Category Archives: Drugs

Anne Case and Angus Deacon: Deaths of Despair

Dr. Sanjay Gupta for his HBO special and Nicholas Kristof and Cheryl WuDunn for the New York Times, all interviewed Anne Case and her husband Angus Deacon. Both of them are economists from Princeton University but we won’t hold that against them. As she said, “Whites are reporting poorer and poorer health, more and more pain, and more and more social isolation. More depression. Along with this increase in mortality from drugs, alcohol, suicide there is just a lot more morbidity, pain, and social isolation.” Anne Case came up with the expression “deaths of despair” and it has become very popular.

Anne Case and Angus Deaton, conducted an important study of mortality and wrote the book, Mortality and Morbidity in the 21st Century. Dr. Gupta interviewed them for the television show. In that book they described “deaths of despair” as “death by drugs, alcohol and suicide.” According to them, so many people have died from deaths of despair to equal all the people who have died of AIDs since the beginning of the AIDs crisis. Those deaths were enough to cause life expectancy to fall first for whites and then for the entire population. That is a very unusual event.

These people were the children of the people that won the world war and were expected to live glorious lives in the land of the free and the brave. The parents expected their children to do even better than they did. Those expectations were often not met. As Deaton put it, “They were promised the earth but they did not inherit it.” Case said, “in every state but 2, cirrhosis of the liver and alcoholic liver disease went up. And in every state drug poisoning went up. In every state between 1999 and 2015 suicide rates went up for people aged 22 to 64. If you treat people in a really shabby way for long enough bad things happen to them. That happened to African Americans forever and it started to happen to whites with a High School degree or less, starting probably in the mid-seventies. And now bad things are happening to both of those groups.

Dr. Gupta that if we wanted to know the effects of economic decline all we had to do was visit the American Rust Belt.  There they produced more steel than the rest of the world put together. 24 hours a day, 7 days a week smog from those plants went into the atmosphere of American cities.

Swissvale Pennsylvania , according to Eric Horgos, is the valley that is  “the epicenter of the greatest industrial collapse in the entire developed world in the 1980s. 1983 is when economic Armageddon hit them.”

Is it surprising that people who lived a certain way that they liked for 30 years and then had the rug pulled out from under them wanted to commit suicide? Is it any wonder they turned to alcohol or drugs? Is it any wonder that they despaired? Is it any wonder that they gave up on politicians that that they had once respected, and then turned instead to a demagogue?

Constant Change


Americans, like Canadians, are living in a world that is changing faster than ever before. And that is change is constant. As a friend of mine always says, ‘Change is the only constant”.  And such constant change can be stressful.

There are all kinds of health problems out there. I know some of them too personally for my taste. People are obese.  It is astonishing how obese people are in the richest nation on earth. In Arizona where I spend a lot of time in recent years, we see it all the time. People have heart conditions. They have cancers. Yet, there is something harder to define. What Dr. Sanjay Gupta called the “real state of stress” in his HBO special.

And everyone wants a pill to solve their health problems. People want quick solutions to their problems. So do I of course. Americans take more drugs than the people of any other country on earth. And Canada is not far behind. Those drugs served a really useful purpose. They can save lives. They can ease pain. Yet, as Dr. Gupta pointed out, in the US  “50 people die every day from prescription pain killers!

Shown on Dr. Gupta’s special, Angela Glass was a mother in Victoria Texas. She knew that stress can be ugly. It can cause issues in every area of your life. Wherever you already have problems, stress can make them worse. Stress compounds the problem. Angela was prescribed a huge cocktail of drugs every day for her stress. She took pain medication–hydrocodone. She took other drugs for anxiety.  Things got worse. She lost a child. She took way more drugs than she was supposed to. She had suicidal thoughts. She considered taking all her pills and ending the pain once and for all. She couldn’t sleep. She was haunted. How many Americans and Canadians have been led down this path to drug dependence? How many Americans and Canadians have died as a result? In one year more Americans died from drug over doses than died in the entire Vietnam War! Since that happened in the United States, it has happened again!


Dr. Gupta believes that all this chronic stress, the pain which comes with the stress, and the desire to make that pain go away have combined to create a toxic brew that is destroying America and Canada. Many take medications even when they know it could take their lives.

This is dangerous stuff.

Chronic Stress


As Dr. Sajay Gupta pointed out on his HBO documentary, in the United States, the self-proclaimed leader of the Free World,  “we are 4.7% of the world’s population and take 80 to 90% of the world’s OxyContin and hydrocodone. And I’m pretty sure that we don’t have 80-90% of the world’s pain.” Another thing is that epidemic of drugs is mostly affecting whites aged 35 to 55. Stress should be listed as a contributing cause to many deaths. Why whites?

