(Roughly) Daily

Posts Tagged ‘public health

“Infant mortality and life expectancy are reasonable indicators of general well-being in a society”*…

… and in the U.S., as Adam Tooze explains, we’re doing not so well of late…

In August America’s Center for Disease Control (CDC) published a set of data that ought to have brought political, economic and social debate to a standstill. If there is one question that should surely dominate public policy debate, it is the question of life and death. What did the Declaration of Independence promise, after all, if not “life, liberty and the pursuit of happiness”. But on that score the CDC in 2022 delivered alarming news. In the last three years, life expectancy in the United States has plunged in a way not seen at any point in recent history.

America is inured to bad news about its health. Life expectancy in the United States has stagnated since 2011, a trend which separates the United States not just from rich peer countries but from most other countries in the world, rich or poor.

Given economic growth and advances in medicine for life expectancy to stagnate requires serious headwinds. In the United States those headwinds include, homicides and suicides, the opioid epidemic (so-called deaths of despair) car accidents and obesity. As John Burn-Murdoch shows in the FT, without those factors the US would have tracked its peer societies much more closely…

But stagnation is one thing, the collapse since 2019 is a phenomenon of a different quality. It is a full measure of the disaster that was the COVID pandemic in the United States. Over a million Americans died of COVID, one of the worst outcomes on the planet.

…it is not only China that has overtaken the United States based on this metric. In 2021 Cuba has a higher life expectancy than the US. So does Albania.

In a society marked by inequality as deep as modern America’s, to speak in terms of national averages is not very meaningful. The circumstances of life and health outcomes are vastly different…

Source: BMJ

…One might think that faced with these stark facts all other subjects of political debate would pale into insignificance. Whatever else a society should do, whatever else a political system promises, it should ensure that its citizens have a healthy life expectancy commensurate with their nation’s overall level of economic development. An ambitious society should aim to do more, as Japan does for instance. Judged by this basic metric, the contemporary United States fails and for a substantial minority of its population, it fails spectacularly. And yet that extraordinary and shameful fact barely registers in political debate, a silence that is both symptom and cause.

Life, liberty and the pursuit of happiness? How China, Cuba and Albania came to have higher life expectancy than the USA,” from @adam_tooze. Eminently worth reading in full.

For an example of the ways in which these wounds are self-inflicted: “The Human Psyche Was Not Built for This.”

* P. J. O’Rourke

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As we ponder priorities, we might recall that it was on this date in 1892 that the first diagnostic public heath laboratory in the U.S. was founded by New York City (as its “Division of Pathology, Bacteriology and Disinfection”). Spurred by the cholera epidemic of the time, it soon took on the diagnosis and tracing of diphtheria and tuberculosis; in 1895, it began production of a smallpox vaccine.

The New York City public health laboratory became a model for other cities’ public health departments. Within a few years, similar labs had become essential components of an effective health departments across the nation.

“The Cholera Invasion,” from Frank Leslie’s Illustrated Weekly, by West B. Clinedinst, 1892. National Library of Medicine.

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Written by (Roughly) Daily

September 9, 2022 at 1:00 am

“By temporarily disrupting the order of the brain, a new order forms. And that order may have incredible value at either the level of mental health and psychology or the level of creativity.”*…

But, Zoe Cormier warns, if the means of that constructive disruption are industrialized and turned into aggressively-marketed products, we could be in for trouble…

Welcome to the strange new world of “psychedelic capitalism,” where dozens of start-ups have already raised millions (and in some cases billions) of dollars to commercialize psilocybin (the psychedelic ingredient in magic mushrooms), DMT (found in the Amazonian brew ayahuasca), mescaline (peyote’s active component), and LSD—despite the fact that all of these “classic psychedelics” are still ranked as Schedule I drugs under the federal Controlled Substances Act. Manufacturing any of these drugs without a license can still land you a long prison sentence. But marketing one, even though they all remain illegal and none have passed all the clinical trials required for approval? That can make you a millionaire…

The days when mind-bending psychedelics were seen as appealing only to drug dealers, nut jobs, and hippies are over. Today, serious-minded people interested in randomized controlled trials and stock valuations are leading the charge.

