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Increasing mortality rates and whiteness as a marked category

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Gina Kolata and Sarah Cohen have written up a massive study of 60 million American deaths over the last 25 years. Their findings are even more striking than those announced in the startling Case and Deaton paper a few months ago, which found mortality rates rising about middle-aged whites:

While the death rate among young whites rose for every age group over the five years before 2014, it rose faster by any measure for the less educated, by 23 percent for those without a high school education, compared with only 4 percent for those with a college degree or more.

The drug overdose numbers were stark. In 2014, the overdose death rate for whites ages 25 to 34 was five times its level in 1999, and the rate for 35- to 44-year-old whites tripled during that period. The numbers cover both illegal and prescription drugs.

“That is startling,” said Dr. Wilson Compton, the deputy director of the National Institute on Drug Abuse. “Those are tremendous increases.”

Rising rates of overdose deaths and suicide appear to have erased the benefits from advances in medical treatment for most age groups of whites. Death rates for drug overdoses and suicides “are running counter to those of chronic diseases,” like heart disease, said Ian Rockett, an epidemiologist at West Virginia University.

In fact, graphs of the drug overdose deaths look like those of deaths from a new infectious disease, said Jonathan Skinner, a Dartmouth economist. “It is like an infection model, diffusing out and catching more and more people,” he said.

Yet overdose deaths for young adult blacks have edged up only slightly. Over all, the death rate for blacks has been steadily falling, largely driven by a decline in deaths from AIDS. The result is that a once yawning gap between death rates for blacks and whites has shrunk by two-thirds.

A few notes:

*Both the Case and Deaton paper and this new analysis are examples of how whiteness in America is increasingly becoming what sociologists call a “marked category” — that is, a phenomenon or group that stands out in its difference from what is assumed to be the normal, the ordinary, and the therefore largely invisible. In other words, until fairly recently the issue of “white drug abuse” would have been much more difficult to notice or even conceptualize, since drug abuse would be framed as either a society-wide problem, and/or a problem for various others, i.e., racial minorities, the poor, counter-culture types etc.

*We can only hope that the striking spike in drug overdose deaths about young and middle-aged whites (it’s unclear whether the Times article is including alcohol overdoses in its numbers) doesn’t lead to yet another wave of counter-productive drug war initiatives. Increasing substance abuse is usually a symptom of deeper social problems more than it is a cause of those problems — although of course as its prevalence increases, it ends up being the latter thing as well.

*It’s quite possible that one explanation for the spike in white overdose rates is, as the story notes, the reluctance of doctors to prescribe painkillers to minority patients, for reasons that are all too easy to guess. “‘Racial stereotypes are protecting these [minority] patients from the addiction epidemic,’” said Dr. Kolodny, a senior scientist at the Heller School for Social Policy and Management at Brandeis University.” Whether the benefits of that sort of “protection” outweigh the medical and social costs produced by racial discrimination in the prescription of painkillers is another question.

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  • joe from Lowell

    *Both the Case and Deaton paper and this new analysis are examples of how whiteness in America is increasingly becoming what sociologists call a “marked category” — that is, a phenomenon or group that stands out in its difference from what is assumed to be the normal, the ordinary, and the therefore largely invisible.

    You can see this very clearly in television ads. When I was a kid, a shot of a crowd of regular folks would be an all-white crowd. A mixed-race crowd would read as a mixed-race crowd, not just a crowd. It would need an explanation – what’s with the mixed-race crowd? Would they like to buy the world a Coke?

    Now, it’s just the opposite. A crowd shot, or a series of individual shots intended to suggest a random crowd, has to be diverse, or it reads as an all white crowd, and that demands an explanation. Are these the “suits” oppressing our skateboarding, juice-box sipping hero?

  • Nobdy

    If this were mostly about opioid prescription wouldn’t you expect to see the rise of death affecting rich college educated whites too? Maybe wealth has some kind of prophylactic effect (Expensive rehabs working? Access to a better quality of drugs and more information about them?) but I think that, as you say in your Salon article, this is more about hopelessness and a feeling of a lost future than doctors prescribing pills.

    Much of the U.S. is in crisis. The Republican party is winning its war against the American public.

