Health equity?

Demands for "health equity" for racial and ethnic groups is a push for more government control. The CDC reported in 2014 that the 5 top causes of death were diseases primarily of personal behavior, 1) diseases of the heart, 2) cancer, 3) chronic lower respiratory diseases, 4) cerebrovascular diseases (stroke), and 5) unintentional injuries. These are most often a result of obesity, smoking, drinking, drugs, lack of exercise and other risky behavior. HIV rates are still very high among young black men who have sex with men, and CDC says risk factors are poverty, high rates of unemployment, and cultural stigmas. Doesn't mention risky sex. I'm no doctor or researcher, but any poor, unemployed man who doesn't have sex with men will not be at risk for HIV.  The costs of unintentional injuries are huge--motor vehicle, drugs, suicide,  work, falls. The burden on employers and society in general runs in the billions of dollars annually. . . $1,097.9 billion 

Potentially Preventable Deaths from the Five Leading Causes of Death — United States, 2008–2010 (cdc.gov)

How Many People Die From HIV/AIDS Each Year? (verywellhealth.com)

Health Risks of Overweight & Obesity | NIDDK (nih.gov)

Societal Costs - Injury Facts (nsc.org)

Five lifestyles which will prolong your life. . . maybe

Have you ever seen this statement--"Americans have a shorter life expectancy compared with residents of almost all other high-income countries." I wish they'd qualify that by race, ethnicity, immigration status and age. Are Swedish Americans less healthy than ethnic Swedes in Sweden? Finnish Americans worse off than those born in Helsinki? German Americans? Drugs, auto accidents, and gun deaths wipe out a big swath of young Americans which unfortunately drastically alters our life expectancy national statistics. Losing weight, eating a healthy diet, and exercising more are good for you as an individual, but probably won't change national statistics as long as those 3 killers are present.

Here's what the journal "Circulation" determined: "Adherence to 5 low-risk lifestyle-related factors (never smoking, a healthy weight, regular physical activity, a healthy diet, and moderate alcohol consumption) could prolong life expectancy at age 50 years by 14.0 and 12.2 years for female and male US adults compared with individuals who adopted zero low-risk lifestyle factors."

Simple, right? Popular health journals and websites (usually sponsored by pharmaceutical companies) have jumped on that one. Buckets of articles and bags of advice have come from that. But. As young adults, people (like me in the 1960s or my parents in the 1930s) observing those five lifestyles were probably not involved in violent gangs, car chases while drunk, stealing to support an opioid habit, or eating wings at the local bar and washing them down with 12 beers several times a week. Those five lifestyles often include a monogamous marriage, higher education levels, stable jobs, church attendance, strong family and friend relationships. It's not that grandma who smoked like a chimney and drank six beers a day didn't live to be 105, or that cousin Ralph dropped dead jogging at age 40, but they are the exception.

I haven't read the whole article, but I know how it will be cited: support take over by the government of our health insurance because look how unhealthy Americans are. Studies in countries with socialized medicine that compare their healthiest and their least healthy show the same spread as the U.S. and that there are income gaps, education disparity and socio-economic differences which government health insurance doesn't change.

This article is free access.  “Circulation” is one of the best peer reviewed journals you can read on cardiovascular issues. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.117.032047

Quitting smoking unassisted

It’s nice when medical opinion catches up with mine.  For years I have questioned the use of public funding for smoking cessation—for Medicaid and Medicare patients, for prisoners and various minority populations and those  in the bottom quintile. It seemed a sop to the pharmaceutical companies, social workers and various cessation gurus.  With no great research on my part I noticed that although I know many former smokers—perhaps a hundred or so—not one of them quit using a drug or group support or counseling method.  The two closest were my father, who quit at 39 when he began spitting up blood from his coughing and lived to 89, and my father-in-law who quit when he reached for his third pack of the day and lived to be 93. Both quit cold turkey. Two of my father’s brothers, Russell and John, and one of his sisters, Gladys, did not quit, developed cancer and died painful deaths.  My father-in-law’s wife, Rosie, died many years before her husband; she didn’t stop smoking and developed lung cancer. I couldn’t begin to count the people my age that I know who are former smokers, including brothers-in-law and sisters-in-law. I know one man who used God—he says he challenged God, if he were real, to take away his desire to smoke. Poof, it was gone, and he stopped. He became a believer—in God. I know a few who became desperately ill, heart disease, COPD, stroke or cancer, and then stopped—and you can call it fear, but it was sheer will power. Their lives, although extended, were shorted by the years of foolishness and addiction.