The “psychedelic renaissance” we’ve awaited for half a century—the promised era when acid, shrooms, and peyote would be brought back into legitimate research and legal access—is finally here. But will it turn out to be worth the wait? Or the hype?

Because it’s not like we ever stopped enjoying them: In the West, hippies, scientists, “healers,” and others have used psychedelics continuously for seven decades. And before we got our hands on them, Indigenous cultures used psychedelics for thousands of years as ritual sacraments. Now dozens of start-ups want to standardize, commercialize, alter, patent, and market these ancient compounds—and they stand to make a fortune doing so.

Will old-school profit-centered tactics bring down decades of dogged work by activists, scientists, and reformers to have these drugs reassessed for their virtues? Will we experience another nasty, research-smothering backlash?…

The profiteers have arrived; get ready for Psychedelics Inc.: “The Brave New World of Legalized Psychedelics Is Already Here,” from @zoecormier @thenation.

* Michael Pollan, in conversation with Tim Ferriss on Ferriss’ blog

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As we tune in, we might spare a thought for Ellen Swallow Richards; she died on this date in 1911. The first female student admitted to MIT, she became its first female faculty member. A chemist, she did pioneering work in sanitary engineering, but is best remembered for her experimental research in domestic science, which laid the foundation for the new science of home economics, of which she is considered founder. She was one of the first ecofeminists, believing that women’s work within the home was not just vital to the economy, but also a critical aspect of our relationship to the earth.

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“Human history seems to me to be one long story of people sweeping down—or up, I suppose—replacing other people in the process”*…

Max Roser argues that, if we keep each other safe – and protect ourselves from the risks that nature and we ourselves pose – we are only at the beginning of human history…

… The development of powerful technology gives us the chance to survive for much longer than a typical mammalian species.

Our planet might remain habitable for roughly a billion years. If we survive as long as the Earth stays habitable, and based on the scenario above, this would be a future in which 125 quadrillion children will be born. A quadrillion is a 1 followed by 15 zeros: 1,000,000,000,000,000.

A billion years is a thousand times longer than the million years depicted in this chart. Even very slow moving changes will entirely transform our planet over such a long stretch of time: a billion years is a timespan in which the world will go through several supercontinent cycles – the world’s continents will collide and drift apart repeatedly; new mountain ranges will form and then erode, the oceans we are familiar with will disappear and new ones open up…

… the future is big. If we keep each other safe the huge majority of humans who will ever live will live in the future.

And this requires us to be more careful and considerate than we currently are. Just as we look back to the heroes who achieved what we enjoy today, those who come after us will remember what we did for them. We will be the ancestors of a very large number of people. Let’s make sure we are good ancestors…

If we manage to avoid a large catastrophe, we are living at the early beginnings of human history: “The Future is Vast,” from @MaxCRoser @OurWorldInData.

* Alexander McCall Smith

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As we take the long view, we might recall that it was on this date in 1915 that Mary Mallon, “Typhoid Mary,” was put in quarantine on North Brother Island, in New York City, where she was isolated until she died in 1938.  She was the first person in the United States identified as an asymptomatic carrier of the pathogen associated with typhoid fever… before which, she first inadvertently, then knowingly spread typhoid for years while working as a cook in the New York area.

Mallon had previously been identified as a carrier (in 1905) and quarantined for three years, after which she was set free on the condition she changed her occupation and embraced good hygiene habits. But after working a lower paying job as a laundress, Mary changed her last name to Brown and returned to cooking… and over the next five years the infectious cycle returned, until she was identified and put back into quarantine.

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“The threat of a pandemic is different from that of a nerve agent, in that a disease can spread uncontrollably, long after the first carrier has succumbed”*…

We were, of course, warned. As we do our best to digest the news of emergent new strains of the COVID-19 virus, a look back at Annie Sparrow‘s 2016 New York Review of Books essay on pandemics…

Pandemics—the uncontrolled spread of highly contagious diseases across countries and continents—are a modern phenomenon. The word itself, a neologism from Greek words for “all” and “people,” has been used only since the mid-nineteenth century. Epidemics—localized outbreaks of diseases—have always been part of human history, but pandemics require a minimum density of population and an effective means of transport. Since “Spanish” flu burst from the trenches of World War I in 1918, infecting 20 percent of the world’s population and killing upward of 50 million people, fears of a similar pandemic have preoccupied public health practitioners, politicians, and philanthropists. World War II, in which the German army deliberately caused malaria epidemics and the Japanese experimented with anthrax and plague as biological weapons, created new fears…

According to the doctor, writer, and philanthropist Larry Brilliant, “outbreaks are inevitable, pandemics are optional.”

