Human Nature: Science, Technology, and Life.

Obama’s Gray Hair

Are the burdens of the presidency graying Barack Obama? Are his gray hairs a sign of life-shortening stress?

Today's New York Times front page makes it sound that way:

For a guy who prides himself on projecting a stress-free demeanor, the changes above his temples are speckled evidence that perhaps the psychological and physical strains of the job—never mind the long process of winning it—are in fact taking something of a toll. (Experts say stress can contribute to whitening locks.) ...

But with the economy struggling, two wars raging and countless other pressures facing him, the president is very likely to see additional signs of wear and tear in the mirror each morning. "Presidents age two years for every year that they're in office," said Dr. Michael F. Roizen, co-founder of RealAge, a Web site that tells you how much older your body really is because of all that smoking and drinking you have been doing. ... Rapidly lightening locks are just one sign that the job is getting to America's presidents.

The front page of today's Washington Post Style section agrees:

Are times so stressful—a plummeting economy and two wars—that our young president is going grayer a mere six weeks into the job? ... With each debate, after every primary fight, it seems Barack Obama's tightly clipped hair became just a dash saltier. ... And it's an article of faith, backed by photographic evidence, that the Oval Office ages the men in it. Look no further than George W. Bush and Bill Clinton.

It's natural to look at the president's gray hair and take it as a sign of job stress. But guess what's even more natural? Gray hair. The Times' headline—"For Young President, Flecks of Gray"—implies that Obama is graying prematurely. Not true. According to a scholarly review published three years ago in the Journal of Investigative Dermatology, "Age of onset of graying also appears to be hereditary, developing usually in late fourth decade. Thus, the average age for Whites is mid-30s, for Orientals late-30s, and for Africans mid-40s, such that by 50 years of age, 50% of people have 50% gray hair."

Obama is 47. As the Times and Post photographs show, he's only marginally gray. He's right on schedule.

Is his gray hair a sign of premature aging, "wear and tear" and "taking a toll," as the newspaper stories imply? Sorry. Evidence published in Medical Hypotheses suggests otherwise:

An office and autopsy study was performed to see if early graying was associated with increased morbidity, earlier age at death, and specific cause of death. 195 consecutive office patients over the age of 40 were studied to see if premature graying of scalp hair (50% or more gray before age 50) was associated with increased incidence of disease before age 50 ...For fathers, mean age at death if prematurely gray was 68.27 years; if not prematurely gray, 66.03 years ... For mothers, the values were 70.55 years and 70.37 years respectively ... 874 autopsy patients dying over a 23-year period (1966-1989) were studied to see if the median age at death (of patients 50% or more gray) differed for any of the six categories of disease (myocardial infarction, congestive heart failure, cancer, stroke, pneumonia/bronchitis, or cirrhosis of the liver/GI problems) when compared to the entire autopsy sample of 19 categories of disease ... This dual office and autopsy study provides no evidence to support the contention that early gray hair is a risk factor.

The study, published in 1991, is getting a bit old. But then, aren't we all? Bill Clinton was 46 when he became president. George W. Bush was 53. That's perfectly consistent with the 50-50-50 rule (50 percent of people being 50 percent gray by age 50). There's nothing premature about their grayness—or Obama's. Being president may be bad for your health. But your gray hair tells us nothing.

Age, Wisdom, and Driving

Here's the theory: Old people are bad drivers. And we're living longer, so there are more old people on the road, so they're causing more accidents. And they're already fragile, so they're killing more people, including themselves. Right?

Wrong. According to the latest data from the Insurance Institute for Highway Safety (flagged by Tara Parker-Pope of the New York Times), it's true that "older people now hang onto their licenses longer, drive more miles, and make up a bigger proportion of the population than in past years as baby boomers age." It's also true that "per mile traveled, crash rates and fatal crash rates increase starting at age 70 and rise markedly after 80," possibly because "physical, cognitive, and visual declines associated with aging may lead to increased crash risk."

That's what makes the bottom-line findings so surprising:

Despite growing numbers on the road, fewer older drivers died in crashes and fewer were involved in fatal collisions during 1997-2006 than in years past. ... Crash deaths among drivers 70 and older fell 21 percent during the period, reversing an upward trend, even as the population of people 70 and older rose 10 percent. Compared with drivers ages 35-54, older drivers experienced much bigger declines in fatal crash involvements.

