When medical care didn’t contribute as much to improved health outcomes

An interesting piece on the efficacy of medicine and medical procedures (TLDR: they aren’t always effective but doctors and patients feel compelled to try something) ends with this suggestion about the power medicine has over the public:

Historians of public health know that most of the life-expectancy improvements in the last two centuries stem from innovations in sanitation, food storage, quarantines, and so on. The so-called “First Public Health Revolution”—from 1880 to 1920—saw the biggest lifespan increase, predating antibiotics or modern surgery.

In the 1990s, the American Cancer Society’s board of directors put out a national challenge to cut cancer rates from a peak in 1990. Encouragingly, deaths in the United States from all types of cancer since then have been falling. Still, American men have a ways to go to return to 1930s levels. Medical innovation has certainly helped; it’s just that public health has more often been the society-wide game changer. Most people just don’t believe it.

In 2014, two researchers at Brigham Young University surveyed Americans and found that typical adults attributed about 80 percent of the increase in life expectancy since the mid-1800s to modern medicine. “The public grossly overestimates how much of our increased life expectancy should be attributed to medical care,” they wrote, “and is largely unaware of the critical role played by public health and improved social conditions determinants.” This perception, they continued, might hinder funding for public health, and it “may also contribute to overfunding the medical sector of the economy and impede efforts to contain health care costs.”

It is a loaded claim. But consider the $6.3 billion 21st Century Cures Act, which recently passed Congress to widespread acclaim. Who can argue with a law created in part to bolster cancer research? Among others, the heads of the American Academy of Family Physicians and the American Public Health Association. They argue against the new law because it will take $3.5 billion away from public-health efforts in order to fund research on new medical technology and drugs, including former Vice President Joe Biden’s “cancer moonshot.” The new law takes money from programs—like vaccination and smoking-cessation efforts—that are known to prevent disease and moves it to work that might, eventually, treat disease. The bill will also allow the FDA to approve new uses for drugs based on observational studies or even “summary-level reviews” of data submitted by pharmaceutical companies. Prasad has been a particularly trenchant and public critic, tweeting that “the only people who don’t like the bill are people who study drug approval, safety, and who aren’t paid by Pharma.”

We might attribute this overconfidence in medical care among Americans to two cultural traits: (1) a belief that science can and should solve problems and lead to better lives and (2) an interest in efficient solutions to complex problems. Yet, one takeaway from this is that a healthier lifestyle may be boring and be hard work to implement (on both an individual and community level) but could be more effective in the long-term than medical intervention.

How one woman helped make preventable injuries an American public health issue

The epidemiologist Susan P. Baker devoted her career to making preventable injuries a public health issue. Here is part of the story:

She embarked on an independent research project — a comparison of drivers who were not responsible for their fatal crashes with drivers who were — and in 1968 she sent Haddon a letter seeking federal financing for her study. He came through with $10,000 and continued to finance her research after he became president of the Insurance Institute for Highway Safety a year later…

Among Baker’s most important legacies is the widespread use of the infant car seat. By examining data from car crashes, she demonstrated that the passengers most likely to die were those younger than 6 months. They were killed at double the rate of 1-year-olds and triple the rate for ages 6 to 12. Why? Because babies rested in their mothers’ arms or laps, often in the front passenger seat, and because their still-fragile bodies were more susceptible to fatal injury than those of older children. Baker published her study in the journal Pediatrics in 1979, making headlines in newspapers across the country…

Around that time, Baker was one of the main authors of a report calling for the creation of a federal injury-prevention agency. Today the National Center for Injury Prevention and Control coordinates with state programs and underwrites research projects aimed at preventing injury, ranging from the intentional (rape, homicide, suicide) to the unintentional (falls, residential fires, drownings)…

Of course, Baker knows that we can’t make the world completely injury-proof. But her decades of research show how fairly simple preventive measures — fences around swimming pools, bike helmets, childproof caps on medicine containers — can save thousands of lives.

I couldn’t help thinking while reading this story that it demonstrates the interplay between science, culture, and government. The first paragraph of the article argues that in the 1960s that few people worried about preventable injuries but this has clearly changed since. Aiding this process was new scientific findings about injuries as well as presentable statistics that captured people’s attention. This reminds me of sociologist Joel Best’s explanation in Damned Lies and Statistics that the use of statistics emerged in the mid 1800s because reformers wanted to attach numbers and science to social problems they cared about. But for these numbers to matter and the science to be taken seriously, you need a culture as well as institutions that see science as a viable way of knowing about the world. Similarly, the numbers themselves are not enough to immediately lead to change; social problems such as automobile deaths go through a process by which the public becomes aware, a critical mass starts pressing the issue, and leaders respond by changing regulations. Is it a coincidence that these concerns about public health began to emerge in the 1960s at the same time of American ascendency in the scientific realm, the growth of the welfare state, the continued development of the mass media as well as mass consumption, and an era of more movements calling for human rights and governmental protections? Probably not.

h/t Instapundit

Using Twitter to predict when you will get sick with 90% accuracy

A new study uses tweets in New York City to predict when a user will get sick – and does so with 90% accuracy.

Using 4.4 million tweets with GPS location from over 630,000 users in New York City, Sadilek and his team were able to predict when an individual would get sick with the flu and tweet about it up to eight days in advance of their first symptoms. Researchers found they could predict said results with 90 percent accuracy.

