Sign Of The Times

Because of course.

Trump told the Dirty Fuels Cartel that if they "donated" a billion dollars to his "campaign", he'd make sure they got to do whatever they wanted.

Now apparently, he's made the same kinda deal with the Pro Lung Disease Consortium.

Why Big Tobacco is betting on Trump

As the industry fights a ban on menthol cigarettes, a Reynolds American subsidiary has become the largest corporate donor to the main pro-Trump super PAC.

America’s top tobacco regulator was on a work trip in the Netherlands in September 2019 when he got wind of President Donald Trump’s plan to take abrupt action on vaping, the booming business offering a substitute for smokers but presenting hazards of its own.

“This was coming out of left field,” said Mitch Zeller, at the time the director of the Food and Drug Administration’s tobacco center.

Zeller supported the plan Trump put forward the next day in the Oval Office: removing mouthwatering flavors, such as mango and mint, that were making e-cigarettes so popular with teenagers. But he feared that Trump’s hasty rollout would doom the effort, he said in a recent interview.

Indeed, Trump soon shelved the proposal amid pressure from lobbyists and political advisers who warned the move could endanger his 2020 reelection campaign because of the popularity of vaping, the heating of nicotine to make an inhaled aerosol.

Four years later, the tobacco industry is banking on Trump’s chaotic approach to public health — and pliable views on policy — as it confronts a new challenge to its bottom line: efforts by regulators in the Biden administration to ban menthol cigarettes, which represent 36 percent of the cigarette market.

The top corporate donor to the main pro-Trump super PAC is a subsidiary of Reynolds American, the second-largest tobacco company in the United States and the maker of Newports, the No. 1 menthol brand in the country. The subsidiary, RAI Services Company, has given $8.5 million to the super PAC, called Make America Great Again Inc., federal records show. The company does not appear to have contributed money to groups backing Vice President Kamala Harris, the Democratic presidential nominee.

Big Tobacco’s bet on Trump shows how corporate interests believe the former president can be swayed by campaign donations — and brought into line even on issues where he has shown some independence from GOP orthodoxy, said former U.S. officials and industry lobbyists. The contributions represent a muscular move by the company into presidential politics. A Reynolds PAC funded by employee contributions donated just $25,000 to a Trump campaign committee in 2016, and the company contributed $1 million to Trump’s inauguration in 2017. These entities do not appear to have made contributions in the presidential race in 2020. A Reynolds representative did not respond to detailed questions about the company’s political giving or its interactions with Trump.

Over the past three decades, political contributions by the industry have declined, especially at the federal level, as companies focused their efforts on state and local controversies over higher cigarette taxes and smoking prevention. Reynolds’s major pro-Trump move bucks that trend.

Brian Ballard, a prominent Trump-aligned lobbyist whose firm has represented Reynolds since 2017, suggested the company make the donations, according to a person familiar with the activity. Reynolds executives have met with Trump on multiple occasions in 2023 and 2024, including a lengthy meeting earlier this year in New York where they emphasized their concerns about a menthol ban, said the person, who, like some others interviewed for this story, spoke on the condition of anonymity to reveal sensitive details. The executives also raised other subjects with the former president, especially counterfeit vaping pens they said were flooding in from China through the Port of Los Angeles and cutting into their profits. Ballard did not respond to an email seeking comment.

Former company employees and lobbyists, as well as former Trump aides, said Reynolds sees Trump as its best hope of achieving a range of objectives, including fending off a proposed ban on menthol cigarettes, which is in limbo. The Biden administration has delayed a final decision after political advisers warned the president that it could cost him votes among Black smokers who studies show favor the products. The delay may give Trump authority over the ultimate policy if he returns to the White House.

The issue is now a thorny one for Harris. She has previously supported efforts to limit the products, though her campaign did not respond to questions about her current position. A Trump spokesman also did not respond to questions about his view. Conservatives believe the issue can be used to erode Black support for Harris: A Republican-aligned group is spearheading a $10 million ad campaign tying her to the administration’s proposed ban.

The advertising blitz is a further illustration of the political significance of Big Tobacco and its causes this November. The industry’s influence could carry over into policymaking next year.

Stephanie Grisham, who witnessed the back-and-forth over tobacco regulation as an aide to both Trump and his wife, Melania, said the GOP standard-bearer will see the Reynolds donations as a sign of “loyalty” and look to return the favor if elected.

“It would absolutely weigh on his thinking,” said Grisham, who has publicly disavowed Trump.

‘Bully him’

Trump is no fan of smoking.

“I tell people, ‘No drugs, no drinking, no cigarettes,’” he said in a podcast interview last month.

For years, he has expressed revulsion for the habit. “I watch people smoke; it looks terrible to me,” Trump said on the campaign trail in 2015. “It’s terrible.”

When he was elected, the teetotaling, cigarette-averse president seemed like a natural ally for antismoking advocates. In 2017, Trump’s FDA commissioner, Scott Gottlieb, put forward a comprehensive tobacco strategy calling for reduced nicotine levels in cigarettes.

A year later, health officials received alarming new data that focused their attention on e-cigarettes. Vaping by minors was skyrocketing, driven by the popularity of products offered by Juul Labs that came with a range of flavors, such as mango and menthol. In 2018, Gottlieb labeled teen vaping an “epidemic” and proposed ways of curbing flavored e-cigarettes, saying he wanted to ban menthol cigarettes and flavored cigars as well.

The issue caught the attention of Kellyanne Conway, senior counselor to the president and Trump’s onetime campaign manager, according to Grisham, Trump’s press secretary at the time and also an aide to the first lady.

According to Grisham, Conway brought her concerns about flavored e-cigarettes to Melania Trump, knowing the first lady wanted to work on issues involving children.

“She knew Mrs. Trump would be able to influence her husband,” Grisham said.

Conway said she never favored banning flavors but “protecting kids,” including a proposal to raise the age to 21 for e-cigarette sales and other tobacco products, which Trump signed into law in December 2019. Conway said she doesn’t favor prohibiting products including vapes and menthol cigarettes, adding, “The Democrats are the party of bans.”

But when Trump gathered his top health officials in the Oval Office in September 2019 to act on the issue of teenage vaping at the urging of his wife and Conway, senior officials framed their action as a sweeping ban. Alex Azar, the health secretary, said the aim was to “clear the market” of flavored e-cigarettes, including mint and menthol, allowing the products to be sold only once they gained formal approval from federal regulators.

Zeller, the top tobacco regulator, who was in the Netherlands when the hasty meeting was called back in Washington, said he believed right away that Trump’s approach was a mistake. His staff hadn’t drafted anything, Zeller said; they weren’t prepared with regulations or policies to make good on the announcement.

“I knew there would be a vacuum in the aftermath of the announcement that would be filled by all those who oppose a flavor ban, creating a political nightmare for the White House,” said Zeller, who is now retired from government and advising a pharmaceutical start-up developing technology to treat tobacco dependence.

Within two months, Zeller’s prediction had come to pass. As health officials readied plans to take most flavors off the market, Trump’s campaign advisers presented him with data showing that vaping was popular among his supporters. On Nov. 4, the day before a planned news conference to launch the decisive action, Trump balked, refusing to approve a one-page memo advancing the policy.

Conway was frustrated, as was the first lady, recalled Grisham, though she said Melania Trump understood how her husband would view the matter. “I think Mrs. Trump threw up her hands because she knew that if anything was going to impact a potential second term, he wasn’t going to do it.”

A Trump spokesman did not respond to questions about the former first lady.

Looking back, Grisham added, the policy was bound to fail because of the chaotic way it came about.

“We rarely did things through a process with agencies as you should,” she said. “So this was more of, ‘Let’s get him in a room, let’s convince him or bully him with his wife there, let’s get him to say yes and say it publicly.’”

Early the following year, the Trump administration moved forward with a scaled-back plan to limit flavored e-cigarettes, notably exempting the popular menthol flavor from the regulation. Public health groups were incensed. The American Lung Association said the lack of more decisive action would “compromise the health of our nation’s children.”

Alienating the base

Public health experts turned their hopes to Joe Biden, who had emerged as a major advocate for cancer prevention in the waning days of the Obama administration.

“If I could be anything, I would have wanted to have been the president that ended cancer, because it’s possible,” Biden said in October 2015, as he announced that he would not seek the presidency that cycle while grieving his son Beau’s death from brain cancer.