A 2013 Gallup Poll of former smokers showed only 8% attributed their success to nicotine replacement therapy—gum, NRT patches—or prescription drugs.  56% credited “cold turkey,” “will power,” or “mind over matter.”  In other words, they decided to kick the filthy, health killing habit.  As a non-smoker, I am thrilled I can go into a restaurant or public event, and not leave smelling like a gambling casino of the 1950s.  However, there was a dramatic drop in smoking among Americans after the 1950  report linking tobacco and cancer, from 7.7 million former smokers in 1955 to  19.2 million in 1964, to 36.2 million in 1979. This was before the anti-smoking campaigns, the laws, and the drugs. Researchers could clearly see and puzzle over the success rate of these people, but chose to go the “assisted” route to find the perfect drug or program.

In my opinion, except for those unfortunate enough to have been mainlined nicotine in the womb, the vast majority of smokers pick up the habit through choice and social influence.  And that’s the way to quit.  Just do it, and don’t hang around with smokers.

http://jama.jamanetwork.com/article.aspx?articleID=1812969

Smoking cessation campaigns

Last year the government spent $54 million on Tips from Former Smokers. These are very moving stories. Sad, too. Lives ruined, or dead. The CDC says 1.6 million were persuaded to quit and after 3 months 220,000 were still abstinent. I don't know how they track that, but I've never known anyone who quit smoking with the federal government's help.
http://www.cdc.gov/tobacco/campaign/tips/resources/ads/tips-2-ad-ellie-full.pdf

My dad quit when he began coughing blood in his 30’s; my father-in-law quit when he reached for the 3rd pack of the day; my son-in-law quit in his early 40s; my brother-in-law quit in his 50s with some back sliding; my niece quit because her son had asthma; my girlfriend quit after lung cancer treatment.  Most of the other family members I recall who were heavy smokers died of different types of cancer—lung, liver, throat, or heart disease.  We lost them much too soon.

Quitting is tough. But not nearly as bad as chemo or COPD or asthma and being sick for the rest of your life.

Patch, pill or hypnosis, how did you quit?

I'm still waiting to meet a former smoker who quit permanently as the result of a government paid for program in their health plan, a work sponsored program, a drug patch or pill, hypnosis, talk therapy, etc. And I don't mean the 3-6 month quitter that the research reports in a clinical study so they get another grant from the NIH.  I'm sure they are out there, or why would we be spending so much money on them? [sarcasm].

Just Google "Smoking Cessation programs" (about 4.5 million hits).  Mayo Clinic claims it's had 45,000 participants in its program to stop using tobacco (smoking and chewing), with 110 randomized clinical trials involving more than 25,000 research subjects.  Where are the success stories?

When I see reports on what percentage of income the poor spend on cigarettes, there is usually a follow up appeal on why we should be spending more money on helping them quit.  Put where is the research that pills, patches, hypnosis and counseling actually pay?

http://www.nytimes.com/2012/09/20/nyregion/poor-smokers-in-new-york-state-spend-25-of-income-on-cigarettes-study-says.html?_r=0

One of these things is not like the others

Didn't Sesame Street have a song like that?

One of these things is not like the others,
One of these things just doesn't belong,
Can you tell which thing is not like the others
By the time I finish my song?

The CDC calls the following 5 items, "high-value prevention services" which can save 100,000 lives each year.

1. Smoking cessation assistance
   
2. colorectal cancer screening
   
3. breast cancer screening
   
4. annual influenza immunization
   
5. daily aspirin to prevent heart disease.

Three quarters of former smokers quit on their own. And I don't know anyone who successfully, permanently stopped smoking with a government sponsored workshop, phone call counseling, nasal spray or a drug patch. Do you? The studies only have a few months or a year follow-up, but somehow the drug companies have got that one included in many government programs.

But I have heard of other uses for the nicotine patch I might consider--like improving memory in older persons. Now that I could get into.

