Philip Alcabes discusses myths of health, disease and risk.

CDC, Measles, and Propaganda

This week, the Centers for Disease Control and Prevention invokes measles  to make you feel guilty and frightened.

The agency announced on Thursday that there have been 175 measles cases in the U.S. in 2013, whereas only about 60 are seen in a typical year lately. Measles, the CDC press release says, “still threatens health security.”

Are they joking?, you might wonder. At a time when nearly 50 million Americans can’t get medical care because they don’t have insurance, and about 30 million will continue to lack health insurance even if the Affordable Care Act is fully implemented — at this point in American history, do the wonks at CDC really expect Americans to believe that an extra 100-odd measles cases represents a threat to the nation’s health?

No, they are not joking. CDC Director Frieden says:

“A measles outbreak anywhere is a risk everywhere.”

That sentence doesn’t exactly parse in standard English, but we get the point: be on guard, be on edge.

“With patterns of global travel and trade,”

Frieden continues,

“disease can spread nearly anywhere within 24 hours.”

This is not true, but truth isn’t at issue. Frieden is settling comfortably into his role as Minister of Propaganda for the unending War Against Risk, that existential danger to our well-being in which we are all supposed to be foot soldiers.

The media have responded as per their wont.  Measles is still a threat, there’s a spike in cases,  it’s about lack of vaccination, and so forth.

Here, the real story is that there’s no grave threat. There were over 100 measles cases in the U.S. in 2008 and over 200 in 2011. So it’s not at all clear that this year’s toll is out of the ordinary. And, of the 175 cases in 2013, most were acquired abroad. Measles transmission in the U.S. occurred in outbreaks among people who weren’t vaccinated for religious reasons, including 57 people in a Hasidic neighborhood in Brooklyn who were infected by a traveler who acquired measles virus in England, and 22 in North Carolina infected by a traveler returning from India.

That these outbreaks occurred among people who were not vaccinated reveals little about vaccination campaigns in the U.S. — religious exemptions have long been recognized for people who do not want their children to undergo immunization. And they have not been severe: a pregnant woman infected with measles in the Brooklyn outbreak miscarried, but there is no way to know whether measles was the cause. One adult was hospitalized with respiratory complications in the North Carolina outbreak.

It’s probably a good idea to be immunized against measles. Measles rarely causes severe illness, but not never. And there is plenty of measles in the world, although it is extremely rare in the U.S.  Immunization is like washing your kitchen counter tops.

But there’s no reason to sign up for Dr. Frieden’s army. Measles doesn’t threaten our health security (when it comes to threats to Americans’ health security, nothing comes close to Congressional Republicans!). We do not need to report our neighbors to the authorities if they aren’t getting their kids immunized. And we really don’t need any more inspections at airports. Our way of life is not under siege.

By Philip Alcabes | December 7th, 2013 | Categories: Disease, epidemics, public health, vaccination | Tags: , , , , , | Comments Off on CDC, Measles, and Propaganda

Gun Violence: The Silence of the Officials

A week after the murderous fusillade in Aurora, Colorado, not one public health official has stepped forward to call for gun control.

Attribute the 9 deaths and dozens of injuries in Aurora to the rash act of an unbalanced man if you wish.  But what about the tens of thousands of other deaths caused by firearms in the U.S. each year?

If HIV infection (9,406 deaths in 2011) and painkiller overdose (estimated at 15,000 deaths per year, according to a report  by Trust for America’s Health and the Robert Wood Johnson Foundation) are public health problems worth discussion, why not firearms?  In 2009, the last year for which complete data are available, there were 31,347 deaths by firearm in the US, according to the US National Center for Injury Prevention and Control.

At The Pump Handle, Celeste Monforton — always worth reading — provides the data showing how out-of-scale America’s gun problem is on the global public health scene:  Our gun-violence death rates are an order of magnitude higher than those of other wealthy nations.

At CNN, Daniel Webster calls for America to wake up to the public health problem of guns.  “America’s high rate of gun violence is shameful,” Webster writes.  “When will we change?”

NYC Mayor Michael Bloomberg can be a tyrant when it comes to personal habits that he thinks impair the city’s health, but he has been courageously forthright on the need to control firearms.

But, like me, Monforton and Webster are academics.  And Mike Bloomberg is, well, Mike Bloomberg.

Where are the health officials?

