Tag: "heart disease"

Good News: Smokers Pay Their Own Way

It is likely that cigarette taxes are near the external cost level at current rates of taxation. If the goal is for tobacco taxes to simply account for the purely external costs of smoking, then that policy goal has roughly been achieved.

Smokers cross subsidize Social Security, as well as Medicare, meaning smokers receive less in benefits paid out, even after accounting for the fact that they pay in slightly less as compared to nonsmokers…. around 13% more 24 year old smokers than 24 year old never smokers will pay into Social Security and Medicare, albeit at slightly reduced rates, but die before they reach the age of typical eligibility for benefits.

[M]ale smokers receive $5,264 less than nonsmokers from Social Security, and $2,763 less in lifetime Medicare benefits than nonsmokers. In Social Security, smokers just get benefits for a shorter period, on average. In Medicare, they get benefits for a shorter period, but are more expensive than average while doing so.

Full Austin Frakt article on the costs of smoking.

Your Fitness Today Predicts Heart Disease 40 Years from Now

In two separate studies, researchers from the University of Texas Southwestern Medical School and the Cooper Institute in Dallas analyzed fitness levels for more than 66,000 people. Over all, the research showed that a person’s fitness level at midlife is a strong predictor of long-term heart health, proving just as reliable as traditional risk factors like cholesterol level or high blood pressure.

Full article on heart health predictions based on fitness levels.

Squandering Medicare’s Money

Medicare spends a fortune each year on procedures that have no proven benefit and should not be covered. According to Rita F. Redberg, writing in The New York Times, examples abound:

  • Medicare pays for routine screening colonoscopies in patients over 75 even though the United States Preventive Services Task Force … advises against them (and against any colonoscopies for patients over 85). In 2009, Medicare paid doctors more than $100 million for nearly 550,000 screening colonoscopies; around 40 percent were for patients over 75.
  • The task force recommends against screening for prostate cancer in men 75 and older, and screening for cervical cancer in women 65 and older who have had a previous normal Pap smear, but Medicare spent more than $50 million in 2008 on such screenings.
  • Two recent randomized trials found that patients receiving two popular procedures for vertebral fractures, kyphoplasty and vertebroplasty, experienced no more relief than those receiving a sham procedure … Nevertheless, Medicare pays for 100,000 of these procedures a year, at a cost of around $1 billion.
  • Multiple clinical trials have shown that cardiac stents are no more effective than drugs or lifestyle changes in preventing heart attacks or death. Yet one study estimated that Medicare spends $1.6 billion on drug-coated stents … annually.
  • A recent study found that one-fifth of all implantable cardiac defibrillators were placed in patients who, according to clinical guidelines, will not benefit from them. But Medicare pays for them anyway, at a cost of $50,000 to $100,000 per device implantation.

David Friedman on Salt and Fish Oil

There is a longstanding argument for reducing the amount of salt modern Americans consume, based on evidence that a high salt diet tends to produce high blood pressure. A recent European statistical study, however, reported just the opposite of what that argument suggests — evidence that lower salt intake was correlated with an increased risk of death from heart disease. Similarly, there is evidence that an increased consumption of omega 3 oils reduces the risk of heart attacks. But it has recently been reported that it also increases the risk of the more serious form of prostate cancer.

Friedman argues that we shouldn’t be surprised by these results. We are the product of evolution that has optimized us for our environment and in any optimization equilibrium a change that improves along one dimension is likely to produce a worsening in other dimensions. He then writes:

The fact that some change produces a gain in one measurable dimension that matters to us is very poor evidence that it produces an overall gain. Before altering behavior or diet, one ought to look for evidence of net effects on life expectancy or other reasonably final goals, not merely for desirable effects on one input thereto.

The entire post is worth reading.

Salt Wars

A new JAMA study finds a strong correlation: the third of folks who eat the least salt die over three times as often as the third of folks who eat the most salt. Yet other studies almost as big find contrary effects. I find it quite disturbing that such big studies can show such different results; something is very wrong in big diet correlation study land.