    • Ronan

      You do see that increase, afaik, just not to the same degree. IIRC from Sam Quinones book on the ‘opiate epidemic’ (Dreamland) he claimed it was also a serious(if not as serious) problem among wealthier and more educated white in these areas.

    • Hogan

      Maybe one reason for increasing use/abuse of opioids among whites is workplace injuries. As unions shrink and OSHA loses funding, safety for blue-collar workers takes a big hit.

      • NotALawyer

        The Bureau of Labor Statistics shows a decrease in the Total Recordable Cases incidence rate for private industry occupational injuries and illnesses for every year since 2004 except for no change between 2011 and 2012. The rate of decrease has been lower since 2010 than it was in 2004 – 2009.
        http://www.bls.gov/iif/oshwc/osh/os/osch0054.pdf (pg. 2)
        Of course, one could argue that reporting has been getting worse.

      • One of the arguments of Methland was that workers in brutal industries like meat cutting and packing got started using various substances in order to be able to handle the working conditions and long hours. At first you could better withstand the conditions and so increase your shifts and your pay, but eventually the backlash from the drug addiction would prevent you from working at all.

  • Ronan

    Surely ‘increasing substance abuse’ is as much a result of increasing supply, and ease of access, of the substance in question? It might also be ‘a symptom of deeper social problems’, but you still have to tackle the problems of supply and ease of access ?

    • Pat

      I think that this also has its roots in the power that Alcoholics Anonymous has acquired over treatment of addiction in the US.

      The primary initial recommendation for addicts of alcohol and pain killers is sudden withdrawal.

      The continuing therapy is to treat the medical condition of addiction as a moral failing.

      The association of addiction remediation with the christian church drives away non-believers from treatment.

      So yeah, many would rather die than undergo remediation like that. Many die who attempt it, especially going cold turkey.

      • Origami Isopod

        Agreed.

        Twelve-step groups are awful. I’m sure I’ll get at least one “testimony” from a True Believer™ in response. Personally I agree with Chaz Bufe.

        • Orbis_Terrarum

          I don’t know that it’s necessarily awful. I know people whose lives have been profoundly improved by AA/NA, if only because it’s much less destructive than what it replaced. However, these are religious movements. Just ask Bill W. They shouldn’t be endorsed by the legal system or as a matter of public policy.

          AA is also hard to apply out of a North American context. I recall reading about an effort to start AA groups in post-communist Eastern Europe that fell apart because Eastern European alcoholics were, given recent politics, understandably reticent about revealing deep personal details of their lives to total strangers.

        • Pat

          So I’ll start by saying that my dad did very well once he started in earnest at AA. Saved his life for 11 years.

          That having been said, AA keeps no statistics about the percent of people who stay on after first arriving, let alone any stats on what fraction of people who stay on improve their lives. It’s a matter of faith, see?

          Dad probably was the one-in-twenty who benefited from AA. He always was a lucky SOB. My concern is for the other 19.

      • Ronan

        That’s an interesting point Pat.

      • Feathers

        Also, the AA model is TERRIBLE for opiate addictions. It basically assumes that there will be relapses on the way to eventual sobriety. With opiates, relapses kill. The body loses its tolerance for the drug, so taking your usual dose again ends up fatal.

        Know of a recent case where the family put the kid through rehab, she came out clean, only to die of an overdose in a fast food bathroom within 24 hours.

        Part of the problem with ending the 12-step model (which needs to happen, or at least it needs to be one choice among several) is that it feels so good for the counselors.

        • Ronan

          (this question to Pat and others as well) What are alternative models to treating addiction that differ substantial from AA ? (that’s a genuine question, not rhetorical or a gotcha)

          • postmodulator

            The AA model means abstinence. There are some therapeutic models that substitute methadone or, more recently, Suboxone for whatever opiate/opiod the addict was taking. Methadone maintenance has had some high-profile successes — William S. Buroughs was on methadone until his death from other causes at 82 — and failures — Anna Nicole Smith died of a methadone overdose.

            Given America’s puritan streak, there are plenty of people distrustful of any addiction treatment that doesn’t involve prayer and force of will.

          • PhoenixRising

            Medical model: Managed withdrawal, vs cold turkey, would probably save a lot of these lives (because again, relapses kill).

            Followup interventions that are shown to work include CBT techniques and…that’s pretty much it.

