Money, Pain, Death

Last December, the economists Anne Case and Angus Deaton published a paper in PNAS highlighting a disturbing trend: more middle-aged white Americans are dying. In particular, whites between the ages of 45 and 54 with a high school degree or less have seen their mortality rate increase by 134 people per 100,000 between 1999 and 2013. This increase exists in stark contrast to every other age and ethnic demographic group, both in America and other developed countries. In the 21st century, people are supposed to be living longer, not dying in the middle of life.

What’s going on? A subsequent statistical analysis by Andrew Gelman suggested that a significant part of the effect was due to the aging population, as there are now more people in the older part of 45-54 cohort. (And older people are more likely to die.) However, this correction still doesn’t explain much of the recent changes to the mortality rate, nor does it explain why the trend only exists in the United States.

To explain these rising death rates, Case and Deaton cite a number of potential causes, from a spike in suicides to the prevalence of obesity. However, their data reveal that the single biggest contributor was drug poisonings, which rose more than fourfold between 1999 and 2013. This tragic surge has an equally tragic explanation: in the late 1990s, powerful opioid painkillers become widely available, leading to a surge in prescriptions. In 1991, there were roughly 76 million prescriptions written for opioids in America. By 2013, there were nearly 207 million.

Here’s where the causal story gets murky, at least in the Case and Deaton paper. Nobody really knows why painkillers have become so much more popular. Are they simply a highly addictive scourge unleashed by Big Pharma? Or is the rise in opioid prescriptions triggered, at least in part, by a parallel rise in chronic physical pain? Case and Deaton suggest that it’s largely the later, as their paper highlights the increase in reports of pain among middle-aged whites. “One in three white non-Hispanics aged 45–54 reported chronic joint pain,” write the economists, “one in five reported neck pain; and one in seven reported sciatica.” America is in the midst of a pain epidemic.

To review the proposed causal chain: more white people are dying because more white people are taking painkillers because more white people are experiencing severe pain. But this bleak narrative leads to the obvious question: what is causing all this pain?

That question, which has no easy answer, is the subject of a new paper in Psychological Science by Eileen Chou, Bidhan Parmar and Adam Galinsky. Their hypothesis is that our epidemic of pain is caused, at least in part, by rising levels of economic insecurity.

The paper begins with a revealing survey result. After getting data on 33,720 households spread across the United States, the scientists found that when both adults were unemployed, households spent 20 percent more on over-the-counter painkillers, such as Tylenol and Midol. A follow-up survey revealed that employment status was indeed correlated with reports of pain, and that inducing a feeling of economic hardship – the scientists asked people to recall a time when they felt financially insecure – nearly doubled the amount of pain people reported. In other words, the mere memory of money problems set their nerves on fire.

Why does economic insecurity increase our perception of physical pain? In a lab experiment, the scientists asked more than 100 undergraduates at the University of Virginia to plunge their hand into a bucket of 34 degree ice water for as long as it felt comfortable. Then, the students were randomly divided into two groups. The first group was the high-insecurity condition. They read a short text that highlighted their bleak economic prospects:

"Research conducted by Bureau of Labor Statistics reveals that more than 300,000 recent college grads are working minimum wage jobs, a figure that is twice as high as it was merely 10 years ago. Certain college grads bear more of the burden than others. In particular, students who do not graduate from top 10 national universities (e.g., Princeton and Harvard) fare significantly worse than those who do".

The students were then reminded that the University of Virginia was the 23rd best college in the United States, at least according US News & World Report.

In contrast, those students assigned to the low insecurity condition were given good news:

"Certain college grads are shield [sic] from the economic turmoil more than others. In particular, students who graduate from top 10 public universities (e.g., UC Berkeley and UVA) fare significantly better on the job market than those who do not. These college grads have a much easier time finding jobs."

These students were reminded that the University of Virginia was the second highest ranked public university.

After this intervention, all of the students were taken back to the ice bucket station. Once again, they were asked to keep their hand in the cold water for as long as it felt comfortable. As predicted, those primed to feel economically insecure showed much lower levels of pain tolerance:

The scientists speculate that the mediating variable between economic insecurity and physical pain is a lack of control. When people feel stressed about money, they feel less in control of their lives, and that lack of control exacerbates their perception of pain. The ice water feels colder, their nerves more sensitive to the sting.

In Case and Deaton's paper on the rising death rates of white Americans, the economists note that less educated whites have been hit hard by recent economic trends. “With widening income inequality, many of the baby-boom generation are the first to find, in midlife, that they will not be better off than were their parents,” they write. Job prospects are bleak; debt levels are high; median income has fallen by 4 percent for the middle class over the last 15 years.

The power of this new paper by Chou et al. is that it tells the human impact of these facts. When we feel buffeted by forces beyond our control – by global shifts involving the rise of automation and the growth of Chinese manufacturing and the decline of the American middle class – we are more likely to experience aches we can’t escape. As the scientists point out, the end result is a downward spiral, as economic insecurity causes physical pain which makes it harder for people to work which leads to even more pain.

It shouldn’t be a surprise, then, that dangerous painkillers become such a tempting way out. Side effects include death.

Chou, E. Y., B. L. Parmar, and A. D. Galinsky. "Economic Insecurity Increases Physical Pain." Psychological Science (2016)