Category Archives: Public health

Pitchforks, pistols and “going postal”

Pitchfork: n. a long-handled fork that has two or three long somewhat curved prongs and is used especially in tossing (pitching) hay

Pistol: n. a handgun whose chamber is integral with the barrel

“Going postal”: v. To become extremely angry or deranged, especially in an outburst of violence. The term derives from a series of incidents from 1983 onward in which United States Postal Service  workers shot and killed managers, fellow workers, and members of the police or general public. Between 1986 and 1997, more than 40 people were killed in at least 20 incidents of workplace rage.

Used to be when the rabble got roused, they’d go after the bad guy with their pitchforks pointed at his butt, thus running him out of town.

No more. We’ve got guns, and we’re gonna use ’em.

Pistol, by Christoph Niemann

Pistol, by Christoph Niemann

How many mass murders are we going to allow before we stand up to the gun lobby???  47 just in the past month!

An article by AP writer Ted Anthony asks, “What is happening in the American psyche that prevents people from defusing their own anguish and rage before they end the lives of others? Why are we killing each other?”

I can answer that:   Because.We.Have.Guns.   Without guns we’d have to resort to fisticuffs, maybe a knife, maybe lots of screaming and yelling.

The other issue, raised by Charles Blow in the NY Times: Are certain susceptible people taking as gospel the call of right-wing crazies like Glenn Beck, Chuck Norris, Michelle Bachmann, Rush Limbaugh to be red-blooded patriots and take up arms if necessary to prevent SOCIALISTS and ATHIESTS and LIBERALS from taking over the country?

What are we becoming?

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The pitfall of pets: painful pratfalls

Pitfall: n. a hidden or not easily recognized danger or difficulty

Pets: n. animals kept in captivity by their “owners” for companionship

Painful: adj. uncomfortable, agonizing

Pratfall: n. an awkward blunder or mishap, a fall on the buttocks

Our beloved pets may lower our blood pressure but a new report indicates that they also can bring us a world of hurt:

Dogs and cats cause more than 86,000 falls requiring emergency room care each year, according to a report from the Centers for Disease Control and Prevention that may be among the first of its kind. That translates into about 240 people who are treated for injuries caused by pets every single day in the United States, the study found.

Cats are involved in some of the falls, but dogs — man’s best friend — are the real culprits, responsible for seven times as many injuries as cats, often while they’re being walked, the report found.

And though more pet-related falls occurred among children and adults in mid-life, elderly people were most likely to break a bone, which can have serious long-term consequences, said Dr. Judy Stevens, the C.D.C. epidemiologist who wrote the report. Women were at more than double the risk for injuries than men.

I certainly can speak to this! I’ve only been to the emergency room once in my life and it was when I tripped over my black standard poodle in the dark and split my lip bigtime on a concrete pillar. Lots of blood, many stitches. No lost teeth, thank god, but I still have the scar.

A few months ago I was walking the same dog and she suddenly cut in front of me (a squirrel!!). I tripped over her leash and slammed into the pavement hitting my chin, hands, elbows, hipbones and knees simultaneously. No hospital trip, but I was crippled for a week and over the next couple of months I became a profit center for my chiropractor.

My sister also has a black standard poodle (it’s a family thing). Last spring she fell over her on the way to the bathroom in the middle of the night, resulting in her first emergency room visit ever – and a broken collar bone.

Because they seem so silly and mundane, these accidents were never studied until now. And on reflection, it seems so obvious that pets can be hazards… how many times have you heard yourself describe your cat or dog as “always being under foot”?

To make the math easy, let’s assume that each ER visit costs an average of $1,000. That’s $86,000,000 right there. Then we add on followup visits, chiropractor visits, lost work time and we’re talking real money.

Pets need to come with a warning label and glow-in-the-dark jackets.

Population boom: teen and unmarried mothers

Population: n. : the whole number of people or inhabitants in a country or region

More babies were born (4.3 million) in the US in 2007 than any other year in our history. Two particular statistics fly in the face of rhetoric from the religious right:

1. The teen birth rate is up again, for a second year in a row. So much for “abstinence only”.

Even at the low point in 2005, the United States had the highest rates of teenage pregnancy, birth and abortion of any industrialized country. Because teenage births carry higher risks of medical problems and poverty for mother and child, state health agencies, schools and private groups have mounted educational campaigns to deter teenage pregnancy.

