Cancer... Considering Prevention
Lynnda and I have long been active bird watchers, albeit just around our homes. We haven't been binocular toting 'birders' out in the wild looking for the long lost Oicle... naaaa, that's not really a bird, but I can't remember any long lost bird names... In South Florida, where it is essentially tropical or a growing zone of 10 for those of you used to measuring weather by what type of plants will grow, we can be used to seeing Great Egrets. But here, instead of seeing a sparrow, or robin out the window, we can literally see Great Egrets hunting, out our window.
The photo above, I took after noticing out the kitchen window, this big guy standing on one of our hedges, hunting Geckos. I watched as he harpooned one that ultimately wriggled free when I took these pictures above and below. The bird stayed until he finally realized that he had frightened off all the Geckos that live in that particular hedge...
I have on several occasions posted on cancer prevention and why we don't take precautions to reduce our personal potential for getting one of the 215 types of the disease. In the blog that I posted earlier today, that will be found after this one, I spent time trying to give readers a sense that this disease in omnipresent and if we don't at least 'try' to avoid it, we will end up dead, or at a minimum badly scarred... like me!
It is 'for sure' that we can't avoid all cancers. Many of us are born with a predisposition to cancer through our genetic make-up. But even people with a genetic code for a cancer can reduce his/her chances of contracting the disease. It is a matter of not only being aware of methods of avoiding it... but of participating in activities designed to reduce the risky activities that can contribute to cancer.
Among these factors are smoking cigarettes; long term, excessive imbibing of alcohol; obesity; exposure to known carcinogens; and not getting asymptomatic diagnostic testing done when there is a known predisposition to certain cancers. These are all well documented and well communicated... but clearly not well understood and/or reacted to by the general public.
But today, there are nearly 2 billion people using the internet and things are capable of changing, if we re-communicate, using the internet to accomplish what we have not done in the past. And it is time that not only the highly educated population get the message, so we have to do it using layman's terms.
It is amazing to me that we know how to avoid some cancers, but we don't... if fact, sometimes we legislate activities that can contribute directly to people getting cancer. For example... when we fill our cars with fuel, some states, like California, require the fuel delivery system to be a closed system... the fuel is delivered through a nozzle that lets little or no fumes escape into the atmosphere. California recognizes that automobile fuel is a carcinogen, which causes increases in healthcare costs... and requires 100% of the fuel nozzles to comply with a law that reduces the potential hazard. Why then do not the rest of the states and provinces do the same?
In fact, several states, and certainly Nova Scotia legislate that there is not a need for a closed system and the person fueling the car "must have their hand on the nozzle while fueling takes place"... there is no clip on the nozzle to keep it open while fueling. This causes the person to be in close proximity to a carcinogen for protracted periods! WHY? Can the government not see that the cost of cancer in Nova Scotia is 'killing the province's budget' as well as it's population? Perhaps it will some day do the right thing, and put this simple legislation in place, and give the gasoline dealers several years to also comply with a requirement to have a closed system on the fumes.
Let's look at smoking as another example of how cancer can be eradicated through disciplined legislation. Smoking causes cancer! Smoking causes heart and cerebral diseases! Smoking is a plague on the planet that can be eradicated. Certainly if cigarettes were to be introduced today as a new dietary supplement, no government would approve it. So why don't we treat it like what it is... a killer, and legislate against it.
We could put the legislation into place that says... if you smoke, you will not be treated for cancer or other disease caused by smoking! Further, legislation could be put in that a person wanting to quit, but can't afford the drugs can get the drugs on the dole... but if caught smoking, they will lose their right to health care. This would render smoking to being a bad habit, not an addiction, and therefore reduce the rate of death by cigarette dramatically... allowing the healthcare system to stay viable financially.
The graph below shows how forty-three years ago, 52% of men smoked. That has reduced to around 30%. Why should we accept the remaining 30% as a drag on our financial viability, particularly in Canada where all healthcare costs are born by the taxes we pay... in the USA it is an issue, since many of the sufferers are over age 65 and therefore on Medicare... or are poor and on Medicaid.