Kathleen Sibelius, Secretary of Health and Human Services, has been silent.  She’s been vocal on healthcare fraud, and earlier this week announced a new public-private partnership to keep people with AIDS in care.   But not a word on guns.

Thomas Frieden, CDC director, can’t be accused of shying from the spotlight.  But he has said nothing about guns.

Under these corrupt officials, gun violence has been cleaned from the public health radar screen.

Try finding an entry on firearm violence at the Department of Health and Human Services website.  Or, go to the CDC’s “A-Z Index” (what other letters would bound an index, one wonders? well, anyway…).  There’s no entry for “guns” or “gun violence.”  Nor for “firearms.”  The entry on “violence” leads to a page on injury prevention that includes links to entries on Elder Maltreatment and Intimate Partner Violence — but not a word on guns.

At Salon, Alex Seitz-Wald wonders whether the NRA has suppressed research.  There’s some evidence for this:  Paul Helmke of the Brady Center to Prevent Gun Violence wrote to Secretary Sibelius over a year ago, asking whether it’s true that Frieden’s CDC has agreed to tip off the NRA when researchers who receive CDC monies are going to publish anything on gun violence.

Seitz-Wald might well be perfectly right.  Certainly, the NRA is unseemly, manipulative, and morally vacuous.  But it doesn’t have the power to program anyone’s thoughts.  It doesn’t cause our officials to be spineless in the face of the infestation of American homes and streets — and movie theaters, schools, colleges, and so on — by guns.

No, it can only be that Frieden and Sibelius — and a tremendous host of less prominent health officials — are all silent about  guns because, really, they aren’t concerned about 31,000 deaths and upward of 400,000 injuries from firearms each year.  Or, not as concerned about the carnage as they are about their jobs.

It’s self-evident that our health officials don’t care about the real health of Americans nearly as much as they do about their own continuation as officials.  More important than saving lives or limbs, apparently, is the officials’ capacity to mount the bully pulpit in order to decry other dreadful scourges.  Like big cups of soda, defrauding the insurance companies, or not exercising.

Our public health officials:  put to the test, and found to be feckless at core.

 

By Philip Alcabes | July 26th, 2012 | Categories: firearms, Health Professions, News, public health | Tags: , , , , , | Comments Off on Gun Violence: The Silence of the Officials

The Agony of the A.M.A.

Sam Stein at Huffington Post comments on the American Medical Association’s latest attempt to (as he puts it) torpedo health care reform by opposing any government-sponsored insurance plan.  The AMA’s announcement was reported Wednesday night in the NY Times.

At DailyKos, doctoraaron explains why he is resigning from the AMA, and is participating in Physicians for a National Health Program.  And DemFromCT notes the high public support for reform, provided it’s affordable.

The AMA is already catching flak for sounding like, well, a bunch of doctors interested only in preserving physicians’ privilege.  Of course, that’s what the AMA is – it’s a trade guild, and (it thinks) it’s doing its job.  The only surprise – especially given how many physicians are firmly behind reform of health care financing — is that the organization is so willing to be so open about being so neanderthal.

The AMA’s statement sounds to us like the organization’s dying gasp.  It’s standing up for a vanishing version of what it means to be a doctor.

In fact, the history of the AMA’s own stance toward social insurance is revealing.  In The Social Transformation of American Medicine, Paul Starr explains that until the 1930s the AMA didn’t like the idea of any medical insurance at all — it was fearful that physicians would fall under the sway of the public health establishment if social insurance were instituted and under the control of insurance companies in the case of private insurance. The AMA has always been more worried about doctors losing control over their own practice than about financing.  Patient care isn’t the AMA’s job, and never has been.

Why social health insurance failed in the U.S. is a complicated story.  It involves ideology, of course, but it’s inflected with plenty of nuance:  the troubled relation of labor unions to American industry, the not-so-troubled relation of industrial corporations to the American political establishment, political favor currying, the rise of scientific medicine, the entire question of whether there should be insurance for medical care.  Through it all runs the AMA’s devotion to the image of the physician as independent decision maker.

The reason for the AMA’s death agony today is that it’s defending a dying species.  Physicians don’t get to make independent decisions much.  And the backward-looking AMA isn’t showing any interest in forward thinking about the positive roles that doctors could play in a really care-centered set-up.

The business of doctoring, which was once a trade that pitted physicians against herbalists, apothecaries, surgeons, patent-medicine hawkers, faith healers, etc., competing for access to Americans’ bodies, has become just a trade, once again. Only now, it’s not that physicians are competing with snake-oil salesmen — it’s that the business of caring for Americans’ health is no longer managed by a medical professional working one-on-one with a patient.

