Gyroscopic Investing

http://www.theatlantic.com/health/archi ... ow/258872/#


The chart ranks the top ten causes of death for each year. In addition to the remarkable decline in mortality overall, it's also noticeable how heart disease and cancer have surged to become two of America's top killers. In 1900, cancer and heart disease accounted for 18 percent of all deaths. Today, that figure's jumped to 63 percent. In addition to being responsible for a greater share of deaths overall, the absolute number of people being killed by these chronic conditions has also grown, from 201 people out of every 100,000 in 1900 to nearly 380 per 100,000 today.

Part of the increase can be traced to our increasingly sedentary lifestyles. But we shouldn't forget that vaccines, regular screenings, and other advances in medicine have drastically reduced the incidence of other ailments that once sealed many an American's fate. The way we've chopped up and redefined some conditions has also changed the country's death profile. There's the seemingly endless "discovery" of new diseases. And it's worth pointing out that the rise of cancer and heart disease, as illnesses that generally affect people late in life, are themselves an indicator of improvements in a society's overall health. The fact that more people are living long enough to be diagnosed with cancer says something about how far we've come.

The original study was released here...

http://www.nejm.org/doi/full/10.1056/NEJMp1113569

The 1900 bar graph highlighting "Heart Disease" is a bit misleading. If you read the original NEJM article, it says...

[During the early 1900s] doctors struggled with cancer, eclampsia, impotence, heart disease (chiefly infectious or valvular rather than atherosclerotic), and arthritis.

During the 20th century, heart disease, cancer, and other chronic conditions assumed more dominant roles (see bar graph),
Source: http://www.nejm.org/doi/pdf/10.1056/NEJMp1113569

So, the "Heart Disease" that killed people back then was actually fairly different from the "Heart Disease" that kills us now. Modern heart disease is overwhelmingly atherosclerotic. Atherosclerotic heart disease was rare in 1900.

This week, SITTING too long appears to be back in the grim reaper news items.

Also... the study uses "Life Expectancy at Birth" to compare the prevalence of age-related illnesses between 1900 and 2010. Infant/childhood mortality has declined considerably since 1900, so "Life Expectancy at Birth" is a fairly useless indicator for comparing the real lifespan of adults between 1900 and 2010. And the infant/child mortality data appears to be missing from 1900 — likely a problem unreliable record-keeping back then.

For instance, the author of the Atlantic article says..

And it's worth pointing out that the rise of cancer and heart disease, as illnesses that generally affect people late in life, are themselves an indicator of improvements in a society's overall health. The fact that more people are living long enough to be diagnosed with cancer says something about how far we've come.

...But this is misconstruing the facts. In other words, if more infants died at age "0" in 1900 than 2010, then that would skew the overall life-expectancy data in a very big way. If the study had looked at life spans of adults who lived to age 50, the change in lifespans between 1900 and 2010 would be much less. The average adult who to the age of 50 in 1900 could expect to live well into their late 60s and early 70s. And that's on average. Many adults in 1900 lived into their 80s and 90s. Most people can prove this by looking at their own family tree going back a few 100 years.

So, despite the misconstruing of the facts, the study actually gives us plenty of data to see how much chronic age-related disease was affecting the adult population in 1900.

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Many causes of death since 1900 have been virtually eliminated (re: diarrhea, infections) so before you conclude that heart disease and cancer are more prevalent it seems to me you would have to know how many of those who died from causes which would be non-fatal today would have died from heart disease and cancer if they had lived long enough.

jackh wrote: Many causes of death since 1900 have been virtually eliminated (re: diarrhea, infections) so before you conclude that heart disease and cancer are more prevalent it seems to me you would have to know how many of those who died from causes which would be non-fatal today would have died from heart disease and cancer if they had lived long enough.

Not so. The historical record says otherwise.

MG's graph shows us that those who were 60 years old in 1900 were on average likely to live to 75 years of age. In other words, many 60 year-olds went on to die before age 75 and just as many lived into their 80s and 90s. If you look up genealogical data for families going back to the 1600s, you typically see that those who lived past the age of 60 on average lived into their 70s. You can actually do this with your own family tree. Additionally, the Founding Fathers (i.e. the 1787 delegates) lived to an average age of 67 — the oldest living to 94. They exhibited typical life spans for the time.

http://en.wikipedia.org/wiki/Founding_F ... amily_life

So, there's plenty of data on "old people" going back a millennia. But, there is no historical record that indicates many old succumbed to heart disease or cancer. Those diseases were quite rare — even amongst old people. Heart attacks (i.e. Myocardial Infarctions) were extremely rare before 1920. By 1930, Myocardial Infarctions caused about 3,000 deaths in America. Today, MI's cause more than 500,000 deaths in America each year.

