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Copyright © 2000, Baylor University Medical Center Facts and ideas from anywhere | ||||
A recent Harris poll of US adults aged ≥25 years asked if they were ≥20% above their recommended weight. In 1985, 15% were ≥20% overweight; in 1990, 16%; in 1995, 22%; and in 2000, 32% (1). If scales had been used in this poll, the percentages would have been much higher. | ||||
As a vital sign, body mass index (body weight in kilograms divided by height in meters squared) is a far more important vital sign than respiration. The higher the body mass index, the shorter the life and the greater the frequency of elevated cholesterol, blood pressure, and blood glucose. Losing weight lowers blood lipid levels, blood pressure, and blood glucose. The normal body mass index is 18 to 25; overweight, >25 to 30; and obesity, >30. Morbid obesity is considered >40. Sixty percent of American adults are overweight, and a high percentage of teenagers in the USA are also overweight. Of the US adults who are overweight, 50% are obese. Recently, I heard the presentation of a patient who had elevated blood pressure, elevated blood lipids, and elevated blood glucose, and the discussion centered on appropriate treatment to lower the elevated levels. The patient was discussed for 30 minutes before I heard the patient's body weight and height mentioned. It turned out that her body mass index was 33. This patient's problem was not elevated blood lipids, pressure, and glucose: her problem was obesity. Nothing improves cardiovascular and diabetic health like maintaining an ideal body weight or losing weight if one is overweight. | ||||
On February 24, 2000, Agriculture Secretary Dan Glickman sponsored the Great Nutrition Debate. The debaters included cardiologist Robert Atkins, whose program, outlined in Dr. Atkins' New Diet Revolution, encourages dieters to eat bacon, pork, steak, butter, cheese, olives, nuts, and other high-fat, highprotein foods and to avoid carbohydrates, including pasta, sweets, some starchy vegetables, and many fruits (2). Another debater was Dean Ornish, an internist originally from Dallas, who wrote Eat More, Weigh Less. He promotes the use of a very low fat diet— fruits, vegetables, brown rice, whole grain pasta, soy products, and some fish—for the prevention of heart disease. He advises limiting meat, poultry, egg yolks, high-fat cheese, and simple carbohydrates, such as sweets and white bread. Other debaters were cardiac surgeon Morrison Bethea, one of the authors of Sugar Busters; biochemist Barry Sears, coauthor of The Zone; and internist John McDougal, author of The McDougal Program. I subscribe to the Dean Ornish plan. The Atkins plan, in my view, will prove to be detrimental in the long run. It originally appeared in 1978, and as yet there are no outcome studies concerning it. I understand that the National Institutes of Health is considering sponsoring such a study. Although dieters on the Atkins diet may lose weight, it's mainly water weight. They lose weight primarily because they have lost their appetites and decreased total caloric intake. Although telling people that pork rinds and sausage are good for them is a great way to sell books, it is irresponsible and dangerous. If a diet sounds too good to be true, it probably is. The Atkins diet produces bad breath, bad body odor, constipation, lethargy, and occasionally lightheadedness. In contrast, it is clear that when people switch from a meatbased, high-protein diet to one that is based on whole foods and plant foods, the risk of heart disease, stroke, and some types of cancer, such as breast and prostate gland, is reduced. In Barry Sears' new book, A Week in the Zone, he recommends eating 10 to 15 servings of fruits and vegetables a day, eating adequate amounts of protein, and treating pasta, bread, grains, and starches like condiments. Bethea's Sugar Busters is a commitment to choose correct carbohydrates. He emphasizes eating whole grains and few sweets, not processed grain products that have had their fiber and nutrients removed. He advises eating lean and trimmed meats—preferably baked, boiled, or grilled—and eating a lot of high-fiber vegetables, fruits, and whole grains. I congratulate the secretary of agriculture for pulling these diet authors together. Possibly his department would be willing to sponsor a study to see whether the high-protein and low-carbohydrate diets actually have any scientific benefit. The low-fat diets have been proven to have health benefits. On the other hand, weight loss is beneficial irrespective of the means by which it is done. | ||||
Gary Critser (3) provided the following story in a recent piece in USA Today. A high-protein, low-carbohydrate diet was first popularized in 1863 by William Banting (no relation to the discoverer of insulin), a retired London undertaker who weighed 202 pounds and measured 65 inches in height (body mass index, 34). For decades he had struggled with obesity (corpulence), and at age 60 he was near his wit's end. He had to walk down stairs backwards, “and with every exertion puffed and blowed in a way that was unseeming and disagreeable.” One day in 1862, Banting had a serendipitous encounter with a young physician named William Harvey (not the 17th-century Harvey of blood circulation fame). Harvey had spent time in Paris during the 1850s studying under Claude Bernard. One of Bernard's ideas was that the liver secreted glucose. As Harvey understood it, “this glucose could be directly produced in the liver by the ingestion of sugar and starch and … [because] a purely animal diet greatly … checked the secretion of diabetic urine … it occurred to me that if a purely animal diet was useful in the latter disease, a combination of animal food with such vegetable matters as contained neither sugar nor starch might serve to arrest the undue formation of fat.” That is exactly what he prescribed to Banting. It was, in short, the first time anyone had formally prescribed a low-carbohydrate diet for weight loss. In less than a year, Banting had lost 46 pounds and pronounced himself “cured” of his “insidious creeping enemy.” Convinced that his mission in life was to help his fellow corpulents onto what he called his “tramway of happiness,” Banting wrote a short account of his experience and cure, A Letter on Corpulence, Addressed to the Public. The response was the first mass dieting craze. After 2500 copies were given away, Banting's Letter went into 3 editions in as many years, selling upward of 100,000 copies. His name became a verb; until 1963, the Concise Oxford Dictionary defined “banting” and “to bant” as meaning “treatment of obesity by abstinence from sugar and starch.” Banting and Harvey did not want any publicity, and Banting—fearing that “it might appear a puff which I know he abhors”—refused to identify Harvey in his first 4 editions. Moreover, when the money rolled in, it became, in Banting's word, an “embarrassment.” Banting donated all profits from his writing to charity and in later editions of his pamphlet published all criticisms he had received of the diet. The diet was taken up in 1879 with great fanfare by the Comte de Chambord, the expatriate king of France. De Chambord quickly lost >50 pounds. But in 1883, the Comte fell ill. Although the immediate cause of his death still is unclear, his doctors all agreed that he had undermined his health by losing so much weight so quickly. Harvey had written: “Extremes should be avoided. As a rule, the diminution should not be allowed to progress more rapidly than at the rate of 1 pound per week and it ought not to be carried to too great an extent.” By then, however, both Banting and Harvey were dead. The latter had lived the productive life of a physician-scholar. Banting had lived to age 81, maintaining his reduced size. His success in doing so may suggest a middle way for today's warring factions of those for and against low-carbohydrate diets. Beginning in the late 1860s, Banting had slowly shifted his diet in the direction of reducing proteins and fats, controlling portion size, and eating carbohydrates in moderation. Later he wrote, “This deviation convinces me that I have hold of the power of maintaining the happy medium in my own hands.” In other words, science or not, proteins or carbohydrates, it is human will and humane advice—not bestsellers—that make for a good diet. | ||||
Gump and Matthews at the University of Pittsburgh recently reported findings of the Mr. Fit study (4). The participants, 12,338 men who were 35 to 57 years of age, had no clinical signs of heart disease at the onset of the study. The investigators asked them about vacations every year for 5 years and then looked at the medical and death records over 9 years for the men who had lived for at least a year after the last vacation survey. Compared with those who never took vacations, men going on annual vacations were 21% less likely to die over the 9 years and 32% less likely to die of coronary heart disease. The more often the participants skipped a vacation, the higher their risk of death. Go on a vacation! | ||||
According to the March 2000 National Vital Statistics Report, during their pregnancy 22% of women gain <20 pounds, 32% gain 21 to 30 pounds, 27% gain 31 to 40 pounds, and 19% gain >40 pounds (5). | ||||
At the American Academy of Periodontology conference on May 7, 2000, in Washington, DC, a study of 3000 pregnant women with severe gum disease indicated that they were 8 times more likely to have underweight premature babies than moms with healthy mouths (6). The likely culprit is prostaglandin, which is labor-inducing and is present in dental plaque. The study by Marjorie Jeffcoat of Alabama showed that prostaglandin levels increased as gum infection worsened. (Prostaglandin injections, of course, are used to induce abortions.) Daily flossing plus good teeth and gum brushing is the best prevention for gum disease. | ||||
Episiotomy, a small cut in the mother's perineum, apparently is no longer routine (7). Once considered “the kindest cut,” episiotomy has been performed on millions of American women for its supposed benefits. Surprisingly, statistics now suggest it was not such a good deal, and many obstetricians are pulling back from the procedure. The episiotomy rate at the Massachusetts General Hospital has fallen to between 10% to 15% of deliveries. Episiotomy was invented in Europe in the 1740s and popularized in the USA in the early 20th century. At that time, however, obstetricians had few tools, fetal monitoring was primitive, and rates of birth-related injury to mother and child were much higher than today. So to spare women the wear and tear of delivery, obstetrician Joseph DeLee of Chicago Lying In Hospital proposed that cutting a small incision would speed labor, lessen trauma, and restore prepregnancy vaginal conditions. As childbirth moved from home to hospital during the 1940s, episiotomies took off. By the 1970s and 1980s, the procedure was entrenched as a routine part of normal delivery. It was performed on >60% of all women giving birth in the USA, including 80% of first-time mothers. Driven by faith and the rationale that a little cut could prevent far more severe lacerations, it became one of the most common surgical procedures in the country after the cutting of umbilical cords. But was the rationale scientifically sound? No one actually knew. Obstetric practice before the advent of randomized clinical trials in 1948 was more of an art shaped by tradition. A review in 1983 from the US Centers for Disease Control and Prevention (CDC) concluded that arguments in favor of routine cutting—preventing lacerations, protecting pelvic muscle tone, and preserving sexual function—do not withstand scientific scrutiny. A clinical trial headed by Jose Belizan in Argentina randomly placed >2600 pregnant women into 2 groups. The women in one group got a routine episiotomy; the women in the other group selectively got one based on need. The study, published in 1993 in the Lancet, found that pain and healing problems were actually more common among women who were routinely given episiotomies than in the group where it was restricted. In a 1995 review, British