2. Forty percent (40%!) of last year’s births – to mothers of all ages – were to single women.  Which leads me to believe that heterosexuals don’t much care about the institution of marriage …  and it has nothing to do with gays marrying (or not).

Along with the boom in birth (less contraceptive use?), we’re seeing a decrease in abortions.

What I want to know is how many of these new babies were really wanted by their mothers? And if many were not wanted, what problems with troubled children are we going to see in a few years?

Another worrisome trend is the continuing increase in C-section use:

In yet another record high, the share of deliveries by Caesarean section reached 32 percent in 2007, up 2 percent from 2006. Experts have repeatedly said some C-sections are not medically necessary and impose excess costs, but the rate has steadily climbed, from 21 percent in 1996.

Not only are C-sections expensive and invasive, but the baby’s long-term health may be jeopardized:

Swiss researchers are reporting in the journal Thorax this month that a Caesarean delivery is linked to a much higher risk for asthma compared with babies born vaginally.

In a study of nearly 3,000 children, the researchers found that 12 percent had been given a diagnosis of asthma by age 8. In that group, those born by C-section were nearly 80 percent more likely than the others to develop asthma. The explanation may be that a vaginal birth “primes” a baby’s immune system by exposing it to various bacteria as it moves through the birth canal.

Prevention: vaccines as public health superstars

Prevention: n. the act of keeping from happening, holding back or hindering

An ounce of prevention is worth a pound of cure.

I’m working on an article for a health magazine on vaccinations for children.

If you don’t have little kids you may not be aware that vaccinations have become a focus of parental angst since a (now-debunked) 1998 study of 8 autistic children by Andrew Wakefield in the UK, which claimed that the measles-mumps-rubella vaccine could cause autism.  Turns out that the doctor was a shill for the kids’ families who were seeking financial settlements. And last week several cases trying to link autism to vaccines were thrown out of court.  (Newsweek‘s Sharon Begley just did an excellent feature on the history and current state of the vaccination kerfuffle – Anatomy of a Scare….)

Wakefield’s British medical license was revoked, but the damage was done. Parents with autistic children had found themselves a scapegoat in the vaccine, and parents of healthy infants began to question the whole concept of vaccination.

  • There were so many shots: “Why when I was a kid,” they said, “we just had the DPT and polio vaccines….”
  • Is this an evil collaboration between Big Government [the CDC] and Big Pharma to get more money from us?
  • Had the vaccines been properly tested – separately and in combination? Was it safe to give babies so many shots at one time?
  • What are all these diseases anyway? Why should we worry?

To make matters worse, the media picked up the controversy and rumors spread like wildfire on the Internet. Celebrities ignorant of science and the scientific method ranted on TV. Some parents decided to forego vaccinating their kids;  some (thanks to a misleading and poorly researched book on vaccinations by the Dr. Robert Sears) decided to formulate alternative vaccination schedules for their babies – delaying some and dropping others.

I interviewed several pediatricians, family practice physicians, and epidemiologists for the article and they all were disturbed by the level of public misunderstanding and the potential repercussions of fewer kids being vaccinated.

“The problem,” said one pediatrician, “is that many of these vaccines have been around long enough and have been so dramatically successful that today’s young parents are unaware of how devastating these diseases can be. In my travels to less developed parts of the world I’ve seen kids struggle for their very lives or die from them.”

Another pediatrician told me that parents always fear for possible health threats to their babies. “Without the actual diseases themselves to fear, they are now focused on vaccine side-effects. Instead they should be worried that many of these childhood diseases are just a plane flight away. Or an unimmunized buddy at daycare away.”

According to the Children’s Hospital of Philadelphia’s Vaccine Education Center:

Before the vaccines we use today parents in the US could expect every year:

  • Polio would paralyze 10,000 children
  • Rubella (german measles) would cause birth defects and mental retardation in as many as 20,000 newborns.
  • Measles would infect about 4 million children, killing 3,000 and causing severe brain damage in many others.
  • Diptheria would be one of the most common causes of death in school-aged children
  • A bacterium called Haemophilus influenzae typ b (Hib) would cause meningitis in 15,000 children, leaving many with permanent brain damage
  • Pertussis (whooping cough) would kill thousands of infants.

