue to evolve. I see it.

I see my work as sacred....caring for people at the end of their lives. In general, it seems that those who have lived a life of general happiness, kindness and amiability get more like that as they age. Those whom are contentious, negative, meanspirited and gernally curmudeons, tend to be more like that in their old age.

My internship took me into ResQuip committees where hospital higherups decided how to cover up mistakes. I've recently heard that there are 98,000 iatrogenic deaths annually in the U.S. When I or one of my family get sick, there is a wealth of diverse sources of treatments. We're fortunate to live in Colorado, where Boulder is nearby, with many alternative treatments that range from very intelligent offshoots of the MD world (that deliver an amazing combination of medicine, treatments, counseling, herbology, diet alternates, etc.) and we've never had a difficult time finding wellness.

Once, having fallen through a reinforced glass ceiling and severly severing my ulnar nerve, I underwent about two hours of surgery at 3 in the morning. Some wonderfully trained surgeon got out of bed to save my hand. I've since given up a lot of bar chords, but like Woody Guthrie said, "If you need more than three chords, you're just showing off."

A dear friend who suffers greatly from PTSD is on way too many medications, which I plan on looking into for him. A few years ao he was homeless in SanDiego. A friend from the 60's found him and put him in charge of watching over a small ranch in the Rockies.

Life is amazing to me. I spent a decade in the 70's traveling the world and meeting wth many leaders of ashrams, cultists, shamans, monks, etc. The answer was found when I took a year long retreat into deep wilderness.

The answer? Relax. Stress is the leading cause of all our illnesses. Anyone want to do a campfire discussion on stress and how to mitigate it?

Nate,

It seems your friend is struggling to find an answer as to why US medical care has deteriorated so badly over the years, despite increasing amounts of money spent on health care, when the answer is quite apparent within his own argument (loosely quoted).

”Despite over $2 trillion a year of modern medical care, US life expectancy has dropped to 50th in the world behind all of Europe and behind some very poor countries. It seems to me that societal factors account for about 85% of differences in life expectancy. Social factors- differences in our artificially created everyday living conditions- are the real keys to human health. Health is improved by money, social status, healthy early childhood, education and a good job. Poverty and lack of control hurt health. Money buys health for individual rich Americans, but has failed to make average Americans healthier. What we decide about health care reform will have no effect on US life expectancy, since doctors have so little influence on health. Like everything else in our artificial modern world, health care and energy problems are really economic and social policy issues.

SIMPLE INCOME IS THE BIGGEST DETERMINANT OF "AVERAGE" LIFE EXPECTANCY (my capitalization for emphasis).

US inequality worsened in the past 30 years. In 2008 the top 10% of the US population got 48.5% of total income, the top 1% got 23%, and just the top 1/100 of 1% (14,988 families) took 6% of it all."

He states, but cannot seem to face the truth, that the problem is the US medical establishment itself, including doctors, hospitals, insurance companies, pharmaceutical manufacturers, and those "investors" who benefit quite handsomely from the ill health and sickness of others.

The mistake in his key argument that, "average" life expectancy will not be improved is misleading because using a "simple average" results in his drawing a wrong conclusion, something simple averages are prone to do. The question cannot be adequately answered by using simple analysis. He could start by using a "weighted average" to "follow the money." Assuming that money spent on healthcare yields benefits to someone, if the US is spending increasing amounts of money, yet not seemingly attaining the desired results, then where is the money going and who is it really benefiting? From that point, the answer should be relatively simple to determine.

What he is arguing quite strongly for, but cannot seem to grasp the concept, is socialized medicine similar to that commonly found in most "civilized" countries. The US has some of the worst medical care by design, primarily because it is designed to provide profits for the wealthy, not provide cures for the sick.

That, however, won't completely fix the underlying problem of the increasing disparity of income between the wealthy and everyone else, but it would at least be a reasonable start.

I strongly disagree that health care reform (not Obama-style health care reform) will have no effect on US life expectancy, which is borne out by the statistics from health care programs in other countries where it is designed to actually provide health care, not wealthy-care.

What is truly egregious is to have an argument like this made by a person who has taken the Hippocratic oath not harm his patients. His argument, that spending more money on health care will not prolong life, is just what the wealthy medical establishment wants to hear from supposed health care professionals in order to avoid having to provide decent health care at a reasonable cost.

Gordon 2342

"When we resist our fate we suffer.
When we accept it we are happy."

???

I'd like to put in a link I got from TAE.

http://www.wired.com/techbiz/people/magazine/16-01/st_thompson

This refers to an academic who coined the term Solastalgia to describe the mental illness you get when you feel homesick when you're at home.
Perhaps not surprisingly, he found these people in an area ripped apart by strip mining of coal - what we call in the UK opencast.
Previous generations of humans could up sticks and find somewhere new. Not the same now, when your garden becomes a dustbowl and the hills go flat.
You stay in the only house you possess. And become ill.