Before 1920 coronary heart disease was rare in America; so rare that when a young internist named Paul Dudley White introduced the German electrocardiograph to his colleagues at Harvard University, they advised him to concentrate on a more profitable branch of medicine. The new machine revealed the presence of arterial blockages, thus permitting early diagnosis of coronary heart disease. But in those days clogged arteries were a medical rarity, and White had to search for patients who could benefit from his new technology. During the next forty years, however, the incidence of coronary heart disease rose dramatically, so much so that by the mid fifties heart disease was the leading cause of death among Americans. Today heart disease causes at least 40% of all US deaths
Source: Mary P. Enig, PhD

Paul Dudley White was appointed White House physician after Eisenhower's first heart attack. In a 1956 television interview to raise funds for the American Heart Association televised, Paul Dudley White said: "I began my practice as a cardiologist in 1921 and I never saw a myocardial infraction patient until 1928."

So, unfortunately, the historical record clearly shows that arteriosclerosis and heart attacks have skyrocketed since 1900.

More evidence that Myocardial Infarctions (heart attacks) are a new phenomenon. Here's a chart of the incidences of the phrase "myocardial infarction" and "heart attack" in books since 1800 (courtesy of Google's Ngram viewer):



It's not like people suddenly became old during the 1900s. There were plenty of elderly adults before 1900 but hardly any mention of those problems in the historical record.

And here are the mentions of different types of "cancer" compared to myocardial infarctions going back to 1800...



By the way... Google has normalized the data by the number of books published each year. So, the data is not skewed by the fact that book publishing has grown considerably over time. You can learn more about Google's Ngram viewer here.

Gumby wrote: Not so. The historical record says otherwise.

Actually, I have no doubt that our modern lifestyles are contributing to diseases. When my first wife contracted lung cancer I did some serious study on the subject and learned that this disease was virtually unheard of before 1900. Does anyone wonder why?

I'm no medical expert but I get a kick out of observing how statistics and charts are so often used in what seems to me to be a very fallacious way of reasoning and I enjoy being the contrarian. There is rarely a day that goes by in which there is not some news story making the mistake of assuming that correlation = causation without considering all the facts, many of which are often unknowable.

I suspect what you are saying is true but we really don't know what would have been the cause of death for those who died of diseases that would be preventable today do we?

jackh wrote:I'm no medical expert but I get a kick out of observing how statistics and charts are so often used in what seems to me to be a very fallacious way of reasoning and I enjoy being the contrarian. There is rarely a day that goes by in which there is not some news story making the mistake of assuming that correlation = causation without considering all the facts, many of which are often unknowable.

Me too.

jackh wrote:I suspect what you are saying is true but we really don't know what would have been the cause of death for those who died of diseases that would be preventable today do we?

We do from a statistical standpoint. It only takes a small random sample of those who lived past 60 years of age to determine what chronic diseases might have afflicted the entire population. That's how practically all studies are done today. Looking at the historical record — particularly the records and biographies of those who lived the longest — gives us a very good record of what killed elderly people back then. The life spans of the 1787 delegates, mentioned above, is a good example of that.

From a purely personal sample of my relative's deaths early in the last century, I concluded that more of the adults died from pneumonia than any single thing- which seems to match the chart.  Infectious lung related illness and tb as a primary cause of death has certainly declined to a minimal percentage in these modern times. Now, while I'm not a huge fan of conventional western medecine, I have to give it the major credit for changing that statistic. I think it's also fair to point out the obvious- that improvements in medecine and sanitation have made a huge improvement in childhood mortality statistics.  

Gumby wrote: We do from a statistical standpoint. It only takes a small random sample of those who lived past 60 years of age to determine what chronic diseases might have afflicted the entire population. That's how practically all studies are done today. Looking at the historical record — particularly the records and biographies of those who lived the longest — gives us a very good record of what killed elderly people back then. The life spans of the 1787 delegates, mentioned above, is a good example of that.