Only the aspirin and the immunization are actually preventative. Two of these are screening for what you already have or will have. Breast cancer screening can find a lump--but doesn't prevent it. Colonoscopies can spot trouble spots that will become cancer but aren't there yet.

If you loved your wife

While I was volunteering at the Midwest Birding Symposium and learning from Jim McCormac about how a drop of water in Lake Superior makes it to the Atlantic Ocean, my husband was the assistant rector at a Cum Cristo (Cursillo) week-end. He's been on so many Cursillo, Cum Cristo, Renewal, and Emmaus Walk week-ends, I've lost count. Maybe I'm crazy but I think he usually says, "This one was the best." But he did tell me about one guy we've known about 35 years who used to be a member of our church. His wife died of cancer some years ago and he has remarried, and I think things are fine, although we were never close, so I really don't know.

Anyway, he was periodically stepping outside for a smoke. Before they all went home, my husband said to him, "You don't love your wife." Obviously shocked, the man asked what he meant. "If you loved your wife, you wouldn't want her to be left alone and grieving after you die of cancer. You've been through this--how can you want this for her?" Then he sympathized and told him about my dad--who quit smoking when he was 39 and said it was 20 years before he stopped wanting a cigarette (he lived to be 89). He says the guy said he'd think about it.

That's pretty bold for a guy as quiet as my husband, but then he told me he'd done that before, and the guy actually did quit cold turkey.

Cursillo isn't about saving anyone for Jesus, because usually they are already Christians; but it couldn't hurt to save a physical life too, and save a wife and children from grieving an early loss.

You know who you are

Someone I love is trying to quit smoking. I suggested he take one day at a time, and he assured me an hour might be a bit much. Then I saw this quote at Dancing Boys Mom. Is this great, or what?

I try to take one day at a time, but sometimes several days attack me at once--Ashleigh Brilliant

I smoked a few cigs in college--had gained some weight. My roommate, daughter of a doctor, thought it might work. Stupid 60s. Fortunately, they tasted so bad, stung my nose, burned my eyes and made my breath stink, so I didn't continue. Can't imagine the attraction for those just starting. That's a lot of hurdles to try to look cool.

Sunday Search the Archives

This one from Feb. 15, 2006 at Church of the Acronym is worth a repeat--we'll be heading to church in a few hours.

334 Must the church always be a follower?
It won't be next year, or maybe not even 2016, but eventually church musicians and pastors will wake up about the noise and volume of their CCM rock, hip-hop and heavy metal music and the damage the blasting loud speakers cause to hearing just as they realized the dangers of smoking and second hand smoke 20 years ago. Too bad they can't be leaders instead of followers in this important health issue.

When we joined UALC in 1976, every meeting room and event was filled with the blue haze of cigarette smoke (with the exception of the sanctuary). I'd grown up in the Church of the Brethren, so smoking was just a plain old generic sin--below adultery and theft maybe, but certainly right up there with swearing and drunkeness. But Lutheran smokers 30 years ago believed in "freedom in Christ," and you were considered a Pharisee if you mentioned it made your clothes stink or burned your eyes. I'm not sure what turned the tide, but gradually smokers went to one room to breathe each others poisoned fumes, and then outside, and now I never see anyone smoking on the property.

What I remember most about this very serious health issue is that the church was not the leader. It was the follower.

How many of our babies and children and teens will need to lose their hearing in the low and high ranges incrementally, to be tested and fitted for hearing aids by age 40? Noise in the church is the latest blue haze that Christians think they can't do without. "Give me Jesus, but don't make me change anything," could be our motto.

I actually shudder when I see young parents taking small children into our X-Alt services because the parents identify with the music and our leadership knows this is a way to fill the seats. People who will floss for dental health, do pilates and kick boxing for exercise, and watch their cholesterol and calories seem oblivious to protecting their ears.

3909

Beyond hot here in Columbus

Yesterday it was 95 degrees in Columbus, OH. I was on duty for the mail run between our church's Lytham Rd. campus and Mill Run campus in the afternoon. There was road construction everywhere, even turning around after discovering I was blocked was difficult. At the intersection on our road I think I waited 4 lights to turn left.

I was surprised to see a number of people driving with an open window. They were all smokers. Inhaling hot smoke in a hot car, waiting at an even hotter, semi-stalled intersection, to creep along onto fresh hot asphalt, and drive behind trucks spewing more heat and pollution. Now how smart is that?