Gosh, I am really shocked how bloody minded a few of the people on this thread are. I shall not name names, but if the shoe fits. . .

I realize that the present global population is probably unsustainable and must inevitably come down, one way or another. I rather suspect it will do so due to a large number of small catastrophes rather than a single massive one. I really must totally disassociate myself, though, from this advocacy that medical care should be cut back or even totally eliminated in order to hasten and intensify the die-off.

First, I must point out that while population overshoot is a global problem, we don't have a global government. What we do have is a couple hundred national governments. It is each nation which must cope with its own population problem and its consequences.

Second, I must point out that the human population is not distributed evenly over the Earth's land surface. Some nations have far higher population densities, and are much farther into overshoot, than others. To the extent that there are inevitable reductions in human populations in the future, these reductions are going to be uneven as well.

My particular interest, and the primary focus of the article at the top of this thread, is the North American context. I must note that population densities for North America are considerably lower than they are for places like Europe and East and South Asia. While I am not really comfortable with a US population of 300 million (and am very nervous about it increasing to 450 million by mid-century), it is nevertheless true that we have plenty of land and water that could be put to productive use, and that we can most certainly feed our population, even without continued inputs of FF energy and petrochemical fertilizers and pesticides. I just fail to see any good reason why a massive population die-off in North America should happen or needs to happen. I certainly don't see any good reason why such a die-off should be promoted or enhanced by such things as shutting down the entire medical care system.

Let's get real here: A snowball in hell has a better chance than does any serious policy proposal to shut down or radically curtail the medical care system in the US. That just isn't going to happen, and everyone here should know that.

Of course, there is always room for voluntary action. If there are those who believe that medical interventions only keep alive those who need to die, and the sooner the better, then what keeps them from refusing to seek treatment for themselves? It would seem to me that anyone who has posted suggestions to the effect that medical care should be curtailed in order to increase mortality rates need to be the very first to volunteer, if they are to avoid having the label "hypocrite" applied to them.

Now it would not surprise me at this point for someone to launch into a tirade about overpopulation. For your information, I have drawn a "Get out of the population lecture for free" card. My wife and I did not have children, and we are much too old to attempt it now. Thus, while I recognize that overpopulation is a real problem, it really isn't MY problem. I didn't contribute to it, and it will not be my offspring that will suffer the consequences. It would thus seem to me that those of you who have had children should have nothing to say to me about population at all.