My position on this issue would be humorous if the data were not so pervasive and sad. To think that someone who favors Barack Obama and liberal human policies could be arguing healthcare based on the financial security of our countries is ridiculous. Except that, if we can't keep our Medicare systems financially stable, people of all ilks will die from all causes, at a much higher rate!
Perhaps if I switch to a subject closer to the North American public's awareness... OIL. A few months ago, speculators drove the price of foreign oil (and domestic) to over $147.50 per barrel. We have to do something to reduce our dependence on foreign oil, I agree... but I will also argue that it is even as, or more important to reduce our dependence on domestic tobacco! Think about it... health care in America costs $1.4 trillion a year... quit smoking and we could cut the costs by as much as $300 billion soon, and over ten years by several trillion dollars! That's a hell of a lot easier than Drill, Drill, Drill!
The American Cancer Society, from whom I garnered these slides on a web site where you too can visit... here is the link which is from their presentation of 2007 data:
http://www.cancer.org/docroot/PRO/content/PRO_1_1_Cancer_Statistics_2007_Presentation.asp
has for years promoted data that proved that a person could reduce their chances of getting certain cancers by simply eating certain foods. It is clear to me that this is an easy thing, at least for those who can afford it. But I can 't believe the number of people with whom I come into contact that are 'meat and potato' people... or worse! The graphic below shows how we have not adhered to the recommendations of the ACS... BTW, the Canadian Cancer Society have posted similar recommendations to all of this...
In this day and age, if we can't get more than 24.4% of our population to eat five servings of vegetables a day in order to reduce the chances of cancer, we are pathetic. Think of the impact on our farmers if suddenly 258,750,000 people started eating five vegetables a day... up from a measly 86,250,000. We would have less cancer and less obesity! Why can't we get to this, or at least to 150,000,000? Because we don't really want to...
So let's look at that obesity issue that the cancer societies also say in-and-of-itself is a cause of cancer... from 1962 we have gone from 13% of the adult population being obese to a 'whopping' 33%. Not only is this causing cancer, but we are having to live with huge increases in diabetes, weight related injuries, breathing problems, and chronic joint damage requiring prosthesis in knees and hips. And all because we are 'accepting' one another getting over-weight... horribly over-weight. Collectively it is a tragedy for the countries...individually it is a tragedy for the individuals. So there, I have done what I have been told is not PC... I didn't vote that way either!
OK, so we can't do anything about our own weight... and we accept living with it... what about our responsibility to our children... I REPEAT... OBESITY CONTRIBUTES TO CANCER... add it up, we have gone from 14% overweight to 50% of our kids under 19 being above the 95 percentile for BMI (body mass index)
I lifted the following from the website from the Centers for Disease Control here in the USA
The Health Effects of Overweight and Obesity
Research has shown that as weight increases to reach the levels referred to as "overweight" and "obesity,"* the risks for the following conditions also increases:1
- Coronary heart disease
- Type 2 diabetes
- Cancers (endometrial, breast, and colon)
- Hypertension (high blood pressure)
- Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
- Stroke
- Liver and Gallbladder disease
- Sleep apnea and respiratory problems
- Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
- Gynecological problems (abnormal menses, infertility)
*Overweight is defined as a body mass index (BMI) of 25 or higher; obesity is defined as a BMI of 30 or higher.
Their website is http://www.cdc.gov/nccdphp/dnpa/healthyweight/assessing/bmi/index.htm
See, I wasn't kidding, with my short, off the top of my head listing a few paragraphs ago, when you wanted perhaps to argue my points.
Now, let's look at the numbers for those young people who we can give a healthy start to, even if we can't control our own situation. 50% of the kids are overweight... 14% of those under 5 years of age! That should be an example of parental abuse! Those kids will have to live with heart disease in their twenties! Diabetes in their teens! Do you accept responsibility for such things? If you do, what will we do about the situation?
Cancer may be hard to beat, but I don't think we as a population has really started fighting it. I think we are leaving it to the doctors to treat it; to the researchers to find the magic bullets to stop it or prevent it... but we need to look at the data below (in the posting below, there is a lot of data on prevalence) for the truth... we have to look at what we are doing.
Comments
However, I'm of the opinion that punitive measures are not effective in encouraging positive changes in behaviour with regard to healthy lifestyle choices.