Biden oversaw the Obama administration’s cancer moonshot and, after leaving office, stood up his own cancer initiative in 2017, in which he repeatedly warned about the risks of smoking. Biden also signaled that fighting cancer would be a presidential priority, vowing on the 2020 campaign trail to renew his efforts to address the disease.

“Once we beat covid, we’re going to do everything we can to end cancer as we know it,” Biden said in February 2021, several weeks after taking office. Two months later, federal regulators announced their intention to ban menthol products, and, in April 2022, the FDA released its proposed rule.

The political sensitivities of banning menthol were immediately apparent, with some Black lawmakers and advocates saying it represented an unfair crackdown on products favored by the Black community. White House aides, meanwhile, stressed that Biden was deferring to public health experts, as the administration asserted that the planned ban could prevent as many as 654,000 deaths in the United States — including as many as 238,000 among African Americans — over the next 40 years.

Menthol, a chemical found in mint plants that can also be made in a lab, provides a cooling sensation when added to cigarettes, making smoking less harsh. A study based on Canada’s experience outlawing menthol cigarettes in 2017 concluded that a similar ban in the United States would lead 1.3 million Americans to quit smoking and save hundreds of thousands of lives.

According to two current U.S. officials and one former senior official, Biden had support for his cancer efforts inside the White House from Harris, the daughter of a cancer researcher, who as a senator had signed a 2018 letter supporting a ban on menthol cigarettes. Fighting cancer “is an issue of personal significance to so many and for me,” Harris said in February 2022 remarks, reflecting on her mother’s death from breast cancer. “You see, after a lifetime working to end cancer, cancer ended my mother’s life.”

The vice president’s office declined to address her position on the menthol ban. A Harris aide said that the issue “is being taken very seriously” but that no decision had been reached.

But as regulators worked to finalize the administration’s menthol rule, warnings of the political blowback became more acute. Cornell Belcher, a Democratic pollster, issued a memo last year arguing that a ban risked alienating Biden’s “base supporters” in the 2024 election, citing his own polling in battleground states. Belcher’s poll and analysis were funded by Altria, a tobacco company. Neither Belcher nor Altria responded to requests for comment.

There has been effectively no progress on the menthol ban over the past year, officials said, with the White House repeatedly missing its self-imposed deadlines to finalize it. In April, Health and Human Services Secretary Xavier Becerra released a terse, two-sentence announcement that the administration needed “significantly more time” to consider debate over the ban. Asked this month about the status of the ban, federal officials referred back to Becerra’s statement.

Even if Biden belatedly moves to finalize the rule, it could now be blocked or rolled back by a newly elected Trump because it requires one year to be fully implemented.

Meanwhile, Harris is already facing well-funded attacks over the administration’s proposed ban.

A memo circulated by a group called Building America’s Future — which is staffed by veterans of Florida Gov. Ron DeSantis’s unsuccessful bid for the Republican presidential nomination — describes menthol as “The Niche Message That Can Reverse Harris’ Consolidation of Black Voters.” The nonprofit is part of an effort to spend $10 million on ads linking her to the stalled rule and targeting Black voters in the battleground states of Arizona, Georgia, Michigan, North Carolina and Wisconsin.

Changing the debate

Black smokers have similarly been at the heart of a lobbying campaign undertaken by Reynolds, according to internal documents obtained by The Washington Post.

One document, marked “confidential,” outlined the “objectives” of the company’s influence efforts. Among them: “Change the debate on menthol in DC.”

Advocates for prohibition say banning menthol would reduce chronic disease and save lives, especially among Black Americans. Reynolds has sought to flip that argument on its head. In another memo circulated to company lobbyists, Reynolds argued that a ban would weaken relations between communities of color and law enforcement. The one-page memo bluntly warns of an “increased likelihood the police will use force on a person of color” if police were required to enforce a ban, which it calls “counter to progressive policing principles.”

The memo includes statements from prominent civil rights activists, including the Rev. Al Sharpton, who is quoted in the memo arguing that any consideration of banning menthol cigarettes must “include a candid discussion about racial disparities and selective prosecution in communities of color.” The National Action Network, which Sharpton founded, has received donations from Reynolds, as both the civil rights leader and the company have acknowledged. They have declined to detail the amount. Sharpton’s organization did not respond to a request for comment.

The company has used a similar argument on Capitol Hill, telling lawmakers that a menthol ban would “create another Eric Garner situation,” said a former Reynolds lobbyist, referring to the 43-year-old Black man killed in 2014 by police after he was stopped on suspicion of illegally selling single cigarettes.

Public health advocates and policymakers have dismissed those arguments as false and inflammatory, noting that the crackdown targets retailers, wholesalers, distributors and other businesses — not individual smokers.

Claims that a menthol ban would lead to abusive policing in Black communities are “unfounded,” 21 attorneys general wrote to Biden in January. “The FDA plainly states that federal authorities will not enforce the proposed menthol ban against individual consumers.”

At the same time, Reynolds has been eyeing what the former lobbyist said the company views as a more potent tool to prevent prohibition of menthol cigarettes: putting Trump back in the White House.

When he was first elected in 2016, Trump wasn’t seen as friendly to the industry, said a former Reynolds executive. “We all knew his profile: doesn’t drink, never smoked,” the former executive said.

The company gave little to his campaign but donated to Trump’s inauguration, which secured executives a spot at a dinner with the newly minted president, said a person who attended. In 2017, Reynolds also put $1.5 million into the pro-Trump nonprofit America First Policies, according to a corporate disclosure.

Though the company has made bipartisan political donations, senior leaders appreciate that Republicans are more lenient with the industry than are Democrats, said a former longtime employee. “The mindset of the organization was, ‘If we can get a conservative leader in place — at the local level, at the state level and at the federal level — it would benefit the industry,’” this person said.

That preference became more pronounced as the Biden administration pursued its menthol ban, said the former lobbyist. The issue is critical for Reynolds: A ban would spoil one of the company’s most significant recent ventures — the acquisition in 2015 of the Lorillard Tobacco Company, which makes the Newport brand of menthol cigarettes.

“The whole reason they bought this company is about to be banned,” said the former lobbyist.

Reynolds executives feel they narrowly escaped a ban under Biden and can’t count on their good fortune should Harris win the presidency, said the former lobbyist and other former employees. They said the aim now is not just to help elect Trump but also to deepen the company’s relationship with him.

Zeller, the former top tobacco regulator, said the company’s plan could work. Trump’s expressed disinterest in the fine points of public policy and the anti-regulatory agenda of the people likely to staff his potential second term would make him “susceptible to outside interests, financial or otherwise,” he argued.

Regulators made modest but surprisingly significant gains in antismoking efforts when Trump was last in the White House, Zeller said. A second Trump term, he predicted, would be different.

“Those days are long gone,” Zeller said.

Hot Air

“It all started with an enquiry from a nurse,” Dr Karl Kruszelnicki told listeners to his science phone-in show on the Triple J radio station in Brisbane. “She wanted to know whether she was contaminating the operating theatre she worked in by quietly farting in the sterile environment during operations, and I realised that I didn't know. But I was determined to find out.”

Dr Kruszelnicki then described the method by which he had established whether human flatus was germ-laden, or merely malodorous. “I contacted Luke Tennent, a microbiologist in Canberra, and together we devised an experiment. He asked a colleague to break wind directly onto two Petri dishes from a distance of 5 centimetres, first fully clothed, then with his trousers down. Then he observed what happened. Overnight, the second Petri dish sprouted visible lumps of two types of bacteria that are usually found only in the gut and on the skin. But the flatus which had passed through clothing caused no bacteria to sprout, which suggests that clothing acts as a filter.

“Our deduction is that the enteric zone in the second Petri dish was caused by the flatus itself, and the splatter ring around that was caused by the sheer velocity of the fart, which blew skin bacteria from the cheeks and blasted it onto the dish. 

It seems, therefore, that flatus can cause infection if the emitter is naked, but not if he or she is clothed. But the results of the experiment should not be considered alarming, because neither type of bacterium is harmful. In fact, they're similar to the ‘friendly’ bacteria found in yoghurt.

“Our final conclusion? Don't fart naked near food. All right, it's not rocket science. But then again, maybe it is?”

