Vol. 191 April 15, 2018 The Gun Violence Epidemic

April 15, 2018

Hub thumbnail 2015

“EPIDEMIC” continues to be a common catch word for headlines. Apparently we have lots of epidemics; the flu, HIV, opioid, Zika, gun violence, etc. We spend a lot of tax money investigating and containing epidemics. . . . Oh, . . . all except for that last one: gun violence.

Why is that? In 1996 the Communicable Disease Center (CDC), our federal bulwark against harmful epidemics, was expressly instructed by Congress NOT to study anything related to guns, i.e. don’t give research grants, don’t establish data bases to track events, and don’t sic the EIS on the gun violence epidemic. In one of his rare Executive Orders President Obama instructed the CDC in 2012 to resume their gun violence research and asked Congress to allocate $10 million dollars for that purpose. Congress never did.

EIS stands for the Epidemic Intelligence Service, a division of the CDC. It has a stellar reputation for laser-focussed field analysis of incipient epidemics to guide early actions to contain them, to reduce any harm to people. Just last week the CDC launched an investigation into a cluster of 53 new HIV cases in Lowell, MA. (In 2007 Boston had a “cluster” of 92 gun-related homicides.) Ironically, the CDC remains hamstrung in any effort to collect and analyze data on the gun violence epidemic at a time when it is asking the general public to participate in identifying any other kind of potential epidemic via internet “crowd sourcing” .

The CDC does keep mortality statistics and issues an annual report of causes of death for each state. The difference of gun-related death rates  between states is huge, and  no one really knows why. Massachusetts had the lowest number of gun-related deaths in 2016: 3.4 deaths per 100,000 population, or 242 gun-related deaths in Massachusetts that year. Texas, Florida, and California had 3,353, 2,704, and 3,184 gun-related deaths respectively that same year. Those three states also had the most suicide deaths and the most accident-related deaths of all the states. That’s interesting, but those rates may not be related in any way to each other . Food for thought? Too bad the CDC can’t collect more data on gun deaths.

A gun is the harmful agent in this epidemic just as a virus is the harmful agent in the AIDS epidemic. True, human behavior is the cause for both of the epidemics spreading, but while we are developing a HIV vaccine we have implemented effective measures to contain the epidemic with “safe sex” campaigns, identification of risk factors, pre-natal treatment of HIV-positive pregnant women, early treatment of exposed newborns, and development of successful medical treatments. All of this was accomplished with the support of the CDC and NIH. Why not provide government support for similar interim steps to reduce the gun violence epidemic? Medical societies and many citizen groups have picked up the “safe gun” banner. Why hasn’t the federal government done so?

One answer is, of course, money. The NRA contributed money to 205 House members (189 Republicans and 16 Democrats) and 42 Senators (35 Republicans and 4 Democrats) in 2012. The Democratic Senator that got the most NRA money got less than the 41 Republicans above him or her on the list. 95 of the top 100 NRA money receivers in the House were Republicans. Most analysts actually consider this as “chump change” ($5,000-10,000 per Congressman) compared to the $18.6 million that the NRA spent on NRA-favorable candidates in the 2012 elections. Analysts speculate that the money buys “allegiance” rather than “influence” (whatever that means). We all know it buys lots of “thoughts and prayers.”

Another answer may be that there are more guns than people in the U.S. It is as if everyone had AIDS, or as if HIV- infected people considered it their constitutional right to do anything with it they wished to. We as a nation did a lot to reduce the harm of HIV without abolishing the HIV virus. Why can’t we take the same approach to gun violence? We could do quite a bit without abolishing guns if we could do research about how guns are spread, how they are used for harm (In fact, 50% of gun deaths are suicides), how we could reduce harmful use (electronic signatures, smart guns, trigger locks, no multiple cartridge magazine, etc.).

The significant reduction of auto accidents deaths was accomplished by multiple means (seat belts, car seat regulations, air bags, electronic sensors, changes in car manufacture, speed limit regulations, etc,) and not by abolishing cars or drivers’ licenses. With better data perhaps we could take effective action to reduce the gun death epidemic.

Claritin:gun cartoon

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Vol. 18 April 1, 2010 APRIL FOOL’S ISSUE

April 1, 2010

APRIL FOOLS DAY (according to one theory that ignores the 13th century literature references to “april fools”) was created around 1582 when the Gregorian calendar moved the first day of the New Year from April 1 to January 1. Those who persisted in calling April 1 “New Year’s Day” were often sent phony invitations to  New Year’s parties. Other pranks to fool people, usually performed in the morning, were soon added to the phony party invitations. Someone who pulled a prank after noontime on that day was also called a “fool”.

