“Are Guns A Public Health Issue?”: Let Us Count The Ways…
Is calling guns a public health issue a political statement? That’s become the underlying issue in the nomination of the White House’s pick for surgeon general, Vivek Murthy. In 2012, Murthy sent out a tweet: “Tired of politicians playing politics w/ guns, putting lives at risk b/c they’re scared of NRA. Guns are a health care issue.” The NRA got Senators to hurl the words back at him during a confirmation hearing, and seems to have convinced not just Republicans but some Democrats to vote against him. Now nobody is talking about bringing his nomination to the floor.
Let’s leave aside the issue of whether a Tweet should be the grounds for an opposition campaign, and of whether Murthy, best known for running an advocacy organization to support Obamacare’s launch, is the most qualified person for the job. If the question at hand is whether it’s partisan to believe that gun violence should be under the purview of the nation’s top doctor, it seems the answer is no. As Lucia Graves at National Journal chronicled last week, Ronald Reagan and George H.W. Bush’s surgeon generals, C. Everett Koop and Louis W. Sullivan, have professed the same view as Murthy without ruffling feathers. “Promoting reasonable gun policies does not make [public health professionals] ‘antigun’ any more than the Insurance Institute for Highway Safety is ‘anticar,’” wrote David Hemenway of the Harvard School of Public Health in his 2004 book Private Guns, Public Health.
Gun violence impacts health in all kinds of ways. There are the more obvious ones, like death and injury. As Olga Khazan pointed out at The Atlantic, suicide rates are higher in states where gun ownership is more common. In 2010, 19,392 people took their own lives with guns, while “justifiable homicides”—self-defense shootings that may have saved a life—numbered only 230. Over two-thirds of homicides and over half of successful suicides involve the use of a gun, and accidental gun deaths average about two a day. The U.S. spends $2 billion a year on medical care for victims of gun injuries; one out of three people hospitalized after shootings is uninsured, according to The Huffington Post.
Then there are the less obvious health effects of gun violence: Lead in the ground from ammunition. Loss of hearing from gunshots. Widespread PTSD that effects everyone from shooters, to victims, to bystanders. “Gun violence traumatizes whole communities,” Hemenway told me. This creates a cycle: “People with PTSD in inner cities often don’t have good access to mental health care, and it makes them more likely to be aggressive.”
Public health experts have a list of possible solutions that fall outside the most fractious debates over firearms. Stephen Teret, a public health expert at Johns Hopkins University, has pushed for the engineering of “smart guns,” which could only be fired by their owners: No more weapons finding their way into the black market, or becoming deadly playthings in the hands of children. (The NRA has fought the new technology.) Teret’s idea would address both intentional and accidental gun hazards, but there are lots of ways to approach the latter—from mandated child safety locks, to features that would make it more obvious if a weapon was loaded.
Hemenway also suggested changing the culture around some aspects of gun use, as a sustained campaign did for drunk driving in the 20th century. “One of the social norms should be that it’s your responsibility, if you’re a gun owner, to make sure your gun is not stolen,” he said.
The power of the surgeon general lies mostly in the ability to shape public conversation, and to do so he or she needs to maintain a high degree of trust, on both ends of the political spectrum. But sometimes advocating for public health means wading into controversial issues, like AIDS or smoking, because people’s lives are at stake. That means a surgeon general must be ready and willing to speak out on all kinds of hazards, even ones with powerful constituencies behind them. Those can include carcinogens from cigarettes, poisons from pollution, and, yes, bullets from guns.
By: Nora Caplan-Bricker, The New Republic, April 3, 2014
“Lethal But Legal”: Rethinking Our ‘Rights’ To Dangerous Behaviors
In the last few years, it’s become increasingly clear that food companies engineer hyperprocessed foods in ways precisely geared to most appeal to our tastes. This technologically advanced engineering is done, of course, with the goal of maximizing profits, regardless of the effects of the resulting foods on consumer health, natural resources, the environment or anything else.