            There is no evidence for the 12-step method.

            I’m convinced that, when the history of the ACA is written, we will be able to credit it with 1 more victory: breaking the back of the rehab-industrial complex by demanding data. From the ashes of that exploitation of hopeful parents, employers and insurers shall rise…I dunno what, but it’s going to be supported by evidence, and it’s going to be medical (medication-supported withdrawal).

            • postmodulator

              The comedian Doug Stanhope has a fairly pungent take on this — what other illness would we treat by saying “Better get you some God?” You take the most religious fundie in the country and tell him he’s got lymphoma, he doesn’t want to hear the word God from his oncologist.

              • PhoenixRising

                Yup. The Mrs felt so strongly that AA is broken that she wrote a little book about how she stopped abusing alcohol without meetings.

                A lot of people buy it and say it helped them. I’m adding that to this conversation to throw in the following data: A higher proportion than you’d expect of those readers are in the UK/Ireland.

                The NHS model is a public-health approach to substance abuse, not the 12-step model plus medical care for anyone who ‘fails’ 12-step badly enough to be hospitalized.

                What this tells us about spiking substance abuse deaths among white Americans–that is not similarly affecting our European relatives who are in the same globalized economy–I’ll leave to someone smarter to figure out.

              • ajp

                Stanhope’s got a lot of brilliant bits. Dude’s comedy is *really* fucking dark though. He’s like…I guess picture an alcoholic and almost suicidally depressed Lewis Black and you’ve got him. He makes Black and C.K. and even Hicks seem like kid’s acts sometimes.

                • postmodulator

                  He’s a friend of a friend, and he’s every damn bit as dark as you’d think.

          • Jenr45

            An alternative method to AA/NA is SMART Recovery. You are asked to leave your religious beliefs at the door.
            You are treated as a person, not judged to be an addict. Abstinence is not a prerequisite or condition for attending meetings. Everyone is in their own place with recovery. It is a meeting of individuals who have similar issues, and DESIRE to work towards solutions together. All types of addiction are welcome. Participation is not mandatory. The act of coming to a meeting can be a big step for many. The website is http://www.smartrecovery.org This site offers great tools for addressing and coping with addiction. I encourage ALL to educate themselves about it. I am including it within this post for easy access. I guarantee someone who feels they have a problem will be reading this post.
            I appreciate the intellectual debate taking place concerning addiction and substance abuse. There are different levels of use. A serious aspect of any type of unhealthy usage is being missed. Most people who identify themselves as problem users have existing mood disorders. The habitual use of a substance is sought to relieve symptoms of acute anxiety/depression. Now, a person is dealing with a dual diagnosis. A lot of abusers/THE PUBLIC are not aware of this.
            Of course, NA/AA are “terrible” because people feel they are not getting all of their needs met. AA/NA/SMART DO NOT REPLACE THE NEED FOR PYSCHOLOGICAL THERAPY TO GET AT THE UNDERLYING EMOTIONAL ISSUE that has exuberated the usage. These meetings address addiction and habit change. PLEASE do not suggest these options are awful. It plants a bias that reaching out for help will not work.
            It is sad…..with all of this attention towards addictions/suicide. Not one media outlet has posted options for those who want to find help. The internet still lives up to its reputation of negative information and no solutions. Judging a process you may not have personal involvement with is not helpful either.

          • Jenr45

            An alternative method to AA/NA is SMART Recovery. You are asked to leave your religious beliefs at the door.
            You are treated as a person, not judged to be an addict. Abstinence is not a prerequisite or condition for attending meetings. Everyone is in their own place with recovery. It is a meeting of individuals who have similar issues, and DESIRE to work towards solutions together. All types of addiction are welcome. Participation is not mandatory. The act of coming to a meeting can be a big step for many. The website is http://www.smartrecovery.org This site offers great tools for addressing and coping with addiction. I encourage ALL to educate themselves about it. I am including it within this post for easy access. I guarantee someone who feels they have a problem will be reading this post.
            I appreciate the intellectual debate taking place concerning addiction and substance abuse. There are different levels of use. A serious aspect of any type of unhealthy usage is being missed. Most people who identify themselves as problem users have existing mood disorders. The habitual use of a substance is sought to relieve symptoms of acute anxiety/depression. Now, a person is dealing with a dual diagnosis. A lot of abusers/THE PUBLIC are not aware of this.
            Of course, NA/AA are “terrible” because people feel they are not getting all of their needs met. AA/NA/SMART DO NOT REPLACE THE NEED FOR PYSCHOLOGICAL THERAPY TO GET AT THE UNDERLYING EMOTIONAL ISSUE that has exuberated the usage. These meetings address addiction and habit change. PLEASE do not suggest these options are awful. It plants a bias that reaching out for help will not work.
            It is sad…..with all of this attention towards addictions/suicide. Not one media outlet has posted options for those who want to find help. The internet still lives up to its reputation of negative information and no solutions. Judging a process you may not have personal involvement with is not helpful either.
            I did not mean to post this twice.

