Monthly Archives: October 2013

Get the Shot!

Being a geek, I’m a big fan of the TV sitcom, “The Big Bang Theory”. It is well written and does a good job of reflecting real science. Several of the characters are scientists. Amy Farah Fowler is Sheldon’s sort of girlfriend. The character is portrayed by actress Mayim Bailik, a neuroscientist who holds a PhD from UCLA .

Here’s the problem; Amy the character, appears to be more scientifically literate than Mayim the real life scientist. Mayim is the spokesperson for a group with views that go far beyond main stream medicine, such as recommending homeopathic treatments and not following scientifically accepted vaccination schedules for infants. The former would substitute ineffective sham medicine (homeopathy) with scientifically proven, efficacious drugs. In the case of the latter, rejecting vaccinations or even delaying an appropriate vaccination schedule puts not only the person or their children at risk of unnecessary illness, but also society at large.

The effectiveness of vaccinations depends on so-called herd immunity. To stop communicable disease does not require absolutely everybody be vaccinated, just a high enough percentage to disrupt transmission. Some individuals can’t be vaccinated for certain diseases for example neonates and pertussis- whooping cough.

Fall and rise of Whooping cough

Fall and rise of Whooping cough

They are protected from this once common disease by virtue of the fact that those around them have been vaccinated and therefore don’t carry the disease. If an older unvaccinated child gets pertussis s/he can transmit the bacterium to an infant with fatal results.

A real problem with getting a vaccination is a misperception of risk. A person may known of someone who got a flu shot, and had a bad reaction or had the shot and still got the flu. This knowledge introduces a bias. It doesn’t however change the fact the the overwhelming odds are in favor of getting the shot. Depending on the vaccine, the strain of influenza, and several host factors,

“ …How well a flu vaccine works is challenging, in general, recent studies have supported the conclusion that flu vaccination benefits public health, especially when the flu vaccine is well matched to circulating flu viruses” – Centers for Disease Control statement. The odds of a severe negative outcome, usually to an allergic reaction to the vaccine are in the one to millions range.

Back to the bias of knowing someone for which a flu shot didn’t work, or had a reaction. Does knowing someone who won the lottery make you more likely to win the lottery? Most folks would say of course not. But this is the same kind of bias. You think of just one outcome among many, many. But that doesn’t change your odds.

We all know someone who doesn’t wear a seat belt. S/he frequently justifies the self-endangerment by claiming that they know of a case where someone died due to the seat belt. The same bias. Evidence from literally billions of passenger miles shows seat belts save lives.

Vaccinations are generally safe and are generally efficacious. Vaccinations protect not only those vaccinated but also others through the herd immunity. Participate in society, get the shot.

Global Warming and Disease Vectors

Mount Nebo, along with other mountaintop resorts in Arkansas, began as a place for the well-heeled to escape the summer miasma in the Arkansas River Valley below. By the middle of the nineteenth century steam boats brought folks seeking respite from the mosquitoes which bred in the swamps and transmitted deadly diseases such as malaria and yellow fever. Public health measures have eliminated these diseases in the United States but climate change raises concern for their return.

Malaria endemic countries

Malaria endemic countries

Recently the Intergovernmental Panel on Climate Change released the findings of their fifth report:Warming of the climate system is unequivocal, and since the 1950s, many of the observed changes are unprecedented over decades to millennia. The atmosphere and ocean have warmed, the amounts of snow and ice have diminished, sea level has risen, and the concentrations of greenhouse gases have increased. Each of the last three decades has been successively warmer at the Earth’s surface than any preceding decade since 1850. In the Northern Hemisphere, 1983–2012 was likely the warmest 30-year period of the last 1400 years.

A warming climate means a wider range for disease vectors such as mosquitoes, ticks and flies that carry viruses, bacteria, and protozoa. Examples of diseases born by these pests include malaria, yellow fever, dengue fever, and equine encephalitis to name a few.

current range of Chagas diease

current range of Chagas diease

Most worrisome is Malaria, a parasitic infection of red blood cells for which there is no real cure. Because of the complex life cycle of the parasite their has yet to be an effective vaccine developed. Malaria infects over two hundred million people world wide and kills about a million each year, mostly children.

The mosquito that carries yellow fever for which there is a vaccine also carries dengue fever for which there is no vaccine. The genus Aedes carries both these diseases, is endemic to northern Mexico, and as the climate warms is advancing northward.

These are some of the diseases we know about, but new diseases arise regularly. In the age of jet travel a new disease can move half the way around the world over night and a warmer climate can provide a more accommodating environment.

Every day as a result of burning fossil fuels for cheap energy the planet gets a little warmer, the weather a little more erratic and the oceans a little more acidic. Climate change has far-reaching consequences and touches on all life-support systems. It is a factor that should be placed high on a list of those things that affect human health and survival. The energy with the cheapest up front costs may be more expensive than imagined in the long run.

Global Warming, Fossil Fuels, Air Quality, and Health

Everybody wants to be healthy, and we go to considerable lengths to achieve the same. Preventive care, diet and exercise all contribute to good health. There are factors however which are beyond our individual capacity to control. Global warming is one of those things that we have to address collectively. It comes about due to the release of certain air pollutants. Reducing these pollutants will not only help mitigate the direct environmental damage but also improve our health.