THE TRADITION CONTINUES.

NIH REPORTS THAT ONLY 20% OF AMERICANS ARE ACTUALLY OBESE.
The NH discovered an error in its formula for calculating Body Mass Index  (BMI), a widely used standard of obesity which is posted on their website. The calculation error results in a grossly overstated BMI which negates decades of provocative research on obesity. The White House spokesperson for Michelle Obama declined comment by saying, “We have other more important health care issues on the front burner right now”. The NIH regrets any inconvenience that this may have caused, reassures researchers that study grant funds will not be reclaimed,  and states, “Hey, we can’t be right about everything.”

LAST SUPPER PORTIONS HAVE INCREASED 69.2% OVER THE LAST MILLENNIUM.
In a related study, and a timely one at that, two researchers studied 52 paintings of the Last Supper and concluded that the size of the main course in the paintings had increased by nearly 70% over the centuries. Plate size increased by 66% and bread size by 23%. The authors of this study published in the International Journal of Obesity just in time for Easter speculate that the increasing sizes reflect the increasing abundance and affordability of food over the years. (Apparently there is nothing new about “Super Size Me”.) (1)

H1N1 (SWINE) FLU PROGRAM A BIGGER STIMULUS THAN THE BANK BAILOUTS
The Government Accounting Office (GAO), the federal government’s premier watchdog agency, reports that the H1N1 (swine flu) epidemic efforts created more of an economic stimulus than the bank bailouts. The amount of money pumped into media outlets by the educational efforts was exceeded only by the amount paid to pharmaceutical companies for manufacturing and distribution of the vaccines, now readily available in excess supply due to underuse. More importantly, much of the trickle down economic benefits occurred in the offices of pediatricians, internists, and family physicians; our lowest income bracket health care providers. When asked by the GAO for comments, the CDC replied, “Hey, we can’t be right about everything.”

VIDEO GAME EXPERIENCE MORE BENEFICIAL THAN HONOR GRADES.
Army recruits with a history of prolonged play on video games have better success records as tank commanders and drone pilots than the valedictorians from the same schools. The study speculates that the better hand-eye coordination and enhanced perception of spatial relationships of the video game players accounts for the large discrepancy in skills between the two groups of students. The study authors speculate that these findings could be generalized to include endoscopic, laparoscopic, angioplastic, and other “minimally invasive”  procedures. “Perhaps it is time we altered our application standards for medical school and post-graduate clinical training.”

VEGETABLES CAN LOWER IQs.
Organic vegetables are suspected of  lowering the IQ in young children by at least 10 points. This result of a study of children in Western Massachusetts, Southern California, Oregon, and other tree-hugging communities surprised the authors who had received funds for the study from the National Association of Vegetable Investors (NAVI). A parallel study in rabbits revealed that carotene (the color in yellow and green vegetables) has a strong affinity for nerve synapse proteins in the brain. The carotene  binds tightly with the nerve protein, slowing the response time, EXCEPT in the occipital lobe which is responsible for vision. (Your grandmother was right after all. Eating carrots can help your eyesight.)

WEARING GALOSHES (OR RUBBERS) IN THE MOVIES DOES NOT HARM YOUR VISION.
This small study revealed no change in vision between children who removed their galoshes while in the movie theater and those who did not. The study authors concluded that “Mothers and grandmothers can’t be right all the time, either”, but admitted that the study result was weakened by its small size since they had trouble finding enough kids who still went to a movie theater to watch movies.

OLIVES IN A MARTINI ARE AS GOOD AS OLIVE OIL IN REDUCING CHOLESTEROL.
“You just have to drink enough of them” say the study’s authors.

PASSAGE OF HEALTH CARE REFORM BILL CAUSES MASSIVE SHIFT OF LOBBYISTS.
Lobbyists for bankers, business groups, hedge funds, insurance firms, Wall Street brokers, and others in the  financial sector are poised to reclaim their historical position as the number one group in expenditures to influence Washington policy now that the health care bill has been passed. The Committee for Truth in Politics, its membership and financing still a secret, has already spent $5 million in advertising opposing proposed financial reforms. The Center for Responsive Politics, which tracks spending by lobbyists, speculates that the financial sector lobbyists want to get back to its spending level of the past decade of $3.9 Billion. (2)

CELL PHONE USAGE MAY INCREASE FERTILITY.
In the midst of the scientific controversy about whether or not the low-level radio frequency (RF) coming from cell phones can cause brain tumors, one study has unexpectedly shown an increase in the birth rate in those women using the cell phone more than an hour a day. The mechanism of enhanced fertility is not known. “We compared the actual time spent on voice calls, texting, twittering, and Facebook and found no fertility differences among them, so we don’t think it is associated with just an increase in social intercourse. Likewise, we found no differences between heavy daytime users and heavy nighttime users.” Dr. Siegal Sadetski, a researcher at Israel’s Gertner Institute, stated, “Scientifically speaking, we don’t have proof yet, but as a public health concern, I’m saying we definitely should adopt precautions.” (3)

References:

1. Believe or not, this fun fact is actually true. Wansink and Wansink from Cornell and VWI are the authors. Look it up!
2. Actually some of these names and amounts are true. Check out Center for Responsive Politics website.
3. This quote is true too, but is wildly out of context. 


