Monday, July 27, 2020

Sick while black: an unhealthy combination

The Covid-19 crisis has highlighted many of the failings of the U.S. healthcare system, including the racial disparities that have always been present. If you have followed the news, you are aware that African Americans and Hispanic Americans have suffered more from Covid-19 than their white fellow citizens. In Chicago, where blacks make up 30% of the population, they make up 50% of Covid-19 cases and nearly 70% of the deaths. Similar statistics are found throughout the country. Part of the reason that blacks have suffered disproportionately is due to social and economic factors: blacks are more likely to live in crowded housing, which increases disease spread; they are more likely to depend on crowded public transportation, where “social distancing” is difficult or impossible; they are more likely to work in low-paid occupations considered essential which cannot be done from home. African Americans also suffer more from the diseases that increase the odds of dying from Covid-19: hypertension, diabetes, obesity and cardiovascular disease.

What you may not realize, however, is that the ravages of Covid-19 are just the icing on the cake of racial disparities. Pregnancy-related deaths, a marker of how well a country’s health care system works, is much higher in the United States than in comparable wealthy countries, even among white women, but is strikingly higher in black women. In countries such as Japan, Australia, France, Germany and Denmark, the number of maternal deaths per 100,000 births ranges from 5 to 8. In the U.S. it is 17 among all women, but in non-Hispanic black women it is 40.8!

Black Americans with cancer, lymphomas and leukemias die sooner than white Americans with the same diseases. Those with lower socioeconomic status, who are disproportionally black, have much more premature coronary disease and die younger of heart disease. Even when they receive “high tech” interventions such as coronary stents, black Americans had higher risk for major cardiovascular events in the years that followed. Black adolescents got fewer flu shots than did white and Hispanic teens.

Hispanic and black Americans are less likely to have a primary care physician, make fewer doctor visits and are less likely to get outpatient mental health care than white Americans. The Affordable Care Act (AKA “Obamacare”) increased access to health insurance for the overall population but benefitted white much more than black Americans. The largest number of Americans get their health insurance from their employers, but small employers are much less likely to offer insurance than large ones, and many blacks work in hazardous low-paying jobs with companies that do not offer many benefits.

What can we do? As the richest major country in the world, we cannot allow any of our citizens to starve or to not have a roof over their heads or die from treatable illnesses. Whether through adopting universal health care, expanding Medicaid or providing a public option for those without employer-based insurance, we must guarantee that everyone has access to basic healthcare.

Since much of an individual’s (and a nation’s) health depends on social factors rather than traditional healthcare, we should strive to see that everyone, white, Hispanic and black, has a living wage and affordable housing and access to healthy foods. New mothers would be less likely to have health issues if the U.S. joined most of the western democracies to mandate paid maternity leave.

We can do better and we must do better. Covid-19 will eventually be behind us, but the health disparities that have been made worse by this pandemic will remain unless we take this opportunity to create a better country for all.

Prescription for Bankruptcy. Buy the book on Amazon

Thursday, July 16, 2020

It's only natural

It is hard these days to shop for anything, whether at the supermarket, the pharmacy or the beauty shop, without seeing products touted as being “natural.” The term is used even more often than its frequent companion, “organic.” Over the past decade, while total food sales have risen 2%, sales of “natural” food have risen 12% and “organic” foods 15%. Clearly these words sell products, but is it always a good idea to buy a natural product over others? What does “natural” really mean?

When a food is using the USDA-approved label of organic, this does have some specificity. By law, products labelled organic must be grown with no genetically modified ingredients, no irradiation, no antibiotics, no synthetic feeds or pesticides, no hormones and no chemical fertilizers. The contents of a package must be over 95% organic to carry the label. (Note that in many parts of the world, “night soil” is used as fertilizer, and while this is organic, I would prefer not to eat food fertilized with the contents of an outhouse.)

There is no legal definition of “natural.” One is reminded of the line from Lewis Carroll’s book Through the Looking Glass, when Humpty Dumpty says to Alice: “When I use a word, it means just what I choose it to mean—neither more nor less.”

Perhaps because of the lack of a defined meaning, you will see “natural” used on supplements, food products, cosmetics and just about anything else you can buy. Unfortunately, many clearly natural products are dangerous. After all, botulinum toxin is a natural substance, found in nature with no human intervention, but it will paralyze and kill you when ingested. (In micro-doses, botulinum toxin is safely used as Botox.) Many natural products found in marketed “supplements” have dangerous potential. These would include cesium chloride and aconite (heart rhythm problems), lobelia (seizures), kava kava and celandine (liver failure) and germanium (kidney damage). If you are taking a “supplement,” look for these ingredients and toss the tablets if any of these products are in them.

“Natural skin care” has become a multi-billion-dollar market, carving out 25% of the $5.6 billion spent in 2018 on skin care products. “Clean beauty” evangelists such as Gwyneth Paltrow have ignited fear in consumers about using many products such as sulfates, parabens and propylene glycol, not on the basis of facts but by using scary statements such as “do you want antifreeze in your moisturizer?” Dermatologists have pointed out that many of the “natural” products touted are more likely to cause allergic reactions than the products they are replacing. [See JAMA Dermatology, December 2019.] A widely used web site from the Environmental Working Group touts safe skin products, but in many cases gets a percentage of sales from products it deems safe, an obvious conflict of interest.

So, when shopping, remember that just as beauty is in the eye of the beholder, natural is in the claims of the seller, and don’t pay up for something unless there is a good reason to do so.

Prescription for Bankruptcy. Buy the book on Amazon