The average American is a psycho

About being a doctor in America

The state examination was passed in 2007, and not only the question of the subject, but also that of the place of work had to be answered. After trying the internship in France and Germany, it went to Minneapolis in 2009. It writes Dr. Peter Niemann about his training as an internist (and the time afterwards) and about the everyday, but also bizarre, life of a doctor in the USA.

Declining life expectancy in the US

About being a doctor in America

Friday 13th December 2019

Many American scientists are like me: The subject of the average life expectancy that has been falling in the USA for years has left us indifferent. The numbers for 2018 are still pending, but many experts already know that a U-turn will be very difficult, because a development that has been going on for years cannot simply be reversed.

But let me first briefly describe the facts: The United States of America is a highly developed country, in fact one of the richest on earth. Like many other countries in the West, they experienced almost uninterrupted economic and demographic growth after the Second World War and, as a result, a steady improvement in the health of their population.

While the average life expectancy was 69.9 years in 1959, this value rose almost continuously to 79.1 in 2014. But then what happened to my colleagues and me for years: The average life expectancy fell in the following years, from 78.9 (2015) to 78.7 years of life (2016) and now the currently available value of 78, 6 of 2017. We will only know whether this trend will be broken when the health authority CDC 2020 publishes its figures for 2018.

Of course, a decrease in life expectancy is not an isolated phenomenon from an international perspective. For example, in 2015 there were several western countries, including Germany, that experienced a decline in the observed lifespan of their citizens. But in contrast to the American figures, these are - so far? - not yet multi-year trends but individual phenomena.

Scientists are looking for explanations, and that's why there are always detailed and therefore readable analyzes on this topic. For example, at the end of 2019 a publication on this caused high waves both medically and in the media, and I refer to it for those interested: Woolf SH, Schoomaker H. JAMA 2019. 2756187. It is worth picking out a few main ideas in order to better understand how this trend is reflected in detail.

First, it is mainly the younger and middle-aged (i.e. 25 to 64-year-olds) men who are most affected by premature death. Second, this is due to a strong increase in drug and (mostly legally prescribed) opiate deaths, as well as a significant increase in the suicide rate and obesity, alcohol and hypertension-related diseases.

Third, women are also affected by this phenomenon, but to a lesser extent. Fourth, it is above all the lower socio-economic classes, i.e. those who have not studied, who are affected. It must be mentioned here that the majority of all professions in the USA, including electricians, nurses and car mechanics, are often taught at universities, so one should rather compare the American men of the lower classes with those in German-speaking countries who have none or who have dropped out Have training.

Fifthly, there are regional differences and here, in particular, certain regions of the East and the Eastern Midwest are affected by the sharp increase in health problems. The states of New Hampshire, Maine and Vermont in the northeast of the USA, as well as West Virginia, Ohio, Indiana and Kentucky are particularly noteworthy. Anyone who is familiar with the USA knows that many of these regions are left behind.

Sixth, many of these phenomena (obesity, increases in drug and opiate use, high blood pressure, and increases in suicide rates) can be found in many other countries outside of the United States. This is very worrying for me. In the end, I have a very bad feeling about these numbers. What can we as doctors do against this trend? Will it continue? Are similar developments to be expected in the German-speaking countries and especially Germany, which is behind Austria, Luxembourg and Switzerland in many indicators?

Declining life expectancy in the US