public health


Almost 10% of Americans think there is a cure for diabetes, 20% weren’t sure. This is a glimpse at the awareness Americans have for a disease someone is diagnosed with every 20 seconds from a survey conducted by Harries Interactive. For a life-long illness that is increasing in the population (20% thought the death rate was declining) there are vey few that are aware of the basics of the disease. Most likely only those affected or who have friends and family members affected have knowledge of the disease, an indictment of the job the health community is doing to raise awareness of diabetes.

This result really was surprising to me as I feel like everytime I turn around there is a commercial or internet site about living with diabetes. I guess that is a result of me exposing myself to health related issues for hours a day, something most people in the population either don’t do or don’t have access to. I would like to see a comparison of the awareness between diabetes and other diseases that affect the general population (breast cancer for example). I’ll have to put the time in to look at different survey results but my gut feeling is the breast cancer charities and awareness programs are deeper penetrating and have a farther reach.

Considering diabetes kills more than 180,000 a year in the US, compared to 40,000 due to breast cancer it should be applauded how much the breast cancer awareness push has succeeded. I mean there is a whole month for breast cancer awareness and they even have pro sports teams sporting pink on their uniforms to boost awareness. With over 16,000,000 (and climbing) in US diagnosed with diabetes it seems there should be more general awareness of the disease. Color me surprised but not blown away, for all the health community does to promote awareness it seems that a large percentage of the population either doesn’t pay attention or simply forgets the information they hear.

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10 years ago the International Diabetes Federation Diabetes Atlas indicated that just over 150 million people had diabetes worldwide.  Now, less than 10 years later the survey shows 285 million worldwide cases, more than half of those aged between 20 and 60.

To put this rise in perspective in 1985 it was estimated there were 30 million worldwide cases.  India and China lead the way in cases but are followed closely by the US.  About 9% of the US population is found to have been diagnosed with diabetes (26.8 million) at a rate of $198 billion a year.  This is 52.7% of worldwide spending on diabetes, an incredible number!

At this growth rate the number should reach above 435 million by 2030 (US population today is 303 million).  As I’ve said before, if we really want to cut down on health expenditures this is a major area of public health we have to target and not just by paying it lip service.  Since a majority of cases are type II (insulin resistance with obesity and diet as contributors) we need to target the food and food services industries and the way the consumer is informed of their decision.

Of course a huge problem is getting people to realize the long term health affects of diet and exercise which is very difficult.  Incremental weight loss and an abstract number like fasting glucose levels are difficult means to motivate people into life altering habits. This has been proven with the massive diet industry which peddles unnecessary measures to lose weight.  This is easily seen by the yo-yo effect from people losing weight off of a diet and then gaining the weight back, only to have to find another diet.  I’ve seen family members go from diet program to diet program to find one which will “keep the weight off” but the only way to keep the weight off is to change your eating and exercise habits,  dirty secret the industry wishes to keep from you.

I guess I got way off topic but the obesity and diabetes problems are closely related, so there’s my diatribe for the day…

GardasilToday the Advisory on Committee on Immunization Practices (ACIP) has advised against the routine use of the HPV vaccine (Gardasil) in boys and men. This should have been met with fireworks, pomp and jubilation in the streets by those who are against vaccines.  Afterall, one of their favorite gambits to run is how the whole pharmaceutical, vaccine and medical industry is in cahoots to poison society with their deadly cocktail of vaccines.

A major organization has decided that it is not efficacious to distribute the vaccine wholesale through the male population but there is not widespread jubilation through the anti-vax community.  Shouldn’t the decleration that an organization this large is breaking from the conspiracy to injure and sterilize us all be a major coup for those wingnuts? Or maybe they know deep down in their hearts that there is science behind the vaccines and if they acknowledge that an advisory committee recommended against widespread use of a vaccine it would throw their whackaloon conspiracy theories out the window.

I haven’t looked through much of the evidence to determine the cost-effectiveness but the BMJ article seems to have some pretty sound minds behind it.  You sure won’t find the whackaloons touting how a government agency charged with researching the effectiveness of vaccines has determined that this one does not hold a great enough benefit to be widely distributed to males because this destroys their crackpot theories.  I bet we do see a bunch of comments circling the  “AHIP said this vaccine doesn’t work and doesn’t protect against HPV.”  Of course that’s not at all what the decleration or science on the vaccine says, but things like facts and sound judgements aren’t usually a tool used by these people.

HPV Safety
One of my favorite places on the internet, the Information is Beautiful Blog, has put up a great graphic about the safety of the HPV vaccine. If you are a visual person (that means everyone) then head over to check out the full version of this graphic which displays the risk of vaccine injury from Gardasil, the HPV vaccine in the US.

With all the kookiness that surrounds the vaccine debate it is nice to see some easily translatable information available to the public and David is usually in the lead with putting together great visuals just for this purpose, to make a visual impact out of the data.

If you’re interested in the HPV vaccine, vaccine safety in general, or how to make stunning visuals that easily and poignantly convey information then it is a must that you head over to the site and browse around.