But the issues go way beyond food, as the City University of New York professor Nicholas Freudenberg discusses in his new book, “Lethal but Legal: Corporations, Consumption, and Protecting Public Health.” Freudenberg’s case is that the food industry is but one example of the threat to public health posed by what he calls “the corporate consumption complex,” an alliance of corporations, banks, marketers and others that essentially promote and benefit from unhealthy lifestyles.
It sounds creepy; it is creepy. But it’s also plain to see. Yes, it’s unlikely there’s a cabal that sits down and asks, “How can we kill more kids tomorrow?” But Freudenberg details how six industries — food and beverage, tobacco, alcohol, firearms, pharmaceutical and automotive — use pretty much the same playbook to defend the sales of health-threatening products. This playbook, largely developed by the tobacco industry, disregards human health and poses greater threats to our existence than any communicable disease you can name.
All of these industries work hard to defend our “right” — to smoke, feed our children junk, carry handguns and so on — as matters of choice, freedom and responsibility. Their unified line is that anything that restricts those “rights” is un-American.
Yet each industry, as it (mostly) legally can, designs products that are difficult to resist and sometimes addictive. This may be obvious, if only in retrospect: The food industry has created combinations that most appeal to our brains’ instinctual and learned responses, although we were eating those foods long before we realized that. It may be hidden (and borderline illegal), as when tobacco companies upped the nicotine quotient of tobacco. Sometimes, as Freudenberg points out, the appeals may be subtle: Knowing full well that S.U.V.’s were less safe and more environmentally damaging than standard cars, manufacturers nevertheless marketed them as safer, appealing to our “unconscious ‘reptilian instincts’ for survival and reproduction and to advertise S.U.V.’s as both protection against crime and unsafe drivers and as a means to escape from civilization.”
The problems are clear, but grouping these industries gives us a better way to look at the struggle of consumers, of ordinary people, to regain the upper hand. The issues of auto and gun safety, of drug, alcohol and tobacco addiction, and of hyperconsumption of unhealthy food are not as distinct as we’ve long believed; really, they’re quite similar. For example, the argument for protecting people against marketers of junk food relies in part on the fact that antismoking regulations and seatbelt laws were initially attacked as robbing us of choice; now we know they’re lifesavers.
Thus the most novel and interesting parts of Freudenberg’s book are those that rephrase the discussion of rights and choice, because we need more than seatbelt and antismoking laws, more than a few policies nudging people toward better health. Until now (and, sadly, perhaps well into the future), corporations have been both more nimble and more flush with cash than the public health arms of government. “What we need,” Freudenberg said to me, “is to return to the public sector the right to set health policy and to limit corporations’ freedom to profit at the expense of public health.”
Redefining the argument may help us find strategies that can actually bring about change. The turning point in the tobacco wars was when the question changed from the industry’s — “Do people have the right to smoke?” — to that of public health: “Do people have the right to breathe clean air?” Note that both questions are legitimate, but if you address the first (to which the answer is of course “yes”) without asking the second (to which the answer is of course also “yes”) you miss an opportunity to convert the answer from one that leads to greater industry profits to one that has literally cut smoking rates in half.
Similarly, we need to be asking not “Do junk food companies have the right to market to children?” but “Do children have the right to a healthy diet?” (In Mexico, the second question has been answered positively. Shamefully, we have yet to take that step.) The question is not only, “Do we have a right to bear arms?” but also “Do we have the right to be safe in our streets and schools?” In short, says Freudenberg: “The right to be healthy trumps the right of corporations to promote choices that lead to premature death and preventable illnesses. Protecting public health is a fundamental government responsibility; a decent society should not allow food companies to convince children to buy food that’s bad for them or to encourage a lifetime of unhealthy eating.”
Oddly, these are radical notions. But aren’t they less “un-American” than allowing a company to maximize its return on investment by looking to sell to children or healthy adults in ways that will cause premature mortality? As Freudenberg says, “Shouldn’t science and technology be used to improve human well-being, not to advance business goals that harm health?” Two other questions that can be answered “yes.”
By: Mark Bittman, Contributing Op-Ed Writer, The New York Times, February 26, 2014
“CVS, Smokes And Liberal Fascism”: Fox News Turns Up The Stupidity
In Fox News Land, no one does anything in the public interest. It’s just Obama’s commie thugs bullying a corporate giant to do what the president thinks is ‘good for you.’