Additionally, the recent rotavirus vaccine protects the against an intestinal infection that’s still one of the  leading killers of the very young around the globe.

The other issue big on young parents’ minds is the timing of vaccinations – so many so close together. But that is how they have been studied, said the docs I spoke to – the current vaccination schedules have proven effectiveness and safety, and alternative schedules have not.

I could go on and on, but this is just a blog post.  If you’d like more information check out the CDC website.

Update 4/23/09: Jim Carrey wrote an outrageous post at Huffington Post yesterday – another celebrity rant by someone who doesn’t understand science. I’m not linking to it, but I will link to Skeptic Dad at Science-Based Parenting, who rebuts in detail the Carrey post. Nice job.

Pro-Life? How do you respond?

Pro-life: n. code word for (usually) Christian conservatives meaning that you oppose abortion.

Mike Huckabee called me the other night. Well, Mike, the former gov of Arkansas, former fattie, former presidential candidate and current talk show host (of course… what better way to stay in the public eye in preparation for his next run) didn’t actually call me in person; his robot did.

“Hi,” said his computer voice, “this is Governor Mike Huckabee – I want to ask you a couple of questions… Did you vote in the last election?”

Since I always want to hear what Republicans are currently spinning, and because it’s true, I said yes.

“Do you consider yourself pro-life?” Huckabee’s voice asked.

Now this stumped me for a minute, because I’m “pro” lots of things. I mean who wouldn’t be pro “LIFE”? It’s better than the alternative, as Woody Allen once said.

Framing the anti-abortion movement as being “pro-life” was a stroke of linguistic genius because the most natural oppositional phrases are “pro-death”, “anti-life” or “pro-abortion” – all of which sound bad, even though none of them are accurate descriptions of those who believe women have the right to choose whether to carry an unwanted pregnancy to term or not.

Planned Parenthood used to have a brilliant slogan: “Every child a wanted child.”  It conveys the heart of the matter: a woman should be able to control her own fertility because who knows better her ability to bear, love and raise that child? No child should have to bear the burden of being born to someone who doesn’t want him. God knows, in this world a kid has a hard enough time getting the love, support, health care and education he deserves being raised by parents who wanted him. Unfortunately every community around the world has growing populations of homeless men, women and children who lacked that nurturance.

Anyway, back to Mike and me.

He took my stammering for a YES and plunged on with the true purpose of his call – to pass along the scary lie that Obama’s top priority was to pass a law to make it possible for anyone to perform an abortion on any woman anywhere anytime.  Now, if I had known Mike was going to call with such a load of codswallop, I’d have figured out how to record the call so I could quote him exactly and could parse the statement phrase by phrase…

The message was paid for by Americans United for Life, but I believe he’s done various versions of the message for other pro-life groups as well.  They are nothing if not well organized and well-funded.

I totally deplore fear-mongering as a persuasion technique – and the Right specializes in it – that and reducing the issue to its most simplistic even if the truth must be twisted or ignored to get there.  Those of us on the left have a greater interest in facts , even if they’re messy and complex to communicate.

So back to “pro-life”.

Our standard catch phrase response is “pro-choice”, which, though truthful,  lacks the emotional impact of “pro-life.”  We are certainly not “pro-abortion”; we’d much prefer the pregnancy be avoided thru the use of contraceptives. But contraception can fail and women do get raped.

Some of us believe we could call the pro-lifers “pro-fetus, anti-child,” because once the child is born conservative ideology says taxpayers shouldn’t have to support “welfare mothers” who can’t make ends meet raising kids alone.

We could also call them the “forced pregnancy” squad.

My own definition of pro-life means we respect the mother’s right to choose to give life or not. And if she does, we as a society are there to help her succeed as a parent and to help her child grow up to be a healthy, responsible, educated and contributing member of society.

