Category: Public Health

Decarceration and Public Health

Check this out. What you will see is a thorough lesson on “how mass incarceration makes us sick”. Actually, you will see a double whammy described in this post.

First, we are reminded that the high and growing rate of incarceration in the US does not provide us with the protection from crime that the general public believes that it does.  Translated, our incarceration rates are significantly higher than those of other first-world countries, but our crime rates are not commensurately lower. Whoops!

And then there is this learning of the pandemic. Prisons make wonderful Petri dishes. Great for spreading pathogens like COVID-19. And as is pointed out here, prisons are not like Vegas. What happens there doesn’t stay there, rather spreading like wildfire to surrounding communities. You all saw the news reports from prisons in Illinois and elsewhere demonstrating these effects during the height of the pandemic. And New York City was quick to clear out as many prisoners from Rikers Island as possible, as quickly as possible, to avoid a coronavirus disaster there adding to their woes. 

And then there are other factors to consider. Like the impact that differential incarceration rates have on racial inequality in health and healthcare. 

Bottom Line. The message here is clear. Mass incarceration can have significant, untoward public health consequences. We need to keep them in mind when we, as a society, exercise our understandable but troublesome penchant for wanting to punish even the most minor criminals with jail time. 

Vaccine Shoutouts

Check this out. What you will see is no great surprise. Rather, it is the finding that social media are playing a major role in helping to relieve “vaccine anxiety.” As an example, watch this video. A really creative way of presenting important comparative vaccine efficacy data. No coincidence that all the players are of color, since vaccine anxiety has historically been much higher among minorities. AND. Not unimportant that the actors quickly and humorously deal with the urban legend that the vaccines contain “chips” that permit recipients to be tracked. 

Bottom Line. With community leaders, social media, word of mouth and other forces at work, it is gratifying to see the vaccine anxiety which has bedeviled up to 33% of the U.S. population begin to decrease significantly. As I have already said in several posts and I will set forth again here, “Public Health” and marketing are often two sides of the same coin.  

And We Are Fat, Fat, Fat!!!

About three quarters of American adults are, anyhow. Check this out. Several interesting points are made in this piece. No great surprise is that this percentage has been steadily, inexorably climbing over the past decade. We can see that all around us.

And no, the requisite interventions to get these numbers back on track haven’t changed an iota over that time period. You know the drill. Eat better, exercise more, etc. Common sense public health measures. Sort of like socially distance, wear a mask, blah, blah, blah. We all know about these behavior changes. We just don’t do anything about them.  

But perhaps the most profound observation here is the statement that while we have listened to Wolf Blitzer blither on night after night for almost a year now about the COVID pandemic, there has been little or no mention of the obesity pandemic during that time. 

Why? Lots of possible reasons here. For example, the deaths that result from obesity are far more gradual and less dramatic than those resulting from COVID. No gasping for breath, “exclusive NBC trips into one of the nation’s busiest ICU’s” etc. Nothing newsworthy. 

Or. Maybe we just can’t chow down the guilt associated with obesity. Heck, it’s not our fault that we get COVID, but it is if we get fat.  

AND. There’s no magic bullet/vaccine coming over the horizon to save us from obesity. We will need to save ourselves.  

Bottom Line. Viral pandemics will come and go. We’ve now seen several in our lifetime. And when they appear, they WILL get plenty of attention, even if only a relatively small percentage of our total population succumbs. 

But obesity is here for the long haul. And is impacting three quarters of our population. I’m thinking it is time to pay some attention to this pandemic!

Worry And Stress With Covid-19

Check this out. What you will find is a Kaiser Family Foundation survey finding that 45% of adults in the U.S. report that their mental health has been negatively impacted due to worry and stress related to the pandemic. Lockdowns, job losses, service in the front lines of COVID treatment, etc. are all contributory factors here. And yes, drug and alcohol abuse are rising as a result. And yes, other articles report significant increases in calls to spousal abuse hotlines.  

Bottom Line. Dr. Fauci tells us that it will take “a year or so” to get back to normal lives following the development of a COVID vaccine and effective treatments. Given the impact that the pandemic is demonstrably having on the psyche of adult Americans, and by proxy on American children, I think he is being too optimistic.

I think it could take generations!