  • SNF

    “We can only hope that the striking spike in drug overdose deaths about young and middle-aged whites (it’s unclear whether the Times article is including alcohol overdoses in its numbers) doesn’t lead to yet another wave of counter-productive drug war initiatives.”

    It won’t.

    These are white people, remember.

    Even Republicans seem to be discussing these recent drug problems with a lot of sympathy.

    It’s going to have a completely different response from what happened when black people were getting addicted to drugs.

    • petesh

      I think your perspective is a little narrow. When grass meant “jazz cigarettes” it was illegal but not that big a deal; when white hippies (such as, ahem, someone not unadjacent to the perpendicular pronoun, to steal a phrase) started dropping acid it soon became very illegal and marijuana enforcement also ramped up for a few decades. Certainly the crack vs powered cocaine distinction supports your view, but I wouldn’t take it a definitive basis for prediction.

      • Kathleen

        I would.

    • AMK

      The GOP response won’t be as draconian as when it was just a “black” problem, but there certainly won’t be any meaningful help forthcoming. This is a class issue, and the GOP is fundamentally the party of rich people….it’s the party of white people to the extent it can use white “culture” and racial anxiety on election day, but poor white lives don’t matter any more than black lives the other 364 days.

      • petesh

        I’d be interested to see a breakdown of political leanings among the white addict population, which might in part vary by choice of drug. In the realm of wild speculation, the pseudo-libertarian tea party may be fueled in part by the absurd war on (some people who do some) drugs. I wouldn’t expect help beyond such useful advice as “shape up and fly right” but even Limbaugh might pause before increasing penalties on use of oxycontin. (Oh, who am I kidding? That guy would claim to have pulled himself up by his own bootstraps.) But rebellious white kids do get slammed, while conformist ones tend not to. So who are these people, politically?

        • AMK

          I don’t think it really matters all that much. There are genuine libertarians who care about ending the drug war, but they’re not the driving force behind the tea party. White kids who actually end up “slammed” for drug abuse are the ones whose families don’t have the resources for legal aid and rehab….ie, gutter people as far as the GOP is concerned.

    • Feathers

      Jeb! is running ads in New Hampshire (well, on the Boston TV which reaches New Hampshire) on the heroin crisis, talking about his own daughter’s addiction.

      This is strange, methoughts.

      • Just means he’s not as stupid as we thought.

  • DrDick

    This is simply another consequence of the hollowing out of working class America that Erik writes about. Teh impacts on working class whites is greater than among minorities owing to lost white privilege.

    • Ronan

      If it is *simply* a consequence of the hollowing out of the working class, then why do you see a decline in mortality from other working class demographics ?

      • Pat

        Perhaps because they didn’t grow up with the expectation that they would have the opportunity to own a house and send their kids to college?

        • Ronan

          Perhaps. But you also have to account for why similar demographics in other developed countries (with sinking prospects) arent affected, or why these economic trends have existed for a generation, but are materialising in this way in this period. Isnt the most obvious, main reason over prescribing ? Just like if you see a heroin or crack epidemic, the background factors (hopelessness and poverty) are certainly important , but the major cause is increased supply of drugs.

          • Crusty

            I think Pat’s answer still applies- in other countries, they don’t have the American Dream narrative and expect that things will always get better.

            • Ronan

              I think that’s getting very vague.In other countries people do have aspirations of upward mobility,and expectations of continuing improvment. They have the same economic trends (though not as extreme) as in the US. In a lot of countries theyve been hit by more severe economic crises. So I still think increased access to the drugs that killed them is the most convincing explanation.

