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Middle-age wipeout from white plague.

IN SEPTEMBER 2015, Scottish-born Angus Deaton--a Nobel Prize winner in Economic Sciences--and his wife and coauthor Anne Case released a study reporting that non-Hispanic white Americans aged 45-54 had experienced an unexpected, and highly significant, increase in mortality between 1999-2013. These findings especially were disturbing since they confounded optimistic expectations for longer and healthier lives in the 21st century. Even more alarming was the realization that no other developed society had undergone such a turnaround in mortality. Furthermore, rising mortality seems limited to middle-aged whites in contrast to the declining death rates for Hispanics and African-Americans.

Deaton stated that, due rising mortality, "half a million Americans are dead who should not be dead." These deaths soon were compared to the events in the former Soviet Union shortly after its collapse, when the life expectancy of Russian men plummeted from 65 to 57 in a decade. Another depressing comparison was to the worldwide AIDS/HIV epidemic that has ravaged the lives of millions since the 1980s.

Deaton's research triggered an explosion of interest in the specific causes for rising mortality. His study stated that these premature deaths were linked closely to drug and alcohol overdoes. Further research has shown that this premise was correct, but similar results also were found to be true for younger white Americans.

A recent New York Times article detailed the results from an investigation of 60,000,000 death certificates compiled by the Centers for Disease Control and Prevention. Coauthors Gina Kolata and Sarah Cohen observed that Deaton and Case had identified only a fraction of drug, alcohol, and suicide deaths for all white Americans since 1990. The mortality for white Americans younger than 65 either had risen or flatlined while mortality for African-Americans and Hispanics had continued to decline, as in previous decades.

In particular, rising mortality rates for white males and females in the 25-34 age cohort made them the first group since the Vietnam War era to experience higher mortality than the previous generation. This increase especially is significant in that the mortality for white women had risen to levels that were comparable with their male counterparts.

Many writers believe that the rising mortality data reported by Deaton most probably was associated with angry white males who had failed to achieve success, but an examination of the data reveals that the mortality for white women was higher than for white men. Deaton suggests that proximate cause of these deaths was the epidemic in prescription drug and alcohol abuse and suicides. Overdose deaths were found in every social class, including pop stars and celebrities, such as Prince and Michael Jackson, but were concentrated in urban areas, especially among less-educated whites, the Southwest, and the depressed Appalachian region from Kentucky to the Carolinas.

What are the causes of this plague of deaths that is devastating American whites of all ages and classes? At first, observers thought that rising mortality rates might be explained by economic factors, such as declining real wages experienced by most Americans, the recent financial crisis, and the disappearance of well-paying blue collar jobs. Narratives were written glumly pronouncing that the drug epidemic was linked to the falling expectations of whites, especially working-class men.

Many other causes were cited, including globalization, automation, the passing of stable blue-collar households, affirmative action programs, and massive immigration bringing some 59,000,000 new citizens to the U.S. since 1965. Of course, all of these factors can explain much of the distress suffered by whites, but adding to the complexity of the topic is that many of the same factors also have impacted African-Americans and Hispanics, but the mortality for these minorities have continued to decline.

Middle aged American whites still have mortality rates that are lower than middle-aged African-Americans, but this difference has sharply narrowed since 2000. African-American mortality has declined by 2.6% per year since 1999, while the mortality of the 4554 white cohort increased by about one-half of one percent annually (to 415 per 100,000; for blacks, it is 581, while Hispanics fare best, at 262). In contrast to other developed societies that were hurt by the financial crisis, middle-aged white American mortality was higher than in the United Kingdom, Germany, France, and Canada.

It is possible that mortality might be explained in part by factors that are unique to the U.S. In a Newsweek cover story, Mike Mariani stated that this nation is exceptional, but only in a bad way compared to other developed countries. For instance, there is America's higher consumption of legal but deadly prescription drugs, namely opioids such as Oxycontin and Vicodin. Americans account for 4.65% of the world's population, but consume 80% of the world's opioids.

In 2014, a record 47,000 Americans died from overdoses from legal and illegal drugs, which is about one-and-one-half times as many as those dying in car accidents or from gun violence. These deaths are the result of an almost invisible epidemic fueled by doctors who have prescribed deadly opioid drugs. According to government statistics, almost 2,000,000 American adults are severely dependent upon prescribed opioids, and nearly 19,000 people fatally overdosed from them in 2015. U.S. physicians wrote almost 300,000,000 opioid prescriptions in 2012, which is enough to provide every adult with a bottle of these pills.

Prescription opioids are the main culprits for the plague of drug overdoses, but a cheaper and deadlier drug--heroin--is not far behind. Unlike cocaine, crack (a free-base form of cocaine that can be smoked), and methamphetamine, opioids are not street drugs; they are prescribed and a disproportionate number of users are white. Nonetheless, there is a thriving black market for opioids and no shortage of doctors who eagerly write prescriptions. Unlike the norm for most drug epidemics, white women die as often as men because they are more likely to go to doctors seeking prescriptions for pain and depression.

