American Lung Association Report Card: Most States Flunk

Cancer is the word for today whether its breasts good news for women or lung bad news for all of us. It's not enough to just not smoke - it seems we've also got to actively education the next generation on the evils of tobacco. That is According to the American Lung Association (ALA). The ALA, Center for Disease Control and Prevention (CDC) and World Health Organization (WHO) announced in December that the problem is so bad, though improving, they used the "E" word. There is a tobacco epidemic. While the CDC and WHO are defending their actions on the H1N1 against unfounded charges of corporation corruption both agencies are moving forward.

Do you know how much money Big Tobacco spent each day in 2006 marketing their products? $34 million. The companies spend billions each year on advertising & marketing their deadly products to try & hook kids to become their “replacement generation.” That’s why it’s so important that the Food and Drug Administration move quickly to implement new marketing restrictions on the tobacco companies. (American Lung Association)

Unfortunately the Food and Drug Administration (FDA) has to count and review exactly what the public wants them to do. Deadline for public comment was extended until December 2009 and the agency hasn't released any comments to the public since the agency's request for comment.

The report finds the federal government made major strides but still has significant room for progress. Most state governments, however, failed to enact critical measures to protect people from deadly tobacco products. Ten states made alarming cuts to their tobacco control programs.

Tobacco's toll continues to be devastating. Smoking-caused illness remains the number-one preventable cause of death in the U.S., killing more than 393,000 Americans each year and costing the economy more than $193 billion. Another 50,000 Americans die from exposure to secondhand smoke. The U.S. Surgeon General has declared there is no safe level of exposure to secondhand smoke.

No state received straight “A’s” on its report card. Six received all “F’s.” They are Alabama, Kentucky, Missouri, South Carolina, Virginia and West Virginia. (PDF)

Only two states, Alaska and North Dakota, received “A” grades for funding tobacco prevention and control programs at 80 percent or more of the level recommended by the Centers for Disease Control and Prevention (CDC).

Research shows that the more states spend on comprehensive tobacco control programs, the greater the reductions in smoking—and the longer states invest in such programs, the greater and faster the impact. States that invest more fully in comprehensive tobacco control programs have seen cigarette sales drop more than twice as much as in the United States as a whole, and smoking prevalence among adults and youth has declined faster as spending for tobacco control programs has increased. (CDC Best Practices for Comprehensive Tobacco Control) (PDF)

No state received an “A” for offering comprehensive tobacco cessation treatments to its Medicaid recipients and to state employees.

Tobacco Control 2009 DC MD NC VA US Tobacco Prevention & Control Spending Smokefree Air Cigarette Tax Cessation Coverage Framework Convention on Tobacco Control FDA Regulation of Tobacco Products F A B D F A C F F F F C F F F F D F D A OVERALL GRADE AVERAGE C D D F C

Despite a perception that smoking is a dying public health danger, the tobacco epidemic persists. It causes tragedy, staggering costs and devastation. In 2008, the latest year for which data is available, smoking in the U.S. failed to decline for the first time in years, staying right around 20 percent. Forty-six million adults smoke. The nation’s progress in ending the epidemic has halted, according to the CDC.

Each year approximately 440,000 people die of a smoking-related disease in the United States. (CDC) The World Health Organization (WHO) says internationally about 600,000 premature deaths per year, countless crippling and disfiguring illnesses and economic losses in the tens of billions of dollars per year.

The rates for our jurisdictions with figures from 2006 and estimates from 2007 CDC death rates. In the District of Columbia and North Carolina the numbers 1 and 2 causes of death are in order: Cancer and Heart Disease. The third cause of death in the DC is Accidents. For Maryland, Virginia and the US as a whole the results are reversed and numbers are 1 and 2 causes of death are in order: Heart Disease and Cancer. The third cause of death for MD, NC, VA and most of the US is Cerebrovascular disease (High blood pressure).