              • Orbis_Terrarum

                Lack of guaranteed healthcare hurts US health a lot. The UK has also experienced extreme deindustrialization, stagnant working class income, and a huge gap between the wealthy and poor, as well as staggering issues with alcoholism and drug abuse. The NHS is still there to take care of everyone, which is probably why mortality rates haven’t risen in similar demographics across the pond.

                • Ronan

                  But lack of access to healthcare also effects working class blacks and hispanics in the US, demographics where mortality declined. I agree greater access to healthcare might have been able to negate some of the increase, but it doesnt explain the trend afaict.

                • Pat

                  I guess I’ll bring up my argument about AA as a matter of American exceptionalism.

                  One of the reasons which I would hesitate to “blame” access to pain killers is historical. For many years fear of addiction kept physicians from prescribing desperately needed pain killers.

                  It’s true that pills are more available now than they previously were. It’s also possible that this contributes to the epidemic of addiction. However, that doesn’t mean that the previous situation was better.

                  Unintended consequences, anyone?

                • Ronan

                  I don’t neccesarily think the previous system was better (I dont know enough about the previous system to say whether or not it was)But I do think it looks like it was a negative consequence of greater access.

                • postmodulator

                  The previous system was bad. Opiates/opiods were carefully rationed even to terminal patients, lest they become habituated. This was a big public health debate in the 80s.

              • guthrie

                A lot of other countries have functioning healthcare and social welfare systems, the latter being especially important in these situations. The USA, not so much.

                As for comparisons with minority mortality rates and changes, surely they started very high, and have fallen, whereas the white rates started quite low and are now rising? I couldn’t work out from the graphs/ article from the NYtimes exactly what the numbers were though; how do the actual numbers stack up?

                • Ronan

                  I dont know the actual numbers. In the Case/Deaton article iirc it was an increase of thousands (5-7, i think) My understanding of their argument now (after corrections) is that the increase was between 1999-2005 (declining before then), with rates mainly remaining flat since then (less so among women, where the increases continued to a lesser extent) These dates (also afaict) match changes in regulations on prescribing, and increases in use, of pain meds.
                  Im not 100% sure if this is correct, but if it is, it seems to be the most convincing explanation to me.

              • Christ Russia has been wrestling with a massive alcohol and drug abuse problem, leading to crashing birth rates and elevated suicide rates, for decades. Where doyou get the idea that other countries depressed workforces are less affected than the US?

          • DrDick

            Oddly, that did not happen when Portugal legalized drugs. Drug abuse, including alcoholism, is a symptom of larger social dysfunction. It kills the pain of the hopeless and oppressed.

            • Orbis_Terrarum

              I read an interview by a neuroscientist at U Toronto (not Gabor Mate) where he claimed that we were reversing causality in thinking about addiction – we think of it as a medical problem with vast social consequences when it’s really a social problem with vast medical consequences. Nothing could be more spot on.

              It’s also worth mentioning that one need not be a member of a subordinated group to be hopeless enough to start using. I have a close relative who developed a severe drinking problem while being a dedicated father and husband and well respected professional in a prosperous city – the culprit was chronic back pain for which alcohol was the easiest and most socially acceptable remedy. Most Americans are basically body-mind dualists, and don’t take the fact that injury and pain can destroy a person’s joie de vivre very seriously.

            • Ronan

              (1) Portugal is a poorer country than the US (2) They didnt ‘legalize’drugs (im in favour of decriminalisation) (3) I support treatment rather than punishment for drug addicts.
              But why is this odd? Youre not comparing like to like.The regulated decriminlisation of illegal drugs with the heavy pushing of pain meds by phamacutical companies and over prescribing by doctors. Why anyway would what happened in Portugal negate the argument?

        • Feathers

          Also, that they don’t have the expectations that it might take emptying their children’s college fund to save the life of their sister who has three kids and is now addicted to heroin.

      • Feathers

        I think a lot of it that white communities and families do not have the same sort of social networks that those who have dealt with poverty for several generations have. “Chris” has hurt his/her back and now won’t find a new job. Chris’s expectations as a white person aren’t as much the issue, as the fact that their friends and family expect that, as a white person, they’ll come out OK at the end of this. As Chris realizes that isn’t going to happen, it gets really ugly. And the aforementioned friends and family aren’t going to see the crisis until the funeral.

