Statistics of Word Use

The New York Times published a table entitled "Choice Words" (January 25) which compares the frequency with which President Obama used certain words in his State of the Union addresses (now I note sometimes abbreviated as SOTU - why must we abbreviate everything?) compared with how often they were spoken by the present Republican presidential hopefuls.

Again - beware of text out of context!

Word - "job" - Could be used as in "My job as president......"
Word - "business" - Could be used as in "The economy is the people's business."
Word - "war" - Could be used as in "the war on ignorance......"
Word - "freedom" - Could be used as in "We all have the freedom to decide for ourselves...."
Word - "government" - Could be used as in "The government of Iran......"

Admittedly, these words were more often than not used in the contexts in which they were assumed to be used.  But this form of information, again, brings to mind the potential "misinformation" that could be generated in the absence of the entire circumstance of the variable being measured.

New Statistics of Heart Disease in the United States

Something new and different!

Facts that may interest you from the American Heart Association "Executive Summary:  Heart Disease and Stroke Statistics - 2012 Update."  (After all, I am a pediatric cardiologist!)

1.  Based on 2008 data, more than 2200 Americans die of cardiovascular disease every day - an average of 1 death every 39 seconds.  Although cardiovascular disease accounts for 1 out of every 3 deaths in the U.S., the actual rate of death decreased by 31% from 1998 to 2008.

2.  There are about 76,400,000 individuals in the U.S. with hypertension.

3.  Cigarette use (despite 40 years of attempts to eliminate):
          a.  21% of men 18 or older continue to smoke.
          b.  18% of women 18 or older continue to smoke.
          c.   19.5% of students in grades 9-12 report "cigarette use."

4.  33,600,000 American adults over 20 years of age have a total serum cholesterol of 240 mg/dl or greater.

5.  The prevalence of overweight and obesity in the U.S. in adults 20 years old or greater is 67%.

6.  Among American children ages 2-19, the prevalence of overweight and obesity is 49%.

7.  The proportion of youth (18 years and younger) who report engaging in no regular physical activity is high and the proportion increases with age.  Among children in grades 9-12, 30% of girls and 17% of boys reported no significant physical activity in the previous 7 days.

8.  33% of adults report engaging in no aerobic leisure-time physical activity.

9.  Total direct and indirect cost of cardiovascular disease (including stroke) in the U.S. was $298 billion (2008).    By comparison, the cost of all cancer (malignant and benign) treatment in 2008 was $228 billion.

Preventive Medicine - Your Job, Not Your Physician's

How often have we read of the need to improve preventive measures in order to improve health as well as to decrease the cost of health care.  Unquestionably true, in my opinion.  But emphasizing preventive care does not demand an increase in physician-visits.  Maintenance of good preventive measures does not require expensive programs.  It does not require physician visits every few months; it does not require unnecessary mammograms, unnecessary CT scans, unnecessary ultrasounds, unnecessary blood tests, etc.   Society (government) has to agree on which measures are statistically preventive, and which are not.  If, hypothetically, a CT scan can detect a treatable disease or disorder in its early stages 100% of the time, but the disease or disorder  has a known occurrence of only 1 in 10,000 population,  should society support the cost of 9,999 normal CT scans to find the 1 with the disease?  In our rush to promote our health we cannot ignore statistical data.  We should not expect insurance companies or government programs to support preventive programs that search for "needles in haystacks."  As wonderful as it may be to be able to preventively treat the above-discussed disease in the 1 patient who may have it, the cost to society of finding him may easily be $5,000,000 (10,000 CT scans at $500 each)!

For the vast majority of us preventive care comes at little or no cost.   All it takes is a common sense diet, a common sense exercise routine (no gym required, believe me), a common sense avoidance of proven potentially dangerous habits, and little more.  These are the essentials of "prevention" - they are effective - they are without any major costs.  You do not need a physician to live a healthy life.  A physician's job should not be to keep you healthy - you can easily do that on your own.  A physician's job is to treat disease and to monitor the treatment of disease. Preventive measures to maintain good health is your job, not his.  

The Rights of Humans and Other Living Things

A recent article in the New York Times, "Animal Studies Cross Campus to Lecture Hall," raises the oft-considered issue of animal rights.  The philosopher Peter Singer has been a leader in the "animal rights" world and has argued that those animals who are sentient beings have a right not to be eaten, or killed for their skin or fur, nor used in experimentation.  The article points to Singer's questioning "how humans could exclude animals from moral consideration, how they could justify causing animals pain."  We have become increasingly aware of animals as thinking, emotional, sensitive creatures, many of whom seem to exhibit caring and moral behavior towards members of their herd, flock, pack, etc.

Does the fact that a living thing exhibits a form of moral behavior automatically grant that creature an unquestioned right to life?  Does the fact that a living thing exhibits sentient behavior automatically grant that creature an unquestioned right to life?  Should rights be granted to living things even if those things have no understanding of these rights nor any obligations to extend such rights to other things?  Do trees have a right not to be cut down?  Do flowers have a right not to be picked?   Are all living things to be given "unalienable rights?"

