Both candidates have proposals for reforming America's health care system. You can read them yourself (Obama's here, McCain's here, and a detailed comparison here).
As statements of policy, these plans focus on the big picture of American health care: how to cover the uninsured, how to pay for insurance, how to contain costs. There is little to be said about specific diseases. Now, we can argue about the merit of talking about health care policy without talking about diseases, but it's not a bad idea. Larger policy statements focus on the system as a whole---they don't need to declare a "war on cancer" or a comprehensive strategy to fight obesity-related diseases. So when the candidates do mention specific diseases, it is the exception, and there must be a good reason for it. Right?
Poor, naive me. You see, I would think that if you were to happen to mention specific diseases, you'd tackle the ones that affect the most people, or cause the most deaths---you know, something like heart disease, cancer, or diabetes. But in the world of politics, it should surprise no one that diseases are mentioned for political rather that medical/public health reasons.
Obama mentions three specific diseases, depending on how you read it: AIDS, lead poisoning, and autism. Somewhere just above a million Americans have HIV. Lead poisoning affects a little over 300,000 children in the U.S. (which disproportionately the poor, affects their future health). Autism, depending on which statistics you read, may affect about 400,000 people in the U.S.
The McCain plan lists two specific diseases: tobacco abuse, and autism. Tobacco abuse is a significant public health problem that increases the severity and prevalence of the major killers of Americans---heart disease, stroke, and cancer (about 40 million Americans smoke).
Let's contrast: heart disease affects over 24 million Americans, and kills almost three-quarters of a million people in the U.S. every year. Even more impressive, we can do something about it.
I don't disagree with health policies avoiding mention of specific diseases, but when they are mentioned, why autism? Autism is a relatively rare condition. It can be disabling, but not always. It isn't fatal. What caused both candidates to give it a prominent mention?
Not to sound overly paranoid, but I wonder if any of the anti-vaccine folks are being placated here. If so, the candidates will learn that there is no placating anti-vaccine nuts. Until you commit to reverse centuries of public health success, the antivax crowd won't be happy.
But perhaps the mention of autism is less sinister. Perhaps it is just that parents of autistic kids are particularly good lobbyists. If so, good for them. I hope they are able to obtain the research and services they need. But let's not forget that the big killers of Americans have changed little over the years, and if the candidates are going to address specific diseases, perhaps those that are the most significant should pop up first.
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I think autism- perhaps because it affects innocent children- is much easier for people to feel sympathetic about than say depression, schizophrenia, or alcoholism/drug abuse. Maybe it's really not sinister at all, and autism simply acts as a stand-in for mental/emotional disorders and illnesses generally. In any event, real progress on autism treatment could well impact other psychological conditions which result in feelings of social isolation, so I think it's all to the good.
Of course, this might be hopelessly naive and idealistic, too.
I'll be watching to see whether McCain gets behind the policies that have made Minnesota the only state to have a significant recent decrease in number of smokers: higher taxes on cigarettes, public smoking bans, and a publicly provided cessation program. My guess is that it won't play to the base.
And PalMD, you are one of the least naive bloggers I've read.
PalMD, are you not reading your updates from the CDC?
Autism affects on in 150 newborns. That's "relatively rare" in your book?
As I'm sure you know, autism advocates hold many different views on immunization, some you may not agree with but calling anyone who questions the lack of strong checks and balances in immunization policy an anti-vax nut is a little looney, in by book.
Our community does agree, however, that supports for those who receive this now fairly common diagnosis are woefully inadequate. The early, intense behavioral therapy recommended by mainstream experts and practicioners routinely costs families in excess of 50K per year...and lasts for many years. Shouldering these costs, or even attempting to, has created a trail of financial and personal destruction all across this country. I'd recommend attending a hearing or two in your state and get up to speed on this public health crisis.
Autism advocates are organized and vocal but have to be, as the funding currently committed to research pales in comparison to ANY of the other, much less common, childhood diseases.
http://www.autismspeaks.org/
I'm not diminishing the severity of autism, only pointing out that on a societal level (not on an individual one), it's a pretty small health burden in this country. The incidence is as I've stated. Your 1/150 number is a bit misleading. If you translate the best available prevalence data, my number of under 1/2 million people is about right.
Compared to the tens of millions suffering and dying from heart disease, cancer, diabetes, stroke, etc., yes, it's relatively rare, and while important, I question the appropriateness of it being the ONE common disease addressed by the candidates.