        In the black families I know, there is a sense that someone going off the rails may not come back, and models of how to deal with it. Also, more drastic measures are taken sooner. Children sent to live with grandparents half the country away to get them away from drug using parents. Also, there is little denial of the systemic nature of the problems, so that probably makes it emotionally easier to ask for help.

        I know this is overly simplistic, but I hope it gets the sense of what I’m trying to say. I’m reminded of a novel, where it was explained to the rich young woman that the family would, of course, help generally in case of a brief crisis, but that, overall, you did have to let people find their level, didn’t you?

        • Ronan

          I do get what youre saying. I think Douthat (!!) actually made a similar argument (I dont say that to dismiss you, I actually think it’s a good point)that minority communities have built up better individual coping strategies and community institutions to deal with these sorts of issues (where Douthat, afaict, differed though was in implying that working class whites should just become as resilient as working class blacks!)

          • Feathers

            You callin’ me a Douthat!?! I’m not going to go back and find is column, you’ve drawn a broad enough picture.

            Some of the issue that people miss in generational poverty is that it becomes generational not because everybody in the family is a wastrel, it’s because the folks who are not wastrels can’t save up any money to get out because there is always a family member who needs some sort of financial help. I have a co-worker who is the first in her family to go to college, and she has a really hard time with her family. Refusing to help her sister pay for some new training program because she and her husband are saving up for a down payment on a house. It’s ugly enough that she isn’t seeing her family as much as she would like.

            One of the ways “white” families stay wealthier is by not having the expectation that you will financially support family members who don’t have it as good as you might. Your nuclear family comes first, not the extended family. I would always try to explain to people that the reason for social security isn’t so much for their retirement, it is so that your mother-in-law doesn’t have to move in with you. And disability is so that your brother can have his own place.

            • Bill Murray

              One of the ways “white” families stay wealthier is by not having the expectation that you will financially support family members who don’t have it as good as you might.

              Is this widely true? I have given my brother nearly $50,000 over the last couple of years to keep him afloat. eta: and am white

              • jim, some guy in iowa

                “is this widely true?”

                not in my experience

                • There’s a whole philosophy of sink or swim that many people espouse–at least when it comes to other people’s problems. And the kind of share and share alike/helping hand behaviors that you are talking about are called “crab bucket” behaviors by highly influential social workers. The extending of a hand to other family members is likened to the way crabs, supposedly, grab hold of the crab trying to get out of the bucket and drag the successful ones back to their doom. I have seen lots of people, in online discussions of family crises, absolutely advocate for refusing to help other family members. “Your lack of planning does not constitute my emergency” is one catch phrase.

                • Origami Isopod

                  Aimai, it really depends on the individuals, the family, the subculture, and the overall culture. The social workers you’re talking about seem very clueless about how poverty and oppression work. That said, there are absolutely people out there who are drains of other people’s money, time, and energy, and this cuts across all socioeconomic strata. Sometimes relatives do have to cut them off for their own well-being, and sometimes continuing to help them is nothing more than enabling their dysfunctions.

    • I think working class whites are discovering that they were only one deck above the minorities on the Titanic.

      • Bill Murray

        steerage class was still in the depths

      • max

        Yes. Instead of pulling minorities up (which would cost money and also those people might be seen at Saks or something), our overlords opted from pushing the WWC down, which was, as a bonus, profitable, since it was all part of the big wage cutting campaign.

        The cost for the upper class? Allowing a tiny number of minorities in the door. Cheap trade.

        35 years of that gives you David Brooks all aghast at Donald Trump.

        max
        [‘They ain’t happy unless they’re segregating somebody.’]

  • wengler

    Why did it take so long to figure this out? We’ve been seeing the effect on rightwing politics for last two decades.

  • libarbarian

    Sometimes this shit makes me feel bad.

    Other time I think “Good riddance to this disgusting trash”.

    • Ronan

      !! If that’s your reaction it’s in no meaningful way different than white racists who take pleasure in the decimation of black communities.

    • keta

      Nice of you to share the depth of your “thinking.”

    • Origami Isopod

      Thanks for the classism, asshole.