The institute's chief of research adds: "No matter how we looked at the fatal crash data for this age group—whether by miles driven, licensed drivers, or population—the fatal crash involvement rates for drivers 70 and older declined, and did so at a faster pace than the rates for drivers 35-54 years old."

So what gives? "Reasons for the fatality declines aren't clear, but another new Institute study indicates that older adults increasingly self-limit driving as they age and develop physical and cognitive impairments," says the IIHS. In that study,

The oldest drivers were more likely to say they restricted their own driving. Drivers 80 and older were more than twice as likely as 65-69 year-olds to self-limit driving by doing such things as avoiding night driving, making fewer trips, traveling shorter distances, and avoiding interstates and driving in ice or snow. The percentage of drivers who said they limit their driving increased with each added degree of impairment. Drivers cited memory and medical impairments more often than vision or mobility ones.

In other words, as we age, self-knowledge and self-regulation compensate for our loss of abilities. As Farhad Manjoo reported four months ago in Slate,

Statistics on current road deaths show that people over the age of 65 are only 16 percent more likely to cause accidents than are people aged 25 to 64. Drivers under 25, meanwhile, are the most dangerous people on the road—they're 188 percent more likely to cause crashes than middle-aged adults.

Aging is a tragic but beautiful process: As we decay in some ways, we grow in others. We become less able to control the world but more able to control ourselves. As IIHS points out, our decline isn't just physical; it's mental, too. Yet we understand ourselves better than ever. Even as our vision deteriorates, we become more clear-eyed about our own limits. And even as our memory degrades, we develop a more important kind of knowledge: We know what we don't know.

Not everyone grows this way. To the extent that self-regulation has reduced fatal crash rates among aging drivers, the implication is that old people can be made more aware of their limits and can adjust accordingly. If you're aging, the lesson is to monitor and govern your driving. And if you're young, the lesson is to cultivate what old people have—self-knowledge and self-control—while your mind and body are still at full strength.

Tobacco: Banned in Boston

The health police have crossed another line. Four months ago, they banned new fast-food restaurants in a 32-square-mile area of Los Angeles. In that case, they crossed the line from restricting food for kids to restricting it for adults. They also extended the practice of health zoning from liquor to food.

Now they've breach another line between paternalism for children and paternalism for adults. The Boston Public Health Commission has just banned the sale of all tobacco products at colleges. Not high schools. Colleges.

Anti-smoking activists are ecstatic. "Boston has taken another step that puts it in the forefront in the United States in protecting people against secondhand smoke," says the president of the Campaign for Tobacco-Free Kids. But the Boston regulations don't just restrict smoking. They forbid the sale of "any substance containing tobacco leaf, including but not limited to cigarettes, cigars, pipe, tobacco, snuff, chewing tobacco and dipping tobacco." Last I heard, there's no secondhand smoke from chewing tobacco. And the tobacco industry is constantly developing new products that confound the equation of tobacco with smoking. That's not because tobacco companies care deeply about public health. It's because secondhand smoke has become a political problem for them—and because, while addicting customers is good business, killing them isn't.

In a press release, the executive director of the Boston commission says the new regulations "will help reduce young people's exposure to tobacco products." Young people? That phrase used to mean minors. Now, apparently, it includes the targets of the new rule: students at "any public or private college, normal school, professional school, scientific or technical institution, university or other institution furnishing a program of higher education."

On what grounds do college students—not to mention students at professional schools—deserve the kind of paternalism previously reserved for minors? The commission offers two reasons. First, "educational institutions in the City of Boston also sell tobacco products to the younger population, which is particularly at risk for becoming smokers." Second, "the sale of tobacco products is also incompatible with the mission of educational institutions which educate the younger population about social, environmental and health risks and harms."

In other words, college students (henceforth known as "the younger population") are so vulnerable to smoking and to deception about the harms of smoking that their access to any tobacco products on campus must be legally forbidden.

It's true that laws across the United States set the legal drinking age at 21. But those laws are based on the argument that alcohol makes people aged 18 to 20 drive dangerously. Where's the evidence that chewing tobacco makes these people drive dangerously?

To repeat: I detest smoking. But if there's no secondhand smoke and no secondhand driving effects, what are the grounds for telling a 20-year-old college student—let alone a 25-year-old professional-school student—that tobacco is off-limits? And if that kind of paternalism can be extended so easily from minors to 25-year-olds, who's next?