🚨 Breaking 🚨

Researches have established a direct link

between kids getting measles

and their parents being dumbass gullible rubes

Live Long And Prosper (?)

Sweat work and raw output are all that matters to the plutocrats.

They don't give half a rat's ass about the labor force because they think they can always go back to the well and bucket up some more suckers to work themselves to death in order to get one more dime to drop to the bottom line on their Monthly Net Revenue Report.

But we are - at once - aging faster and dying sooner. That's a bad combination if you want workers who can show up and last long enough to get good at what you need them to do.

America has a life expectancy crisis. But it’s not a political priority.

The commissioner of the Food and Drug Administration had an urgent message last winter for his colleagues, brandishing data that life expectancy in the United States had fallen again — the biggest two-year decline in a century.

Robert Califf’s warning, summarized by three people with knowledge of the conversations, boiled down to this:

Americans’ life expectancy is going the wrong way. We’re the top health officials in the country. If we don’t fix this, who will?

A year after Califf’s dire warnings, Americans’ life expectancy decline remains a pressing public health problem — but not a political priority.

President Biden has not mentioned it in his remarks, according to a review of public statements; his Republican challengers have scarcely invoked it, either. In a survey of all 100 sitting senators, fewer than half acknowledged it was a public health problem. While recent federal data suggests that life expectancy ticked up in 2022, a partial rebound from the ravages of the coronavirus pandemic, no national strategy exists to reverse a years-long slide that has left the United States trailing peers, such as Canada and Germany, and rivals, such as China.

“I wish that life expectancy or health span were a fundamental political issue in the 2024 presidential campaign,” said Dave A. Chokshi, a physician and public health professor who formerly served as health commissioner of New York. “We’re not living the healthiest lives that we possibly could.”

The Washington Post spoke with more than 100 public health experts, lawmakers and senior health officials, including 29 across the past three presidential administrations, who described the challenges of attempting to turn around the nation’s declining life expectancy. Those challenges include siloed operations that make it hard for public and private-sector officials to coordinate their efforts, a health-care payment system that does not reward preventive care and White House turnover that can interrupt national strategies.

Many suggested the nation needed an effort that would transcend political administrations and inspire decades of commitment, with some comparing the goal of improving life expectancy to the United States’ original moonshot.

“We’re no longer an America that talks about building a national highway system or sending a man to the moon, and yet it’s that kind of reach and ambition that we need to have to tackle the declining longevity problem,” said Sen. Elizabeth Warren (D-Mass.).

Experts, officials and lawmakers acknowledged that a political pledge to reverse the nation’s life expectancy slide could quickly backfire, given the need to focus on long-term goals that might not be reflected in short-term progress reports. A politician attempting to improve life expectancy could be out of office by the time improvements were detected.

“Politicians, in general, haven’t wanted to engage on this because it feels kind of squishy and the solutions don’t seem clear,” said Ashish Jha, the dean of Brown University’s public health school who this year stepped down as the White House’s coordinator of the national covid response.

In an interview, Califf confirmed he’d urged colleagues in “so many” meetings to take action on America’s eroding life expectancy.

The trend is “quite alarming,” the FDA commissioner said, sitting in his office in White Oak, Md., where he oversees the nearly $7 billion agency that regulates drugs, food and other common products used by Americans. “All of the leaders within the [Department of Health and Human Services] I’ve talked with about this.”

White House officials said the president and his team were focused on combating the “drivers” of life expectancy declines, pointing to efforts to reduce drug overdoses, create an office to prevent gun violence and other initiatives. A senior health official in the Biden administration said pledging to improve life expectancy itself “would have to be viewed as something for a legacy.”

“Maybe a second-term priority for Biden,” said the official, who spoke on the condition of anonymity to speak frankly about internal White House operations.

No single reason explains why America’s life expectancy has declined, with chronic disease, poor nutrition, insufficient access to care and political decisions all linked to premature deaths. There also is no single strategy to turn it around — and no agreement on how to do it. Some public health leaders and policymakers have called for sweeping reforms to how the health-care system operates, while others home in on discrete factors such as lethal drug overdoses, which have spiked in recent years and received considerable attention but are not solely responsible for the decline in life expectancy.

The paralysis over how to address the nation’s declining life expectancy extends to Congress, where a handful of lawmakers — mostly Democrats — have repeatedly portrayed the slide as a crisis, but most other lawmakers have said little or nothing.

“We don’t talk about life expectancy, because it just makes it clear what kind of failed system we currently have,” said Sen. Bernie Sanders (I-Vt.), who has repeatedly warned about the rise in premature deaths, including organizing a July 2021 Senate hearing on the issue. Just 11 of the panel’s 18 senators attended, several only briefly; just five asked questions.

“I talk to other senators about life expectancy data and watch their eyes glaze over,” Warren said.

The Post submitted questions about life expectancy to all 100 sitting senators, sending emails, placing calls and making visits to their offices. Forty-eight senators — including 35 Democrats, 11 Republicans and two Independents — said they agreed that declining life expectancy was a problem. Many of those lawmakers pointed to their own legislation intended to combat opioid misuse and address conditions such as cancer and other factors linked to causes of premature death. All told, the 48 senators cited more than 130 separate bills focused on health-care issues.

Despite the flurry of legislation, the nation’s progress on life expectancy has stalled, with the United States increasingly falling behind other nations well before the pandemic. No senator has crafted a bill specifically intended to improve life expectancy or create goals for health leaders to reach.

Lawmakers have also worked at cross purposes, with Republicans fighting Democrats’ efforts to enact legislation linked to gains in life expectancy, including efforts to expand access to health coverage and curb access to guns. Sen. John Neely Kennedy (R-La.), whose state had the third-worst life expectancy in 2020, about 73 years, recently suggested that life expectancy would even go up for young Americans.

“I mean, the life expectancy of the average American right now is about 77 years old. For people who are in their 20s, their life expectancy will probably be 85 to 90,” Kennedy said on “Fox News Sunday” in March. His office did not respond to requests for comment.

Other Republican senators or their staff suggested they did not have a view on the issue because the senator did not sit on a relevant committee.

Sen. Jerry Moran (R-Kan.) has “no jurisdiction over this issue,” his office wrote in response to questions about whether Moran had views on declining life expectancy. Moran, who sits on the Senate panel that determines funding for health agencies, has cast votes on numerous health-care matters, including repeatedly voting to repeal the Affordable Care Act.

In the absence of national solutions, some officials pointed to local efforts such as a new initiative in New York, which has repeatedly pioneered public health improvements later copied across the country. City leaders in November pledged to raise New Yorkers’ life expectancy to a record 83 years, saying a coordinated approach could prevent premature deaths. Ashwin Vasan, the city’s health commissioner, testified in front of the city council, urging members to pass a law requiring the city’s health commissioner — including his successors — to work toward shared public health goals.

“This is a test for government. And I really am hopeful that New York City can pass that test,” Vasan said after his testimony, standing outside New York’s city hall.

‘Further and further behind’

Life expectancy in the United States was once a source of national pride — a reflection of civic improvements, medical advances and other investments that set the nation apart from other countries.

“The future of human longevity, especially for Americans, seems bright indeed,” then-Sen. Larry Craig (R-Idaho) proclaimed at a 2003 congressional hearing, where expert witnesses listed scientific and technological breakthroughs that they expected would soon push U.S. life expectancy past 80 years.

But even the most optimistic expert at the panel warned that America’s prospects could dim. James Vaupel, director of the Max Planck Institute for Demographic Research, urged federal officials to immediately prioritize a “real mystery”: the emerging international gap in life expectancy.

“The United States is doing so well on so many fronts, but it’s falling further and further behind on this critically important [measure], life itself,” Vaupel warned the Senate panel, imploring officials to “really start worrying about this.”

It would take about a decade before Vaupel’s warning was heeded. Policymakers instead were focused on a more urgent political priority related to life expectancy: the growing cost of having so many older Americans seeking services through programs such as Medicare and Social Security.

So when the Obama administration and congressional Democrats hammered out legislation that would become the Affordable Care Act — the sweeping 2010 law that expanded health coverage to millions of Americans and made other changes to the health system — there was little fear life expectancy would decline.

