trans fat kills, but smoking massacres

Monday, June 22, 2015

In sports, fans get to boo and cheer because they have an emotional connection to their team and are invested in the outcome of the game. If only the same were true in the real world, where decisions made by the courts, elected officials and others have an impact on individual lives and society as a whole. For that reason, it would be very appropriate to take the FDA to task and boo loud and long. Given the responsibility for protecting the public by regulating food and drugs, those in charge of the Food and Drug Administration have forgotten their mission. Instead, they have allowed politicians to misshape their mission and in the process, allow millions of people to die.

Why the diatribe now? It’s about the announcement that trans fats (partially hydrogenated oils) will be an effectively banned substance in the food supply. It only took 14 years for that decision to occur, since transfats were found to be a health risk by the National Academy of Science Institute of medicine in 2002. That led to the 2006 requirement that trans fat be labeled and 2013 FDA determination that transfats were no longer generally recognized as safe. FDA Commissioner, Margaret Hamburg, was quoted: “Further reduction in the amount of trans fat in the American diet could prevent an additional 20,000 heart attacks and 7,000 deaths from heart disease each year – a critical step in the protection of Americans’ health.”

That’s a lot of deaths to prevent, but in the scheme of things, there is a bigger fish and the FDA, the Surgeon General, the President and Congress have turned a blind eye to the tragedy of tobacco because it might be too hard work to mount a war against tobacco companies and their lobby. Plus, it would be extremely expensive, since the huge government income derived from taxes on tobacco would need to be replaced.

The numbers are compelling:

  • The American Heart Association estimates that cigarettes cause a quarter of all preventable deaths in the US each year, a total of 440,000 deaths. (The math says that is 60 times the expected numbers of lives to be saved by removing trans fat from the American diet.
  • In 2012, the Brooking Institute reports that federal and state governments collected 17.6 billion dollars in tobacco tax.
  • In 2012, the Federal government spent $231 million for lung cancer research.
  • The vast majority of lung cancers, more than 80% are attributed to tobacco use and second hand smoke.

There is no positive medical use for tobacco products. It is addictive and significant efforts are made to treat that addiction and stop people from smoking. New smokers are created day, though not as many as in past years. The high school smoking rate is 15.7% and that beats the 2020 US government goal of 16%. That rate should be zero or as close to zero as possible. More than 2,000 youths become regular smokers every day. Those new smokers are more than enough to replace the people who die every year from tobacco use and continue the demand for a product whose recognized side effect is disease and death.

Tobacco is a tough battle and government workers and elected officials have chosen not to take the high road because it is tough. Their lack of fortitude can be seen in their battle against trans fat that took so many years and their less forceful, politically expedient than approach. For a food product that is generally recognized as unsafe, food manufacturers can still apply for waivers for its use and are being given a three-year window to alter their product. Knowing that research showed their product to be unsafe in 2002 presumably did not give them enough time to do the right thing.

Saving 7,000 lives is a big deal ,but it is not time to cheer the FDA. It is time to boo them loudly, for the more than 400,000 people it allows to die each year.

 

 

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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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