I still say you have no way of knowing whether those people you are excluding from the control group because they died of diseases which are preventable today would have died from cancer or heart disease. Couldn't it be that the very same factors that made them susceptible to the preventable diseases would have also made them more susceptible to cancer or heart disease if they had lived long enough?  Doesn't seem out of the realm of possibility to me at all.

jackh wrote:I still say you have no way of knowing whether those people you are excluding from the control group because they died of diseases which are preventable today would have died from cancer or heart disease. Couldn't it be that the very same factors that made them susceptible to the preventable diseases would have also made them more susceptible to cancer or heart disease if they had lived long enough?  Doesn't seem out of the realm of possibility to me at all.

It's highly unlikely. "Preventable" diseases are typically infectious and communicable. (And let's not forget that "Accidental" deaths were higher back then too). The "factors" that made people overwhelmingly susceptible to those infectious diseases were typically unsanitary conditions, age, physical contact, lack of vaccines to prevent further contagion, etc. Those exogenous factors have no bearing on what makes someone susceptible to heart disease or cancer.

Furthermore, heart disease and cancer increased at a much faster rate at times during the 20th century than preventable diseases had previously declined. As you can see, from the chart below, preventable diseases typically declined at a steady rate during the 20th century.

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...But heart attacks, arteriosclerotic heart disease and cancer increased dramatically during the 20th century. For instance, here is a chart of the incidence of heart disease and coronary heart disease (CHD) since 1900. Notice how heart disease increased sharply after 1920?...

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If your theory was correct, you would expect to see steady increases in those chronic diseases rather than the sharp increases that actually happened.

It's also worth pointing out that there's plenty of evidence in the historical record of scientists and doctors observing the dramatic rise in arteriosclerosis in the early 1900s — even among the young.

Here's a preface from a book, published in 1908, about Arteriosclerosis:

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[align=center]Source: http://books.google.com/books?id=mL4NAA ... &q&f=false[/align]

And little did anyone know that heart attacks would soon see a dramatic rise after 1920. Remember, heart disease and heart attacks don't just afflict the elderly. They often afflict middle-aged adults. So, it's abundantly clear that arteriosclerosis was increasing rapidly after 1900.

Notice how the author observed the strong "universal habit" of people staying active and exercising, despite the rise in arteriosclerosis.

Those are really good statistics, Gumby!

It looks like transfats or sugar+refined grains correlate well with the increase in the heart attack statistics.  There's even a dip in the 1980's where presumably people started to eat less transfat under guise of lowering their saturated fat or cholesterol intake.  If the trend continues, transfat will have been a stronger contribution to heart attacks than carbohydrates.

It even blows away lung cancer which now known to be batshit insane behavior compared to eating.  The rise in breast and protate cancer is easily explained by environmental xenoestrogens (plastics, pesticides, insecticides, etc.) or contraceptives.

I just question how much of these statistics are from a low starting base of no literature publishing or inadequate diagnostic tools pre-1940.

MachineGhost wrote:It looks like transfats or sugar+refined grains correlate well with the increase in the heart attack statistics.

I think you hit the nail on the head, MG. Check this out (via Google Books)...



Sucrose is "table sugar" — which began to be mass-produced in the late 1800s when its production was increasingly mechanized. You can see that as the word "Sucrose" entered the lexicon, so did "arteriosclerosis".

And here we see the introduction of trans fats in our lexicon (i.e. hydrogenation) matched with the widespread rise in mentions of heart attacks/myocardial infarctions.



Absolutely fascinating.

MachineGhost wrote:I just question how much of these statistics are from a low starting base of no literature publishing or inadequate diagnostic tools pre-1940.

Hard to say for sure. But my digging through Google Books pre 1940 is showing that people were very surprised at the sharp increase in arteriosclerotic cardiovascular disease. It really seemed to come out of nowhere for them. If you go into Google Books and start pulling up books on cardiology from the late 1800s and early 1900s, you see authors pontificating on why new modern cardiovascular problems were increasing so rapidly (as I showed in my previous post). They didn't have very good diagnostic tools, but doctors were constantly dissecting dead bodies like crazy to understand what was happening with arteries and the heart — that's the only way they were able to learn and teach. In their autopsies, they observed more and more hardening of arteries on people who died of completely unrelated causes. If you read through some of the medical literature from that time, it's actually shocking how much they were able to observe back then about the lining of the arteries and the composition of deposits in and around the heart through autopsies. They were aware of the problems, but struggled to determine the causes and solutions. And here we are more than 100 years later...still trying to figure it out.