epidemiologist Archie Cochran indicated that routine episiotomy adds to the trauma, suturing, and complications of delivery. More recently, a study by Repke of Nebraska in collaboration with colleagues at the Brigham and Women's Hospital in Boston reviewed cases of 600 new mothers and found that the women who had episiotomies had an increased risk of intestinal problems for as long as 6 months after delivery. They found that women with the incision had even more complications than women who experienced spontaneous tears during labor. That study was published in the British Medical Journal in January 2000. Episiotomies still are useful in emergencies: when a baby is very large, labor is very long, or the fetal heart rate is depressed. Some doctors do them when a bad tear seems imminent. Others use them in deliveries when instruments are needed to help the baby out. Episiotomy shortens the last stage of labor by 10 to 20 minutes. So when speed is needed to prevent injury or asphyxiation, it can be essential. As the pendulum of medical fashion swings from routine to restricted episiotomies, physicians disagree about what constitutes just the right amount of intervention. Whatever that “right amount” is, it is clear that episiotomy as a routine procedure for delivery is gone. | ||||
Dr. Allan Zarkin was sentenced to 5 years' probation for carving his initials into the belly of one of his patients after delivering her child (8). The sentencing occurred on April 25, 2000. Dr. Zarkin will be barred from applying for a medical license for 5 years. The patient was Dr. Liana Gedz, a dentist who was close to Dr. Zarkin before the incident. She had earlier settled a lawsuit against him for $1.75 million. After successfully performing a caesarean section on Dr. Gedz at Beth Israel Medical Center in New York City in September 1999, Dr. Zarkin stunned nurses by carving his initials into Dr. Gedz's belly. He was indicted in February 2000 and faced up to 25 years in prison if convicted of the most serious charge he faced, first-degree assault. The State Supreme Court Justice in Manhattan cited Dr. Gedz's desire and Dr. Zarkin's lack of a criminal record as reasons for agreeing to the plea bargaining. In February 2000, the State Department of Health fined Beth Israel Hospital $14,000 and ordered it to improve its oversight of physicians. Dr. Gedz plans to undergo plastic surgery to obscure the carved initials on her belly. | ||||
Only 35% of newborns in American hospitals have their hearing tested before they go home, and 33 infants a day go home with undiagnosed hearing loss according to the National Campaign for Hearing Health (9). At least half of the newborns in 24 states have their hearing tested before leaving the hospital. The campaign is to make that universal in all states. New screening hearing tests cost only $15 to $40 each. Babies do much better if hearing deficiencies are diagnosed before 6 months of age. Maybe parents should not take the baby home without knowing if the baby can hear. | ||||
Tens of thousands of unwed birth mothers abandon their unwanted babies every year (10). That's a crime in every state except in Texas under certain conditions. So the mothers often dump the babies, run, and hide. Dozens of newborns are found dead in garbage cans or other trash depositories every year. Most of those abandoned are left in hospitals, in churches, or on doorsteps. Those babies live and generally acquire loving adoptive parents. But they lack medical records or parental background. In 1998, at least 31,105 babies were abandoned in the USA, and 33 were found dead. It is believed that many more dead babies are never found. Most of those found are never identified. A law enacted in Texas helps protect from prosecution a mother who abandons her baby within 30 days of birth if she delivers it safely and unharmed to a hospital or other emergency medical center. Al Neuharth, the founder of USA Today, believes that such a law is a realistic way to save the lives of unwanted babies. Most pregnant unwed mothers who give birth are scared. Child dumpings are acts of desperation. Decriminalizing safe child abandonment can save babies' lives and find them families. It also can enable unfortunate unwed birth mothers to find their place in society without fear. Twenty-three state legislatures now in session, including California, New York, and Florida, are considering infant-abandonment laws similar to that in Texas. They should enact them. So should the rest of the states and the federal government. Good for you, Al Neuharth! | ||||
John Colapinto has written a compelling story, As Nature Made Him: The Boy Who Was Raised as a Girl (11). In 1966, a tragic accident in a Winnipeg hospital resulted in Bruce Reimer's losing his penis. It was burned beyond repair during cauterization. He and his identical twin were born to very young parents. Devastated, Bruce's parents sought out the advice of experts, eventually coming to John Money at The Johns Hopkins Hospital in Baltimore. A leading expert on human sexuality, Money believed that gender was imposed not by nature but by nurture. Although he had worked with infants born with ambiguous genitalia, Money realized that here was an opportunity to prove his theories. One twin would be raised as a boy and the other as a girl. A surgical castration was performed at age 22 months. There was one problem. The new little “girl” didn't feel or act like one, something that became apparent when the child, now called Brenda, entered kindergarten. Colapinto details Brenda's misery, her social failures, the cruelty of other children, and the enormous strain experienced by the family. Clearly, this experiment in gender reassignment wasn't working, and the multitude of psychiatrists consulted didn't help. But Money continued to promote the experiment as a triumph, encouraging other doctors to reassign genders to newborns of ambiguous sexuality. He also pressured Brenda to have more surgery. Eventually, an older female psychiatrist befriended the distraught “girl,” who insisted on urinating standing up. By age 14, Brenda had had enough. She had a double mastectomy to remove the breasts created by female hormones and let her extended family know that “she” was now David Reimer. The “expert” here, namely John Money, was wrong. It might be better to listen to small children. | ||||