Age, Prejudice, and Prognosis

Earlier this year, I criticized Medicare for spending $35,000 on a heart implant for a woman who was about to turn 100. The basic argument was:

Should we means-test people on Medicare not just for wealth, but for age? ... The theory is that just as some people have enough money, others have had enough time. If you make it to 100 and can fund your own surgery, that's terrific. But Medicare should focus its resources on people who haven't been as lucky as you. Living to 99 is no tragedy. It's a blessing.

Several of you chastised me for callousness. And now a report from a recent American Heart Association conference backs you up. Marilynn Marchione of the Associated Press tells the story:

Eighty-year-olds with clogged arteries or leaky heart valves used to be sent home with a pat on the arm from their doctors and pills to try to ease their symptoms. Now more are getting open-heart surgery, with remarkable survival rates rivaling those of much younger people, new studies show. ...

In Florida, Dr. Paul Kurlansky led a study of 1,062 octogenarians who had heart bypass surgery at Mount Sinai Medical Center in Miami Beach from 1989 through 2001. ... Average survival was roughly six years—almost the same as similarly aged people who do not have heart disease. Overall, 90 percent survived their surgery to leave the hospital. This improved dramatically as the study went on, from 85 percent in the early years to 98 percent by its end. Even more impressive: 65 percent survived without surgery-related complications and even more without long-term complications ...

A Yale cardiologist draws exactly the conclusion I rejected: "Age itself shouldn't be an automatic exclusion." Marchione adds: "Not every older person can undergo such a challenging operation, but the great results seen in the new studies show that doctors have gotten good at figuring out who can."

This doesn't settle the underlying question of whether there's such a thing as having lived long enough, regardless of what a new device or surgery will do for you. But it does underscore that age, like race, is a crude basis for making individual projections.

Motherhood at 70

I've promised to make this page a reliable headquarters for anyone who wants a single URL or RSS for all the Human Nature stuff. So here's a link to yesterday's piece on the Indian woman who just broke the world record for being the oldest woman ever to deliver a child. Excerpt:

There will be mothers at 71 and 72. It will be done because it can be done, and because doctors such as Bishnoi see themselves as liberators. They're not just defeating society's strictures. They're defeating nature's.

More here.

Age, Wealth, and Medicare

Should Medicare pay big bucks to extend people's lives past 100?

I've been noodling that question since Friday, when the New York Times ran a story headlined, "Rise Seen in Medical Efforts to Treat the Very Old." The story focused on a woman who got a pacemaker and defibrillator a month before her 100th birthday, apparently courtesy of Medicare. Estimated cost: $35,000. The doctor who did the surgery "said that he has implanted about two dozen devices like hers in patients 90 or older over the past five years," according to reporter Anemona Hartocollis. Other doctors said they've done similar procedures on patients in their mid- to late-‘90s.

There's going to be a lot more of this, Hartocollis pointed out. Doctors say they're doing more and more bypasses, cancer surgeries, cataract operations, and joint and valve replacements on people 90 or older. The population of U.S. centenarians (people 100 or older) has nearly doubled since 2000. Trends suggest that within 40 years, it could exceed 1 million.

The objection to spending Medicare funds on all these procedures is obvious: The money would be better spent on younger patients.

The rebuttal offered in the Times is that people who survive to very old age are particularly healthy. They've "demonstrated a survival prowess," said one medical expert. "The older you get, the healthier you've been." The implication is that they're worth spending money on because they'll live longer.

I wonder whether this rebuttal looks at the question the wrong way. Suppose we were talking about wealth instead of age. A woman with an unusually large fortune asks for an investment in some project of hers. Her advocate points out that people with lots of wealth tend to have accumulated it through unusual talent or connections and are therefore more likely to get the best return on money invested in them.

We'd see that argument as rewarding and compounding inequality. Why not look at age the same way? Isn't health, like wealth, an unequally distributed asset? Isn't it, in fact, the ultimate asset? And if that's the case, should we means-test people on Medicare not just for wealth, but for age?

Actually, means testing is the wrong term. Age isn't really a means; it's more like an end. So let's call it an ends test. The theory is that just as some people have enough money, others have had enough time.

If you make it to 100 and can fund your own surgery, that's terrific. But Medicare should focus its resources on people who haven't been as lucky as you. Living to 99 is no tragedy. It's a blessing.