Bob Kocher, a venture capitalist who worked in the Obama White House as a health-care and economic aide, said one reason the crafters of the Affordable Care Act were so intent on “bending the curve” on health spending “was our belief that life expectancy was going to keep going up for the foreseeable future.”

By 2013, public health experts had begun issuing more prominent warnings about life expectancy, pointing to the rising number of opioid overdoses, suicides and other preventable deaths. Senior officials across the Obama, Trump and Biden administrations said they were aware of those concerns but that their focus was on improving discrete factors linked to life expectancy, not on the overall number.

“Every meeting at the VA was about ‘life expectancy,’ but I can’t tell you we put charts on the wall of ‘what’s the life expectancy of a veteran,’” said Robert A. McDonald, secretary of veterans affairs under President Barack Obama.

The nation’s current top health official, Health and Human Services Secretary Xavier Becerra, told The Post he’s acutely aware of the life expectancy decline, calling it the “byproduct of some very serious problems” such as gun violence and drug overdoses. But he downplayed the need for a national strategy, saying there was no reason to declare a public health emergency as he has done with the coronavirus and opioid deaths, adding his agency lacked the power to reverse the trend.

“We are so disjointed as a health system in the country,” Becerra said, suggesting that the responsibility to address life expectancy fell on “many of us,” including state health directors.

While Biden hasn’t directly addressed declining life expectancy, some of his rivals have invoked it on the campaign trail.

“We used to think that life expectancy was just going to keep going up, and that’s just not been the case,” Florida Gov. Ron DeSantis (R) said in a CNBC interview in August, linking the decline to the pandemic, drug overdoses and other causes that began years ago. The DeSantis campaign did not respond to a request for comment about how the Florida governor would reverse the trend if elected president.

“If we had regulatory agencies that were actually interested in looking at data, we would be trying to figure out why the all-cause mortality [for Americans] has increased,” Robert F. Kennedy Jr., running as an independent in the 2024 campaign, said in an interview with The Post this summer. “These aren’t covid deaths.”

Political commentator Matthew Yglesias says America’s life expectancy decline reveals systemic problems that leave the country at risk. (Marvin Joseph/The Washington Post)
Political commentator Matthew Yglesias has repeatedly urged politicians to focus on life expectancy, saying that America’s decline reveals systemic problems that leave the country at risk. “Tackling America’s weirdly short life expectancy should be a priority,” Yglesias wrote in one 2022 post.

Although Yglesias has fans within the Biden administration who have sought his counsel after he has written about traffic safety and crime, his appeals on life expectancy haven’t led to similar invitations.

“I think it winds up being a harder topic for politicians to get their heads around,” he said, noting the array of factors that span agencies and administrations.

Califf said he’s keenly aware of his agency’s limits when confronting life expectancy.

FDA is one of the nation’s most powerful regulatory bodies — its staff often tout that they oversee about 20 cents of every dollar spent by U.S. consumers — and Califf is pursuing initiatives, such as banning menthol cigarettes and improving access to generic drugs, that fall in his agency’s purview. But FDA can’t control how hospitals and doctors get paid. It can’t craft legislation, such as curbing access to firearms.

“The highest cause of death in children is guns. That’s a fact,” Califf said. “That’s not something FDA can do something about.”

‘It’s a hard sell’

In Congress, a handful of members have insisted that lawmakers must focus on life expectancy, saying it’s a core responsibility.

“Sometimes, we may, in the midst of our work, lose sight of the big picture … to create a nation in which the people in the United States can live long, healthy, happy and productive life,” Sanders said at the 2021 Senate hearing he convened on lagging life expectancy.

There is a notable partisan split in how members of Congress view life expectancy and whether they say urgent action is needed. Just 11 of the Senate’s 49 Republicans told The Post they believed that declining life expectancy was a public health problem.

The lawmakers who portray the recent decline as a crisis are often Democrats from states with the highest life expectancy — such as Massachusetts (79 years in 2020, according to federal data) and Vermont (78.8 years). Meanwhile, GOP lawmakers representing some of the states with the lowest life expectancy — Mississippi (71.9 years), West Virginia (72.8 years) and Kentucky (73.5 years) — declined to comment or did not respond to repeated questions about whether the issue represents a public health problem.

“It’s a hard sell with senators who live in some of the lowest longevity states. And it breaks my heart,” Warren said.

A further complication: Senators concerned about declining life expectancy offer radically different prescriptions for fixing it.

Alabama Sen. Tommy Tuberville — one of the few Republicans whose office said he was “deeply concerned about this trend” — linked America’s decline to drug overdoses, suicides and alcoholism.

“The facts show clearly that this is being driven largely by an increase in deaths of despair, with fentanyl overdoses being the leading cause of death for Americans 18 to 45,” Tuberville spokesman Steven Stafford said in a statement, pointing to legislation to improve mental health funding and secure the Southern border.

In comparison, Sanders has repeatedly called for sweeping reforms, insisting in an interview that “a failed health-care system is tied into a corrupt political system dominated by enormously powerful corporate interests.”

Even Democrats in neighboring states offered significantly different diagnoses. In the eyes of Rhode Island Sen. Sheldon Whitehouse (D), the No. 1 cause of America’s life expectancy problem is clear: broken payment incentives for doctors and hospitals.

But Sen. Chris Murphy (D-Conn.) traced the life expectancy decline to loneliness.

“Americans are just much less physically and spiritually healthy than they have been in a long time,” said Murphy, who has proposed a bill to create a White House office of social connection.

Ten senators singled out the burden of chronic disease, echoing The Post’s own review, which found that among people younger than 65, chronic illness erases more than twice as many years of life as all the overdoses, homicides, suicides and car accidents combined.

New York’s state of mind

In New York, officials are trying to put a framework around those often abstract challenges. Vasan urged the City Council in November to support HealthyNYC, his agency’s initiative backed by Mayor Eric Adams (D) that seeks to avert about 7,300 premature deaths by 2030.

“We want New Yorkers to experience more birthdays, weddings and graduations, more holidays and holy days, more life lived,” Vasan told the lawmakers, citing targets for reducing chronic diseases, cancers and other drivers of premature death. Council members are considering legislation to ensure that future leaders stick to the commitments — a suddenly urgent need with Adams embroiled in a fundraising scandal.

“We wanted this to be something that outlives us, that actually helps people,” said Lynn Schulman, chair of the City Council’s health committee.

Vasan and Schulman said HealthyNYC can be a template for other cities — the latest effort in New York’s long history of trying to tackle life expectancy. Under former mayor Mike Bloomberg, the city raised cigarette taxes, banned smoking in workplaces and attempted to limit sale of large sugary drinks. When Bloomberg left office in 2013, New Yorkers’ projected life expectancy was 81.1 years — more than two years longer than the national average — compared with 77.9 years when he took office in 2001.

“If you want to live longer, you could move to New York — or just vote for me,” Bloomberg said in a speech to Democratic voters during his short-lived 2020 presidential campaign. (Public health experts have cautioned that it may take decades to fully understand the link between Bloomberg’s initiatives and longer life expectancy.)

But Bloomberg’s efforts provoked backlash from food-makers, industry groups and some elected officials. Even as New York took steps a decade ago to limit salt and soda consumption, GOP lawmakers in other states crafted legislation to prevent their own local leaders from taking similar steps.

The Bloomberg legacy “is not a torch anyone has really wanted to carry,” said Yglesias, warning that the former mayor’s public heath agenda would be politically difficult to replicate elsewhere. “Conservatives really don’t like it. … I think it’s fallen out of style on the left as well.”

Sanders, who has spent years pushing for sweeping changes to America’s health system and economy, said Washington’s work to boost life expectancy could begin with a simple framing device.

“The administration, the Congress should have upon their wall, a chart which says … ‘What’s our life expectancy now [and] how do we get up to the rest of the world?’” Sanders said. He pointed to Norway’s life expectancy of more than 83 years. “That should be our goal.”

Head Space

I only played 4 years of full contact tackle football (thru high school), and not counting the several times I kinda got my bell rung (on and off the field), my number of actual concussions is likely well under 10.

Whether or not they all might've been real concussions, repeated blows to the head can be a problem, so I surely do worry a little. I'm in my 8th decade now, and I have to wonder if there's some really bad shit waiting for me that will take away what little sense I had in the first place.