    • Linnaeus

      Other time I think “Good riddance to this disgusting trash”.

      Not to pile on, but please reconsider this sentiment.

    • Orbis_Terrarum

      …yeah, I would reconsider these reactions. Frankly, I think that the mythology that claims lower middle class and working class whites are more viciously racist/sexist/conservative was developed to comfort well off liberals who don’t want to believe that many their neighbors and fellow soccer moms/PTA members in the suburbs are bigoted assholes.

      • Linnaeus

        This. Bigotry sometimes expressed in a more genteel fashion is still bigotry.

      • Jackov

        Also a convenient way to avoid examining one’s own culpability.

      • alex284

        aided and abetted by the right, that likes to think of liberals as hypocritical suburbanites. I have read many rightwing columns/blog posts/whatever where they imply suburbanite=liberal.

        I don’t know how many people believe that, but it’s jaw-dropping that anyone would considering how conservative the burbs are.

      • Origami Isopod

        This, exactly. High-tech guys who are Gamergaters, for example, are far more vicious sexists than the vast majority of working-class men.

        Also, money permits greater ease of segregating oneself from the “undesirables.” Not that there are never racial tensions in mixed-race neighborhoods, but there’s also the phenomenon of having numerous mundane daily interactions with people unlike oneself and unclenching a little as a result.

        • twbb

          You can see that kind of thing being created in Brooklyn where wealthy whites are intentionally invoking both de facto and even de jure segregation, the latter through lobbying authority by means of noise complaints, pushing for police to remove homeless from the area, etc.

    • djw

      What the hell?

    • kayden

      Hopefully you’re not calling an entire group of people “disgusting trash”. If so, that’s a nasty takeaway from this post.

    • geniecoefficient

      Calm down, people, didn’t you notice the handle? Is Poe supposed to apply in the presence of a conspicuous clue? The comment is a joke at the expense of libertards.

  • Paul, there is a lot of discussion about how demographics are treated in the Case and Deaton paper. Start with Andrew Gelman’s blog.

    • Ronan

      afaict Gelman’s correction was that the increase in mortality stopped for men in 2005, but continued for women. What (non snarkily) does this dispute in Pauls post?

      • A lot of the treatment of the study in media and blogs were not aware that there were more complicated demographic issues going on- like a bolus of boomers moving through different age groups in different years. The take home message of the study trumpeted by many was not necessarily true. I wasn’t contradicting anything specifically from Paul.

        • PhoenixRising

          The point of this data review, though, is that the effect seems to hold across US births 1961-1989 (2014 data for death rates of 25-44 and 45-55 in that time period).

          So it ain’t just the pig in the python.

  • The Pale Scot

    You guys seem to under the impression that the users are lying around popping pills and watching Duck Dynasty. Opiates greatest attraction is that they allow you to go to work when your too injured or sore. The shit costs money, and I bet most of them are in the “you don’t work you don’t get paid”, AKA as restaurant and non union construction. My neighbor’s mom works in an electronics factory, she’s 60 something, obese with multiple conditions, which are covered by her union insurance. She’ll lose that insurance if she doesn’t show up for work. She keeps to the prescription, her husband on the other hand is a fiend. But as long as the unit he runs in the same factory is getting A’s in efficiency, nobody is going to stop him.

    My conversations with people doing jobs that I used to do is that the pace is faster and extended. Ex., In the 80’s I worked in food service. You served lunch until 2, had a few hours off and then went back for dinner. Now it’s service from 10 to 10 with maybe 15 minutes to eat. You don’t work dinners unless you’re working lunches, so you end up doing straight 12 hour shifts because dinner is where the money is.

    Back in the day I knew heroin addicts that worked 3 jobs to feed their habit, one of them sleep every couple of days. Dope makes you nod off only if you’re maxing out. Smaller doses gets you cleaning your bathroom at 2am, as one of them told me.

    • AMK

      This seems like a very important point…..but I wonder how many of these workers are getting these drugs illegally, and how many are getting prescriptions (at least initially). I would be less than surprised to discover that the frequency of opiate prescriptions has also exploded since 1999, in tandem with the cost of the pills and size of the checks the drug companies write to the various doctors’ organizations.