Stress of course is a natural phenomenon.  As Robert Sapolsky, a neuroscientist from Stanford University said,

” When you look at the stress hormones we secrete exactly the same chemicals as a lizard and a fish and a bird. This is ancient, ancient biology. For 99% of the beasts out there what stress is about is 3 minutes of some screaming crisis when somebody is very intent on eating you or you are very intent on eating somebody, and everything your body does at that time makes perfect sense. You increase your heart rate, your blood pressure, your breathing rate, you turn off everything that is not essential and you shut down growth, tissue repair. When a lion is chasing you and you are running for your life and one of the things you are doing is all sorts of metabolic stuff to divert energy to your thigh muscles. Oh my god you think you only have 3 months until your taxes are due and you divert energy to your thigh muscles. That makes no sense whatsoever and that’s where you pay the price.”


Robert Sapolsky who wrote a book Why Zebras Don’t Get Ulcers points out that when a lion is chasing a zebra it needs stress to get away. Stress is entirely good in that situation. Yet once the zebra gets away the stress level returns to normal. That also happens quite quickly. Life is good again. The zebra relaxes. The stress was entirely good.  It saved the zebra’s lie.

As Dr. Gupta said, “Stress is not the enemy. It’s the constant never-ending toxic stress–that’s the stress that’ll kill you.” Chronic stress in other words is what we should be stressed out about. Sapolsky says he has learned a lot about stress from the baboon world. What he learned is “What makes psychological stress really corrosive is lack of control, lack of predictability, lack of social support. If you are chronically stressed you will chronically increase your blood pressure and you are going to get more liquid turbulence into your blood vessels and hit the walls. They pound the walls and they cause microscopic bits of scarring, tearing, and inflammation there. And you get plaques and you get the whole cascade there. It’s a fairly straight biological line from chronic stress to your blood pressure that is chronically elevated. It’s a much more indirect route to liver sclerosis.”

Sapolsky was convinced that stress is the common cause of liver sclerosis, suicides, and opioid overdose.  They are all related. Stress is the root problem, he is convinced. “Our lives are more psychologically corroded by stress. Stress: am I valued? Stress: do I have a meaningful place in the community? Stress: is there even a community I can rely upon. Stress: why am I here?” Note all these questions point to social issues.


Social Cancer


Nicholas Kristof and Sheryl WuDunn writing in the New York Times in 2020 said there was “a cancer growing at the heart of the nation.” They meant the USA of course, but really as Jonathan Haidt showed it goes much wider than that. I clearly includes Canada and other countries such as the UK and Australia.

It is that social “cancer” that I want to look at. To do that, I must find it. That may not be easy.

Kristof and WuDunn have a suggestion of where to look:

We have deep structural problems that have been a half century in the making, under both political parties, and that are often transmitted from generation to generation. Only in America has life expectancy now fallen three years in a row, for the first time in a century, because of “deaths of despair.” [They wrote this in 2020]


I had heard that expression before. I think it was another physician, Dr. Sanjay Gupta. Dr. Gupta is both a physician and a television medical analyst. He had some very interesting things to say on a fascinating television documentary.


The trigger for Dr. Gupta’s documentary  was another startling fact that as far as I was concerned had gone under the radar. As he said, “In the 1960s Americans had among the highest life expectancy in the world. Today [2019] the U.S. ranks at the bottom of major developed nations.”

In that documentary, Dr. Gupta interviewed another physician a forensic pathologist Dr. Cyril Wecht, in Greenburg Pennsylvania, who said “the previous year I did 356 autopsies. Of those more than 300 were drug deaths. And this is what is being experienced throughout the country.” He also said, “this is far greater than what we experienced with AIDs. It is a very significant epidemic of monstrous proportions.” As Dr. Sanjay Gupta said, “what we are dealing with in fentanyl is 50 times stronger than heroin.” Drugs are part of the problem, but I actually think they are more a symptom than the cause. I will post more about this in the future. It is a fascinating issue.

As Dr. Gupta said, “In the United States life expectancy is dropping faster than any other demographic in the world.” According to the Center for Disease Control, “Middle-aged whites are the highest increase in the deaths of despair.” This group also has very high rates of drug overdose. Whites?  Who would have thought that?

What is going on here? That is what we must figure out. What is the cancer at the heart of the United States and Canada?