Vol. 16 March 1, 2010 What’s Good for Your Heart? Less Salt, Less Fat…or NOT?

March 1, 2010

Modest reductions in dietary salt could substantially reduce cardiovascular events and medical costs
and should be a public health target” (1)
– New England Journal of Medicine, Feb. 18, 2010
.

.“The human body is very adaptable. When you drink water and ingest salt your kidneys
keep what you need and excrete the rest.” (2)
– Nathan Talbot, MD, 1969, Harvard Professor of Pediatrics,
expert  in research in life-raft survival physiology
.

“Whether or not salt is bad for your health is still controversial. One camp says that salt is part of eating healthy.
The other says that salt causes high blood pressure, strokes, and heart attacks. Both may be right.”
– Salt: A World History, Mark Kurlansky, Penguin Press, 2002

.
First known warning that salt could lead to high blood pressure and  a stroke: 600 AD, “Yellow Emperor’s Classic of Internal Medicine” (3)

Date that American Medical Association Newsletter cautioned that the “average American consumes two to three times the recommended amount of salt”: Dec. 24, 2007

Average salt consumption per day of American men and women in 2005-2006 respectively: 10.4 grams / 7.3 grams

  • “Eating that much salt is not a problem for people with healthy kidneys. The research supporting a reduction in salt [to reduce cardiovascular disease] is far less consistent than that supporting weight loss, smoking cessation, and exercise.” Hillel Cohen, MD, Albert Einstein College of Medicine (4)

Daily intake of salt recommended for healthy adults by U.S. government:  5.8 grams (a little over 2 teaspoons)

Recommended salt intake limit for adults over 40, blacks, or people with high blood pressure: 3.8 grams (about 1 1/2 teaspoon)

“Ideal” limit of daily salt intake according to the president of the American Heart Association because “everyone is at risk for heart disease”: less than 1/2 teaspoon (4)

Estimated amount of reduced annual health care costs in U.S. if salt intake was reduced by 3 grams ( about 1 teaspoon) a day: $10-24 Billion (5)

Number of big, basic assumptions that this figure is based on: 2

  1. salt reduction lowers blood pressure
  2. lower blood pressure lowers risk of stroke and heart disease

Per cent of salt in the U.S. diet that comes from added salt at the table: 20%

Per cent of salt in U.S. diet that comes from processed food: 80%

Year that Morton Salt Company added magnesium carbonate to salt to make it pour more easily: 1911

  • Who can forget that little girl under the umbrella? “When it rains it pours.”

Year that a book boosting sea salt reported that salt companies REMOVE magnesium from salt to make it flow more freely and to make money selling the magnesium: 2005 (6)

“There is no significant evidence for concluding that dietary saturated fat is independently associated with an increased risk for heart disease… Specific nutrients used to replace saturated fats may not reduce, and may increase, risk of cardiovascular disease. More data is needed to elucidate those effects.” (7)


Number of studies/subjects/years of followup reviewed by this mega-analysis to support the above quotation: 21 studies / 347,747 subjects / 5-23 years  (7)

Number of grams of sugar and calories in a cup of LOW-FAT fruit flavored yogurt: 46 grams sugar / 233 calories

Number of same in a cup of WHOLE MILK yogurt (contains fat) with unsweetened frozen berries: 24 grams sugar / 230 calories (8)

References:
1.Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease, NEJM 362;7, Feb. 18, 2010, 590-599
2.Personal communication from the “Chief” to us pediatric residents
3. Salt: A World History, Mark Kurlansky, Penguin Press, 2002
4. The Salt Shake, Kenneth Weintrub, Boston Globe, Feb. 1, 2010, G 4
5.Compelling Evidence for Public Health Action to Reduce Salt Intake, Editorial, NEJM 362;7, Feb. 18, 2010, 650-652
6.Sea Salt’s Hidden Powers, Jacques de Langre, PhD, 2005
7. Am J Clin Nutrition 91:535-546, March 2010, R. Krauss, et al.(online Jan 2010)
8. Boston Globe, Feb. 24, 2010, A. Boomer, G21


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