Full post by Robin Hanson here.

Fight on Fat

How Portland, Maine, took a stand against childhood obesity. It spent $3.7 million to rally schools and other sites in the state. More families adopted 5-2-1-0 a day: At least 5 servings of fruits and vegetables, 2 hours or less of screen time, at least 1 hour of exercise, and 0 sugary drinks. After all that, the childhood overweight-and-obesity rate for southern Maine dipped 1.5 percentage points to 31.3%.

Full article on Maine’s resistance against obesity.

Could Bypass Surgery Become a Thing of the Past?

Researchers at the University of Western Ontario, led by Dr. Geoffrey Pickering …  have found a solution: …. successfully regenerating the blood vessels, but doing so in a way that prevents them from “shriveling up.”

The strategy has been successful so far. Employing it in adult mice not only led to blood vessels that have lasted so far for over a year, but the blood vessels themselves are now surrounded with muscle tissue — meaning that the body is able to use those vessels to properly regulate blood flow.

If this or a similar strategy is effective in humans, it could mean fewer heart attacks and could also make bypass surgeries a thing of the past. Moreover, ischemia doesn’t only affect the heart — it can also lead to strokes, when blood flow to the brain is restricted. Ischemia is also a problem for diabetes patients, which can sometimes lead to disability or even amputation when blood flow to the limbs is cut off. This type of treatment may be effective for those situations as well.

Alex Knapp in Forbes.

Nothing to Fear, But Fear Itself

Do we pay too much to avoid minuscule risks? Yes, according to a new study that finds that “in the face of a low-probability fearsome risk, people often exaggerate the benefits of preventive, risk-reducing or ameliorative measures.” Consequently, the researchers find that “in both personal life and politics, the result is damaging overreactions to risks,” says Ronald Bailey, Reason Magazine’s science correspondent:

  • Scared people who do not understand or care about parsing probabilities end up spending far more than is rational to avoid truly tiny risks.
  • Worse yet, policymakers are often stampeded by frightened constituents into enacting regulations that cost far more than the benefits they offer in risk reduction.

The researchers conducted an experiment with Harvard and University of Chicago law students who were asked what they would be willing to pay to avoid a one-in-a-million cancer risk. They could check off $0, $25, $50, $100, $200, $400, $800 or more. One set of students was merely asked the question while another was given a highly emotional description of how gruesome cancer can be and then asked. The unemotional group averaged about $60 to avoid a one-in-a-million risk of cancer, while the emotional group averaged $210, nearly four times more, says Bailey.

Residents of the Mediterranean Don’t Really Like the Mediterranean Diet

A Mediterranean diet is rich in fruits, vegetables, olive oils with only a little meat. Numerous studies have attributed lower rates of heart disease to it. Ancel Keys, a scientist from Minnesota popularized the diet with a pair of best-selling books. According to The New York Times:

The healthy versions of these diets do have one other thing in common: they are what the Italians called “cucina povera,” the “food of the poor.” In Ancel Keys’s day, Mediterraneans ate lentils instead of meat because they had no choice. “A lot of it is to do with poverty, not geography,” says Sami Zubaida, a leading scholar on food and culture.

The diet that Keys and his colleagues invented bore little resemblance to what Mediterraneans actually wanted to eat.

Do Smoking Bans Reduce Heart Attacks?

Basically no:

  • “In contrast with smaller regional studies,” says a RAND Corporation study, “we find that smoking bans are not associated with statistically significant short-term declines in mortality or hospital admissions for myocardial infarction [heart attack] or other diseases.”
  • In fact, “An analysis simulating smaller studies using subsamples reveals that large short-term increases in myocardial infarction incidence following a smoking ban are as common as the large decreases reported in the published literature.”

In other words, although heart attacks do decline in some places with smoking bans, there are just as many places where they rise. On average, the difference between jurisdictions with smoking bans and jurisdictions without smoking bans is essentially zero.