Or should we determine that living things that are human beings are ex parte and deserving of special rights because of their species - rights that are not to be conferred on other living things.  Would it be fair to argue that an animal that has a right not to be killed should also have a moral obligation to refrain from killing?  If an animal attacks and kills another animal does that animal have a right to a fair trial?  Does a sentient, caring, loving service dog have a greater right to life than a non-sentient newborn with major abnormalities that would forever limit his abilities to sustain a  sentient or normal existence?

I would argue that we humans are ex parte.  Not a religious argument, but an evolutionary one.  We are unique in the world.  Morality, which humans understand to a degree infinitesimally greater than any other living thing could understand, confers on humans a special niche.  Even the most severely limited human, who is non-sentient, whether newly born or in the depths of old-age related severe dementia, has a greater right to life than the kindest and most caring of any other living thing.  Human beings are very special living things and have "unalienable" rights that do not devolve to other living things.  Other living things have only the rights we humans grant them, for they are unable to understand rights and obligations at any meaningful level of development.

Sure, we absolutely should be kind and attentive to other living things.  But the argument that they have rights in any way equivalent to those of the most non-sentient, most damaged human animal is not a consideration.

Keynes, Krugman, and Common Sense

"Keynes Was Right" argues Paul Krugman in his NY Times Op-Ed column of Dec 30. "The boom, not the slump, is the right time for austerity at the Treasury" said Keynes in 1937. His pro-Keynes argument goes on for four half-page columns without once citing any historical or present-day evidence that this concept has ever actually been shown to work! He chides FDR for cutting spending too soon thereby prolonging the recession of the 1930s at a time when the economy was showing signs of improvement. Obama has made the same mistake, Krugman maintains. Now is the time to spend more, buy more debt, etc. to get the economy to improve even more quickly.

Let's assume Krugman and Keynes are correct. Does one just keep buying debt (printing money) as the economy continues to slump? Surely there must be a point at which economists would agree that it may be time to consider the alternative - namely a limit on spending. How does Krugman (or Keynes) know when that point has been reached? He does not inform us. How can one be certain that continued government spending in the 30s would have speeded a recovery? Where are the data that show continued spending is the answer to our current economic issues?

It's all theory. Common sense may teach otherwise. To paraphrase Ecclesiastes: "For everything there is a season - a time to be born and a time to die, a a time to sow and a time to reap, etc." Well perhaps during periods of recession there may be a time to spend and a time to stop spending. I think Moody's agrees.

Medical Expenditures - Life v. Death

In a recent essay in the New York Times, Dr. Peter Bach discusses the "worth" of medical care, even if the end result is death.  He cites an example from his medical background of a "middle-aged man" with no reported chronic medical history who appeared in the emergency room with a life-threatening acute illness.  Though close to death, with a grave prognosis, proper treatment was instituted and three weeks later the man left the hospital in apparent good health.  Bach speculates that, had the patient in fact died, many "policy analysts" would have called the expense of those three weeks a "waste of health care dollars."

Bach confuses terminal patients with non-terminal patients is this discussion of costly treatments.  This "middle-aged" man is hardly the same as a very elderly man with a known terminal disease who happens to come to the emergency room with a similar clinical picture.  We all accept the fact that caring for the sick many mean caring for people who may die, but such patients represent a very broad and varying landscape.  The distinguishing factor should not be "people who may die," but "people who may live!"

I have heard no arguments regarding expenditure for saving a life.  The ongoing valid argument concerns expenditure in situations where this probability is, in fact, virtually non-existant.

Musings on Today and Tomorrow

How important is it to worry about tomorrow's world?  What are we really trying to accomplish?  Are we trying to preserve the planet as it exists for us?  Have we decided that preserving an environment that pleases us, a way of life that is comfortable and satisfying for us, should continue for eternity?  Since we have developed methods to actually affect how the future planet may evolve, we seem to have declared that the existence we know today is the existence to be preserved forever.

This "preservation complex" seems to be a natural one.  After all, who doesn't want to maintain the planet as a place of comfort for "those who come after us."

Though we seem to be morally committed to creating a "better world" for those who follow us, can the "happiness" of the world we exist in truly predict the "happiness" of the future world?  Larger evolutionary and ecological factors may evoke a different response and the happiness of succeeding generations may differ from our concepts of happiness today.  Future beings will evolve in one form or another irrespective of our attempts at conservation.  Though global warming, for example, may be an unwanted circumstance for extant homo sapiens, it may devolve into the initiation of another way of life  -a way of life quite alien to what exists today.  Maybe a happier life.  Our global warming problem my become their nurturing environment!

The philosopher Derek Parfit has expressed his concern about our "bias toward the future."  He conjectures that the time of human presence on this planet is just be a beginning, with a future that is significantly longer than its past.  We fret, he says, about the probability of future pain without remembering the pain of the distant past.  The pain of the past, he believes, was probably outweighed by the happiness of the past - and so, in all likelihood,  will the pain of the future.