That individual suffering isn’t the main focus of the big, costly healthcare system is well known to anyone who has sought diagnosis of a troubling condition or relief from chronic problems.  That physicians are themselves just cogs in the system isn’t so obvious — until you listen to them talk about their own frustrations.  They wish their practice could be driven by patients’ needs or, at least, by evidence on what treatments work best.  But often the control is exerted by the institution, and by insurance companies’ policies on pricing and payout.

The AMA is still fighting for the vanishing breed, though.  Someday soon, the AMA will have to disband because its constituency, the exalted independent physician, will have become extinct and the organization will have failed to recognize just what the rest of America — including most physicians — wants.  Meanwhile, don’t be surprised to hear its dying gasps.

ADDENDUM:

Just saw Abraham Verghese’s “To the AMA:  It’s Not About You” post at Atlantic magazine today.   He urges the organization, “please don’t tell the American public (a public already disenchanted with physicians and health care) that you are doing this for their benefit because of your great concern for the patient. The public does not believe you. They aren’t that naive.”

By Philip Alcabes | June 12th, 2009 | Categories: Health Professions, News, Physicians, public health | Tags: , , , , | 1 comment

It isn’t health if it isn’t for everyone

A couple of weeks ago we toured the Wildlife Health Center at the Bronx Zoo with Dr. William Karesh, director of the field veterinary program for the Wildlife Conservation Society and VP for WCS’s Global Health Program.

We learned that veterinarians from the Wildlife Health Center do rounds for all animals in NYC’s zoos and aquarium; animals needing special care are brought to the center.  Health records for all animals in zoos are electronic and are maintained with common software – making it straightforward for health records to be transferred whenever the animal is transferred from zoo to zoo, anywhere in the world, and of course facilitating research.

Animal health seems far removed from human health – not only in that it’s much harder for caregivers to see any person’s prior health records than it is for vets to see an animal’s.  We think of wildlife health as distinct from our own.  Even when an event like the 2001 foot-and-mouth disease outbreak in Britain causes us economic distress and affords people the ghastly sight of piles of cow carcasses piled up in farm fields, we don’t see the connections easily.

Increasingly, it’s becoming apparent that the health of human populations depends on equilibria in the wider world.  We have our military-style campaigns to defend Fortress Humanity from microbial invaders:  we use antibiotics, vaccination, and close monitoring of routes of ingress via food and water.  They work, at least up to a point.  But the evidence of MRSA, antibiotic-resistant TB, avian flu, S. Saintpaul in jalapeño peppers, and the new swine flu is that those measures aren’t perfect.  There’s not going to be any Conquest of Contagion (as Charles E.-A. Winslow put it in 1943),  and so-called victories such as the use of immunization to eradicate smallpox and control polio won’t be repeatable for every germ.

In the long run, as the One World, One Health movement suggests, we’ll have to shift to a much broader view of the planet as a system – in which we humans are co-resident with other species.  We might manage to ward off a serious flu outbreak with vaccine (the jury’s still out on whether the current swine flu strain can become highly damaging or not, but it’s reasonable to think that some flu strain might).  And we should improve food-safety systems to guard against outbreaks of salmonellosis and the like.  But we have to move toward a more complex understanding of how human health, animal health, environmental conditions, and international transfers of food, animals, goods, and people interact, especially with respect to the movements of microbes.

In that regard, it’s  troubling to learn from DemFromCT’s post at DailyKos yesterday that Sen. Max Baucus says that a new healthcare plan in the U.S. will not cover undocumented immigrants. It’s cruel, of course, to deny care to immigrants.  But it’s also shortsighted.

If we continue to have a huge, frequently mobile proletariat of migrant workers  forced by economic duress to travel from country to country in search of a living wage and we also make it impossible for them to get care, we’re harming ourselves.  Even those who aren’t moved by the humanitarian aim of ensuring all individuals a decent life should be moved by self-interest.  Creating a means by which disease and disability can move around with the people who suffer from them will undermine whatever arrangements we make for health.

One Health means we have to think about the interactions of many species – and it’s ridiculous to exclude some members of our own.

By Philip Alcabes | May 23rd, 2009 | Categories: Disease, News, public health | Tags: , , , , , , , , , , | Comments Off on It isn’t health if it isn’t for everyone