Coffin Nail Fail

Here’s some good news:  the Centers for Disease Control and Prevention National Center for Health Statistics reported this week that the percentage of the adult population that smokes cigarettes has reached its lowest level since the government began keeping track of that activity.

11034958_web1_m-smoking-edh-171122The CDC report concluded that, in 2017, 13.9 percent of the adult population in the United States smoked cigarettes.  That number is down from 15.5 percent in 2016, and has been steadily declining over the years.  Back in the 1960s, more than 40 percent of American adults smoked.  Ask anyone who was around during the ’60s, and you’ll hear stories that give you an idea about just how dramatically things have changed since then.  When UJ and I went with our grandparents to University of Akron Zips basketball games back in those days, for example, people could smoke in the hallways before entering the seating area.  At halftime when you walked through the hallway to get popcorn or a hot dog, you walked through a thick, gag-inducing wall of smoke emitted by throngs of smokers.  Now — unless you’re in a Las Vegas casino — you almost never encounter even a whiff of smoke in a public place.

Why are the numbers of smokers falling?  Some attribute it to aggressive ad campaigns against smoking and some attribute it to changes in general social mores; others think that a positive feedback loop may have occurred, where the decline in the number of smokers means people see fewer smokers and aren’t tempted to start smoking themselves in the first place.  There’s also another reason for the decline:  call it coincidence, but people who are smokers often seem to have fatal health problems, like the cancers that claimed three of the heavy smokers in my family.

While the overall trends are encouraging, there’s still work to be done.  Even though adult smokers now number less than 14 percent of the population, that still amounts to millions of people who are in the grip of a very bad habit.  And the statistics show a real disparity in the percentage of smokers by location, with city dwellers much less likely to smoke than residents of rural areas.  We need to continue to work on getting current smokers to quit, and convincing potential smokers to never pick up one of those coffin nails in the first place.

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The Suicide Cascade

The recent deaths of Anthony Bourdain and Kate Spade have focused attention on a growing health problem in the United States:  suicide.  If it seems like suicide has become more commonplace in recent years, that’s because that is exactly what has happened.

anthony-bourdain-dead-6Coincidentally, the federal Centers for Disease Control and Prevention released a report last week that sketched out some statistics on suicide in America — which are deeply disturbing.  The CDC report states that suicide has been steadily increasing for more than a decade and is now the tenth leading cause of death in the United States.  The CDC looked at data from individual states from 1999 to 2016 and found that suicide rates have increased in virtually every state.  In half of the states, the rate has increased by a mind-boggling 30 percent.

The CDC report found that, in 2016, almost 45,000 Americans died by suicide, with especially sharp increases in suicide rates in Idaho, Montana, Wyoming, Utah, North and South Dakota, Kansas, Minnesota, Oklahoma, Vermont, New Hampshire and South Carolina.  The statistics also show that women are beginning to close the historical suicide “gender gap,” in which men have been far more likely to take their own lives; suicide rates among American women also have surged.

What causes a person to commit suicide?  Why would someone as interesting and witty and evidently successful as Anthony Bourdain, for example, decide to take their own life?  The CDC report found that more than half of the people who committed suicide did not have a diagnosed mental health condition.  Another recent study, on suicide trends in 27 states, also determined that suicide is more than a mental health issue, with many of the people acting as a result of relationship problems or loss of a loved one, substance misuse, physical health problems, or other personal or financial strains.

And suicide also seems to have a nefarious cascade effect, in which each suicide makes the next one more likely.  It’s apparently due to a variation of the “broken windows” effect, in which learning of someone’s suicide gives struggling people who otherwise might not think of it the idea that suicide is a viable option.  The effect has produced well-known instances of “suicide clusters” in towns or schools, in America and elsewhere — which may mean that we should hold our breath and hope that highly publicized suicides, like those of Kate Spade and Anthony Bourdain, don’t trigger an even greater epidemic of self-inflicted harm.

We all need to keep our eyes open, pay attention to our friends and colleagues who are struggling, and try to help them understand that their lives are worth living, even in times of great difficulty.

The “Avoiding Panic” Dodge

These days we’ve got plenty of people advising us not to panic about the Ebola virus.  Whether it’s those ubiquitous, generic “psychologists” who seem to pop up whenever there is some significant incident, or public health officials who want to reassure us that in the grand scheme of things Ebola is really not that big a deal, experts galore are urging us to control the inner demons that might otherwise transform us into a howling, red-eyed, torch-wielding mob that could end modern civilization as we know it.