Bravo, CVS. That’s a bold and even historic move, banning cigarettes. It’s true it isn’t costing the company much—the sticks accounted for just $2 billion of its $123 billion in revenue last year, according to The New York Times. But even so, it’s a decision by an American mega-corporation that was made in… sit down and steady yourself… the public interest! Everyone’s for that, right? Right? Wait, what’s that rumble I hear over the gloaming?…
Why, it’s Fox News! And they aren’t happy. Yes—you read that right. On Fox News, CVS’s decision not to sell an addictive product that kills hundreds of thousands of Americans prematurely every year stinks of a big commie plot. Daytime host Gretchen Carlson said something idiotic Wednesday even by daytime Fox News’s idiotic standards. From Media Matters:
“Is it OK legally… to restrict tobacco availability in a private store like this?” She questioned her guests as to whether they would continue shopping at CVS and observed that, “For people who smoke, you know, they have a right to buy cigarettes. It’s not illegal.”
Is it legal?! Good God. Quintuple bacon cheeseburgers are legal. And yet, some restaurants choose not to offer them! Lawbreakers! Pinkos!
Yes, pinkos, see, because they’re becoming part of, you guessed it, the Obama agenda. That was the worry of Neil Cavuto, who wondered if CVS was “getting scaredy cat” since “with the health-care law and the changes and everything else,” selling tobacco products “didn’t look good.” And to round things out, Dana Perino, who actually used to stand at a podium to convey to the American people the substance of their government’s positions and policies, asked on the show called The Five: “Is this President Obama now saying that corporations are allowed to have values and express them? Because if that’s the case, maybe corporations then don’t have to provide contraceptive care to their employees or their health plans.”
See the thread there? It’s Obama’s fault. A corporation makes a decision of its own volition, on the highly logical grounds that if it purports to be in the health business it shouldn’t also be in the cigarette business, and it’s Obama’s fault. If he weren’t out there making people buy insurance, and if that nettlesome wife of his weren’t forcing all these poor children to grow all that awful kale, if they weren’t trying to make America… healthy (!), CVS never would have done this.
Perino turns up the stupid by dragging in the Hobby Lobby case. Private corporations in the United States can do a lot of things. If that Chick-Fil-A guy wants to close on Sundays to honor Jesus? Fine, let him. But there are things corporations can’t do—there are laws and regulations they have to follow. And they have never claimed a right to the free exercise of their religion. That’s because corporations aren’t people, my friend. They don’t have a religion. They have Catholic and Methodist and Jewish and Hindu and Muslim and Jainist and atheist and all kinds of employees. The idea that a corporation has a religious “value” is preposterous, although with this Supreme Court, admittedly anything is possible.
But that’s a side point. What Fox News is really unhappy about, of course, is what it likes to call “liberal fascism,” as defined by the concept’s savant, Jonah Goldberg. As I slogged my way through Goldberg’s tedious book on the subject a few years back (producing this rather amusing review), I noticed that as he plowed through history, liberal fascism started out as, oh, the Civilian Conservation Corps, which I recall him comparing to the Hitler Youth. After all, both were in the 1930s, both involved kids wearing uniforms, both movements professed the goal of social uplift. One was dedicated to the greater glory of one man; the other to flood control and forest protection—but OK, Jonah, whatever.
Once he got to our time, Goldberg was reduced to arguing that the liberal-fascist tendency was alive and well in Whole Foods. Because Whole Foods purveys salubrious items, wants you to have things that are “good for you,” and that sounded to him suspiciously like things Hillary Clinton wants, and she’s the biggest liberal fascist of all. Or was until Obama. Who is—until he leaves the White House and Hillary moves back in when she’ll take back over.
So now, anything a corporation does that smacks of being in the public interest will reek of liberal fascism and will thus be met with resistance in Ailes-land. Car companies pursuing improved gas mileage, introducing more hybrids? Manufacturers using sustainable materials and processes? Junk-food makers cutting back on the sugar and salt? They’re not trying to do anything good for the world. They can’t be doing that. Normal, good, red-blooded, private-sector Americans don’t do that. There must be a reason, and in Foxland, it’s that these folks are ninnies who are just preemptively kowtowing to the thugs Obama keeps on the payroll to dream up new rules Americans should have to live by.