Hey, I've got diseases that are important to me and my family, but i hardly expect the candidate to make my pet issues the country's. I'm sorry if that sounds harsh, but it's reality.
Why ASD works for politicians vs. what you have listed:
There are effective medical treatments for heart disease, cancer, diabetes, stroke, etc. and personal responsibility can reduce or eliminate the risk of health complications or death for these diseases.
Neither of these is true for ASD.
I have no problem devoting lots of resources to research and treatment for autism. It's just still very odd that one disease that has a much smaller burden on society than many others is singled out.
And I wouldn't really go there with "diseases of fault". Of course no one deserves autism, but no one deserves heart disease, diabetes, etc, and life style changes can only help some people too some degree.
Quantify and qualify burden on society ?
Im sure you are not implying there are no avoidable ways to reduce the risk factors associated with the diseases you listed.
Give an example of a way to reduce the risk of being diagnosed with an ASD?
I don't think it's odd at all. In my view, the specific mention of autism versus other disorders and conditions is an attempt by both candidates to correct historic and all too common errors regarding diagnosis and medical treatment of autism. For a long time, distinguised scientists and doctors said autism was the result of parental neglect. For a long time after that, it was viewed as a purely psychiatric disorder. This incuriousity allowed and encouraged snake oil and pseudo science to take root, some of which persists to this day.
You don't get too many people "treating" heart disease with exorcisms.
Only quite recently, with a serious push from advocacy groups (like those responsible for the Combating Autism Act of 2007), is autism being viewed by leading medical professionals and scientists as a broad biomedical disorder comprised of several subtype, which may have different treatment options (whether behavioral and medical). This book may be an eye opener for you in that regard.
http://www.amazon.com/Autism-Its-Medical-Management-Professionals/dp/18…
The historic neglect of this disorder by the medical community badly needed correcting. I appalaud both candidates for their efforts in this regard.
I don't think highlighting autism diminishes the importance of fighting other, more prevalent diseases. The candidates rightly note that the long term costs are, in fact, significant. Think 35 billion per year. That's a big enough societal cost in my book
http://www.hsph.harvard.edu/news/press-releases/2006-releases/press0425…
Excellent points, PAL! I agree 100% about how both candidates are trying to appeal to their bases with their specific stances. And since there are anti-vaccine nut-jobs on both sides, they're both going for the autism crowd! But it's interesting to me that McCain specifically is trying to fight tobacco-related illness. Are most smokers Democrats? Is it the Republicans or the Democrats who are pushing to ban smoking in public places these days? I really can't tell! On the one hand, Cigar Dave is a big proponent of "Smokers' rights" and he's a pretty hard-core Republican. On the other hand, it seems that smoking cigarettes is more prevalent among the poor and working class, and the not-so-poor pseudo-intellectual crowd who pontificate for a living. Both tend to lean a little more to the left.
Either way, as a physician, you can't really argue against the public health benefits of anti-smoking or anti-obesity policies. However, as a Libertarian who believes pretty much in peoples' rights to do whatever the fuck they want, I do take issue with it. Besides, I enjoy a nice cigar and a Big Mac as much as any good red-blooded American!
DWMD- my guess is that McCain is actually focusing on tobacco use to appeal to people like you. You see, if diseases mostly result from unhealthy choices, we are justified in not providing medical care for everyone (cause it's "people that made bad choices" who need it, ergo they deserve to be sick, god punishing sin, ect.).
If only the left was as cruel as the Libertarian right. Then folks that smoke cigars and eat Big Macs and vote for McCain (or worse!) wouldn't get any healthcare at all.
@Dadvocate- wait, autism isn't a psychiatric disorder? Look, I'm happy to talk about the neruological basis for autism... but it's not like depression et al are completely without neurological underpinnings either. Why is "purely psychiatric" a pejorative?
Of course, I haven't even mentioned psychiatric illness and its burden (as such) yet...perhaps more later. The candidates (some) have a little bit to say...
Becca, while I will concede that many sick patients are truly victims of bad luck (or bad genes), the great MAJORITY of ADULT patients in the hospital are either smokers, obese, alcoholics or drug addicts (or just too damn old to be walking the earth anymore). If you don't agree with that, then you are obviously not a physician or you've never actually worked in a hospital. PalMD... back me up here.