The counseling to avoid panic is a dodge, of course, because no one is panicking.  But by depicting concerns about how the Ebola issue has been poorly handled as indications of unfortunate mass hysteria, the people who have dropped the ball can deflect and avoid legitimate inquiry.  Tsk, tsk!  They’re the rational ones; the rest of us are excitable, poorly informed boobs who are just going to make matters worse.  Like the policeman at the yellow tape of a disastrous crime scene, they just want us to move along.

We shouldn’t fall for this sham in this case, and should insist on getting answers to some entirely reasonable questions.  Ebola isn’t a phantom menace; it is a deadly disease, and in the latest outbreak in West Africa it has had a mortality rate of 70 percent, according to  the World Health Organization.  In America, we have established the Centers for Disease Control and Prevention precisely to deal with the enormous risks posed by such dread infectious diseases. When a man infected with Ebola reached America and received treatment in Dallas before dying, it appears that the CDC and the Dallas hospital that provided the treatment were unprepared to deal with the case in a way that ensured effective containment of the disease.  First one nurse, and then another, were found to be infected, and now we learn that the second nurse was permitted to board an airplane when she was exhibiting a low-grade fever that is one of the first signs of the virus.

Is it panicky and irrational to question how and why these circumstances could possibly occur?  If you were one of the 132 unsuspecting passengers flying from Cleveland to Dallas with that nurse — people that officials are now trying to trace and presumably monitor — wouldn’t you think it was entirely legitimate to question the competence of the CDC and to ask whether it was following any kind of meaningful containment strategy?

It is becoming increasingly clear that the CDC has badly fumbled this situation, which means that it is failing at the principal reason for its existence in the first place.  Demanding answers about how that happened is not a a sign of hysteria, but rather of requiring accountability by a government agency that simply has not done its job and, in the process, is exposing the people it is supposed to protect to unnecessary risk.

First Ebola, Then Zombies

The news about Ebola in west Africa is dreadful.  A new assessment of the outbreak by the World Health Organization forecasts that the number of people infected and killed by the disease may increase dramatically and become “endemic” in that region — which means that it would never be fully eliminated in countries like Sierra Leone, Guinea, and Liberia.  The WHO also says the death rate for those infected with Ebola is 70 percent.

The Centers for Disease Control and Prevention predicts that the Ebola epidemic may infect 1.4 million people in west Africa by the end of January.  Multiply that number by the 70 percent death rate and you see an enormous human disaster if steps to control the disease don’t work.  Even worse, with each new infected person, there is an increased risk that the devastating disease will break out of west Africa and penetrate into the world at large — and if that happens the forecasted numbers will become astronomical.

And then there is this story from Liberia, which reports that two women killed by Ebola have mysteriously risen from the dead.  The two were about to be buried when they returned to life, causing panic in their communities.  The news report of the incident helpfully notes:  “Since the Ebola outbreak in Nimba County, this is the first incident of dead victims resurrecting.”  The report is silent on whether the two women have since exhibited the signs of undead behavior — like staggering around and munching on the brains of the living — that are familiar to any fans of zombie movies.

Of course, under these circumstances jokes about a zombie apocalypse aren’t very funny.  The zombie story just highlights the fact that west Africa is totally ill-equipped — culturally, medically, and scientifically — to deal with an outbreak of a highly lethal contagious disease.  When you combine superstitious people, the absence of doctors who can reliably diagnose and treat the disease and determine whether its victims are actually dead, an insufficient supply of bodysuits, decontamination supplies, medication, and other necessary supplies, and inadequate sanitation and means of disposing of the bodies of those killed by Ebola, you have created an ideal setting for an uncontrolled epidemic.

A recent New York Times story about one overworked gravedigger in Freetown, Sierra Leone paints a bleak picture and powerfully makes the case that the Ebola outbreak may have reached a terrible tipping point.  We had all better hope that — zombies or not — the efforts to control the disease are effective.

The CDC And The Mass Breakdown Of Governmental Competence

For years the Centers for Disease Control and Prevention was one federal agency that seemed to be a model of governmental efficiency and capability.  Like NASA in the glory days of the Mercury, Gemini, and Apollo programs, the CDC was a little agency with an important mission and dedicated employees who helped to guide the national responses to epidemics and infectious diseases.