The silver lining here is that they’re on the losing side of history. One imagines that in due course, Rite Aid will follow, and Walgreens, and Duane Reade, and in a few years’ time cigarettes will be out of all drugstores. And then the convenience stores will start to tumble, and the vast majority of Americas will agree that this is fine. And the Fox News demographic will start aging into the grave, and Gretchen Carlson can go on fuming to a smaller and smaller audience, and the rest of us will be able to say to them, in the words of Stevie Winwood: Light up and leave us alone.
By: Michael Tomasky, The Daily Beast, February 7, 2014
“How To Stop Heroin Deaths”: Up To 85 Percent Of Users Overdose In The Presence Of Others
Philip Seymour Hoffman who died of an apparent heroin overdose on Sunday, was just one of hundreds of New Yorkers who fall victim to this drug each year. Heroin-related deaths increased 84 percent from 2010 to 2012 in New York City and occur at a higher rate — 52 percent — than overdose deaths involving any other substance.
I am an emergency physician at NYU Langone Medical Center and Bellevue Hospital, but I rarely see victims die of heroin overdose because most fatalities occur before patients get to the hospital. Overdoses often take place over one to three hours. People just slowly stop breathing; often they are assumed to be sleeping deeply, or they are alone.
The most frustrating part is that each of these deaths is preventable, because there is an antidote to heroin overdose that is nearly universally effective. Naloxone, an opioid antidote, is a simple compound that has been in clinical use for more than 30 years. It can be administered via needle or as a nasal spray, and it works by displacing heroin from its receptors in the brain and rapidly restoring the overdose victim to consciousness and normal breathing.
An analysis in the Annals of Internal Medicine last year suggested that up to 85 percent of users overdose in the presence of others. This provides an opportunity for friends, family and other non-health care providers to intervene. In New York State, it has been legal to distribute naloxone to ordinary citizens since 2006. But the distribution has to be done with medical supervision. Naloxone is purchased by the city and state health departments, which then distribute the antidote through hospitals, harm-reduction programs and other outlets at no cost to patients.
Some New York City hospitals are now distributing kits containing naloxone to users and their friends and families. For the past three years, the New York City Department of Homeless Services has administered naloxone in shelters. And a new pilot program on Staten Island — which has the highest rate of heroin overdose deaths in New York City — is supplying the antidote through the Police Department’s 120th Precinct there.
The city’s health department is conducting a large study following people who get naloxone to assess how frequently the antidote is used to reverse overdose. In 2012, the health department filed a public letter to the Food and Drug Administration recommending that the F.D.A. approve naloxone for over-the-counter use. The letter stated that more than 20,000 kits had been distributed in New York City. It also noted that more than 500 overdose reversals had been reported by civilians who had administered the antidote.
Some people might argue that the widespread distribution of a safe, effective and inexpensive antidote might actually encourage drug use. But that’s like suggesting that air bags and seatbelts encourage unsafe driving. Naloxone is a public-health method of intervening when a life is in the balance. Its distribution is endorsed by the American Medical Association.
A new bill that would make it easier for users to obtain naloxone was introduced in the New York State Legislature just last week, and on Tuesday it passed the State Senate Health Committee. It would increase access to the antidote by allowing doctors and nurses to write standing orders — prescriptions that can be used for anyone — and issue them to community-based drug treatment programs. The programs would then train people on the signs of overdose and provide them with the naloxone kits. This means that the programs would not have to have a doctor present to distribute the antidote, overcoming one major hurdle that impedes widespread distribution.
This bill empowers a community to protect itself and others. If the bill becomes law, it would be one step closer to making naloxone available over the counter — as it already is in Italy.