Air pollution has been linked to several of the leading causes of death in the United States. Asthma, chronic bronchitis, emphysema, lung cancer, myocardial infarction, congestive heart failure, and stroke have all been shown to be linked in multiple peer reviewed articles in major medical journals. Even conditions as diverse as Type II diabetes and Alzheimer’s’ disease have shown correlations with air pollution levels.

Chronic exposure to gasses such as ozone and nitrogen oxides and fine particulate matter

particulate matter

particulate matter

cause an inflammatory reaction in sensitive tissues and contribute to poor health. The source of the pollutants is a result of our quest for the cheapest possible energy sources to power our lives. There is a deal with the devil in cheap energy sources, mostly fossil fuels. Burning coal and oil and to a lesser extent natural gas result in the production of these unhealthy pollutants.

That good news is that the USEPA through the Clean Air Act regulates these pollutants and constantly reviews the scientific data supporting limitations of pollutant release. The act was passed in 1963 and has been significantly amended several times to tighten air quality standards. Enforcement of the act has led to considerable improvement of air quality, but currently something like one third of Americans live in counties which are out of containment.OzoneFormationDiagram

In 1990 Congress directed the EPA to conduct occasional scientific reviews as to the costs and benefits of air quality regulations. A 2009 study by the National Research Council finds that the cost for health care from one coal fired power plant is 156 million dollars per year. Collectively 62 billion dollars a year is spent as a result of burning coal to make electricity. This is due to the health effects of pollutants at currently allowed levels. Another study showed that over 20 years of clean air act regulations, one dollar spent on air quality protection resulted in a savings of 44 dollars in health care costs. The EPA estimates that the investment of 65 billion dollars in 2020 will save a total of 2 trillion dollars in health care.

One argument to revitalize the economy is to cut regulations, thus lowering the cost of doing business. Lowering air quality standards may save business and the consumer money on energy production but will greatly increase health care costs- out of proportion with the savings on energy costs. This is not the time to try to save money limiting the actions of the EPA, regardless of the budget cutting fervor in congress. We can pay a little for air quality but overall save a lot by supporting strict air quality standards, even if it means abandoning coal fired electricity production.

There is no question that somewhere in the future we will stop burning fossil fuels to produce energy, whether it is due to depletion of the resources or our recognition of the harmful effects to health and the environment. Any and all programs which get us away from fossil fuel consumption will benefit society. Ultimately we need clean sustainable energy sources such as wind and solar which release no air pollutants.

ObamaCare

ObamaCares

Quality health care in the United States has until recently been a luxury; that is, something only for those that can afford it. This should change over the next few years as the Patient Protection and Affordable Care Act – more colloquially known as Obamacare – rolls out.

healthcare costs

healthcare costs

Currently our system of “every man/woman/family for themselves” has resulted in total health care costs which are on the order of twice the rest of the industrialized world as measured as a fraction of the gross domestic product.

Sadly, because of our past approach, we’ve end up with poorer health care outcomes such as higher infant mortality rates and shorter life expectancies. There are several reasons why we pay more but get less compared to the rest of the world. First and foremost is the lack of preventive care for the poor or those that think it is unnecessary.

infant mortality

infant mortality

When it comes to health care, the old saw “an ounce of prevention is worth a pound of cure” rules. An example or two should suffice: The absolutely most effective health care dollar spent is the dollar spent on vaccinations. Horrible diseases such as small pox and polio have been eradicated. Other diseases that caused high infant mortality rates such as diphtheria and pertussis in the past have been drastically reduced.

Yet much preventive care is unachieved. Consider heart attacks and stokes as a cost factor. Either of these conditions can cost hundreds of thousands of dollars to treat after the fact, but literally pennies a day to prevent with blood pressure medication.

Over a million families file for bankruptcy every year. Medical bills are the principle cause or contribute to these filings over sixty per cent of the time. Obamacare will reduce bankruptcies by abolishing lifetime benefit limits and price discrimination for pre-existing conditions, thus lowering out of pocket costs for families.

What is cheaper to you personally? Assisting the poor (and mandating those who can but refuse to) obtain health care? Or picking up their tab through higher premiums for your health care? The rest of the world has the answer and it is the former. That is why Obamacare will lower costs overall by adopting policies which favor preventive care and full participation in our common care.

Considerably more savings in health care can be had if we control costs via even more collective action. A Titanium alloy hip joint costs about 350 bucks to produce yet insurers are charged close to ten thousand dollars, a markup of three thousand per cent! Why? Because they can, and we pay unnecessarily. In Belgium, on the other hand, the national health system takes a bid for the same joint. The resultant cost is less than a thousand dollars, a tenth of the cost we pay for the exact same item.

There are many things that benefit us collectively such as education, police and fire protection, national defense, infrastructure for commerce, scientific research, and the list goes on and on. It is time we recognize that our health care should fall into the same category. The Patient Protection and Affordable Care Act is a step in the right direction but there is still more that can be done to lower costs further and improve care.