What has to be noted is the District of Columbia has no ability to raise taxes on tobacco without Congressional permission from "tobacco growing" state legislators. However MD, NC and VA have no such restrictions. 

GERD! James Gerd!

We used a college homecoming weekend dinner to hold a staff meeting and the question of why no GERD stories arose. We couldn't think of any reason other than the lack of recent studies on the subject. Lo and behold we find a recent H1N1 death attributed to symptoms that included GERD:

"A 52-year old man is Santa Rosa County’s first confirmed death associated with H1N1 Swine Flu, according to the county’s health department."

"The man died September 11, according to information released Tuesday from the Santa Rosa County Health Department. Health officials were notified of his death September 28, when the results of additional lab tests were received. The man had hypertension and GERD (gastroesophogeal reflux disease). In keeping with Florida Department of Health policy, no additional information was released."

“The death of a loved one under any circumstances is always a tragedy,” said Sandra Park, A.R.N.P., interim administrator for the health department. “Our hearts and prayers go out to his family and friends at this difficult time.”

"The man was admitted to the hospital on September 4. At that time, a rapid flu test for H1N1 was performed and the result of that test was negative. Additional testing, however, confirmed that the man was ill with H1N1."

We're not trying to be the "flu police." We're concerned about the lack of information being presented to us by our local jurisdictions when we have proof positive that the information is false in relations to the flu. What we don't understand is why the jurisdictions refuse to give us the full and unvarnished truth. Reading daily obituaries shows deaths that the local health departments don't or refuse to report. Most disturbing are the reports that the standard H1N1 test return negatives when autopsies reveal positives results. That type of information is better presented to the living than the dead.

CBS News reports what a doctor tells his patients in this two (2) week old report from Dr. Jonathan LaPook: "Smoking and obesity both increase acid reflux and must be addressed. I tell my patients to limit alcohol, caffeine, chocolate, peppermint, and fatty foods (I know, basically anything that gives them even an iota of pleasure in life). I also suggest keeping a food diary to try to identify culprits such as tomato-based products or certain spicy foods. If their symptoms resolve then they can try to reintroduce the things they miss the most. Elevating the head of the bed can sometimes help."

Research physician, Dr. Ronnie Fass, reported in Renal and Neurology News on the latest drug treatment for GastroEsophageal Reflux Disease: “Patients with diabetic gastroparesis and symptomatic documented GERD may have trouble adhering to treatment because of difficulty swallowing, the need for treatment when they do not have water available, or the need for a portable way to take medication...”

The new drug treatment evaluated by the doctor: "...Metozolv ODT, which rapidly melts on the tongue, gives these patients a new choice that may be more convenient than traditional metoclopramide tablets, Ronnie Fass, MD, Professor of Internal Medicine at the University of Arizona added. “Patients with diabetic gastroparesis and symptomatic documented GERD may have trouble adhering to treatment because of difficulty swallowing, the need for treatment when they do not have water available, or the need for a portable way to take medication.”

The National Post's Dr. Yoel Abells writes that: "Gastroesophageal reflux disease (GERD) is quite common. Epidemiologic studies suggest incidence rates are increasing and that up to 20% of the adult population suffers from this condition to varying degrees..."

"...Complications associated with acid reflux disease arise from the irritating effect the stomach contents have on anatomical structures. For example, the acidic contents can inflame the vocal cords, resulting in hoarseness, or spill into the lungs causing hyperreactivity of the airways and an ensuing cough. Asthma can worsen as a consequence of GERD. Up to 5% of individuals suffering from chronic GERD develop Barrett's esophagus, characterized by changes in the cells lining the esophagus. Although rare, over time, this condition can lead to esophageal cancer."

That such a common occurrence can be present in an uncommon virus seems more than a matter of chance. From its first typing by the World Health Organization (WHO) and the Center for Disease Control and Prevention (CDC) have maintained that pre-existing conditions can present opportunities for the relatively harmless virus can cause complications that could lead to death. Originally the time line for infections to complications that could lead to death was over ten (10) days. Current deaths have reduced that timeline from ten to five (5) days with the fifth day being the date of death for some individuals. Most individuals do survive - this isn't about the relatively healthy - this is about those who are most susceptible. You and I.