Of course, "really bad shit" could be waiting for me no matter what - I just don't like thinking about some kind of increased risk.

Here's a bit of an update via WaPo that tells the story from a slightly different perspective.

They watched their husbands win the Heisman – then lost them to CTE

For years, Heisman weekend was a chance to remember their husband’s glory. Now it’s a reminder of a sport’s violent toll.

Behind the doors of sports’ most exclusive and secretive club is the sight of oil paintings and hardwood, the smell of cigar smoke baked into cushions and walls, the feel of familiar faces and the shuddering reminder of hangovers past.

“'The Heisman flu,'” says Barbara Cassady, whose late husband, Howard “Hopalong” Cassady, was granted lifetime entry into the club in 1955, when the Ohio State halfback was awarded the Heisman Trophy, the annual honor for college football’s most outstanding player. From then on, one weekend every December was a massive reunion with a guest list filled with sports’ upper crust — a high school reunion meets a royal wedding meets Oscar Night.

“We were treated like kings and queens, and everybody would be half-smashed," Cassady continues. “Then we’d all go home.”

Nobody thought much about what life was like in the months that divided their Decembers. It was just exhilarating to see each other, to welcome a new member and get a break from whatever stresses may be playing out at home, because for a few days, the band was back together in New York and the Blarney Stone stayed open all night.

“All the guys welcome you back and tell old stories,” says Jean Sullivan, whose late husband, Pat, played quarterback at Auburn and joined the club in 1971.

The years passed; change was inevitable. The weekend, once open to men only, expanded to include a women’s luncheon at the opera house, a Broadway play and a hospitality room. Even when ESPN turned the annual presentation into a made-for-TV spectacle, there were dimly lit places to hide and catch up — the bar or breakfast the morning after the ceremony, wives turning up still in their pajamas.

One thing that never changed, though, was that certain topics were taboo. O.J. Simpson, for instance, who won the 1968 Heisman, or Charles White, whose high-profile addiction and mental health issues led to the sale of his 1979 trophy. The weekend was too short to talk about Rashaan Salaam’s suicide or to dwell on the cognitive problems emerging as one more thing many members had in common. If a winner died or mysteriously stopped coming, nobody said anything.

“The players and wives do develop a unique friendship,” 1996 winner Danny Wuerffel says. “But it’s not really built to be someone’s close-knit support group.”

In 2019, not long after her husband died, Barb Cassady went to New York to visit with these friends she had known for decades. She greeted Paul Hornung, who joined the club in 1956, but Hornung looked at her blankly.

“Oh, my God,” Cassady remembers thinking, “he doesn’t know me.”

Still, she didn’t mention it to Hornung’s wife. Because as long as they had known each other, as close as they had become amid all the good times, there were some things you just didn’t talk about.

But when past winners line up to welcome a new member, they will do so as one of football’s grim realities breaches their club’s inner sanctum. Four Heisman winners have been diagnosed with chronic traumatic encephalopathy, the degenerative and often devastating brain disease linked to repeated hits to the head.

Many of the winners’ wives, often their husbands’ caretakers and support beams, find it increasingly difficult to ignore the changes that afflict their friends — and the challenges their peers have learned to live with or ignore.

“We’ve been together all these years,” says Jerri Spurrier, whose husband, Steve, won the Heisman in 1966. “We have experienced the downfall of these men over the years, and that’s what has hurt the most.”

In the 1980s, back when the club was smaller and the weekend more intimate, winners got whisked around the city by limousine. Judi White-Basch, who married her freshman-year sweetheart, Southern California running back Charles, remembers feeling as if she had joined a royal family. The first year the couple came back, they shared a limo with Simpson and his wife, Nicole, after whom Charles and Judi had named their first daughter.

“This is what we’re all about!” Judi recalls Simpson saying that December evening in the mid-1980s. He and White had attended Southern Cal a decade apart, became record-breaking running backs and were feted as superstars who would change the game. “You’re the most prolific Trojan out ever!”

Judi says she noticed that members of the Downtown Athletic Club, which hosted the Heisman for decades, were elderly and White. But because Charles had won football’s most prestigious trophy, it was as if he was one of them. “I was just tagging along,” she says.

The other wives were kind and welcoming, Judi remembers, and she joined them on a group vacation from reality. Because the daily schedule was packed with social events and autograph signings, couples spent hours talking and bonding: Skeeter and Doak Walker, Jane and Jay Berwanger, Jerri and Steve Spurrier.

“We couldn’t wait until the next year to go and see these people again,” Jerri Spurrier says. “You learn to trust and love each other.”

Judi fit in by telling stories about Charles’s appearance on “American Gladiators” and how he would take their five children for nature walks. He seemed to have a sixth sense for detecting when his wife was exhausted or overwhelmed, letting her sleep in or drawing a bath so she could unwind.

“To a woman,” she would say, “you couldn’t wish for anything better.”

It was enough to get her through the weekend because, especially in this gilded setting, she didn’t want the other wives to know that Charles invited his NFL teammates to their daughter’s birthday party but no-showed it himself. Or that, in 1987, police found him outside a warehouse, high on cocaine and wielding a trash can lid, convinced someone was trying to kill him. Or that sometimes Charles was so volatile that Judi checked herself and the kids into a hotel near Disneyland, waiting for him to turn back into himself.

“Then come back,” she says, “and pretend like nothing ever happened.”

Eventually Charles’s problems became so severe that Judi just stopped making plans. They stopped going to the Heisman ceremony in part because the man in the oil painting — smiling, chiseled, the adonis Judi had known since they were teenagers — was slipping away.

She struggled to explain Charles’s behavior to her best friend, their children, herself. So she stopped trying. Charles was just Charles, Judi told herself, because to win a Heisman Trophy and reach the NFL, you’re just … different. The man from the portrait still showed up most days, and when he didn’t, Judi and the kids agreed that Daddy was just as wonderful as always but that, for some reason, he occasionally went “haywire.”

At least at home, she wouldn’t have to cover for him. If they skipped the December weekend in New York, she wouldn’t have to smile and pretend as if it was an effective — if all-too-brief — escape from the isolation, loneliness and powerlessness she often felt.

“And I’ll add another word: shame,” she says. “I doubled down on trying to make everything perfect. I thought that if I could make the perfect house, if Charles didn’t have to worry about anything, if I take care of the bills, if I did everything — that he would be okay.”

Judi takes a breath.

“I loved him with my heart, soul and mind,” she continues. “But I was so ashamed. I had to protect myself, protect our family. And I didn't want anybody to know.”

IN 1994, AFTER SIMPSON was arrested (and later acquitted) in connection with the murders of Nicole Brown Simpson and Ron Goldman, Judi’s mother and sister begged her to leave Charles. But she couldn’t. Not for another 10 years, anyway.

“I only left when I felt like I couldn’t live anymore,” she says. “My life was ebbing away. I lived with so much uncertainty, so much chaos.”

He would call Judi sometimes, slurring as he demanded that she get him a house or a new Cadillac. He worked for Southern Cal then, first as an assistant coach then as an office worker. He slept in the locker room sometimes; other times he asked players for a few bucks. In 2012, he wrote a letter to the school to announce his immediate resignation.

He sold his Heisman a dozen years earlier. Eventually his Heisman ring, a less famous token of the club’s membership, was gone, too. So was his Rose Bowl watch and another ring commemorating the Trojans’ 1978 national championship. Judi says Charles would later suggest some of the items were stolen, though because he was later diagnosed with early-onset dementia, she cannot be sure what’s true.

Either way, she says, “everything is gone.”

Charles’s condition worsened, and in 2018, Judi and the kids moved him into a memory care facility. With his memories vanishing, he scrawled his kids’ names on a card so he wouldn’t forget. He wore Trojans gear to remind himself of who he used to be. Judi and daughter Tara took turns as his caretaker, and sometimes eldest daughter Nicole, who used to ride on her daddy’s shoulders and sit across from him when they went to Buffy’s on Sundays after church, broke down crying because not only were White’s mementos gone but so was the man who collected them.

“The best father in the world,” Judi says Nicole told her, “and then he just left. There’s no explanation.”

TWO DECADES AGO, a Florida resident went to give a speech, something he had done dozens of times, and just froze. “I don’t know what’s wrong,” Howard Cassady told his wife.