Pregnant teenhood: Bristol Palin wouldn’t recommend it

Pregnant: n. containing a developing embryo, fetus, or unborn offspring within the body

Bristol Palin did her first interview yesterday (on Fox, where else?) and she made two statements that indicate that Reality has a way of intruding on Ideology, even on a Palin person:

“I like being a mom, I love it. Just seeing him smile and stuff, it’s awesome…It is very challenging but it’s so rewarding…Of course, I wish it would happen in ten years so I could have a job and an education and be, like, prepared and have my own house and stuff… I just hope that people learn from my story and, I don’t know, prevent teen pregnancy I guess… It’s not just the baby part of it that’s hard, it’s that I’m not living for myself anymore I’m living for another human being…I’d like to be an advocate to prevent teen pregnancy because its not a situation you strive for I guess…Kids should just wait–it’s not glamorous at all.”

And actually, “abstinence only” might not be such a great idea after all:

I think abstinence is like, like the…I don’t know how to put it…like the..the main….everyone should be abstinent or whatever, but it’s not realistic at all.”

Like, whatever. Too bad she didn’t figure this out a year or so ago. And nationally the numbers reflect the toll “abstinence only education” has had on the teen birth rate, which is suddenly spiking across the country after fifteen years of steady decline.

The highest teen birth rates are in the South and Southwest; Mississippi is highest with 68.4 per 1,000, followed by New Mexico, with a rate of 64.1 and Texas, with 63.1. The lowest rates are in the Northeast.  New Hampshire had the fewest teen births with 18.7 per 1,000. Vermont, with 20.8 per 1,000, and Massachusetts, with 21.3 per 1,000, were also low.

Hmmm. The states most likely to support abstinence only education have teen pregnancy rates three times higher than use using more comprehensive sex ed programs. And how about this recent study, summarized at USA Today:

Teenagers who pledge virginity until marriage aren’t making good on their promises not to have premarital sex, according to a new study published in the January issue of the journal Pediatrics.

The Johns Hopkins University School of Public Health analysis finds pledgers are just as likely to have sex before marriage as those who didn’t pledge to remain virgins, but the pledgers are much less likely to report using birth control or practicing safe sex when they do.

The report reviewed data from a federal survey of teenagers who said they had never had sex and had not taken a virginity pledge and matched them with peers of similar characteristics who had taken a pledge. Both groups were surveyed in 1995 and again five years later when they reported on their sexual behavior, sexually-transmitted diseases and safe sex practices.

Both those who pledged and those who didn’t pledge did not differ in their sexual practices or the incidence of premarital sex, but pledgers used birth control and condoms less often. Also, 84% of pledgers denied ever making an abstinence pledge.

I’m shocked. SHOCKED! I tell you.

Patients’ patience: waiting costs us

Patient: n. an individual awaiting or under medical care and treatment

Patience: n. the quality of bearing pains or trials calmly or without complaint; manifesting forbearance under provocation or strain

For years my ex had an internist who habitually ran an hour behind. No matter what time he arrived for his appointment he was seen an hour later. He spoke to the administrator about it, he chewed out the doc, and even threatened to bill him for the wait time (he was a lawyer, and had billable hours down!). Finally he found a new doc.

Princeton economist Alan Krueger wrote about this a couple of days ago:

…Time is money. So, although it doesn’t currently enter into our national statistics, the time that patients spend getting health care services should be reflected in the way we calculate America’s national health care expenditures.

Any student of Econ 101 knows that economists measure costs by opportunity costs, meaning everything that is given up to get something else. Time spent interacting with the medical system could be used for other activities, like work and leisure. Moreover, spending time getting medical care is not fun. This time should be counted as part of the cost of health care.

He suggests that we undervalue the cost of health care by about 11% by excluding the opportunity costs of waiting for care, which he calculates at about 847 million hours annually. Valuing the time at an average of $17.43 he says Americans spent the equivalent of $240 billion waiting around in 2007.

He says that if we’re going to modernize health care record-keeping, we should be including patient time in the equation:

Failing to take account of patient time leads us to exaggerate the productivity of the health care sector, and to understate the cost of health care. The time that patients spend seeking, receiving and paying for health care services is just as real as the dollars they spend for medical services.

I know scheduling is a constant challenge because emergencies do arise, but other industries have figured out a way to keep irregular systems rolling; why can’t physicians?