Much of human history can be seen as a struggle for survival between humans and microbes. Pandemics are microbe offensives; public health measures are human defenses. Water purification, sanitation, and vaccination are crucial to our living longer, better, even taller lives. But these measures of mass salvation are not sexy. While we know prevention is better and considerably cheaper than cure, there is little financial reward or glory in it. Philanthropists prefer to build hospitals rather than pay community health workers. Pharmaceutical companies prefer the Western market to the distant and poor Global South where people cannot afford to buy treatments. Education is a powerful social vaccine against the ignorance that enables pathogens to flourish, but insufficient to overcome the corruption of public goods by private interests. The current enthusiasm for detecting the next panic-inducing pathogen should not divert resources and research from the perennial threats that we already have. We must resist the tendency of familiarity and past failures to encourage contempt and indifference…

An important (and in its time, sadly, prescient) read: “The Awful Diseases on the Way,” from @annie_sparrow in @nybooks.

See also “6 of the Worst Pandemics in History” (source of the image above) and “A history of pandemics.”

[TotH to MK]

Hannah Fry

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As we prioritize preparation, we might recall that it was on this date in 1935 that physicist Erwin Schrödinger published his famous thought experiment– now known as “Schrödinger’s cat“– a paradox that illustrates the problem of the Copenhagen interpretation of quantum mechanics.

This image has an empty alt attribute; its file name is s-cat.jpg

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“24 hours in a day, 24 beers in a case. Coincidence?”*…

Social distancing makes a soul thirsty– and as the Journal of the American Medical Association reports, that has had consequences…

Alcohol consumption has substantially increased during the COVID-19 pandemic… We examined national changes in waiting list registration and liver transplantation for ALD and the association with alcohol sales during the COVID-19 pandemic. We hypothesized that waiting list registrations and deceased donor liver transplants (DDLTs) for alcoholic hepatitis (AH), which can develop after a short period of alcohol misuse, would disproportionately rise…

This cross-sectional study found that waiting list registrations and DDLTs for AH increased significantly during COVID-19, exceeding the volumes forecasted by pre–COVID-19 trends by more than 50%, whereas trends for AC and non-ALD remained unchanged. While we cannot confirm causality, this disproportionate increase in association with increasing alcohol sales may indicate a relationship with known increases in alcohol misuse during COVID-19. Since less than 6% of patients with severe AH are listed for transplantation, increasing waiting list volume during COVID-19 represents a small fraction of the increase in AH, a preventable disease with 6-month mortality up to 70%.

Pandemic drinking is up– way up. So, it turns out, is serious liver disease: “Association of COVID-19 With New Waiting List Registrations and Liver Transplantation for Alcoholic Hepatitis in the United States.”

And lest we think think that waning COVID-19 pressure will be the end of all of this, a warning: “The Coming Age of Climate Trauma.”

[Image above: source]

* Steven Wright

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As we muse on moderation, we might recall that it was on this date in 2012 that Charles Darwin received about 4,000 write-in votes in the election in Georgia’s 10th Congressional District. Republican Paul Broun, an M.D. who was running unopposed for re-election, had given (the September before) a campaign speech at the Liberty Baptist Church Sportsman’s Banquet in which he said “All that stuff I was taught about evolution and embryology and the Big Bang Theory, all that is lies straight from the pit of Hell.”

In response, radio talk show host Neil Boortz and University of Georgia plant biology professor Jim Leebens-Mack spearheaded a campaign to run the English naturalist and evolutionary theorist against Broun, a young earth creationist. They had no expectation of unseating him (and indeed, Broun carried his district handily) but hoped to draw attention to these comments from the scientific community and to have Broun removed from his post on the House Science Committee– at which they also failed.

Paul Broun [source]
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