dripAt the end of my previous post, I challenged you to come up with other explanations for the study claiming that marriage results in better survival from cancer. How did you do? Some of my alternatives are below. I bet you came up with some others.

A Few Alternative Ways of Explaining the Study

#1 Married people have more money

There is plenty of evidence that married people are economically advantaged over single people. They have the benefit of financial favoritism built right into federal laws. (That’s one of the reasons motivating the advocacy of official, legal same-sex marriage.) Single people are also targets of economic discrimination. For example, single men are paid less than married men even when they have been on the job the same number of years with the same level of accomplishments, and even when they are twins.

The authors did take household income into consideration but economic assets include more than just income. The greater wealth of married people could account for their getting to the doctor sooner, getting the best available treatment, and being more likely to survive their cancer.

#2 Married people have more access to health care

With more money comes more options for high quality health care – or any health care at all. Even apart from differences in wealth, though, there are differences in access to health insurance. For example, married people sometimes have access to health insurance through their spouse’s plan. Single people do not.

If single people had as much money and as much access to health insurance as married people, maybe they would fare just as well as married people when struck by cancer.

#3 Doctors and nurses discriminate against single patients

In Singled Out, I reviewed research on discrimination against single people by medical professionals. In a particularly telling study, physicians admitted that they provided better care and more complete care to patients who had supportive families than to those who seemed to be alone. What’s more, they said that other doctors, nurses, and staff also did the same.

If doctors provide better quality care to their married patients than to their single patients, then perhaps it should come as no surprise if married people show up at their doctors’ doorsteps sooner, if they are more likely to get the definitive treatment, and if they are more likely to survive their cancers.

More evidence for this explanation comes from a series of studies just published a few months ago in Sweden. In a study of patients with newly metastasized cancer, those who were living alone were prescribed less combination chemotherapy and surgery than patients who were not living alone. In another study in which Swedish oncologists were interviewed, the doctors said that they worried that patients living alone did not have social support, and so they ordered less chemo for them.

#4 Married people and single people are different people – any way that they differ, other than in marital status, could explain differences in health outcomes

The authors found that in their dataset, the married patients were younger than the unmarried patients and they had higher incomes and more education. They controlled for those factors statistically, so perhaps those particular factors do not explain the results, but any other differences between the two groups might.

Consider, for example, that some of the unmarried patients may have been single-at-heart (scroll down after clicking). They are people who live their best and most meaningful lives as single people. They do not want to be married. If people who are single-at-heart were badgered into getting married (perhaps in part by media stories telling them that if they stay single, they will die of cancer), do you really think they would be healthier?

Or say you are married and miserable. You want to get divorced but now you wonder whether transitioning into an unmarried state will kill you. Seriously?

There’s another difference between always-single people and married people that has long intrigued me. Single people value meaningful work more than married people do. It is a difference that shows up even in prospective studies in which people are first asked about their values in high school. Those who will stay single already value meaningful work more than those who will marry.

If single people value quality of work more than married people do, then maybe on the average, they value quality of life more, too. Suppose you knew that if you went to the doctor more often, and – if diagnosed with cancer – you submitted to every version of slashing and burning and poisoning that anyone recommended, you would live a few year longer? Now suppose your choice was to skip all that and live your life as fully and freely as possible, outside of hospitals and doctors’ offices? I have never been faced with that choice, but I think I would be very tempted to choose the latter. That’s not an indication of valuing life less but of valuing quality of life more. For cancers that are especially deadly, such as the pancreatic cancer that runs in my family, the odds that any treatment will be successful are slim.

Now about All that Social Support that Married People Supposedly Get

The belief that married people are interpersonally connected and socially supported, whereas single people are isolated and “don’t have anyone,” is a myth. It is a stereotype that has been debunked by a variety of studies with a variety of research designs. (Here are some of them – scroll down after clicking the link.)

There is also some evidence to suggest that a husband may not be such a great source of support for women with cancer, and that friends may well be. Studies of women with breast cancer have shown that husbands are, on the average, not very good at relieving women’s stress or helping them recover more quickly (Bolger et al., 1996). But if those women have supportive friends, then it did not matter if their husbands were not supportive – they could still cope reasonably well with the help of their friends (Manne et al., 2003).

Remember, too, that in the study in question, no supportive behaviors were monitored or measured, and neither were any coping behaviors. We really don’t know if the married people got more support than the single people did, whether they complied with the recommended medical regimen more, or anything else.

In my next post, I’ll provide examples of how serious media sources and even an academic journal offered misleading descriptions what the study really did show. I’ll show you exactly what they said, and then tell you what I think they should have said instead, or in addition.

[Note: Thanks again to Alan, Jeanine, and Erin Albert for sending me links and questions about this study. And special thanks to Mona Bjork; when she read Part 1 of this series, she sent me the information about the Swedish study showing that doctors prescribe less treatment for singles living alone. I hadn’t known about that.]

Hospital patient image available from Shutterstock.