A booming economy, huge tobacco settlements, and large budget surpluses have done little to lift 1 in 5 American children out of poverty, and 74% of those children in 1998 lived in families where at least 1 adult was working (12). That rate is up from 61% just 5 years ago. The number of children without enough food increased by more than 3.7 million in the USA between 1997 and 1998. Nearly 12 million children lack health insurance. Only 1 in 10 children of the nearly 15 million families eligible for child care assistance get aid. Roughly 850,000 children are homeless. A record 547,000 children were in foster care last year, a 35% increase since 1990. States have not spent the billions of federal welfare funds designed to ease poverty. Poor children are twice as likely to be delivered at low birth weights and to die before reaching their first birthday as nonpoor children. They are also twice as likely to be abused or neglected and 3 times as likely as the nonpoor to live in substandard housing. Texas is not doing so well either. Texas is 50th in the number of children with health insurance; 48th in the amount of welfare given to poor people; 47th in the number of children with up-to-date immunizations; 46th in the number of children living in poverty; and 45th in the number of women receiving early prenatal care according to The Children's Defense Fund, the State of America's Children: Yearbook 2000. | ||||
A new study shows that, on average, teenagers in the USA are getting about 2 hours less sleep a night than they need, putting them at risk for automobile accidents, falling asleep in class, and general moodiness (13). The National Sleep Foundation released a poll in March 2000 confirming that teens are staying up too late and waking up too early. How much sleep is enough? Sleep needs vary by age and from person to person, but here are some general nightly guidelines. Toddlers need 11 hours plus a 2-hour nap during the day. Preschoolers need 11 to 12 hours. Half of preschoolers also nap during the day. School-aged children need about 10 hours. Teens need an average of 9 hours, although realistically they can function on 8 hours. Adults generally need 8 hours but needs vary. The average adult gets slightly under 7 hours on weeknights and 7.5 hours on weekends. Sleep deprivation is a serious matter for teens. Of the estimated 100,000 car crashes a year linked to drowsy driving, almost half involved drivers aged 15 to 24 according to the US Department of Transportation's National Highway Traffic Safety Administration. Students who are tired, of course, are more likely to doze off in class and are less able to concentrate, learn, and solve problems. Sleep deprivation translates into impaired performance. Too little sleep also makes adolescents grumpy and irritable at a time in their lives when they are already on an emotional roller coaster. When adolescents don't get as much sleep as they need, it changes their outlook on life. Things that are happy and pleasant seem less so, and things that are sad and unpleasant seem more so. Teens, like adults, become more emotional when they are sleep deprived. If something strikes them as funny, they may get silly and giggly. If something is sad, they are more likely to cry, and if they are frustrated or angry, they have a harder time controlling their emotions. Maybe schools need to teach children more about the importance of sleep, and both parents and teens might try to cut back on activities so sleep is not squeezed out. | ||||
For years there was a belief that physicians worked longer hours than anyone else. That's no longer the case. One of my sons works in Silicon Valley for a computer firm (BroadVision), and he works at least 12-hour and occasionally 15-hour days. He has told me that is typical of his colleagues. Young lawyers apparently put in similar days in their first few years. According to a report in US News & World Report, the average workweek (among salaried Americans working ≥20 hours) lengthened from 43 to 47 hours a week from 1977 to 1997 (14). Over the same years the number of workers putting in ≥50 hours a week jumped from 24% to 37%. Scarcely a decade ago, Americans viewed the work habits of the Japanese with some awe. Now according to a recent report of the International Labor Organization, the USA has moved past Japan to become the longest working nation in the industrial world. The average American now works the equivalent of 8 weeks a year longer than the average Western European. In Norway and Sweden, ordinary workers get 4 to 6 weeks of vacation and up to a year of paid parental leave. In France, a 35-hour maximum workweek is becoming the law of the land. Workhappy America is enjoying unparalleled prosperity. Unemployment is at a 3-decade low of 4.2%. In Western Europe the unemployment rate by contrast is 10%. Over the past century as a whole, physical work has become easier, and work has become less physical. White-collar workers, however long they work, have more control over their time than factory workers do. In 1900, men in America worked 10- hour days and 6-day weeks in factories and even longer on farms; shorter hours were mostly the lot of desperate people who couldn't find work. Vacations were an exotic exception in 1900 and enjoyed by less than 2% of the population. The USA, of course, was built on a foundation of hard work as well as natural bounty. As an immigrant nation, the USA benefited from a large pool of workers self-selected for their long-term goals and their readiness to endure hardship in the here and now. | ||||