Since a lot of other people have put in their 2 cents (and sometimes a dollar), I'll add my random thoughts to this very good discussion.
Having tried to become a BTO (big time operator) and failed in farming, we as a family are struggling to find our way, hanging onto the family farm, using off-farm jobs, renting out most of our cropland and retaining pasture for our cattle herd, which is making the mortgage payments. We can't afford health insurance and have been rejected for Healthwave (state-run coverage) for our kids for two years, as the clerics in Topeka don't know how to read business tax returns (they tend to equate gross income with net, and assume we have "all" that income to spend as we see fit. We have bought individual policies for our kids as money has become available.
My Dad had a massive heart attack in 1981, followed by a 4-way bypass that saved his life. I credit the quick thinking of a lady who happened to be sitting beside him in church who recognized the symptoms and drove him to the hospital before his attack actually hit. I credit the hospital staff and surgeons who handled the trauma very well. However, his attack stuck him with his insurance company, which proceeded to raise his premiums until he had paid all the medical expenses back plus a healthy (unhealthy?) profit before he was old enough for Medicare. After three more attacks,starting in 1997, he finally succumbed in 2004 while walking to the pasture to check on the cows, when the third one hit him. Each time, the experts sent him home to die, but he was back on a tractor in a month. Mom actually blames his death on the drugs he allowed his doctor to prescribe, Paxel in particular.
The health advice given to him by the "experts" would have killed him way back in the '80's had he followed it. Even though I was striving to be a BTO, I was having big doubts about the whole system and was looking at alternatives then, so I could give my Dad choices. Since my college major was animal science, I tapped into that knowledge and realized human nutrition was atrociously behind. The diet they tried to put Dad on (bland, no salt) I knew from empirical studies on pigs would kill him. Mom and I put him on fresh food, largely home-grown, vitamins (good ones, not from large corporations) and minerals, plus exercise. (With modern agriculture, farmers are notoriously out of shape.) He got plenty of farm-fresh eggs and home-grown beef and lamb, fed without antibiotics and all the other hormones and junk the experts recommend, and real butter, not margerine. When he died at 76, the mortician was amazed at his muscle tone. He'd never prepared a body that old that was so strong, rivalling men in their 20's.
I feed a natural product to our livestock and eat it myself. It's a menefee humate from New Mexico, recommended to me by a friend involved in natural fertilizers (been using it for 15+ years). It contains a primitive bacteria that goes into spore form when conditions are bad and back to a bacteria when conditions are good. It digests the woody tissue of plant cell walls, making about 30% more of plant matter and minerals available. It also contains trace minerals, and the carbon appears to have special properties that absorb toxins produced by biological diseases, thus helping natural immunity to stay strong. It works so well, the only time I need to vaccinate is before I sell my calves, largely to satisfy the "system". The cost is minimal--less than $.03/head/day.
The balance of minerals in the soil is extremely important. I recommend the writings of Dr. William Albrecht, former head of the Agronomy Department of The University of Missouri, before Monsanto started pumping research money into it. I also recommend Neal Kinsey (www.kinseyag.com) for soil improvement. My experience tells me that farm animals can get by in a tough winter or drought if they have a good supply of minerals. Dr. Albrecht's research led him to the conclusion that animals eat short-term for taste, but long-term for minerals. Transfering that to human behavior, is it possible that our obesity is a result of our craving for minerals not present in our diets, causing us to eat more and more, especially sweets and starches and even mood-altering drugs? In the wild, plants that have a good mineral content are also sweet. Is modern food manufacturing, perhaps unknowingly, taking advantage of that built-in behavior to sell us crap? Toward the end of his life, Dr. Albrecht made the outrageous statement of "Tell me where you got your cancer and I'll tell you what minerals you've been deficient in for years", since different organs vary in their mineral needs. In my area of the high plains, our soil is horribly lacking in selenium and copper. Selenium is directly tied to prostate health and (surprise, surprise) men around here have a high rate of prostate problems. Some of the health problems were alleviated when we shipped food around, thus mimicking the buffalo's migration north and south on these prairies, picking up various minerals and storing them in their marrow, but with the modern emphasis on yield, coupled with DNA manipulation, and soil degradation, we can grow food that looks good and tastes sweet (modern carrots,for example) but lack minerals. I suggest getting a good refractometer and learn how to use it to monitor your own gardening/farming endeavors.
My wife works at the local nursing home, an excellent facility, and they are feeling the pinch of actual cutbacks in state Medicare. Hours are reduced, and other cost-cutting measures are being implemented, much to the chagrin of the half of the residents who can afford to pay their own way. ("For $4000/month I'm paying, you are not going to turn down my thermostat when I'm not in my room!")
Part of the problem of a complex society is that we become so specialized, few of us have the ability to step back, look at the big picture, and say the emperor has no clothes. A BIG share of our GDP is money spent to alleviate the problems caused by not thinking long-term about new ideas, products and processes. Subtract the money spent on fixing the problems (health care, pollution cleansing, etc.) and it quickly becomes apparent we have little or no real wealth. In the nursing home, for example, a lot of effort is spent adding drugs to counterbalance the detrimental effects of the previous drug that was prescribed to alleviate the effects of the previous drug, and so on.

Thank you all for the many excellent responses to the “Medical Dark Matter” paper.

I agree with the many posters who emphasize clean water, vaccines (yes I believe they work great, although the recent H1N1 experience has revealed ways public health doctors have over sometimes oversold the horrors of vaccine preventable diseases and the safety and efficacy of vaccines), maternal health, appropriate antibiotics (widely abused for viral and self limited conditions, but are true miracle drugs) and trauma care. I can’t prove that kind of very basic medical care (like I delivered for Doctors Without Borders) works, but I think it does. I can’t guarantee a healthy lifestyle will work for anyone, but I think it often does.

I could be wrong, but my best read of the available data is that whether US healthcare is broken or not, adjusting it won't much affect our longevity. If we stuck to perhaps the most basic 5% of medical care we'd lose only 2 months out of 78.1 years on average and gain $2 trillion annually. Maybe we could do a lot of good with an extra $6700 per person per year.

I think Europeans live longer not because of single payer healthcare (a more economic and just system) but because their living conditions are more health favorable than the US.

Thank you all for helping me better understand and communicate this difficult subject. I agree change will be all but impossible. Single payer makes much sense but is politically 'off the table'. Reducing futile, cruel end of life care (ICU deaths with a tube in every orifice increasingly borne disproportionately by poor people of color whose doctors can't or won't communicate well with them) would reduce human suffering, but is quickly called 'death panels'. People angrily defended the status quo in healthcare reform town hall meetings. (My favorite comment was "Keep your damn government hands off my Medicare!").

I figure TOD is ground zero for inconvenient truths. Further suggestions are appreciated.