death by numbers

Monday, May 5, 2014

Too often the lessons we learn from sport happen off the court and the saga of Donald Sterling, the Los Angeles Clippers and new NBA commissioner, Adam Silver, provide our latest education. What we learned that a leader can make a strong stand against evil, enforce a decision that may or may not be legal and aggressively change a culture that harms many. If only there were a leader that could stand up to the evil that challenges the health of millions.

The United States are blessed with an abundance of medical resources and spending money on health care is a national pastime. Some consider that money inefficiently used because in many surveys, the US is not a leader of the pack for many of the parameters that measure a healthy population. To be fair, there is only so much that 300 million people can buy with a $2.6 trillion health care budget, especially when there is waste and inefficiency. So  it is big news when, on May 1, the Centers for Disease Control and Prevention identified the five things that kill more people in these United States than any other diseases:

  • heart disease
  • cancer
  • COPD including emphysema and chronic bronchitis
  • stroke
  • unintentional injuries

The CDC estimates that these five disease are responsible 900,000 deaths each year in this country, or two thirds of all deaths. They also have pretty specific estimates of how many people had premature, preventable deaths every year:

  • heart disease     91,757
  • cancer                84,443
  • COPD                 28,831
  • Stroke                16,973
  • Injury                 36,836

Doing the math, that’s a total of more than a quarter million people.

The CDC also had a much less public press release on April 24 that talked about the human and dollar cost of smoking. The reason smoking is so relevant to the premature death discussion is that is a primary risk factor for heart disease, COPD and stroke.  And it is THE cause for more than 90% of lung cancers. And while I don’t dispute the CDC number that only 84,000 people died early from cancer, the National Institutes of Health pegged the lung cancer death toll for 2013 at 159,480.

One could say that smoking is a personal choice and the government should not infringe on personal rights, but the CDC pegs the cost of smoking at $289 billion per year including $133 billion for direct medical costs. That does not include the $5.6 billion of lost worker productivity because of second hand smoke.

One could also say that people have the right to be free of others influence when making personal decisions. The tobacco industry invested $8.4 billion in advertising in 2011. I say invested because there is a presumption that they would like to have a return on their money and that comes from recruiting new smokers and asking their hooked customers to smoke more. One could also argue that the advertising could be balanced by government health advertising warning of the dangers of smoking, but only $4.8 billion is spent, less than 1/50 of the tobacco taxes expected to be collected in 2014.

So here is where we need strong leaders, like the NBA commissioner, to stand up and tell the evil that is the tobacco industry, that their product that has no useful medical or health benefit is no longer welcome. The monies spent to battle tobacco related diseases could be spent in better ways to enrich the lives of the 120 million families in these United States. That $133 billion in tobacco related medical costs could fund more than 1,000,000 extra teachers in our schools every year. It could provide a $100 basket of fresh vegetables and fruits delivered to every family every month; the tobacco growers could be asked to grow something useful and I’m certain that Amazon, Netflix or EBay has the infrastructure to make the deliveries happen. It is almost enough to double the annual budget of the Department of Veterans Affairs.

If only we had strong leaders who would stand up to lobbyists and those corporations who prey on those addicted to their product. If only we had leaders who would change culture. If only……

For those who read this column regularly, remember that last week, you were promised death by numbers.

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the skinny on mrsa

Monday, October 14, 2013

Instead of working on offense, defense or special teams, the Tampa Bay Buccaneers are developing a game plan to control MRSA infections, and recent headlines made it sound like an invasion from outer space. In reality, it’s just another bacterial infection that has taken on celebrity status. Methicillin resistant staphylococcus aureus is no longer the rare bacteria that only attacked hospital patients, but instead has morphed into a routine cause of infections in the general population.  MRSA has become so common in situations where people share close spaces and contact, that the Centers for Disease Control and Prevention has a dedicated website for teaching coaches and athletic directors.

The story of MRSA is similar to many other bacteria in the era of antibiotics. Over prescription, often for inappropriate indications, has caused certain bacteria to adapt and mutate to become resistant to drugs that a few years ago would have been very effective. The problem begins with a patient expectation and continues with a doctor wanting to please their customer. It takes longer to explain why antibiotics don’t work against viruses, then add a doctor’s concern that the patient won’t be satisfied without a slip of paper to take to the pharmacist and the result is a plethora of antibiotic prescriptions. Other sources of antibiotic use can also filter their way into the human body. A study of Canadian agriculture found MRSA in 10% of pork products, in 70% of pigs and 45% of pig farm workers.

MRSA is a common cause of skin infections, along with streptococcus. The names have to do with what the bacteria look like under the microscope. The difference has to do with the complication potential. MRSA can spread more deeply, developing abscesses and occasionally causing wide spread infection in the body, affecting a variety of organs including bone, joints, heart and lungs. As with any infection, prevention is better than treatment and the Buccaneers have been trying to deep clean their training facilities to prevent infection spread. Good intentions sometimes don’t succeed.

As it turns out, people can be colonized with MRSA and it can be found in the nose of more than 2% of the population. There it sits, waiting for an opportunity to pounce and infect a laceration, scrape or other break in the skin. And athletes are at increased risk for transmitting the infection from person to person, especially in sports like wrestling and football. Studies looking at high school football in Nebraska found that almost 15% of players had an MRSA infection. The CDC has reported of recurrent MRSA infections in college football teams with teams reporting up to an 8% infection rate; it’s especially high among linemen.

While cleaning equipment, mats and turf can decrease the risk of MRSA infection, the problem infection resides in the athlete and that makes MRSA infection control tough.  Historically, hospitals tried to limit the MRSA infection rate by intensive cleaning, plus culturing and treating all patients who presented for admission. Those patients were discharged MRSA-free from the hospital only to be infected by family members who were also carriers or because they were living in a nursing home or other care facility where MRSA lived. On return for their next visit, these patients re-infected the hospital.

The CDC recommends a five step approach to controlling MRSA in athletes:

  • Any athlete with a suspected skin infection should be referred to a health care provider
  • Those with a potential or confirmed infection or open wound should avoid whirlpools or therapy pools that are not cleaned between each athlete use
  • Educate athletes about cleaning and disinfecting guidelines
  • Educate athletes about ways to prevent spreading infection
  • Consider excluding athlete from participation pending health care provider evaluation

The good news is that MRSA can be treated with a variety of antibiotics. The bad news is that bacteria continue to mutate. The arsenal of antibiotics that works this month or this year may become obsolete. MRSA is just one type of bacteria that is on the public health radar. Both doctors and patients need to be on the same page when it comes to antibiotic use. There should be a reason for an antibiotic prescription and not just because it meets the patient’s consumer satisfaction standard. Similarly, increased agricultural use of antibiotics needs to be considered when it comes to food safety and the spillover that may occur with mutant bacteria.

These are the issues that lurk in the background that make it even harder as the Tampa Bay Buccaneers try to sort out their training facility infection woes.  No matter how well the team trainers and doctors do their job, unless, they stop playing the game, the player risk for the next infection is always there.

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