The recent destructive tornado in Arlington, Texas, stimulated investigation into safety during such events (15, 16). The wind speed during tornadoes can be anywhere from 70 to >260 miles per hour. At lower speeds, tree trunks, tree limbs, and signs are broken. At higher speeds, homes and buildings may be completely blown away, cars disintegrated, and the ground scoured of trees and grass. The danger of a tornado is not simply the tornado's wind but what's in the wind. There is really no good place to hide during a tornado. Safety from a tornado under the girders of a highway overpass is a myth. In reality, this inadequate shelter is more likely to kill than to save lives. When tornado winds squeeze under the overpass, they speed up, increasing as much as 25%. The shifting winds will most likely blast a person with debris and then blow the person away. The best shelter in a tornado is a basement or an interior room on the lowest floor of a sturdy building. If caught in the open when the tornado is spotted, it is best to drive perpendicular to the tornado if possible to get out of its path. If there is time, the car should be abandoned and a permanent building sought. Vehicles can become airborne or roll over, so they are not good tornado shelters. Abandoning a car for a ditch means being in the open and therefore a target for debris. Thus, a ditch should be a “last ditch” action, the last resort. Some experts believe it's even better to stay in a vehicle than to leave it for a ditch. If a permanent shelter is found, it's good to cover oneself with a mattress or at least a blanket. Tornadoes in Texas are most frequent, of course, in April, May, and June. | ||||
The number of guns in homes is declining. In 1968, apparently 50% of homes in the USA had guns according to Sourcebook of Criminal Justice Statistics, 1999 (17). By 1983, the percentage had fallen to 40%, but in 1993 it had risen again to 51%. In the last 6 years it has fallen to 36%. | ||||
Homicide and robbery rates decreased nationwide from 1991 to 1998 (18). In 1991, the homicide rate in Dallas was 48.64 per 100,000, and by 1998 it had fallen to 23.14 per 100,000, a 52% decrease. The robbery rate in Dallas in 1991 was 1095 per 100,000, and in 1998 it had fallen to 540 per 100,000, a 51% drop. | ||||
The number of accidental deaths in homes and public places other than roads rose 21% from 1992 to 1999, according to the National Safety Council, which attributed much of the increase to a larger number of elderly people prone to falls and more drug overdoses (19). The number of unintentional deaths in those places rose by 3800 (8%) in 1999 over 1998. One quarter of the people who fall and fracture a hip die within a year of the fall, and half never return to their prior level of mobility or independence. Fatal falls rose to 15,900 in 1999 compared with 12,100 in 1992. Poisonings from solids or liquids rose to 9500 from 6400. Death rates from poisoning for people <25 years of age were constant, but rates rose 40% among those aged 25 to 44 and 111% among those aged 45 to 64. The rate among people aged ≥65 fell 23%. Illegal drugs were responsible in 37% of the poisonings in the persons aged 45 to 64. The number of unintentional firearm deaths fell by about 100, to 900, in 1999 compared with 1998. | ||||
Americans are logging an unprecedented number of miles behind the wheel, but the death rate on US roads dipped to its lowest in 1999 (20). Overall, 41,345 people died on US highways in 1999. That's the lowest number in 5 years. Although Americans drove more than 2.6 trillion miles last year, the fatality rate dipped to 1.5 per 1 million miles driven, the lowest rate since the government began keeping track in 1966. The fatality rate based on population also hit a record low, 15.2 deaths for every 100,000 people. Alcohol was involved in 15,794 deaths, or about 38%, of all highway fatalities last year. That's the lowest number of alcohol-related highway fatalities recorded. Seat belts were worn regularly by 67% of Americans in 1999 compared with 70% in 1998. At least 63% of those killed in traffic accidents in 1999 were not wearing seat belts. The number of pedestrians killed in 1999 dropped 10%, from 5220 in 1998 to 4695 in 1999. Fatalities involving trucks dropped to 5203 last year from 5374 in 1998. Motorcycle crashes killed 2537 people in 1999 compared with 2284 in 1998. The number of people injured in crashes was the same in 1999 and 1998: 3.2 million. The best remedy appears to not drive too much or, if driving, to wear a seat belt, get plenty of sleep beforehand, and avoid alcohol. | ||||
USA Today did a computer search of 2300 publications worldwide, the Associated Press wire, and aviation databases for accidents and incidents in the month of February 2000 (21). There were 3 findings. 1) An average of 3 times each day, a safetyrelated accident, incident, or threat was reported. For US-based airlines flying about 22,000 flights a day, the average was at least 1 per day. 2) Airlines worldwide made at least 35 emergency landings. US airlines made at least 20 of them. 3) Most incidents probably went unreported. Most countries did not show up even once in the search. Most incidents that were found happened in the USA, one of the countries that aviation experts say has the highest safety standards. Federal Aviation Administration inspectors find or take administrative action against US passenger airlines an average of 170 times a month for violating safety rules. In February 2000, the Federal Aviation Administration issued at least 40 directives ordering airlines to inspect or correct an unsafe condition in a plane or a part. Thus, although the odds of being in a fatal airline crash are extremely small, less serious accidents and incidents occur almost daily worldwide. | ||||
Of the 50 states, Kentucky is number 1 in smoking and number 2 in tobacco growing (22). More than 30% of Kentucky adults smoke. The national rate is 23.2% according to the CDC. Kentucky produced 400 million pounds of tobacco in 1999, second only to North Carolina's 429 million. In May 2000, Kentucky launched its first statewide kick-the-habit campaign with an initial goal to fall to number 2 in its smoking rate. It will spend $5.5 million over 2 years on smoking prevention programs, $25 million less than the CDC estimated Kentucky should be spending considering the size of its smoking habit. Nevertheless, this is the first time Kentucky has attempted a statewide antismoking campaign. Kentucky also has the highest rates of youth smokers and smoking-related deaths and runs up $800 million a year in medical bills for smoking-associated illnesses according to the CDC. | ||||