According to Andrew Koloday, chief medical officer at Phoenix House, doctors are more likely to prescribe opioids for white patients than for minorities. If this conjecture is true, it implies that African-Americans and Hispanics have dodged much of the drug crisis simply because of this racially stereotyped practice by physicians. Before 2000, opioids were designed to mimic the effects of opium and were intended to relieve the pain suffered by cancer patients. Today, doctors can choose from a variety of opioids, including Fentanyl, Vicodin, Percocet, Opana, and, since 1996, Oxycontin, the so-called wonder drug that proved to be the most popular, as well as the deadliest.

It should come as no surprise that opioid drugs are highly addictive. Their chemical structure is so similar to heroin that their usage was controlled tightly until the late 1990s. After that, Federal regulations were loosened, which allowed doctors to prescribe opioids for anything from back aches to migraine headaches.

At first, Oxycontin was believed to be much safer than earlier opioids that already were being widely abused. Oxycontin was promoted heavily by Purdue Pharma, which claimed that, due to its time-release formula, the likelihood of addiction was less than one percent, while its sales reps assured doctors that this new drug would not even cause a buzz.

Oxycontin sales swelled from $45,000,000 in 1996 to well over $3,000,000,000 by 2010. Although Purdue Pharma pleaded guilty in 2007 to Federal charges of misbranding Oxycontin and misleading doctors about the risks of addiction, its sales have continued to flourish. Opioids prescriptions increased fourfold during the 2000s. As a consequence of its notoriety, heroin-like effects, and relative ease of acquisition, Oxycontin became the recreational drug of choice for countless Americans, from moms, teenagers, middle class strivers, and poor whites.

For whites younger than 65, mortality rates rose during the 2000-14 time frame. However, mortality increased the most (23%) among less-educated whites compared to four percent for college-educated individuals, indicating that the drug abuse crisis involves both race and class but has been far more severe for the white working class, who have been subjected to greater levels of stress than the more comfortable middle and upper classes.

The data shows clearly that the drug epidemic has hurt a vulnerable segment of the poor whites, especially those without high school diplomas. In 2014, the drug overdose deaths for the 25-34 white cohort was 500% greater than in 1999, while the overdose deaths for the 35-44 white cohort tripled. Drug overdoses and suicides have negated many of the benefits from the improved treatment for major killer diseases like cancer, AIDS, and heart disease.

The Times article by Kolata and Cohen notes that Ian Rockett, a West Virginia University epidemiologist, believes that the death rates from drug overdoses and suicides "are running counter to those of the chronic diseases" Similarly, Dartmouth University economist Jonathan Skinner observes that the current pattern of drug overdose deaths resembles the spread of a highly infectious disease.

Although deaths from drug overdoses among African-Americans has edged up slightly since 1990, overall African-American mortality has fallen, largely due to the decline in AIDS deaths. The result is that the gap in mortality between whites and African-Americans has narrowed by about two-thirds since 1990. "This is smallest proportional and absolute gap between African-Americans and whites in more than a century," relates Skinner.

Overdose deaths still remain uncommon overall among young white adults in the 25-34 group, but the current trends are ominous. In 2014, there were 20,000 deaths from all causes for this age group, but nearly 8,000 from overdoses. For 25-34 white adults, the death rates from overdoses increased from six per 100,000 in 1999 to 30 in 2014. Suicides for the 25-34 group went up from 15 to 19.5 over this period. Similar increases in overdose deaths and suicides were discovered in the 35-44 and 45-54 white groups studied by Deaton, whose work has led to other investigations of rising mortality among whites of all ages.

In Coming Apart: The State of White America, 1960-2010, Charles Murray, a political scientist affiliated with the American Enterprise Institute, has chronicled the destructive effects of the trends that have "marginalized" working-class whites while simultaneously altering the beliefs and behavior of the upper class. Murray contends that a growing segment of working-class whites feels isolated from a society that effectively has banned them from full participation.

There are good reasons for their resentment. Almost none of the rewards from the nation's economic growth has gone to the working class, since the real incomes of all workers in the lower half of the income distribution have not increased since the late 1960s. Instead, many poor whites, whether they are working, underemployed, or jobless, have found ready solace in legal and illegal chugs.

The white plague is devouring many of the most-vulnerable persons among us, and it remains questionable if poorly educated whites will be able to find a solution to their steadily worsening condition.

James W. Thomson is a freelance writer and owner of Thomson Investments, Bellevue, Wash
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Title Annotation:Medicine & Health
Author:Thomson, James W.
Publication:USA Today (Magazine)
Date:May 1, 2016
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