Smoking. It doesn't just damage your lungs and heart--it must destroy your brain cells too.

Another reason to give up smoking

This is a new one on me. Back pain. I've had back problems and pain off and one since my horse fell on me when I was 12 years old. Holding two babies, one on each hip aggrevated it when I was in my late 20s. But I've never been a smoker. Just the mother of one. Now there are new guidelines for aching backs from the NCQA, the National Committee for Quality Assurance (I assume that's medical insurance). $90 billion a year is being spent on x-rays, CT scans, injections and surgeries! Wow.

One of the top suggestions of the guidelines is to quit smoking. Smokers with back pain have more severe back pain that lasts longer and they have poorer outcomes after surgery.

Fear of litigation on the part of doctors is the primary reason you might getting the help you don't need.

Let's see: Cancer; heart disease; lung cancer; wrinkles; body odor; bad breath; slow healing; COPD; and now back pain. Geesh. Smoke gets in your eyes--and everything else, apparently.

Seen in the WSJ.

3823

We're fat, lazy and addicted, but we can control the climate

This morning I was listening to a radio interview with Governor Strickland (Ohio) who gave a rah-rah presentation about what a boost bio-mass energy sales are going to be for an agricultural state like Ohio. This was prefaced by the usual blah-blah about the seriousness of global warming and what we're going to do about it, because we, the human race, can turn it around.

And the thought occurred to me:

We can't do the right thing for the one body we actually do control--we eat too much, full of bad stuff and don't exercise; we smoke, drink and use drugs, legal and otherwise, all of which we know are bad for us; but we claim not to be able to stop these bad habits. To top it off, we teach our children that a minuscule loop of latex will protect them from the most vicious and voracious bacteria and viruses in history. And we're going to stop global warming by putting corn into gas tanks, mercury into light bulbs, buying phony carbon exchanges and gazing at the moon on Earth Day?

Where's the tooth fairy when you need him?

3757

Smoking bans

Ireland was the first country to implement a true smoking ban. Not very many states have a ban, but Ohio is one of them. Unfortunately, the legislation is poorly worded, so there will probably be lawsuits. Like if a cross country trucker is driving through Ohio, is it illegal for him to smoke in his cab. Huge parts of Canada are smoke free (although that's sort of to be expected since it is much more socialistic than the U.S.), New Zealand has a full country ban and most of Australia.

I heard two guys on a morning drive/talk radio show discussing this as a loss of freedom. Saying only the restaurant owner should decide, and then determine if he needed smoke-free sections. That view totally ignores the needs of the wait staff, kitchen and janitorial staff, the band and musicians. And as a non-smoker, I could never get away from it even in the non-smoking section of restaurants. I can remember when clerks in stores smoked at the cash register, when librarians smoked in their offices and at public desks, and people smoked inside our church in the classrooms and fellowship hall. It wasn't pleasant. Everyone stunk smelled bad.

Clean air is good for the tax payer (lower health costs which we hope will offset the decrease in tobacco taxes), good for the worker, and good for the brain. So on this issue, I definitely side with the liberals, who are the folks against personal freedom, because the freedom of others matters too. If you have a partial ban now in your city, state or country, eventually it will be total. There's absolutely nothing positive about poisoning yourself and the air around you. Get over it, and get on with living.

3717

Do smoking cessation pills and programs work?

I know many former smokers; my son-in-law quit 9 years ago, his father knows the exact day in 1980 that he quit after 37 years of being a smoker. Both my father and my husband's father began smoking as teen-agers; one quit at 39, the other around 50 (his wife didn't quit and died of lung cancer). A good friend of ours quit about 5 years ago in his 60s after heart surgery, but has recently been diagnosed with cancer. I know many people who thought they could not live without a cigarette but miraculously discovered after lung cancer, COPD or triple by-pass, they could indeed live well and not smoke. Of all the former smokers I know, all quit by. . . quiting. They stopped lighting up, usually cold turkey not gradually, and just suffered the short term consequences and discomfort rather than the agony and pain of losing a lung or the disability of having a stroke or heart attack.