A man in Alabama began experiencing panic attacks, anxiety and paranoia, blanking as he tried to remember friends’ names. “I don’t think my brain is right,” Pat Sullivan told his wife.

Club members kept sojourning to New York for their gathering each December, and the wives ate their lamb chops and drank their cocktails and pretended nothing was wrong. Even amid the discovery and rise of CTE, it didn’t feel right to talk about the fact that Tony Dorsett, who won the 1976 Heisman, said in 2013 that he sometimes drove his daughters somewhere and forgot where he was going.

Nobody asked Roger Staubach, who won the 1963 Heisman, about the long-term effects of the 20 concussions he estimated he suffered. Nor did anyone bring up 1970 winner Jim Plunkett’s declaration six years ago that his “life sucks” because of chronic headaches and unexplained neurological conditions. At the 2017 Heisman ceremony, when Oklahoma’s Baker Mayfield hoisted the trophy, nobody asked 1985 winner Bo Jackson whether he was serious months earlier when he told USA Today he would have never played football had he known about the sport’s link to brain injuries.

“We never talked about it. Never,” Barb Cassady says. “Everybody knew Hop was having a rough time. Every Heisman winner knew it. But it was never a topic.”

When Howard Cassady and Pat Sullivan died in 2019, their wives donated the men’s brains to Boston University’s CTE Center. Months later, Jean learned her husband had Stage 3 CTE, or a debilitating amount of scar tissue on their brains. Cassady’s was Stage 4, the disease’s most debilitating and advanced form, and after Hornung died in 2020, he, too, was found to have Stage 4 CTE.

Jean Sullivan went back to New York, and she could avoid the subject no longer. The Heisman Trust discontinued the women’s luncheon, she says, but she nonetheless finds time to ask winners with visible CTE symptoms if they have resources and support.

“When I go back, I see the struggles,” she says. “You recognize memory issues; you recognize anxiety. We know of so many that have these symptoms, but they don’t know where to go or where to get help."

She wishes the Heisman Trust would direct some of its power toward making sure the winners of its trophy are connected with mental health experts, those trained in cognitive decline, organizations such as the Concussion Legacy Foundation. Jean says her attempts to spearhead such an effort have been disappointing because they have been met with silence.

The Trust’s executive director, Rob Whalen, says Heisman weekend includes no presentation or formal discussion about CTE or football-related brain injuries.

“We hope to God that something gets figured out and there’s an improvement in this area,” Whalen says. “But it’s not really what the Trust is focused on for our charitable giving. ... Our missions are youth development and underserved communities, and we don’t know how the two tie together.”

Regardless, Barb Cassady can’t help but study the men each year. She watches their faces as they gather and a new member is announced.

“Am I thinking, ‘That poor guy has CTE?’ You don’t know,” she says. “The quarterbacks, they — well, he gets hit a lot, too. So who knows?”

A moment later, she continues.

“There’s going to be so many more,” she says.

CHARLES WHITE DIED IN JANUARY of esophageal cancer, just 64 years old. Judi was holding her former husband’s hand as he passed. A few months later, she and several of their children joined a video conference with Thor Stein, the Boston University pathologist who studied Charles’s brain. He revealed that Charles had Stage 4 CTE, and if Judi felt closure, daughter Nicole felt relief. Because this proved that her father hadn’t abandoned the family. He had been taken away.

“The Dad that used to be was something so powerful,” Judi says. “This let us forgive.”

Months later, Judi received an invitation to the Concussion Legacy Foundation’s annual gala in Boston. It had been years since she attended an event such as this, but early last month, she put on a black, off-the-shoulder pantsuit and drove from her home in New Hampshire to a hotel in downtown Boston. Her 22-year-old granddaughter went with her, and the two of them mingled despite not recognizing most anyone there.

Then up walked Lisa McHale, the foundation’s family relations director. Her own husband, former NFL player Tom McHale, had CTE when he died in 2008. Lisa is often among the first voices to comfort families after they learn a relative had a disease that, she says, “makes our loved ones not terribly lovable.”

Judi White-Basch, former wife of 1979 Heisman Trophy winner Charles White, and granddaughter Giovannia Hemmen flip through a book looking at pictures of Charles from his college days. (Andrew Dickinson for The Washington Post)
Lisa introduced Judi to other football wives. Their husbands had endured similar fates, and of the 1,035 brains of football players examined at Boston University, nearly three-fourths had CTE. In many cases, their wives had dealt with it, covered it up, kept their families together just as Judi had.

“Everybody has got the same story,” she says. “Everybody that I was talking to, they had this same shame and pain, like: ‘All this time, I had to hide. I had to protect. I had to pretend.’ I’m like, ‘Oh, my gosh, I’m not alone.’ ”

At the end, Lisa McHale shared another contact. There was a woman in Alabama who had even more in common with Judi.

Judi made the call last Friday, only a week before this year’s Heisman ceremony. She paused as she dialed, thinking of what she hoped to say, waiting to hit the call button. She was dialing Jean Sullivan, Pat’s widow, and she wanted to know how Jean felt as she watched the decline of the man she loved. She wanted to talk about being the member of sports’ most exclusive and secretive club, though not the one everyone talks about each December. She and Jean and Barb are charter members of a new community, a fledgling sisterhood of those who had been with a star football player at their peak and nadir, a support group whose membership will surely grow.

“Their special club takes a toll. There was a cost. We didn’t know it, but there always is,” Judi says. “She had the wonderful joy of being with him and loving him through the joy and anticipation of it, the experience of it and also the opposite, still loving and supporting them at their worst.”

Finally ready, she pressed the button and waited.

“I just knew,” Judi says, “I was going to talk to somebody that could understand.”

Weathering

USAmerica Inc is a rich and powerful thing. Compared with other people around the world, Americans live charmed lives.

Except we don't really.

And here's another little gem via WaPo:

STRESS IS WEATHERING OUR BODIES FROM THE INSIDE OUT

Physicians and public health experts have pointed to one culprit time and again when asked why Americans live shorter lives than peers in nations with similar resources, especially people felled by chronic diseases in the prime of life: stress.

A cardiologist, endocrinologist, obesity specialist, health economist and social epidemiologists all said versions of the same thing: Striving to get ahead in an unequal society contributes to people in the United States aging quicker, becoming sicker and dying younger.

Recent polls show adults are stressed by factors beyond their control, including inflation, violence, politics and race relations. A spring Washington Post-Ipsos poll found 50 percent of Americans said not having enough income was a source of financial stress; 55 percent said not having enough savings was also a source of stress.

“We should take a step back and look at the society we’re living in and how that is actually determining our stress levels, our fatigue levels, our despair levels,” said Elizabeth H. Bradley, president of Vassar College and co-author of the book “The American Health Care Paradox.” “That’s for everybody. Health is influenced very much by these factors, so that’s why we were talking about a reconceptualization of health.”

The Washington Post’s efforts to gain a deeper understanding of how stress can cause illness, disability and shorter lives led to a once derided body of research that has become part of the mainstream discussion about improving America’s health: the Weathering Hypothesis.

Stress is a physiological reaction that is part of the body’s innate programming to protect against external threats.

When danger appears, an alarm goes off in the brain, activating the body’s sympathetic nervous system — the fight-or-flight system. The hypothalamic-pituitary-adrenal axis is activated. Hormones, such as epinephrine and cortisol, flood the bloodstream from the adrenal glands.

The heart beats faster. Breathing quickens. Blood vessels dilate. More oxygen reaches large muscles. Blood pressure and glucose levels rise. The immune system’s inflammatory response activates, promoting quick healing.

Once the threat passes, hormone levels return to normal, blood glucose recedes, and heart rate and blood pressure return to baseline. That’s how the human body should work.

Life brings an accumulation of unremitting stress, especially for those subjected to inequity — and not just from immediate and chronic threats. Even the anticipation of those menaces causes persistent damage.

The body produces too much cortisol and other stress hormones, straining to bring itself back to normal. Eventually, the body’s machinery malfunctions.

Like tree rings, the body remembers.

The constant strain — the chronic sources of stress — resets what is “normal,” and the body begins to change.

It is the repeated triggering of this process year after year — the persistence of striving to overcome barriers — that leads to poor health.

