death and taxes

Monday, April 28, 2014

While the NFL may try to lay claim as America’s national sport, there is no doubt that baseball is king of statistics. The basics of hitting, batting and fielding averages have matured to an alphabet soup of performance indicators and averages, all to judge talent and project performance. Numbers matter in baseball from a single year and the .300 batting average and winning 20 games, to lifetime achievements, whether you believe in Hank Aaron’s 755 or Barry Bonds’ 762. Numbers matter in medicine but sometimes they frustrate. Welcome to the rant.

For all that can be done to improve the quality and quantity of life, it is what the patient brings to the table that may be most important. John F. Kennedy perhaps best summarized the ideal for medical care in this country when he asked his fellow Americans: “ask not what your country can do for you — ask what you can do for your country.” And in the case of lung cancer…not much on both sides.

Last year, an estimated 228, 190 people were diagnosed with lung cancer, a close third behind prostate and breast cancer, give or take a couple thousand patients. Last year 159,480 people died of their lung cancer, almost three times as many that died of prostate and breast cancer combined. Those are somber statistics, especially when $315 million were spent by the National Institutes of Health on cancer research.

More statistics. Smoking is the principal factor that causes lung cancer and is responsible for 90% of new cases per year. Radon is responsible for almost all the rest of ling cancers. It is an odorless gas that is released from elements found in earth and rock when they naturally decay. Exposure occurs in the workplace, especially in miners who work underground and in house basements, especially houses that are relatively airtight. Radon causes cancer more easily in smokers and the risk of cancer increases when smoking and radon exposure mix. Still of the 20,000 or so cancers caused each year by radon exposure, about 10% occur in nonsmokers.

It would seem that the best way to prevent lung cancer would be to get rid of smoking. The Surgeon General has had warning messages on cigarette packages since 1965 and every adult qualifying for Medicare has known since they were 18 years old that smoking kills and while tobacco has no redeeming medical benefit, about 20% of the US population smokes.

There is, however, a major incentive for government and your local politicians to be thankful for the 42 million Americans who smoke because they generate $17 billion in tax revenue at both the federal and state level. That is $17 billion with a B, is more than 53 times the amount spent on lung cancer research. Of course, smoking is also a major risk factor for the big killers, heart disease and stroke. Money is spent on research for those diseases and it costs money to care for those afflicted. But the numbers don’t lie. Income from smokers is on the plus side of balancing the government budget.

There are three types of lies according to Disraeli, Twain and others: Lies, damn lies and statistics. One can reach numerous conclusions from the same numbers. In baseball, I choose to believe that Hank Aaron holds the home run record, regardless of what the record books say and I get to interpret baseball stats that way. I also choose to believe that there is no joy in Mudville every time a new smoker is conscripted into the population. There is also no political will to take on the tobacco companies and the gas stations who are the prime sellers of tobacco products. A million here, a million there and pretty soon you’re talking real money…like $17 billion. In tight economic times what politician wants to raise taxes by $17 billion…unless they think there is a market to tax E-cigarettes? Stay tuned for more statistics.

 

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