So when I read about Medicaid paying for smoking cessation programs I wondered if that's the best use of our tax money. 41 million Americans have their health insurance through Medicaid, and 29% of them are smokers. Medicaid is handled by the states--in Ohio, 37.6% of our state taxes go to fund Medicaid. Thirty-eight of the 50 states offer some sort of coverage for at least one smoking treatment according to MMWR 2006:55:1193-1197. Some are a mix and match between drugs and behavioral modification.

Obviously, it's not healthy for anyone to smoke, but does any one but the pharmaceutical companies and the people who run these programs really benefit?

3562

Smoking and movies

No matter what you say about violence, sex and dirty language in movies, they aren't going to kill your children (later in life), but cigarette smoking will. And it is on the increase in movies. Over at Facts and Fears, which warned in an op ed about this a few years back they now report a study published in a pediatric journal:

"A new study appearing in this month's Archives of Pediatric and Adolescent Medicine evaluates the relationship between smoking initiation and movie-going habits from a different perspective -- but the results are analogous, to an amazing degree. The authors, from the University of North Carolina at Chapel Hill and the Pacific Institute for Research and Evaluation, evaluated 735 youngsters, aged twelve to fourteen, at the beginning of the study, in 2001. One of the key measures they recorded was which of ninety-three popular films they had seen over approximately the past year. Two years later, the researchers re-interviewed the study group to determine how many of them had begun to smoke, and the relationship of smoking to their earlier, self-described moviegoing habits.

White teens who had higher exposures to R-rated movies -- and about two-thirds had such exposures -- had an almost three-fold higher rate of smoking than their peers who had lower or no R-rated movie exposures. (Interestingly, and for no obvious reason, black teens did not have that same increased rate of smoking based upon R-rated movie viewing.) Girls and boys both had higher smoking initiation with increased attendance at R-rated movies.

The authors point out that several other studies -- one of which is the study I discussed in my 2003 op-ed -- have now confirmed that young teen exposure to movies that portray, or are likely to portray, smoking have a significant impact on initiation of smoking by a factor of about three (this degree of elevation was found in all the studies). It should be noted here that approximately 100% of R-rated movies do have smoking scenes."

Personally, I don't know why you are letting your kids see R-rated movies, but maybe you need a heads up here.

3032 What it costs to smoke

How do I count the ways? My heart and hopes are with my 38 year old son who has been smoking half his life. When the morning cough and the expense ($8/day--almost $3,000/year) became alarming, he made another resolve to quit. He's made some really good progress this week, and is down to 5 from 45 cigarettes a day.

My husband grew up in a home with smoking parents. His mother who was very fair and blond lost about 5 inches of height in her later years and had a lung tumor (non-operable). Smoking is much harder on women than men. She quit smoking about 5 years before her death (I think she forgot she smoked), and actually recovered some brain function. When I met my husband nearly 50 years ago, he coughed every morning but he wasn't a smoker. We think he probably coughed at least an hour or two each morning when he worked in an office where smoking was allowed. I can remember in 1967 when I was in graduate school at the University of Illinois and he drove me to class, he would cough all the way from our house to the drop off on campus--probably a 20 minute drive. When he went to work for a downtown firm in Columbus in the mid 70s in an older, poorly ventilated office, he told them he would quit if they couldn't get him away from the smokers, so they stopped letting the employees smoke in the office. Over time, smoking has been eliminated in most public places, even stadiums, but I remember when the library employees smoked behind the circulation desk--patrons didn't, but staff areas were OK. And in retail stores--the clerks were all smoking at the registers. You couldn't get away from it. It was bizarre.

I heard Rush Limbaugh complaining today about the liberal conspiracy behind the smoking initiatives in various states. Rush may be right that the backers are liberals, but I hope we can stop issue 4, which will again allow smoking in bars and restaurants, and pass issue 5 which will stop it. Apparently, Rush hasn't noticed how many people earn their living working as waitresses, bar tenders, bussers and kitchen help in restaurants. A public non-smoking law was passed in Scotland this year, and within a month, when they tested the employees of restaurants, there was a huge improvement in their lung function (reported in JAMA).

Vote NO on #4, the amendment to the Ohio Constitution, called euphemistically, "Smoke Less Ohio," which will bring smoke back to our restaurants, hotels, nursing homes, etc.

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