Blood pressure remains high. Inflammation turns chronic. In the arteries, plaque forms, causing the linings of blood vessels to thicken and stiffen. That forces the heart to work harder. It doesn’t stop there. Other organs begin to fail.

Struggling and striving

It’s part of the weathering process, a theory first suggested by Arline T. Geronimus, a professor and population health equity researcher at the University of Michigan.

Geronimus, whose book “Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society” published in March, started out studying the health of women and babies as a graduate student in the 1980s, having been influenced by two distinctly different jobs she had as an undergraduate: one as an on-campus research assistant, the other as a peer companion at an off-campus school for teen mothers.

At the time, she said, conventional wisdom held that the Black community had higher rates of infant mortality because teen mothers were physically and psychosocially too immature to have healthy babies. But her research showed younger Black women had better pregnancy and birth outcomes than Black mothers in their mid- to late 20s and 30s.

For this, she was criticized as someone arguing in favor of teen pregnancy, even though she was not. Shaken but undeterred, she continued trying to understand the phenomenon, which meant better understanding the overall health of the community these teens depended on for help. As she studied those networks, she recognized “people’s life expectancies were shorter, and they were getting all these chronic diseases at young ages,” she said.

But she hadn’t come up with a name yet for what she was witnessing. That happened in the early 1990s while sitting in her office: “‘Weathering’ struck me as the perfect word.”

She said she was trying to capture two things. First, that people’s varied life experiences affect their health by wearing down their bodies. And second, she said: “People are not just passive victims of these horrible exposures. They withstand them. They struggle against them. These are people who weather storms.”

People seem to instinctively understand the first, but she said they often overlook the second. It isn’t just living in an unequal society that makes people sick. It’s the day-in, day-out effort of trying to be equal that wears bodies down.

Weathering, she said, helps explain the double-edged sword of “high-effort coping.”

Over the years, Geronimus widened the aperture of her research to include immigrants, Latinos, the LGBTQIA community, poor White people from Appalachia. She found that while weathering is a universal human physiological process, it happens more often in marginalized populations.

Regulation of cortisol — what we think of as the body’s main stress hormone — is disrupted. Optimally, it should work like a wave with a steep morning rise followed by a rapid decline, which slows until reaching baseline at bedtime.

But existing research suggests that is blunted by repeated exposure to psychosocial and environmental stressors, such as perceived racial discrimination, which flatten this rhythm.

Stress-induced high cortisol levels stimulate appetite by triggering the release of ghrelin, a peptide that stimulates hunger.

The interplay between elevated cortisol and glucose is especially complex and insidious, eventually leading to obesity, fatigue, cardiovascular disease, poor immune and inflammatory functions, higher breast cancer mortality rates and other metabolic disorders. Dysregulated cortisol also increases depression and anxiety and interferes with sleep.

Weathering doesn’t start in middle age.

It begins in the womb. Cortisol released into a pregnant person’s bloodstream crosses the placenta, which helps explain why a disproportionate number of babies born to parents who live in impoverished communities or who experience the constant scorn of discrimination are preterm and too small.

During the coronavirus pandemic, pregnant women experiencing stress endured changes in the structure and texture of their placentas, according to a study published this year in Scientific Reports.

An illustration of a silhouette of a male adolescent standing next to a seated baby. Both silhouettes fill with grainy pink dots while pink pulsates toward them
The toxic stream can persist into childhood fueled by exposure to abuse, neglect, poverty, hunger. Too much exposure to cortisol can reset the neurological system’s fight-or-flight response, essentially causing the brain’s stress switch to go haywire.

Too much stress in children and adolescents can trigger academic, behavioral and health problems, including depression and obesity.

Stress can change the body at a cellular level.

The effects of relentless stress can be seen at the chromosomal level, in telomeres, which are repeated sequences of DNA found in just about every cell.

Telomeres are the active tips of chromosomes, and they protect the cell’s genetic stability by “capping” the ends of the chromosomes to prevent degeneration. (Think of the plastic tips of shoelaces.)

Researchers have discovered that in people with chronically high levels of cortisol, telomeres become shortened at a faster rate, a sign of premature aging.

The shorter the telomeres, the older the cell’s biological age.

Shortened telomeres cause a disconnect between biological and chronological age.

‘A societal project’

“I don’t think most people understand weathering stress. Stress is such a vague term,” Geronimus said. “But it still gives us a leverage point to get in there and see a more complex and more frightening picture of what it does to people’s bodies and whose bodies it does it to.”

Changes in seven biomarkers in cardiac patients during a 30-year period showed Black patients weathering about six years faster than White people, a 2019 study published in SSM-Population Health found.

Research also found that Black people experience hypertension, diabetes and strokes 10 years earlier than White people, according to a study published in the Journal of Urban Health.

The impact of repeatedly activating the body’s stress response is called allostatic load.

Research has shown that Mexican immigrants living in the United States for more than 10 years have elevated allostatic load scores compared with those who have lived here for less than a decade, and a study of Ohio breast cancer patients published in May in JAMA Network Open found that women with higher allostatic loads — who tended to be older, Black, single and publicly insured — were more likely to experience postoperative complications than those with lower allostatic loads.

“The argument weathering is trying to make is these are things we can change, but we have to understand them in their complexity,” Geronimus said. “This has to be a societal project, not the new app on your phone that will remind you to take deep breaths when you’re feeling stress.”

So, in short, social inequality causes stress, leading to shortened telomeres and, in turn, premature aging, disease and early death.

Still Kickin'

I've had my 3 score and 10. From here on out, I'm on bonus. And I can live with that.

University of Oxford professor John Bell, a native of Canada, offers a sobering assessment of what other high-income nations see when they view life expectancy in the United States.

“You know you’ll never be last, because America is always last,” Bell said.

It is a paradox that confounds the world: The United States is among the wealthiest nations in history, and yet its citizens die earlier than those in some poorer nations.

It wasn’t always this way. In 1980, the United States was in the middle of the pack of wealthy nations, according to a detailed analysis of more than 40 years of life expectancy data by The Washington Post.

Life expectancy was rising before it flatlined, drifted downward and then cratered during the coronavirus pandemic. That is despite having much of the world’s most cutting-edge medical research and higher health expenditures per person than any other nation.

“You’re looking at a situation where we are performing extremely poorly relative to our income, relative to our educational attainment, relative to our history,” said Samuel Preston, professor of sociology at the University of Pennsylvania.

Nicola Triglione, a cardiologist in Milan, visits the United States often to study the latest health-care innovations. But, he said, he would never move to the United States. He knows too many Italian doctors who moved to the country but found the lifestyle unsustainable. The problem wasn’t their patients’ health — it was their own.

“After maybe 10 years, they come back, and they say: ‘I’m done. [The Americans] work too much, it’s a money game, they have, I don’t know, four weeks of vacation a year?’” Triglione said.

While the United States specializes in high-tech interventions for acute illness, other countries emphasize preventing illnesses.

As far back as the 1970s, experts showed that as countries got richer, the gains from their wealth in terms of life expectancy became smaller. But what is happening now with the United States is something else entirely.

The collapse of the Soviet Union in the 1990s, notably, occurred after a decline in health that got even worse during that period. Some experts see an alarming parallel.

“Historically, demographic trouble tends to presage broader difficulties of social division,” said former treasury secretary Lawrence Summers, recalling that it was demographers who foresaw the collapse of the communist system by identifying hugely surging mortality rates.

“There are lots of arguments about how to measure GDP, satisfaction, unemployment,” Summers said, “but death is kind of unambiguous.”

And it’s not just a matter of divergence between other high-income nations and the United States. Even within the United States, the disparities are stark: How long you live often depends on where you live.

The Post analysis shows that the gap between the richest and poorest areas was far wider than in other wealthy nations. And despite this widening gap, people living in the wealthiest areas of the United States don’t live longer lives than people in the poorest parts of France, where health outcomes are far more equal.

In France, overall life expectancy has increased about equally in the richest and poorest areas. In the U.S., there’s been a widening gap.

The divergence between wealth and health is a relatively recent trend. For much of history, there has been a direct link between economic growth and people living longer.

The United States, a booming economic superpower after World War II, saw life expectancy increase substantially at that point.

The dramatic rise in life expectancy during the 20th century is largely attributed to the spread of treatments for infectious diseases. In the latter half of the century, declines in smoking in many countries pushed down cardiovascular disease, another major killer.