Instead, we need to create a grassroots cultural change, where social preasure encourages physical fitness and healthy lifestyle choices.
The BlueNose Marathon Event in Halifax, their relationship with elementary schools as well as the YM/YWCA and its Strong Kids Program are efforts that should be applauded. Testimonials from individuals such as John Stanton of the Running Room and his active participation in promoting health will serve to encourage and motivate change as do "eat fit" programs that teach parents how to feed their families nutritious meals on a shoe string budget.
As an individual establishing a new business to help social entrepreneurs and companies design and manage their charitable giving and community engagement programs, it strikes me that some company might be well positioned to establish a community fit program where employees mentor and coach others in their desire to lead a healthier lifestyle.
I expect there are employees/people like myself who would welcome the opportunity to "pay it forward" once they've achieved some degree of personal success themselves.
I don't however believe that punitive measures will create a positive environment for the changes we seek and I dare say the medical ethicists would have a strong argument in their opposition to withholding medical care. It's certain that few, if any of us, have lifestyles above reproach. Maybe doctors shouldn't treat people who have unsafe sex, individuals who purposely seek adventure sports, people who do drugs or kids that bike/ski/skateboard without helmets.
Instead, why don't we provide tax incentives to individuals and families who demonstrate and maintain improved health over a sustained period. Obese people who reach and maintain a healthy BMI for a sustained period. Smokers who quit and improve cardivascular/pulmonary function. Borderline diabetics who learn to control their blood sugar with healthy eating habits.
Maybe our province can thank them by acknowledging the estimated savings in future health care costs.And, motivate others by asking if they've received their provincial government "fit cheque" yet.
When your only tool is a hammer, everything looks like a nail.
And when you (or whoever becomes the czar deciding who gets care and who doesn't) draw up the list of the unworthy, please be sure to include all those who played hockey in their youth or were skiers (not eligible for any joint related treatment), those who choose to ride bikes on busy streets or highways (no treatment for accident trauma), and those who drive tiny cars to save themselves money on gas (injury treatment levels will be prorated to match those incurred by someone driving a Hummer.
Your research is great and the issue thought provoking, but we're basically far more advanced in seeing the problems than we are in finding solutions.
The target is people like myself, people who aren't drawn to the traditional sports based exercise formats. Far too often, the gurus of exercise create an 'jock' environment around exercise, which suggests that if you don't do it 'right', it's a waste of time.
Perhaps we should revisit the venerable 'Participaction' model, which focused on encouraging physical activity PERIOD, and stressed the pleasures of a walk around the block.
BRuce
In the meantime, I'll offer the interesting story my doctor told me last week. He has a patient who is a smoker, and a test showed a suspicious mark on his lung. While waiting for a ct scan, the man stopped smoking. Then, when the scan showed there was no cancer, he went back to smoking again.
I'd be interested in hearing your analysis of that man's motivations.
Interesting Comment Ron,
People who throw stones aught not live in glass houses, eh? Although I am not good at Biblical quotes, this is what I understand Jesus was trying to say with "Judge not...".
Again, I would try to ask why should we accept certain habits as OK just because we live in a free society. If the actions of one are to limit the freedom of the masses, should we allow the one to act... second hand smoke in a small room with a baby in it for example.
The guy/patient with the cigarette... he proved he could quit with adequate motivation, there fore establishing his cigarette smoking as nothing more than a bad habit! If he can afford to smoke at $10.00 per pack ( BTW...$3,650 per year in after income tax dollars at a pack a day); and he is not hurting any innocents; and he understands the implications of cancer (surgical procedures that will leave him unable to live a full rigorous life; radiation therapy that will take 30+ days of his life and leave him with probable burns on his back or front; chemo therapy which will leave him wishing he never ever smoked the first cigarette)... he should have at it! He may survive.
However, his biggest problem is that he has a physician who likely cleared him of cancer, but didn't check him for cardiovascular disease, cerebral vascular disease, peripheral vascular disease because he is a smoker and therefore has a predisposition to heart attack, stroke, and amputation due to circulatory problems... This because our healthcare system can not afford to screen patients due to the high cost of treating chronic diseases caused by smoking, obesity, pollution and sedentary life styles.
