Regional mortality numbers expose scandalous, demographic bias, the Old South most benighted
In the last year, I learned we do more preventative maintenance on our cars than on our heart health— and the tide won’t turn until a resistant medical industry embraces in-depth, affordable prevention tools. One invisible marker: local clinics take years to incorporate into their basic protocols the best, latest heart research and testing, letting far too much sickness pass under the dam. On top of bureaucratic resistance is erratic, bean-counting insurance coverage, plus public ignorance, apathy and active defiance of expertise. Intensive, medical interventions end up focusing with great expense on disease/death caretaker/hospice models, undervaluing advanced warnings and preventive care systems.
Item: COVID spread, despite safe, breakthrough vaccines, superb advice and quality masks, needlessly killing hundreds of thousands and maximizing long COVID impacts. In its sustained horror, this calamity captures the ordinary operations of a broken health care industry, lurching from crisis to crisis as overwhelmed hospitals put in play strong prevention resources.
A Modest Proposal (I thought)
A year ago, I asked my overtaxed GP to oversee a full assessment of my mild heart issues (high cholesterol responsive to statins). I am facing my final stretch run, and I didn’t know what I didn’t know. I requested a simple, available blood test detailing the size and nature of my LDL (low density lipid) particles. I also requested a no-frills, 15 minute artery scan that exposes where hard calcium deposits exist (as a base diagnostic measurement, looking forward). I hit immediate resistance as my doctor was blocked by clinic (and insurance) protocols in effect told, “You’re not bad enough to justify such tests.” Right, exactly why I wanted scientific input.
What! I had to be worse off to find out how I could be better off. I was handcuffed because I hadn’t more greatly abused my body. That logic exposed why only truly endangered heart disease patients win the backward lottery model at play. That allergy to prevention proved why first heart attacks kill half the ambushed victims (cuts down on prevention, for sure). My doctor doubted that Medicare would cover either test (which it did, and much more). The blood test ($100) and the calcium artery are not unusually expensive (which IMO everyone over 50 should get, anyone remember preventative lung x-rays).
I offered to cover costs but protocol ruled. It took a month of prodding and pushing to overcome hurdles, boosting a modest shortness of breath episode and my past GP’s endorsement. It took my wife (elsewhere) over three months of pressure to get the same approvals (and Medicare paid). First unhappy lesson: Decent physicians are impeded by protocols and insurance fears. Tests ultimately confirmed that my overall risk is less than average, but I gained a key baseline to measure future prospects. No longer flying blind, I have made simple life adjustments, readying for the future. Just like we change our car’s oil for the future.
As with politics, “it’s the system, stupid”
Such unhealthy resistance rules the system, with key players in tragic concert: Big Pharma’s (non healthcare) stock and profit-driven biases; sluggish insurance companies miss the great savings from prevention (vs. expensive, emergency interventions); understaffed clinics and doctors resist updating protocols, wary of liability suits; stirred up by the mixed bag of government policies. The result is that ordinary (pre-heart disease aware) patients, unless they self-educate, indulge in high-risk life (or death) styles: Insufficient exercising, unhealthy eating, obesity and bad sleeping habits—capped by refusing annual testing and expert input. The tragedy is that mortally-threatening heart disease is years in the making, readily open to prevention vs. hard-to-anticipate diseases, like organ cancers, that surface with deadly force, without conspicuous symptoms. Ditto, high blood pressure and diabetes, “silent” killers (unless you look).
Equally important is public obliviousness to the scandalous correlation between mortality rates and geography. Rushing to a good ER or hospital promptly after a heart attack greatly improves odds of not joining the deceased 50% group. For the others, this 2X4 is often the first shocking evidence one has “heart disease,” which then divides the world between the reckless deniers and prudent survivors. The latter go into full prevention mode and live to tell the tale. We’re talking about the top American killer, one in five deaths.
By far the highest heart disease death rates plague the Old Confederacy plus Oklahoma (the very worst state—draw a line from WV to Texas then across to SC). OK suffers more than three times the heart disease deaths than all of Mass. plus the west coast, explained by fewer top facilities, less awareness and more denial (along with high-risk behavior). Here’s a scandalous national fatalities map. Not so curiously, Trumpers dominate these areas, and the large, diverse population precludes simple genetic or tribal explanations. Knowledge and cutting risks produce longer lifespans. Family genes do count for individuals, but rejecting science (as many do fair elections) boomerangs when it comes to heart disease.