During that time, the practice of medicine in the United States shifted in a way distinct from other high-income nations. Robert L. Phillips, a professor of family medicine at Georgetown University and executive director of the Center for Professionalism and Value in Health Care, said only 13 percent of internists go into primary care, with the rest choosing to become specialists.

Primary care doctors, also known as general practitioners or family doctors, are supposed to be the first to see patients, catching potential problems early. They treat relatively simple problems themselves or send their patients on to specialists.

In the United States, there is little incentive to work in primary care. Studies show that American specialists earn far more than primary care doctors.

Despite being a specialist, Triglione, the Italian cardiologist, said he found the low status of American primary care doctors jarring. In Italy, these doctors are the central hub of the health-care system, seeing patients regularly for years and earning more than most specialists.

Primary care doctors work like a “movie director,” he said, coordinating all aspects of care. “You go to the specialist, but then you come back to your general practitioner. It’s a relationship.”

During the coronavirus pandemic, this lack of centralization became a painfully obvious failing of the U.S. health-care system, especially compared with highly centralized systems such as those in Taiwan, which was able to contain the outbreak to a far larger extent and saw a much lower number of deaths per capita than the United States.

America not only had a population with chronic illnesses that made it susceptible to covid-19, but a patchwork health-care system that struggled with the coordination needed to prevent its spread.

Could the United States get back on track? It certainly has the resources to do so.

Many other countries, including high-risers such as Portugal and Taiwan, have achieved vast improvements in life expectancy during the past 40 years while the United States stagnated. Both countries did so, in part, by creating national health services, but they also did so with significant economic growth and transitions to democracy.

The worry for many experts is that other nations may be following the destructive trends seen in the United States. Even successful countries are having to adjust and resist the spread of New World Syndrome — the processed foods and sedentary lifestyle that are factors in lowering U.S. life expectancy. Even high achievers, such as Norway and other Nordic nations, are seeing an alarming increase in inequality in life expectancy.

Notably, obesity is rising around the world. “There’s not one population globally that we have data on that has reduced obesity, which is a pretty bad scorecard,” said Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington.

Outside the United States, some experts hope they can chart a new course. Britain, one of America’s closest allies, is seeing a particularly sharp slowdown in life expectancy gains and suffered greatly during the pandemic, led by many of the same trends as in the United States.

Britain has a national health system focused on people, not profits. Bell, the Oxford professor, is spearheading a plan in hopes that Britain and other nations can make up lost ground by combining new diagnostic technologies with lessons from the pandemic in delivering vaccines, screening and other preventive measures expeditiously.

“The problem in America in this world of prevention of disease is: Who is going to pay for it?”

Light In The Attic

I worry a bit about things like CTE and Dementia and Alzheimer's.

I played some pretty hard football for half a dozen years, so CTE is a fair (though fairly low)  probability, but the prospect of actually losing my mind to something like Alzheimer's Disease kinda freaks me out.

I can only think of a couple of Great Aunts in my family who went a little wacky once they landed north of about 90 - it's just that there's all kinds of weird shit in the environment that could be lookin' to get me one way or another, and Alzheimer's is the really big scary one for me because it can come from practically any direction.

Luckily, they're starting to get a handle on it - they at least know a lot more about the mechanisms - and now there's this new thing that says there may be a gene that can delay the onset of the disease, even if you're pretty much "destined" to get it.

If it pans out, there's a pretty good chance to produce medicines that inoculate against it, or allow for mitigation and management. 

Yay, nerds BTW.

How one man's rare Alzheimer’s mutation delayed the onset of disease

Genetic resilience found in a person predisposed to early-onset dementia could potentially lead to new treatments.

Researchers have identified a man with a rare genetic mutation that protected him from developing dementia at an early age. The finding, published on 15 May in Nature Medicine1, could help researchers to better understand the causes of Alzheimer’s disease and potentially lead to new treatments.

For nearly 40 years, neurologist Francisco Lopera at the University of Antioquia in Medellín, Colombia, has been following an extended family whose members develop Alzheimer’s in their forties or earlier. Many of the approximately 6,000 family members carry a genetic variant called the paisa mutation that inevitably leads to early-onset dementia. But now, Lopera and his collaborators have identified a family member with a second genetic mutation — one that protected him from dementia until age 67.

“Reading that paper made the hair on my arms stand up,” says neuroscientist Catherine Kaczorowski at the University of Michigan in Ann Arbor. “It’s just such an important new avenue to pursue new therapies for Alzheimer’s disease.”

Mutated protein

Lopera and his colleagues analysed the genomes and medical histories of 1,200 Colombians with the paisa mutation, which causes dementia around ages 45—50. They identified the man with the second mutation when he was 67 and had only mild cognitive impairment.

When the researchers scanned his brain, they found high levels of the sticky protein complexes known as amyloid plaques, which are thought to kill neurons and cause dementia, as well as a protein called tau that accumulates as the disease progresses. The brain looked like that of a person with severe dementia, says study co-author Joseph Arboleda, an ophthalmologist at Harvard Medical School in Boston. But one small brain area called the entorhinal cortex, which coordinates skills such as memory and navigation, had low levels of tau.

The researchers found that the man had a mutation in a gene coding for a protein called reelin, which is associated with brain disorders including schizophrenia and autism. Little is known about reelin’s role in Alzheimer’s, so the researchers genetically engineered mice with the same mutation. In mice, the mutated form of reelin caused the tau protein to be chemically modified, limiting its ability to cluster around neurons.

The study challenges the theory that Alzheimer’s disease is primarily driven by amyloid plaques, which are the targets of several drugs recently approved by the US Food and Drug Administration. The drugs effectively remove amyloid from the brain, but lead to only a moderate improvement in rates of cognitive decline.

The fact that the man stayed mentally healthy for so long despite the many amyloid plaques in his brain suggests that Alzheimer’s is more complicated, says Yadong Huang, a neurologist at the Gladstone Institutes in San Francisco, California. He suggests that there could be multiple subtypes of Alzheimer’s, only some of which are driven by amyloid. “We do need different pathways to really finally deal with this disease,” he says. The link to tau, he says, is especially promising because it suggests that tau plays a role in mental decline. Several therapies targeting tau are currently in clinical trials.

Shared mechanisms

Lopera says that the reelin mutation is extremely rare in the general population, but that his team is now looking for this and other mutations among people with the paisa mutation. The man’s sister, who had both the paisa and reelin mutations, began developing cognitive impairment at age 58 and severe dementia at 64 — later than average for someone with the paisa mutation. The authors say that she had experienced head injuries and had other disorders that could have contributed to her developing dementia earlier than her brother.

Arboleda notes that the mutated reelin protein binds to the same receptors as a protein called APOE, which is also associated with Alzheimer’s disease in people who do not have the paisa mutation. In 2019, the same group had identified a woman with the paisa mutation who developed dementia 30 years later than average, owing to a mutation in APOE2. Like the man in the latest study, the woman’s brain contained much higher levels of amyloid than would be expected in someone with so few Alzheimer’s symptoms.

“It’s really cool because it’s telling us there’s some shared mechanisms,” Kaczorowski says. Reelin and APOE compete to bind to the receptor, and the two findings suggest that either a stronger reelin protein or a weaker APOE protein can protect the brain against the disease. Arboleda says this suggests that therapies targeting reelin or APOE might be even more effective in sporadic Alzheimer’s cases, which tend to be less aggressive and progress more slowly than the early-onset type that the Colombian family experiences.

As with many people with Alzheimer’s, the man’s hippocampus — a brain region controlling learning and memory — was smaller than average at the time of his death, suggesting that it was degenerating. But because his cognitive abilities remained relatively intact, Kaczorowski says, neurons in other parts of the brain might have repurposed themselves to make up for the damage. Knowing whether that happens, she adds, could help to inform future therapeutic strategies.

“The vast majority of research focuses on why some people have Alzheimer’s, very few are on conditions where a factor can go against this disease,” says Huang. He says that further research is needed to pin down the mechanism through which reelin and APOE affect tau, and whether targeting these proteins could help people with Alzheimer’s who do not have the paisa mutation. “This is one of those few cases that really opens the door for anti-Alzheimer’s research.”

self-portraits

William Utermohlen