Recently, during a routine visit, a patient asked if I was worried about the Ebola virus. The question made me think. I responded that it certainly is a frightening virus and has caused great mortality. However, his question actually triggered thoughts of how there are many other public health issues in our country that cause significant mortality on a daily basis that have me even more concerned.
For example, we lose over 200 people a week in our country to drunk driving–related fatalities. That is the equivalent of a commercial airliner crashing every week. Unfortunately, this isn’t as highly sensationalized as one person dying from the Ebola virus. However, if the media covered each fatality due to drunk driving, we would be discussing at least one new preventable death per hour. In March, Malaysian Airlines Flight 370, with 239 people on board, went missing. An extensive multinational search for the plane was undertaken. Since the flight disappeared, approximately 6700 Americans have died as a result of drunk driving–related fatalities. I by no means intend to minimize the significance of the loss of life from the Ebola virus worldwide or the loss of life sustained on the Malaysian airplane. However, I would like to see more concern from our country and its citizens about public health matters that result in tremendous preventable morbidity and mortality occurring daily right under our radar.
Neglect to use seat belts continues to be a major public health issue. Seat belts can reduce serious crash-related injuries and death by about 50%. Accidental injuries, with motor vehicle accidents leading the way, are the leading cause of death for teenagers. However, deaths due to opiate overdose are catching up. Once again, this is another preventable cause of death.
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About 3200 children age 18 or younger smoke their first cigarette every day. Approximately 480,000 people die yearly in the US from cigarette smoking–related illnesses. This includes those who die from exposure to second-hand smoke. Five million people die worldwide annually from smoking. These numbers are astounding.
Yet we continue to allow the sale of tobacco products. When a new medication is evaluated for approval by the FDA, there is a lengthy and detailed process to demonstrate safety and efficacy prior to being deemed appropriate for public use. However, we continue to allow cigarettes to be sold when we have known for decades about their potential devastation. In 1918, Alton Ochsner was a junior medical student when his instructor called students over to see a “rare” case of cancer of the lung. He wanted them to see it because they may never see another case again. Just a few years later, Dr. Ochsner noticed he had 4 patients with cancer of the lung in the same year. He was one of the earliest to correlate that each of his patients had about a 20-pack-year history of cigarette use. This was almost 100 years ago.
Often, I tell adolescents who are in for a well visit that if I could talk with them about seat belts and tobacco use versus just performing the physical exam, I would choose the seat belt and tobacco counseling. Fortunately, I get to address both. Each year, I ask the teens to come back the next year and let me know 2 things: whether they are still not smoking and whether they are still wearing a seat belt. Often, upon their return, they let me know of their continued success right away.
In summary, of course the Ebola virus is concerning and certainly frightening. However, to answer my patient’s question, I am less worried about the spread of Ebola, which I feel certain will ultimately be contained, than I am about these persistent and preventable threats to human life.