According to the Centers for Disease Control and Prevention, drug overdose is now the leading cause of injury-related fatalities in the United States, ahead of motor-vehicle collisions and firearms accidents. We make cars safer by having speed limits, seatbelts, crumple zones and D.W.I. laws. We make it harder to buy a firearm with background checks and waiting periods, and we teach gun safety and sometimes mandate trigger locks. We can make heroin safer, too, by supplying methadone or buprenorphine as medications to treat physical dependence, providing clean needles to help prevent the spread of hepatitis and H.I.V., and facilitating the wide availability of naloxone to counteract overdoses.
While Mr. Hoffman’s death was without a doubt a tragedy, it is also emblematic of a societal need to take action to prevent the hundreds of deaths that otherwise go largely unnoticed. We can’t control heroin — that’s the job of law enforcement — but we can make it safer.
By: Robert S, Hoffman, Emergency Physician, NYU Langone Medical Center and Bellevue Hospital; Director of the Division of Medical Toxicology at New York University School of Medicine, Op-Ed Contributor, The New York Times, February 6, 2014
“You Don’t Need To Be A Scientist”: West Virginia Can’t Get Its Story Straight On The Chemical Spill
Over the weekend, West Virginia authorities lifted the last remaining tap-water ban in effect since a January 9 chemical spill at the Freedom Industries plant in Charleston contaminated the water supply of 300,000 people. But in a press conference Monday, Governor Earl Ray Tomblin hardly inspired confidence that the water was safe to drink, saying, “It’s your decision” to choose to drink the water and “I’m not going to say absolutely, 100 percent that everything is safe.” Tomblin, a Democrat, later added, “It’s a very complicated issue. I’m not a scientist, you know.”
There’s the problem. Scientists don’t know much, either, about the leaked chemical, “crude MCHM,” and on Tuesday a Tomblin spokeswoman confirmed that a second chemical, a modified form of PPH, also leaked into the water during the spill. The Center for Disease Control insists that 1-part-per-millon or less of crude MCHM isn’t harmful, but adds, “Due to limited availability of data, and out of an abundance of caution, pregnant women may wish to consider an alternative drinking water source until the chemical is at non-detectable levels in the water distribution system…. Few studies on this specialized chemical exist and most have been conducted on animals.” The CDC reported that toxicologic information on PPH is also limited but does “not suggest any new health concerns.”
This is little comfort to #aquapocalypse victims whose tap water still smells like licorice, despite following a U.S. Agency for Toxic Substance and Disease Register (ATSDR) recommendation that they flush their plumbing systems until the odor goes away. Dr. Paul F. Ziemkiewicz of the West Virginia Water Research Institute explained to me that crude MCHM is a surfactant that lowers the surface tension between a liquid and a solid—in this case, water and coal. It’s a detergent of sorts, cleaning coal by separating it from non-burnable (and thus non-usable) mined substances such as shale. Because crude MCHM is only slightly soluble in—and lighter than—water, it is possible that traces of the chemical could settle at the top of water tanks in homes, continuing to contaminate its contents even after households have flushed their plumbing system. Little is known, too, about PPH, which made up five percent of the leaked tank’s total capacity. According to the Charleston Gazette, “A Freedom Industries data sheet on the chemical says it can irritate the eyes and skin and is harmful if swallowed. The sheet lists the material as less lethal than Crude MCHM but also says no data are available on its long-term health effects.”
With the state sending mixed messages, West Virginians affected by the spill are hoping scientists can provide more clarity on the chemicals. “The governor has closed the book on this disaster,” said Rob Goodwin, an activist in Charleston, “and it’s unfortunate because the disaster relief aid as it was, especially in rural areas, is going to stop because the state is no longer seeing this as an emergency anymore.” Goodwin thinks that in the absence of a regulatory standard, the least the state and the water supplier, West Virginia American Water, could do is clarify and expand the flushing instructions. (Goodwin advises draining hot water heaters completely and minimizing exposure by leaving the home during the process.) But the state has confused even this relatively simple matter. West Virginia authorities rejected ATSDR’s flushing advice, and when asked about it Monday, Tomblin said, “I’m not aware that we did. I have not seen that.”
No wonder there’s still “a big demand” for the bottled water being trucked in by FEMA—a supply that, according to the West Virginia Division of Homeland Security, is only expected to last through the weekend.
By: Claire Carusillo, The New Republic, January 22, 2014
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