Furthermore, Libertarians believe people are (or should be) smart enough to take care of themselves. The founding fathers did not set up this government to hold everyone's hand throughout their lifetimes and charge the taxpayers for other people's stupidity. If I eat or smoke myself into oblivion, well then that's my own f***ing problem and it really shouldn't be yours. Additionally, that's why I WORK and PAY for health insurance. No one's giving me a thing. Also, I resent being called "the Libertarian right." I, like other Libertarians, believe in INDIVIDUAL LIBERTY FIRST AND FOREMOST! I am basically pro-choice with respect to EVERYTHING (including paying taxes). As such, I'm voting for Bob Barr, and NOT McCain, who is really anti-choice about many things (like Obama).
If you don't understand what Libertarians believe or don't believe, I suggest you look at their platform on this website: http://www.lp.org/platform
While I agree that a disproportionate number of my patients are suffering from various forms of disease in which behavior plays a part (especially smoking), i'm not ready to support a health care system that directly penalizes people for their ill health. A really, really big topic for another post...
Oops. I think you've probably wandered into a grey area -- the "care most about" vs. "find most useful to advancing [his/her] agenda.
I'd bet McCain cares a whole lot about [skin cancer] [melanoma], but finds that publicly talking about tobacco abuse and autism gets him traction.
I'm not so sure about Obama.
In the current episode {run up to election} I believe both candidates are looking for the highest-voter-yield per mention.
This isn't disparaging to either candidate. "Talking about" publicly, in this age of instant access to more detailed and nuanced position statements, doesn't equal "what I will do if elected."
Becca said "I think autism- perhaps because it affects innocent children- is much easier for people to feel sympathetic about than say depression, schizophrenia, or alcoholism/drug abuse."
I have a son who severe learning disabilities (in his senior year in high school the psychologist speculated he had Aspergers, he was diagnosed with speech issues before the DSM included Aspergers) and hypertrophic cardiomyopathy with obstruction.
That is NOTHING compared to a very close relative with schizophrenia. A condition that affects about 1 in 100 persons, about half again as much that have autism (all over the entire spectrum).
My son will do okay. He has shown the ability to learn and keep a job. The "scary" 1 in 150 includes the high functioning autistics like my son (if he had been born two years later when the criteria was changed!). Our relative lost her job, and her future is very dim.
The services to those with mental health issues is very very bad. Recently in our state six people lost their lives to this very broken system:
http://seattlepi.nwsource.com/local/378130_browning08.html
Autism is not fatal.
Untreated mental health can be fatal, and not just to the person with the disease.
Go Quetzalcoatl!
"The services to those with mental health issues is very very bad. Untreated mental health can be fatal, and not just to the person with the disease."
The same can be said of ASD.
Chucky, tell us when the last time a person with autism was driving down the freeway randomly shooting other drivers. Tell us about the time someone with autism used a knife to attack a random person on the street or elsewhere. Tell us about the time an autistic person killed his pregnant wife:
http://seattlepi.nwsource.com/local/378924_gergen13.html
Come on... tell us why the panic over 1 in 150 for autism (which is for the entire spectrum) instead of 1 in 100 for schizophrenia?
Tell US HCN about a Doctor that shot their autistic child?
Tell us about the murders and Aspergers was used as a defense?
Tell us about autistics thrown out of church and having restraining orders placed against them?
Tell us about ASD individuals being thrown off of planes because they are a danger to the surrounding passengers and crew?
For a look at the candidates' positions on these and other issues, see http://www.specialneeds08.blogspot.com
Chucky, said "Tell US HCN about a Doctor that shot their autistic child?"
You are totally clueless. Of course, Doctor Karen McCarron didn't use a gun, she murdered her autistic daughter, Katie, by sufficating her with a plastic bag:
http://leftbrainrightbrain.co.uk/?p=371
All of this is irrelevant. The fact is, we all have our pet issues, but statistically, heart disease and cancer are the big baddies. The question is still, why mention this one disease, bad as it is, when it has a much smaller societal health impact than many others?
Yes, it is important and has a big impact, but nothing compared to many others.
"You are totally clueless. Of course, Doctor Karen McCarron didn't use a gun,"
You are correct. There have been tooo many of these stories over the years to keep them all straight. Take the Hint.
Pal MD,
The fact is, we all have our pet issues, but statistically, heart disease and cancer are the big baddies.
From a health perspective yes. From a political and societal perspective not so much. At a National level heart disease and cancer are covered by NIH, HHS, CDC. ASD is covered by NIH, HHS, CDC, DOE, DOL, SSI, NIMH.
There are medical treatments for heart disease, cancer, diabetes. Science would do very well to improve upon them since all of these problems have existed since the dawn of man. What has science positively offered to the population with ASD?