The average state tax on cigarettes was 34¢ per pack in 1999 (23). States with the highest cigarette taxes per pack include Alaska, $1.00; Hawaii, $1.00; California, 87¢; Washington, 83¢; New Jersey, 80¢; Massachusetts, 76¢; Michigan, 75¢; Maine, 74¢; Rhode Island, 71¢; and Oregon, 68¢. The states with the highest taxes per cigarette pack tend to have the lowest cigarette smoking rates. Despite these taxes, cigarette-related illnesses in smokers are inadequately paid for by the smokers. | ||||
The nation's drug czar has purview over heroin, cocaine, and marijuana, but not alcohol (24). A policy research group called Drug Strategies has produced a report that calls alcohol “America's most pervasive drug problem.” Alcohol-related deaths outnumber drug-related deaths 4 to 1. Alcohol is a factor in more than half of all domestic violence and sexual assault cases. Between accidents, health problems, crime, and lost productivity, researchers estimate that alcohol abuse costs the economy $167 billion a year. In 1995, 4 of every 10 people on probation said they were drinking when they committed a violent crime, while only 1 in 10 admitted using elicit drugs. The argument for not putting alcohol under the nation's drug czar is that heroin, cocaine, and marijuana are harmful and against the law but alcohol is used in moderation with no ill effects by many people. The counterargument is that an enormous number of people can't and never will be able to drink in moderation, and that number may be as high as 10 to 15 million Americans. | ||||
The CAT scan, designed to diagnose illness, is gaining use among people who feel fine (25). Some physicians are promoting it as the most credible provider of a clean bill of health and the surefire detector of incipient disease. Never mind that insurance does not cover it on a preventive basis. The number of CAT scans—which reached 26 million in the USA in 1997, the most recent year for which figures are available—has been rising by about a million a year, and a big chunk of that growth is coming from seemingly healthy Americans willing to fork over $700 of their own money for it. The US Army this year is spending $1 million to provide preventive screening for 4000 soldiers as part of routine physical examinations. The army hopes to gain sufficient funding to cover full-body scans for all its troops, according to the surgeon general of the army. The union representing Los Angeles police officers has arranged for a $190 discounted rate for its healthy members to get a scan. Kenneth Cooper, head of the Cooper Clinic in Dallas, is a major proponent of CAT scanning. Critics see more at stake than the out-of-pocket expenses. Results riddled with false positives can turn healthy CAT- scanned customers into patients, forcing insurance companies to provide coverage of unnecessary and potentially dangerous biopsies and other procedures. Critics say the problem is that almost any medical treatment applied to the masses will produce startling results in a few. The question is whether the benefits for those few outweigh the total cost. The same treatment that saves a few lives can ruin a few more. Moreover, it's rarely clear that a life has been saved. A malignant tumor found in a CAT scan may have sat dormant for years and might never have grown threatening. But the discovery of a tumor, indolent or not, almost certainly sets in motion a set of exploratory procedures that themselves could prove life threatening. Without question, early detection is crucial in certain kinds of cancers. Proponents say this opposition to CAT scan screening is reminiscent of early resistance to mammograms, which many physicians insisted were useless until overwhelming evidence emerged to the contrary. As technology plays a larger and larger role in diagnosing illness, the role of physicians, especially internists, could shrink. Whole-body CAT scans for someone without symptoms may not be routine in 2000, but I suspect by 2010 they will be used far more frequently. | ||||
In 1997, the nationwide average waiting period to receive a donated heart was 740 days; for a kidney, 962 days (26). Nearly 70,000 people in the USA are on waiting lists for organs, a number that has more than tripled since 1990. The number of donated organs each year, about 20,000, has remained steady during the 1990s. | ||||
The cloned-pig capital is Blacksburg, a city of nearly 40,000 residents in southwestern Virginia and the home of Virginia Polytechnic Institute and State University (27). Scientists and PPL Therapeutics, a subsidiary of the Scottish firm that cloned Dolly the sheep in 1997, announced in March 2000 that they had cloned 5 pigs at their research facility in Blacksburg. The pigs were created through a process that involves fusing an adult pig cell with another pig's egg cell, the DNA of which has been removed. The resulting embryo is then inserted in a surrogate sow. In winning the international race to clone pigs, the Virginiabased PPL team heralded a revolution in cross-species transplantation. In the past 3 years, sheep, cattle, and mice have been cloned in Scotland, Virginia, and Hawaii, but scientists have been vying to clone pigs because their organs are more compatible with human organs. The market for pig organs could exceed $6 billion a year. Pig hearts and kidneys fit for transplant are estimated to cost around $50,000 a piece. The scientists at PPL say this month's breakthrough could end a global shortage in hearts, kidneys, livers, and other organs needed by thousands of people worldwide, including about 70,000 in the USA. An official of PPL expects the company to begin clinical trials for pig-to-human organ transplants in 4 years. To breed successful organ donors, scientists must now work on genetically altering problematic pig cells, including eliminating a pig gene that adds a sugar group to pig cells that is rejected by the human immune system and adding at least 3 genes to a cell to prevent delayed rejection of pig organs. Meanwhile, the world's first cloned piglets are living the life of celebrities. When they're not hamming it up in front of cameras, the piglets are suckled by their surrogate mother, Destiny, in a secret barn in Blacksburg, hidden from animal rights activists and other potential threats. The prospect of breeding pigs as organ donors gives some Blacksburg residents the creeps. Those people having the creeps, however, will be very happy if they need a new organ. This research is clearly at the cutting edge. Pigs appear to be the big hope of transplantation. | ||||