Smoke Attacks

Knowing is not enough; we must apply.
Willing is not enough; we must do" - Goethe

Maybe its just us but we like to go to the source and maybe only "squints" can get away with submitting a "uncorrected proofs" prepublication copy. We were never allowed to submit such a thing when we were in school but that was a long time ago. The Goethe quote comes from the pages of the report. What they found and published as a scientific evidence was the title "Secondhand Smoke Exposure and Cardiovascular Effects - Making Sense of the Evidence" concludes that: "...that data consistently demonstrates that secondhand-smoke exposure increases the risk of coronary heart disease and heart attacks and that smoking bans reduce this risk. Given the prevalence of heart attacks, and the resultant deaths, smoking bans can have a substantial impact on public health."

This might be news to smokers and the paid defenders of the "right to smoke"campaign but for those of us challenged breathers this isn't news. While some people might remember the movie Basic Instinct for Sharon Stone's legs - for us it was the lighting of her cigarette that preceded the crossing. That kind of smoke attack strikes us whenever we see a dangerous gang of smokers crowding the entrance of some public building. You have to take a deep breath before crossing their path and holding it until you can clear the area. This same type of physical reaction can occur whenever a person is terrified of being attacked.

The Center for Disease Control and Prevention (CDC) issued a statement in support of the report saying:

• "Exposure to secondhand smoke could cause acute coronary events, such as a heart attack.
• Evidence suggests that even brief secondhand smoke exposure might trigger a heart attack.
• Smoke-free bans decrease acute coronary events."

One of the wonderful things about our smokefree DC though there is no smokefree MD or VA. Whenever we travel south and stop through VA we have to share air space with smokers separated only by a door or partition. Whether or not Virginia adopts or makes any changes to current laws or not is yet to be determined. To those of us desperate to breath we'll just have to hold our breaths until then.

Bill Maher who we credit with the "thinning the herd" comment smoked up until a few (more than nine) years ago. Who knew that he was actively pursuing that goal. Now we know!

While we certainly felt attacked and all but the most dense of smokers thought somehow blowing their smoke in the air was effort enough for us as long as it wasn't in our faces. It's doubtful that even this report will be received with any more belief. To again quote Maher not as long as our Government "is a Mafia that wants a cut."

Smokers Oh My

We don't smoke but we share high blood pressure and or diabetes. At our age this makes us susceptible to "lose our minds up in here, up in here." If it weren't for our coffee intake we'd have to make more of an effort to exercise our bodies and our minds. Aunt Pearlie worked crossword puzzles and loved SCRABBLE on the PC and against her friends on a board. She kept her wits about her longer than her twin and drank her MAXWELL HOUSE every morning. Pearlie wasn't big on exercising once she lost the ability to walk. Her twin, Aunt Mamie continued to walk up until her final days though she needed the aid of a cane. She wasn't a walker but outlived Aunt Pearlie.

If we understood the technical research better we'd translate it here but BBC News did a much better job than we could. We are in age range in the study done in conjunction with the UK and from the Universities in America.

"Smoking, high blood pressure and diabetes were all strongly linked with dementia, which the researchers say is not unexpected since these can damage the brain and the small blood vessels that supply it."

"Current smokers were 70% more likely than those who had never smoked to develop dementia, people with high blood pressure were 60% more likely than those without high blood pressure, and people with diabetes were more than twice as likely than those without diabetes to develop it."

The curse of aging is the possibility of losing the thing that we value most, our memories and the knowledge of who we are. Aunt Mamie, the twin, was a remarkable woman desperate to retrieve the fading memories. Wanting to do whatever to get back the ability to remember and to not to forget. Dementia robs you of the ability to remember the things that should be instinctual. You can forget to breathe.