I learned an important lesson: being (stubbornly) pro-active is everything. Thanks to extensive research by my brilliant wife (while I was stressing my heart health over politics), our persistence leaped past transparent systemic healthcare obstacles. Medicare serves us well. Those with no or low insurance are doubly punished by citizen-killing states who irrationally refuse federal subsidies. Clearly, many regular clinics are not geared to favor even once-a-lifetime full risk assessments, thus denying patients critical personal information and the life blueprint I eventually unearthed by going outside the clinic. I objected to enduring a heart attack (or stroke) to discover readily fixable problems.
So I started hunting my options, talked to friends, and found exactly what I needed: a local, “functional medicine” physician who had departed the restrictive clinic world to do in-depth, analytic, body-wide, preventative medicine. A refinement of scientific, western medicine, “functional medicine” doctors address holistic body (and mind) dynamics: how systems interact, how organs, blood chemistry and the all-important gut realms work in harmony when health reigns (disease reflecting discontinuity). In the big picture, family disease history and life-style come into play, plus sleep patterns, exercise, stress, even oral gum health (talk about a direct line into the blood system).
What my decent GP and clinic could not assess—where does my aging (but fairly healthy) heart and support organs fit into my overall life map and choices?—I found elsewhere. While my functional doctor’s high expertise was not covered by Medicare, nearly all of her many added tests were, and the total lab outlay was reasonable. Further, what this dedicated healer charged for her time (some pro bono) did not break the bank—and her relevant learning curve is advanced by certification by a top heart disease program; see the heart health books of Bale and Doneen).
By any prudent measure, if I live a healthier, less anxious, with no emergency-rush-to-the-ER episodes, this risk assessment outlay is a bargain. Peace of mind (from relative healthfulness supported by a customized blueprint) delivers obvious “savings” galore. And miracle to behold, were I to breathe easier for two or five or ten years (beyond my otherwise fated lifespan), what price for that?
What this seeker of knowledge needed is what I found: a smart, responsive, detail-oriented “personal” physician ready to commit the time needed. That’s the ultimate lesson learned from this adventure, only taking 76 years to get wide awake. One’s never too old to learn humility—or appreciate how a “functional” paradigm focuses on available medical evaluations that show how to live longer and in better shape. In fact, modest life changes have awarded more energy (less fatigue and brain fog), making me even more cheerful than before. That happens when one is more serene about facing inevitable breakdowns. Now I can release fears about a heart attack and return to fret about looming political disasters. Hey, I describe better health care, not world repair care.
General considerations: assess family longevity (mainly direct lineages) to learn vulnerabilities, keep weight moderate, eat healthy without tons of salt, sugar, or junk food, do regular exercise (and get slightly out of breath). Learn about heart attack cues: shortness of break, heart arrhythmia, upper body and arm pain, nausea or general fatigue. Statistics confirm direct links of heart disease with diabetes, obesity, smoking, high alcohol intake, high stress, inactivity—and whatever you never know by not getting annual lab checks (blood pressure, cholesterol rates, insulin/blood sugar). And press to do an overall risk assessment before you die.
Need any more incentive to “know thyself” and your health status? My finale is an eye-opening CDC summary of death statistics, firmly signaling what’s not yet happening as both systemic reforms and greater basic knowledge will save inestimable lives. Just like with COVID or other preventable diseases. Dying is inevitable, but so is wisely managing one’s ultimate blessing—being alive and in good shape and willing to learn what you don’t know.
- Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States.
- One person dies every 34 seconds in the United States from cardiovascular disease.
- About 697,000 people in the United States died from heart disease in 2020—that’s 1 in every 5 deaths.
- Heart disease cost the United States about $229 billion each year from 2017 to 2018.3 This includes the cost of healthcare services, medicines, and lost productivity due to death.
Coronary Artery Disease
- Coronary heart disease is the most common type of heart disease, killing 382,820 people in 2020.
- About 20.1 million adults age 20 and older have CAD (about 7.2%).
- In 2020, about 2 in 10 deaths from CAD happen in adults less than 65 years old.
- Every year, about 805,000 people in the United States have a heart attack.Of these,
- 605,000 are a first heart attack,
- 200,000 happen to people who have already had a heart attack,
- About 1 in 5 heart attacks are silent—the damage is done, but the person is not aware of it.