The March 24, 2000, Science announced that the entire gene sequence, or DNA coding, of the fruit fly has been completed (28). The fruit fly has been used as a model for human biology for a century. The researchers also found that it possesses genes similar to 60% of the genes known to cause human diseases, including cancer and Parkinson's disease. The study, called the Berkeley Drosophila Genome Project, was done at the University of California, Berkeley. The entire gene sequence was not expected to be completed until 2002. The drosophila blueprint, about 13,600 genes, is in a database at the National Institutes of Health. Scientists and companies can use it for research and drug development. | ||||
Fifteen years ago, the US military decided to find out if drugs stopped working after the date stamped on the bottle (29). Sitting on a $1 billion stockpile of drugs and facing the possibility of destroying and replacing its supply every 2 or 3 years, the military began a testing program to see if it could extend the life of its inventory. The testing, conducted by the Food and Drug Administration, ultimately covered more than 100 drugs, both prescription and over-the-counter. The results, never before reported, showed that about 90% of them were safe and effective far past their original expiration date. At least one drug worked 15 years after its expiration date. Thus, the expiration dates put on drugs by manufacturers typically have no bearing on whether they are usable for longer periods. The drug maker is required to prove only that a drug is still good on whatever expiration date the company chooses to set. The expiration date does not mean, or even suggest, that the drug will stop being effective or will become harmful after that date. Manufacturers may put expiration dates on for marketing rather than scientific reasons. Turnover, of course, is more profitable than products on a shelf for 10 years. Drug industry officials apparently do not dispute the results of the Food and Drug Administration's testing, within what is called the Shelf Life Extension Program. They also acknowledge that expiration dates have a commercial dimension. Drug manufacturers say, however, that relatively short shelf lives make sense from a public safety standpoint. From the companies' perspective, any liability or safety risk is diminished by limiting the period in which the consumer might misuse or improperly store a drug. It is not known how much of the >$120 billion spent annually in the USA on prescription and over-the-counter medicines goes to replace expired drugs. A poll done for the Wall Street Journal showed that 70% of 1000 respondents said they would not take a prescription drug after its expiration date; 72% said the same of an over-the-counter remedy. Some people apparently believe that drugs suddenly turn toxic or lose all of their potency upon expiration. This simply is not the case. | ||||
According to the World Health Organization (WHO), about 75 million pints of blood are given worldwide each year (30). More than half that amount, 45 million pints, are given in the richest third of the world's countries. The poorest third account for just 1.3 million pints. More than half of the world's countries fail to perform full tests on donated blood, increasing the risk of spreading AIDS and other diseases, according to the WHO. About 5% to 10% of people with the AIDS virus are estimated to have been infected via blood transfusions. Only 43% of the WHO's 199 member states test blood for HIV/AIDS, hepatitis B, or hepatitis C. Malaria and syphilis also can be transmitted through transfusions. Each year, unsafe transfusions and injection practices are estimated to account for 8 to 16 million hepatitis B infections, 2.3 to 4.7 million hepatitis C infections, and 80,000 to 160,000 HIV infections. If one needs a blood transfusion, it's a good idea to be a patient in the USA. | ||||
According to Global Infectious Disease Threat and Its Implications for the United States, prepared by the National Intelligence Council (http://www.cia.gove/cia/publications/nie/report/nie99-17d.html), >33 million people on earth are living with AIDS or infected with HIV: 23.3 million live in sub-Saharan Africa and another 6 million in South and Southeast Asia (31). An estimated 650,000 to 900,000 people in the USA have HIV/AIDS. By 2010, Asia and the Pacific could surpass Africa in the number of HIV infections. In India alone, the number could be as high as 40 million in a few years. Russia's HIV-infected population could exceed 1 million by the end of 2000 and double yet again by 2002. HIV/AIDS is undermining economic growth in Africa and could cause more political destabilization. It appears that HIV/AIDS is more effective than war in destabilizing certain countries. | ||||