Similar to Google’s Flu trends, which uses “flu” search trends to pinpoint where and how outbreaks are spreading, Sadilek’s system uses an algorithm to differentiate between alternative definitions of the word ‘sick.’ For example, “My stomach is in revolt. Knew I shouldn’t have licked that door knob. Think I’m sick,” is different from “I’m so sick of ESPN’s constant coverage of Tim Tebow.”

Of course, Sadilek’s system isn’t an exhaustive crystal ball. Not everyone tweets about their symptoms and not everyone is on Twitter. But considering New York City has more Twitter users than any other city in the world, the Big Apple is as good as a place as any for this study.

While one could look at this and marvel at the power of Twitter, I think the real story here is about two things: (1) the power of big data and (2) the power of social networks that Twitter harnesses. If you have people volunteering information about their lives, access to the data, and information about who users are connected to, you can do things that would have been very difficult even ten years ago.

It is interesting that this study was conducted in New York City where there is a high percentage of Twitter users. How good are predictions in cities with lower usage rates? Are we headed toward a world where public health requires people to report on their health so that outbreaks can be contained or quelled?

“Anti-obesity housing”

The design of housing units is rarely meant to just be functional. But here is design that I have not heard about before: a new “Bronx co-op apartment building” that is meant to reduce levels of obesity:

The building, called the Melody, has a backyard with brightly colored exercise equipment for adults, and climbing equipment for children. It also has both indoor and outdoor fitness centers.

City officials say it’s the first in New York to be built with design elements aimed at countering obesity.

Two flights of stairs feature silhouettes of dancing women and jazz playing through speakers and motivational signs posted throughout the building tout the benefits of exercise.

A sign posted between the elevator and stairs, for example, notes that stairs are a healthy choice.

This description doesn’t sound like much has changed: couldn’t a lot of housing units be enhanced with playground/exercise equipment and signs/images that promote exercise?

The New York Times has more on why this building has the specific design elements that it does:

Near him hung a sign, between the building’s sole elevator and a staircase door, reading, “A person’s health can be judged by which they take two of at a time, pills or stairs.”

In 2010, the city released a 135-page guide called Active Design Guidelines, on the construction of buildings that would encourage exercise and mobility; it was compiled by city agencies in collaboration with health experts and architects. City officials said that while the Melody was the first to incorporate its suggestions, other projects were being developed.

Builders do not receive tax credits or compensation for following the rules in the guide, but doing so can earn them points in a rating system administered by the United States Green Building Council called LEED, for Leadership in Energy and Environmental Design.

The city’s guidelines are more detailed and specific than LEED rules, which reward builders who, for example, use less toxic paints or locate their buildings near subway stops. The city’s guide encourages windows in gyms, bicycle storage areas and stairways that are bright, centrally located and attractive.

This is interesting. Of course, we will have to wait and see whether these design elements actually do increase levels of exercise and activity and decrease obesity levels.

When I think about other designs that promote exercise, New Urbanism springs to mind though I’m not sure I have seen them use exercise as a selling point. Since their developments are intended to be walkable or bike-friendly, this pitch could be made but what they often highlight is the community that is fostered by denser space and the environment-friendly design.

At some point, I may just have to dig into the “Active Design Guidelines” although you have to register online to download a copy or purchase a copy.

Drop in crime due to decreased lead exposure?

The crime rate in the United States is down again and people are looking for reasons why. Here is an interesting possible answer from James Q. Wilson: crime is down because people are exposed to less lead. This is how the reduction in lead would help:

In recent years, neuroscientists have made important progress in identifying the precise mechanisms by which lead exposure reduces impulse control…

While we can’t always control what we feel – many of our urges are ancient drives, embedded deep in the brain – we can control the amount of attention we pay to our feelings. When faced with a tempting treat, we can look away…

The tragedy of lead exposure is that it undermines one of the most essential mental skills we can give our kids, which is the ability to control what they’re thinking about. While the unconscious will always be full of impulses we can’t prevent, and the world will always be full of dangerous temptations, we don’t have to give in. We can choose to direct the spotlight of attention elsewhere, so that instead of thinking about the marshmallow we’re thinking about Sesame Street, or instead of thinking about our anger we’re counting to ten. And so there is no fight. We walk away.

This is an interesting argument. I suspect there is a bigger story that could be told about lead reduction over the years: Wilson hints at the background as the EPA announced a phased-in reduction in the lead in gasoline in late 1973 and lead was banned from paint in 1977. These facts are taken for granted now but I imagine these were public health announcements that created some discussion at the time, particularly from industry lobbying groups.

Is there a way to test the lead hypothesis by looking at a comparison group?

If this turned out to be a primary factor in the reduction of crime, how would public officials, police officers, and the public work with this information?

Walgreens and food deserts in Chicago

Chicago Breaking Business reports that Walgreens is about to unveil expanded food offerings in a South Side store in Chicago. The expanded food line at 10 Walgreens stores is part of an effort to help combat the city’s food deserts:

The stores will offer more than 750 new food items such as fresh fruits and vegetables, frozen meat and fish, pasta, rice, beans, eggs and whole-grain cereals. The Deerfield-based drug store chain said it was approached by Mayor Richard Daley last year to bring more healthy food to areas that the city has identified as food deserts, namely neighborhoods that lack supermarkets.

Large American cities often struggle with this issue: low-income neighborhoods that have little or no access to fresh and healthy food. If the only options available are buying food from a convenient store or gas station, it is more expensive and less healthy. In the long run, this has consequences for building wealth and public health.