    • postmodulator

      There are some people using pills as party drugs. Dangerous: they interact big-time with alcohol, and can both suppress respiration and (for the ones that include acetaminophen) shred your liver.

  • sylvainsylvain

    Late to the party…

    It seems pretty well accepted at this point that the overdose numbers are spiking in part because prescription opiates are getting harder to buy. An addict can’t get their maintainence supply, then turns to the street (heroin, fentanyl, etc).

  • j_doc

    Interesting NYTimes article in that how often do you see journalists trying to do medical research?

    Very ambitious, and good for them to start with a primary data set and go from there. However, medical research is hard, and this sort of epidemiological study usually involves a whole team of people who have spent a significant chunk of their professional lives training to be expert at specific elements of the task. MD researchers, statisticians, data mining experts, etc. Were the authors here “regular” reporters? Did they get guidance from experts? Was their analysis reviewed?

    In-depth reporting from primary sources is awesome, but it’s also really easy to generate garbage in lieu of useful medical research if you don’t know what you’re doing.

    • Feathers

      From someone who used to work with economists – this looked fairly straightforward. Cause of death, age, and race – all taken from the death certificates. Except for the size of the data set, the analysis is a very basic Excel spreadsheet generating a chart.

  • mch

    Point of order.

    “…what sociologists call a “marked category” — that is, a phenomenon or group that stands out in its difference from what is assumed to be the normal, the ordinary, and the therefore largely invisible.”

    The marked and unmarked are terms and ideas developed by scholars of linguistics (Saussure, Jakobson) and borrowed by many others (often sloppily — linguistics is VERY hard stuff — but even so, often productively). Get far into this territory and you’ll soon be dealing with (real) deconstruction….

  • mch

    In a completely different direction. As my legal aid lawyer daughter suffers from sciatica in her final months of pregnancy and my doctor son prescribes I don’t know what to whom (I know he worries over these issues greatly): when did we stop accepting pain as an inevitable part of life? Some 20 years ago,I would guess, I remember mentally endorsing calls for using drugs more to alleviate pain (doctors were reluctant), and since then a whole industry of “pain management” has grown. So I am not of “pain is good” school. And yet.

    I have been reading lately about the Long Hunters, about scalping as practiced by Native Americans and their European frenemies, about life on the southwestern frontier in the 1700’s. And I’ve been thinking about pain. (My daughter worries so much more than I ever did about the pain of childbirth. You do it. You got to. I never worried beyond that.) Not just our capacity to endure it but our expectation of it as part of life, of living (and of dying).

    • Origami Isopod

      when did we stop accepting pain as an inevitable part of life?

      Um, you know what? Pain should not be “a regular part of life.” This is some straight-up Calvinistic bullshit. Pain impairs your ability to function and degrades your quality of life. The idea that we should just accept it as inevitable infuriates me.

      Oh, and yeah, let’s not go back to the days when excruciating childbirth was considered normal and acceptable because “the sin of Eve.”

    • ??Something pain frontier scalping childbirth life??

    • Malaclypse

      when did we stop accepting pain as an inevitable part of life?

      You should read Medical Nemesis by Ivan Illich.

      Note that, while Illich is always interesting, that’s because he is pretty much the textbook* definition of a crank.

      * Irony intended.

  • mch

    So, I’m the Calvinist (or something or other, certainly a crank — does the one commenter have any idea what “Calvinist” might usefully mean?) because I suggest that experiencing pain is inevitable? “Um, you know what? Pain should not be “a regular part of life.” That shift to “should” is interesting. Should is a long way from inevitable.

    If you hang around doctors long enough, you hang around lawyers defending suffering people, you have had painful menstrual periods and a few babies, you have just lived a little longer than the average age of LGM’s (mostly male, I hazard) readers: you get a feel for the inevitability of pain. I expressed interest in a shift in the discourse of pain over the last two or so hundred years in the US. Like I am the first to do this!?! Get real, folks. Every creature in the end dies, usually in pain. As they say, that’s life. Something to think about. It’s not about celebrating pain…. Gee, I keep overestimating the readership here.

    • Ronan

      I tend to agree with your main point (i don’t know how people got from inevitable to good). My mother works in a pharmAcy in a small irish town and has seen this coming for over a decade. People being prescribed pain medication when it really wasn’t necessary, and then developing dependencies over time

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