The personal savings rate in the USA has been declining steadily over the past few decades, and recently the savings rate dipped into negative territory (32). The savings rate in the USA is the lowest among industrialized nations. The US Census Bureau recently reported that half of American families have net financial assets of <$1000. Personal bankruptcies continue to climb despite low unemployment rates and the soaring stock market of the past few years. The best long-term solution to the nation's savings crisis is to teach our children good financial habits. The foundation of saving, of course, is delayed gratification. An accessible nonbreakable bank is a good beginning. Matching money saved by a child is an added incentive. When my grandchildren were about 5 years of age, I wrote each a check for $10 with the understanding that if they retained that check and returned it to me the next year, I would double the amount. If they retained that check until the following year, I would double the amount again. By doubling the amount for 12 years and assuming no interest or dividends collected, the account would have $20,480 in it. Assuming that that money would double each 7 years thereafter, the account would be worth over $5 million when the child reaches age 65. It would actually be more than that because of interest and dividends accrued during the first 12 years. Most health bills start accumulating after age 65. Sixty years from now $5 million will probably be able to pay for pretty good health insurance, assuming we don't have any radical change in our health care delivery system by that time, something which is certainly unlikely. | ||||
In April 2000 in South Dakota, a heart the size of a grapefruit was discovered in a natural sarcophagus of stone in the chest cavity of a dinosaur's fossilized skeleton (33). A report of the discovery was published in the April 21, 2000, issue of Science. Examining this stony material with computerized imaging techniques disclosed that the heart was more like that of a bird or a mammal than any known reptile. The evidence for a 4-chambered heart with a single aorta strongly suggests that this dinosaur, and perhaps many others, had a higher metabolism than previously believed. If this is true, dinosaurs may have been warm blooded instead of cold blooded like reptiles and thus could have engaged in more sustained activity in foraging and fighting, chasing prey, or escaping predators. Such advanced hearts are capable of distributing oxygenated blood more completely throughout the body. The finding also seems to strengthen the hypothesis that some dinosaurs were ancestors of today's birds, which are warm blooded. Fossils retain the original shape and structure of the body part, if not the original matter and cellular structure. Scientists suspect that when this dinosaur died, it was almost immediately buried in waterlogged sand, perhaps the sediment beneath a stream. Submerged in such an oxygen-poor environment, some of the animal's tissues petrified before decomposition set in. Unlike teeth and bones, the tissues of organs usually rapidly decay before they can be fossilized through mineral replacement. Previously, the only known internal traces of a dinosaur were fossilized intestines found in sediments from a former lake bed in Italy. The most recently found dinosaur was a 660-pound, 13- foot-long, plant-eating animal that lived and died not long before the extinction of all dinosaurs, which occurred about 65 million years ago. What makes the discovery especially surprising and puzzling is that the heart resembles a mammal's or a bird's but belonged to an ornithischien, or bird-hipped, dinosaur, one of the 2 main lineages of these great animals. Despite the name, these dinosaurs were far removed from those that are presumed by many paleontologists to have been ancestors of birds; these ancestors are presumed to be theropods, members of the other main lineage known as the saurischien, or lizard-hipped, dinosaurs. Thus, it is possible that dinosaurs of both lineages—not just the bird ancestors—had advanced hearts and high metabolisms. | ||||
USA Today analyzed compensation packages at 389 of America's largest companies and published details of the top 200 compensation packages on April 5, 2000 (34). The pay included salary, bonuses, long-term incentives, other compensation, and the value of restricted stock awards. The 1999 compensation for Timothy Koogle of Yahoo was $1.7 billion and for Steve Case of America Online, $1.1 billion. That works out to >$4 million a day compared with the US median household income of about $40,000, or $110 a day. Seven of 1999's 10 most highly compensated chief executive officers (CEOs) run technology companies, and the other 3 oversee new economy transformations. The median compensation package of 200 highly paid big-company CEOs jumped to $17.6 million in 1999, up 111% from a similar group of CEOs in 1998. Four of the 10 highest compensated CEOs are £50 years of age. The median compensation last year for an old economy CEO was $13 million and for a new economy CEO, $46 million. In contrast, the median salary for a special education teacher is approximately $40,000. President Clinton was paid $200,000 in 1999, and Tiger Woods made $49 million in 1999. Something seems a bit out of kilter here. | ||||
Each of the 30 major league teams has 25-man rosters plus those on the disabled list. The year 2000 salary survey revealed that only 14% of the players accounted for more than half of the player payroll for the 30 major league clubs (35). The average salary was $1,983,849 in 2000, up from $1,724,310 in 1999, an increase of 15%. The median salary was $700,000, up from $495,000 in 1999, a rise of 41%. The New York Yankees have the highest payroll, namely $92.9 million, almost 6 times Minnesota's $15.7 million, the lowest figure. The highest paid player is Los Angeles ace right hander Kevin Brown, at $15.7 million. Of the 2000 players, 382 were paid at least $1 million. The highest paid position on average is first base at $2.88 million. The lowest paid are catchers at $1.37 million on average. If money is your game, it's better to be a great baseball player than a great physician. Most physicians today know more about the great baseball players than about the great physicians. | ||||
About 60 million Americans looked for health information online in 1999 (36). Some of the most researched health conditions included depression (19%), allergies or sinus problems (16%), cancer (15%), bipolar disorder (14%), arthritis (9%), heart disease (8%), and sleep disorders (8%). | ||||
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