Why More Physicians Should Enter Industry

Actually, there should probably be a “???” inserted after that title. Why? Here’s the deal. We have often discussed the “doctor shortage” in clinical practice. BUT. This blogging bioengineer believes that the dearth of physicians in industry is inhibiting the development of new technologies that could be used to save countless lives. A multiplier effect when compared to the outcomes of the work of physicians “in practice.” Bottom Line. If a physician is qualified to practice or to participate in technological development in industry, which path should she take? Where can she “do the most good?”  Tough decision!

No Data vs “Bad” Data

Here’s a multi-layered discussion of the problem with “data” about doctors’ performance. In this case, complications resulting from surgery. The first issue discussed is one we have covered before. Small sample sizes in numbers of procedures, significant differences in the risk patterns of different doctors’ caseloads, etc. BUT. There is another problem. More specifically, the study reported here indicates that the patients who are supposed to benefit from these data by using them to help them to choose surgeons cannot appropriately interpret them. AND. Those patients who could theoretically benefit most by using the data are least able to make appropriate interpretations and are most likely to be swayed by other issues like insurance coverage. Bottom Line. I continue to be amazed that our society increasingly believes that simply blurting out “data” to consumers is going to yield better decision making. I see this magical thinking in articles like this, in DTC advertisement with laundry lists of side effects and warnings, etc. It is a shame that with all of the great work done by Tversky and Kahneman on Behavioral Economics, clearly demonstrating that most decisions are made via short cuts and rules of thumb rather than by well-informed consideration of all of the facts, we continue to hold on to this vision of the rational decision maker.  Get real!!!

Hamburgers And Opiods

Check this out. What you will see are the results of a study that clearly indicate a relationship between the amount of largesse that physicians receive from the manufacturers of opioid products and the number of prescriptions that they write for such drugs. Mercifully, this reporter was astute enough to explain that the study is correlational. It could be that the schmoozing is causing the Rx’ing or vice versa. Or none of the above. Bottom Line. Whatever the direction of causality here, this finding, when published in the popular press, likely leads the reader to the unfortunate conclusion that the pharmaceutical industry is nefariously and purposefully fueling the opioid crisis.   Are we?

Patient Compliance???

We have all heard, and marveled at, stories of “grapefruit sized” tumors being surgically excised from patients. But check this beauty out. What you will likely be amazed and horrified to read is the story of a woman, pictured above, who had a tumor of 132 pounds removed.  It was growing at 10 pounds a week and was quite likely to kill her within a couple of weeks if not removed. Every time I see a case like this, I would like to talk to the patient post -surgery and ask what the heck they were thinking that let them get into this state to begin with. I understand the defense mechanism of denial, but this is sort of over the top. Bottom Line. What does all of this have to do with the “patient compliance” title? Simple. Cases like this are a profound reminder that patients are not necessarily approaching their health care in a rational way. SO. We need to understand the headsets of patients that allow themselves to get into this state, and find out what we can learn from these cases that we can generalize to dealing with the population at large. 

Obesity And National Security???

This is one of those thing that, although I had never thought about it before, makes all the sense in the world when somebody points it out. Check this out. Obesity is virtually an epidemic across the U.S., but especially in the South. Guess what area of the country provides a disproportionate % of new Army recruits! You got it! SO, how does that work out. It works out that only about half as many recruits are qualified to serve now as were qualified during WWII. Not good when there is no draft and you need soldiers. AND. Training related injuries have gone way up as the result of the poor physical condition of, well, fat Southern recruits. And so have expenditures to treat these injuries. Bottom Line. I am always amazed to hear about the myriad consequences that one variable can have on so many others. Would you ever have connected the words obesity and national security before? You will now!

Patients Want To Know About Cancer Drug Shortages???

Check this out. What you will see are survey findings about patients’ knowledge of, and attitudes toward, shortages of cancer drugs. What you will see here is a data set that struck me as peculiar in several ways. First, the survey data reported are from a nationally representative sample, rather than a “purposeful” sample of cancer patients. While random is usually good for general representation, talking to cancer patients might have made much more sense here. Given the nature of the sample, it is hardly surprising that the average citizen is not aware of the shortage of cancer drugs. Why would they be? AND. What does one do with information like the finding that the average consumer would change treatment centers rather than accept a substitute cancer agent for one that was in short supply at their center? How would the average person be able to make the evaluation if this was a good move or a risky move? Bottom Line. I have commented before on what I see as the risk of assuming patients should be evaluating information like physicians do. Making sophisticated medical choices. This research, which seems to ask the wrong questions of the wrong respondents, is a perfect example of such folly!