Health for life

Castrated men living in Korea centuries ago outlived other men by a significant margin. The findings, reported in the September 25 issue of Current Biology, a Cell Press publication, suggest that male sex hormones are responsible for shortening the lives of men, the researchers say.

The evidence comes after caul study of genealogy records of noble members of the Imperial court of the Korean Chosun dynasty (AD 1392-1910).

"This discovery adds an important clue for understanding why there is a difference in the expected life span between men and women," said Kyung-Jin Min of Inha University.

The castrated boys in Korea lost their reproductive organs in accidents—usually after being bitten by dogs—or underwent castration purposefully to gain early access to the palace. Eunuchs were allowed to marry and had families by adopting castrated boys or normal girls.

People in those days kept caul genealogy records as proof that they were of the noble class. By poring over those records, Min and colleague Cheol-Koo Lee of Korea University found that eunuchs lived 14 to 19 years longer than other men did. Amongst the 81 eunuchs they studied, three lived to the ripe old age of 100 or more, a feat of longevity that remains relatively rare even in developed countries today.

The incidence of centenarians among Korean eunuchs is at least 130 times greater than it is in the developed countries, Lee notes, and that cant be explained simply by the benefits of life in the palace, either. Most eunuchs spent as much time outside the palace as they did inside it. And, in fact, kings and male members of the royal family had the shortest lives of all, typically surviving only to their mid-forties.

The findings may offer some clues to life extension and, in the meantime, men might take heed, Min and Lee quip. "For better health and longevity, stay away from stresses and learn what you can from women."

Your doctor will see you now!

If only the U.S. health care system had the democracy of the French, the efficiency of the Germans, the primary care of the Brits and the common sense of the Swiss. Then wed be able to see our beret-wearing PCPs ad lib, receive care in 9 minute aliquots, mutter "bullocks!" when were told were too old for dialysis and then die old and quietly at home.

Victor Fuchs, writing in the Jan 2 edition of JAMA, has a slightly different perspective.  He notes that American history is dominated by waves of immigrants who came here to escape oppression. We are far more distrustful of government.  We are also less likely to support redistributive public policies. That may be partly due to a more heterogeneous population that is less sympathetic to the less fortunate when they fall outside the right social or demographic class. Last but not least, our system of government is quite inefficient compared, say, to a parliamentary system.

Thats why:

1. Government spending on health care is comparatively lower: 46% in the U.S. vs. 75% in Organization for Economic Co-operation and Development (OECD) countries.  As a result, a) administrative costs are fragmented, and b) there is less ability to negotiate prices with providers and suppliers

2. There is a different mix of services: in the U.S., less top-down control means more high tech, specialists and amenities with relatively less reliance on physicians and hospitals to render health care services.

What is the way forward?  Dr. Fuchs recommends that future health orm efforts not be modeled on Europe.  Instead, Americans should scale back their expectations and focus on what is necessary, not desireable.

If government is to assume a greater share of health care costs beyond the current 46% level, it should probably worry about funding basic care, not all care.  In addition, Americans are less likely to support total equality; they want to preserve the option of "buying up" when they can afford it.  Last but not least, future orm is going to have to find a middle ground between all the advocacy groups, stakeholders and special interests that dominate the mix of services.

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