I hope he doesn't get the cancer, but also that he doesn't have a stroke (also known as a brain attack), or heart attack, or loose a leg to vascular disease.
Why would another-wise intelligent human being, risk such high odds... does he play poker?
BRuce
You have restated my question well, but haven't answered it - other than with an attack on the doctor. In fact, I find that question a fascinating one, and the answer probably has to do with how most of the people in this world cope with their lives.
But you also haven't addressed the other issues I raised about where one draws the line once we start withholding healthcare for those 'we' (whomever gets that job) deem 'irresponsible'.
I think my questions about the responsibility for later medical problems of those who are involved in athletics are valid. I have a son who had two dislocated shoulders playing hockey, the second happening frighteningly easily. Is it not likely that he will have consequences later in life? Who should pay for that?
To come back to my original point, addressing the issue of 'preventable costs' to the healthcare system opens some complex doors. All my references to date have been intended only to encourage you to ask 'hard' questions about how to reduce preventable health costs, and those are questions that start 'at home'.
Ron, let's consider the smoker who quits when confronted with the spot on the lung... from the early stages of life, particularly adolescence, it seems we don't understand our mortality. In fact, I sense that many, including me, believed that we as individuals are different. We will live without illness because we are special. We challenge mortality through risky activity, smoking only one of them... jumping onto moving trains; unprotected sex; drinking and driving and so on. Gradually our experiences seem to mature us and the riskiest of these activities fall by the wayside. But some of them became habits and addictions... I suspect that smoking and eating and drinking are among these... and they are a little bit harder to quit (quitting is a new word in most vocabularies) as we age. There are fewer thought of immortality as we age because our frailties become more obvious as we age.
When the patient was brought in-front of his mortality with the diagnosis, perhaps his first reaction was that if he quits, he will have a better chance at living. Once the physician excused him of the cancer diagnosis, immortality seeped back in, and the cigarette returned.
The reason I brought in the physician at this point of my original comment about this situation was because it is at this point where we can help those who have already quit, to retain the smoke free status. By at least testing for the other diseases, we can let the patient know that he continues to cheat death. I have met several very old people who have smoked most of their adult life and are well into their late years... I suspect that there are genetics specialists that could give good explanations of this phenomenon.
relative to where one draws the line... there are countless examples of laws that have to make a line in the sand... in this case, I indicated that once the line is crossed, there should be lots of options for people. Some examples of lines in the sand are in the Child Protection Laws of Canada ... we not certain what the right age is, but we are determined to legislate when a youth should be treated as an adult even when sometimes the laws don't seem fair to circumstance.
I really don't think it is fair to legislate these issues relative to participating in activities unhealthy to individuals and too costly for the system for people who are already caught up in chronic diseases... but we need to start somewhere.
I suggest teaching students about health responsibility from Grade One. And I suggest debate on implementing new rules on what is acceptable as far as achieving not only an understanding of most health issues, but also what is acceptable as far as personal achievement of same. In Switzerland, all youth, male and female are required to spend time (two years I believe) in the military or police force at the age of 19. They are then required to spend two weeks a year in active duty... through all of this, they must be in condition to accommodate the rigors of their jobs. Our society could easily implement similar rules, although I don't assume military or police work are the only alternatives... as long as being in condition is a requirement.
What we learn early, as habits, stick with us and are hard to quit... smoking comes to mind. If we could get the youth on good habits early, it would be a start to fixing our system in Nova Scotia.
On the who should pay issue... we all are paying, through the taxes we shell out annually. Medicare is not free in Canada... we pay 9.5% of our gross national product for healthcare in our country. We pay through sales tax, and income tax. In Nova Scotia healthcare comes from the general budget, and that has dollars in it from all sources, not just one tax. My concern is that we are spending so much, that we must find ways to reduce it... I think that controlling activities that lead to chronic diseases, cancer and vascular disease are at the heart of managing healthcare costs... they are around 70% of our cost.
If we don't get to this, and aggressively, I am also concerned that the care of the elderly will be impossible through our current budgets. We can not afford assisted living and nursing care in the future, if we don't change the way we are looking at the things that are inordinately impacting healthcare... smoking, obesity, excessive anything, and a sedentary life are the major impacts that I believe can be managed... BRuce