The politics of health policy

A paper published in PLOS ONE, U.S. state policy contexts and mortality of working-age adults, results in this USA Today article: "More Americans die younger in states with conservative policies, study finds". 

What is the factual situation that the PLOS ONE paper sets out?

Americans die younger than people in most other high-income countries. With a life expectancy of 78.8 years in 2019, Americans died 5.7 years earlier than people in Japan, the global leader; 3.3 years earlier than their northern neighbors in Canada; and 2.5 years before their closest geopolitical allies in the United Kingdom. Shockingly, U.S. life expectancy falls between two middle-income countries—Cuba and Albania. 

Within the United States, life expectancy differs markedly across geographic areas such as states and counties. In 2019, it ranged from 74.4 years in Mississippi to 80.9 years in Hawaii. U.S. life expectancy has stagnated, largely because of higher mortality among adults 25–64 years of age. According to a comparison of U.S. life expectancy to the average of 16 other high-income countries in 2006–2008, deaths before age 50 accounted for 67% of the shortfall among U.S. men and 41% among women. 

Mortality rates provide another sobering picture of the early deaths among so many individuals in the United States. Based on rates from 2019, for every 100 babies born in the United States, two will not survive to their 30th birthday, six will not reach age 50, and 16 will die before they can enjoy retirement at age 65. Like life expectancy at birth, differences across states in mortality rates among adults ages 25–64 are striking.

In the PLOS ONE paper but not mentioned in the USA Today article are things like this:

Fig 4 demonstrates that, for women and men and across all lag times, lower working-age mortality from alcohol-induced causes was associated with more liberal labor policies and more conservative marijuana policies.

and

We examined four counterfactual scenarios in which all policy domains in all states were set to the maximum liberal score of 1 (Scenario 1) or the maximum conservative score of 0 (Scenario 2); the maximum liberal score of 1 applied to all domains except marijuana and health and welfare, which were set to 0 and 0.5, respectively, because conservative marijuana policies were associated with lower all-cause mortality, and no association was observed for the health and welfare score (Scenario 3, “Hybrid”); and domains trending in conservative or liberal direction were set respectively to their 0 and 1 extremes (Scenario 4,”Status Quo”).

Scenario 1 is "all liberal" and Scenario 3 includes conservative marijuana policy "because conservative marijuana policies were associated with lower all-cause mortality". These are the results:

In their simulation for 2019, Scenario 1 results in 86,181 fewer age-adjusted deaths among women and 84,949 fewer deaths among men, for a total of 171,030 lives saved. Scenario 3 results in 92,057 fewer deaths among women and 109,393 fewer deaths among men, for a total of 201,450 lives saved. So adopting liberal policies for essentially everything but marijuana results in 201,450 - 171,030 lives saved = 30,420. 

That is, the cost of liberal marijuana policy is 30K lives per annum.

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Now, suppose this above was well-settled science, with widespread validation of the results. How would this inform policy advocacy of the two political parties? 

Among the Republicans of today, there is no regard for science, and driven purely by partisan concerns, they would ignore all of this. 

More interesting are the Democrats, who are much more reality-driven, but who also have a strong faction in favor of liberalizing marijuana. Will they give up their pot dreams in favor of lives? Or will they argue that those 30K lives per annum is an acceptable cost to pay for whatever benefits marijuana liberalization provides (e.g., maybe less incarceration, or some measure of social justice)?

W.H.O. on alcohol

As a follow-up to this post from 2014, a poster from the World Health Organization.  The message is that much use of alcohol is harmful (and that by putting its ill-effects in numerous buckets, the harm is made to seem less).

In 2016, the harmful use of alcohol resulted in some 3 million deaths (5.3% of all deaths) worldwide and 132.6 million disability-adjusted life years (DALYs) – i.e. 5.1% of all DALYs in that year. Mortality resulting from alcohol consumption is higher than that caused by diseases such as tuberculosis, HIV/AIDS and diabetes. Among men in 2016, an estimated 2.3 million deaths and 106.5 million DALYs were attributable to the consumption of alcohol. Women experienced 0.7 million deaths and 26.1 million DALYs attributable to alcohol consumption.

Autism breakthrough?

Studies: Autism risk linked to herpes infection during early pregnancy

NEW YORK - Scientists from Colombia University and the Norwegian Institute of Public Heath have discovered that women actively infected with genital herpes during early pregnancy was twice as likely to have a child diagnosed with autism spectrum disorder (ASD) later on in life.

 Alarmingly:

About one in five American women has HSV-2, also known as genital herpes. HSV-2 is a highly contagious and lifelong infection, usually spread through sex.

More here:

The finding mirrors earlier epidemiological data indicating that activation of the maternal immune system during early-to-mid-pregnancy is associated with long-term developmental and behavioral problems in offspring.

However, of these pathogens examined : Toxoplasma gondii, rubella virus, cytomegalovirus, and herpes simplex viruses type 1 and 2, only herpes simplex virus type 2 was implicated.

“The cause or causes of most cases of autism are unknown,” says senior author W. Ian Lipkin, director of the Center for Infection and Immunity and the John Snow Professor of Epidemiology at Columbia’s Mailman School. “But evidence suggests a role for both genetic and environmental factors. Our work suggests that inflammation and immune activation may contribute to risk. Herpes simplex virus 2 could be one of any number of infectious agents involved.”

Just how bad for us is sugar?

In his talk, "Sugar: The Bitter Truth", Robert H. Lustig, MD, UCSF Professor of Pediatrics in the Division of Endocrinology, goes on a jihad against sugar. What to make of it?

Lustig argues that fructose and ethanol are two carbohydrates in a class of their own. The metabolism of these two involves products that are not exactly good for the liver. Moreover, these are chronic toxins, the damage starts showing only after a thousand meals. The results are obesity, diabetes and heart disease. (Perhaps cancer, too.)

The only safe form of fructose is in fruits where it comes in relatively small quantities along with fiber, which slows down its absorption, and along with other nutrients whose benefits outweigh any harm from fructose. Fruit juice is a no-no. Sugar and high-fructose corn syrup are both equally bad.

Less convincing is Lustig's arguments about how fructose, which unlike glucose and other carbohydrates doesn't cause the body to send satiety signals, causes overeating. The simple reason is that in the cases where you overdose on fructose, you get an equal amount of glucose, which presumably will make you feel full.

Alan Aragon has a detailed criticism of Lustig's ideas, "The bitter truth about fructose alarmism".

Gary Taubes, in the NYT (April 13, 2011), agrees with Lustig.