That’s why the recent stories about some appalling security lapses at the CDC are so troubling.  In one instance, poor handling of anthrax — a disease that the CDC’s own website cautions can cause serious illness and death — potentially exposed a number of employees to the bacteria.  In another incident, CDC employees improperly shipped a deadly strain of bird flu to a Department of Agriculture poultry research lab.  The breakdowns are especially disturbing because the CDC also is supposed to ensure that other laboratories follow federal safety standards.  The CDC is investigating these breaches and developing new procedures to address the “potential for hubris” in an agency that may have grown too comfortable with working with dangerous spores, bacteria, and infectious agents.

Given the CDC’s public health mission, any security breakdown that could expose people to a deadly infectious disease could be catastrophic.  But the CDC’s problems seem to be symptomatic of a larger, equally concerning issue:  a broad-scale series of failures in federal agencies.  In the past year, we have witnessed a colossal failure in an attempt by the Department of Health and Human Services to build a functioning health insurance exchange website, mass failures by the Veterans Administration to provide adequate care for veterans, a stunning security breach that allowed Edward Snowden to spirit away enormous amounts of highly classified data, and a southern border so porous that thousands of unaccompanied minors have been able to cross into our country.  And those are just a few of the stories.

For years, there has been a divide in this country between those who want the government to assume a more significant role in regulating our affairs and those who resist that approach because they believe a larger government role means less freedom and fewer individual liberties.  The recent dismal performance of our federal agencies suggests that a new factor should enter into the equation:  is the federal government even competent to do what we are asking it to do?  In view of the many recent breakdowns in governmental performance, that is a very fair question. 

Mumps On Campus

The Ohio State University is reporting an outbreak of 23 cases of mumps on campus. Eighteen students and one staff member — as well as others with links to the University community — apparently have the disease.

Mumps is one of those diseases, like scarlet fever or measles, that people used to get as kids before vaccines became commonplace. I had mumps when I was a tot, and so did all of the kids in my family. I remember being tired and having a sore throat and swollen glands, but getting to eat ice cream and drink 7-Up and read Archie comic books in bed made it bearable.

We tend to think of childhood diseases as not so serious, and usually they aren’t — at least, not if you get them when you’re a kid. If you get mumps as an adult, however, it can have more serious consequences, including swelling in some tender areas for post-pubescent males. Mumps also is the kind of disease that sounds tailor-made for transmission in a college campus setting. According to the Centers for Disease Control and Prevention:

“Mumps is spread by droplets of saliva or mucus from the mouth, nose, or throat of an infected person, usually when the person coughs, sneezes, or talks. Items used by an infected person, such as soft drink cans or eating utensils, can also be contaminated with the virus, which may spread to others if those items are shared. In addition, the virus may spread when someone with mumps touches items or surfaces without washing their hands and someone else then touches the same surface and rubs their mouth or nose.”

Now, compare that description of mumps transmission to the close quarters and hygiene standards found in the off-campus residences and dorm rooms maintained by college students, and you’ll soon find yourself wondering how big an outbreak of mumps on a college campus could become. (If you’re an Ohio State basketball fan, you also find yourself hoping that all of the members of the team have been vaccinated.)

Which raises one final point: you don’t get mumps if you had it as a kid or you’ve been vaccinated. I thought vaccinations for mumps was pretty universal in the United States. An outbreak of 23 cases of the mumps suggests that understanding may be unfounded — which is deeply troubling. Aren’t parents getting basic vaccinations for their kids these days? If they aren’t, why not? It makes you wonder if other basic public health steps are being ignored, and what other outbreaks and consequences might lie in store for us as a result.

How Fat Are Our Kids?

This week a federal study reported that the obesity rate for American kids between 2 and 5 years of age fell 43% in a decade. The study, undertaken by the Centers for Disease Control and Prevention and to be published in the Journal of the American Medical Association, indicates that obesity during that age group has declined from 14 percent in 2004 to 8 percent in 2012.

Not surprisingly, there’s disagreement about what might have caused the decline. Some argue that federal programs, including the availability of food stamps and the women, infants, and children assistance program and federal nutrition guidelines, other national efforts such as First Lady Michelle Obama’s “Let’s Move” initiative, and pressure on food companies to stop targeting ads to young children are responsible for the decline. Others question whether there really was an “obesity epidemic” in the first place and are skeptical that federal programs had anything to do with the decline reflected in the CDC study.

I don’t have a dog in that fight. My question is more fundamental — why are people celebrating the finding that “only” 8 percent of little kids are obese? That seems like a pretty damning figure to me. How does a two-or three-year-old become obese, except by the inattention of their parents? Most two- and three-year-olds I know aren’t out shopping for themselves. Don’t their parents know how to say no?