Today the Wall Street Journal published an open letter by Coke CEO Muhtar Kent (read here) titled “Coke Didn’t Make America Fat.”  While that is not an untrue statement, it belies the contribution coke (soda for you Yankees) does make to the rising obesity rate. As Le nutritionniste puts it (google translation here), this is a PR move by the Coke corporation in the face of a possible tax on sugary drinks (for my thoughts on the tax, see here), and one that is presented pretty well.

I agree with many of the points made in the piece, such as this one; “If we’re genuinely interested in curbing obesity, we need to take a hard look in the mirror and acknowledge that it’s not just about calories in. It’s also about calories out.”  This statement is very true, we are a sedentary people now and we need to recognize the benefits of exercise, not only on our weight but on all aspects of health.  There are very few conditions (DMD is one of the few I can think of at the moment) that aren’t benefitted by healthy diet and exercise.

But this doesn’t get the companies who provide us with socially unhealthy products off of the hook. Take alcohol and cigarettes for example.  We have recognized that although there is nothing wrong with someone individually consuming these products there is a social cost of widespread use.  We see these costs both in the healthcare sector as well as the criminal justice system (DUI, DWI, etc), where time and money are spent to curb the problem.  Taxes have managed to bring down the use of these products, especially cigarettes.

I won’t mess with the tax/no tax issue but will say that Arkansas has implemented a tax system on cokes that funds pieces of their medicare pie.  There don’t seem to be any uprisings over this although I’m sure it was a fight to pass.

The big problem I have with Kent’s letter is in the first paragraph. “We at the Coca-Cola company are committed to working with government and health organizations to implement effective solutions.” It seems that you would have then volunteered to take all of your products out of public schools and gathering areas where the majority of attendees are children.  Unfortunately my home state of Texas had to take matters into their own hands to mandate that your drinks be taken out of our schools.  I wish they would do the same with food in the lunchroom, but I shall be pleased with small steps.

Overall I don’t like the tone that Kent takes, he shrugs off the responsibility his products bear on rising obesity rates while putting the blame on the public by saying we don’t exercise enough.  He presents percentages which can truly be confusing to the public rather than absolute values, blames the food industries and takes credit for employing over 200,000 Americans.  All of this does not absolve the products he sells and he should step up to the plate and admit the health consequences of overconsumption of his products.  This smells of the tobacco industry parroting their (intentional lies) beliefs that tobacco wasn’t addictive years after the medical community was trying to spread the truth.

Today KevinMD discussed the article published online today at the New England Journal of Medicine about imposing a tax on soft drinks and sugary drinks.  The massive quantity of these drinks sold in the US are definitely a health problem but as with most industry issues this attempt is doomed to fail.  A massive lobby group representing the corn industry will not allow this to pass.

With government subsidies artificially increasing the production of corn there have been multiple avenues to rid ourselves of this surplus.  One highly effective way the corn and food industry uses these massive amounts of corn is through the use of High Fructose Corn Syrup (HFCS).  The amount of sugar additives and caloric sweeteners in our drinks continue to rise as HFCS is used in not only the most popular soft drinks but also fruit juices.

I think it is a good proposal that would help to curb consumption of these drinks that are leading to an epidemic of American obesity but it is up against a lot of clout and money that is entrenched in Washington (especially with a Midwest President).  This type of strategy worked with the cigarette tax as our nation’s rate of smoking continues to fall from a high above 30% in the 1980’s to below 16% in 2007.  The increased tax rate was well associated with this fall in cigarette consumption as shown by this graph.

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For the public health’s sake I hope that we can see this same kind of decrease in soft drink consumption.  From 1977 to 2001 the rate of consumption in the US has risen 135% according to researchers at UNC.  Taken with the information that fructose is more taxing on our cardiovascular health we should take this as a burgeoning public health crisis.

And we’re not helping our kids in school.  As I’ve written about previously, the nutrition of public school lunch and beverages is bad.  We send our kids to school to learn and this is exactly what they’re learning.

One of the blogs I have rabidly followed over the last year and a half is White Coat Underground.  The author, PalMD, is a physician (internist) and a well-respected member of the science/medicine blogosphere and last night a post of his caught my eye.

Obesity is a bad thing. This isn’t a moral judgment. If one of your values is long life and good health, then obesity is a bad thing.

PalMD talks a little bit about his struggles with his weight and how he is starting a “diet” which he will be updating regularly.  This is interesting for a physician to speak about publicly, especially someone who is so well followed on the internet.  Although he blogs under a pseudonym his real identity was outed a while ago so his patients can find him if he wants.

I think this is a good point for the public, especially in light of the negative comments I’ve seen about Dr. Benjamin’s (Obama’s pick for Surgeon General) weight.  Physicians are as normal as anyone else.  While walking through downtown Chicago you see the whole spectrum of human existence and vices; obesity, smoking, unhealthy eating, and even a few harsh words exchanged.  You never know which of these people is a nurse, physician, public health official or medical student.  One would like to think that physicians lead a healthier lifestyle than everyone else but the truth is they are just as vulnerable to unhealthy habits as everyone else.  It is true that a lot of these vices are stopped or scared out of medical students because of the knowledge, images and patients they see but just knowing the risk doesn’t stop people from participating in unhealthy behavior.

My question is one that has been asked before but I’d like to get some input from the readers; should physicians and health care workers in general be held to a higher standard of healthy living, and if so, why?  You can respond in the comments or by email which can be found on the right sidebar.

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