A Pig in a Poke

Which illnesses frighten you the most? Leprosy, with its disfiguring skin and facial changes? Tuberculosis, depicted in the theater by frail, pale young women coughing up blood onto their bed linens? Perhaps high blood pressure, which has the following signs and symptoms…[none]?

Let’s face it: infectious diseases are inherently the most terrifying. The thought of viruses, bacteria, protozoa, or parasites invading our body parts and invisibly spreading toxins remains a child-like fear throughout our lives. The Bubonic Plague (poetically rendered as “The Black Death”) is perhaps the prototype, although centuries have passed since rats swarmed through London. Of late you’ve no doubt heard of the influenza epidemic of 1918, the most infamous public health catastrophe of the 20th century.

Even in recent years, infectious diseases, unlike many more common illnesses, seem to grab the headlines, producing a somewhat distorted view of American health emergencies. Television viewers are apparently numb to the endless litany of articles on obesity and overweight, extremely unhealthy conditions that affect 67% of the adult population. A personal myth seems to be: “If there are commercials about diabetic medications and blood testers, diabetes really can’t be much more dangerous than athlete’s foot.”

On the other hand, mention a new or revived infectious disease on the air and you’re guaranteed an attentive audience. SARS, an extremely rare type of bird-flu, resulted in mass-media hysteria in 2003. Every station covered the story as if a new plague had arrived—the humble author of Dr. Fischer’s Little Book of Big Medical Emergencies did almost 50 separate interviews on the topic! [but he’s not complaining]. Remember West Nile Encephalitis? That caused more panic several summers ago than Elizabeth Taylor’s performance as Cleopatra. And how about “Mad Cow Disease”? I assume that McDonalds hasn’t changed its menu.

Diabetes, hypertension, high cholesterol (and 40 other conditions in 9 organ systems directly related to obesity) don’t grab headlines because of “over-exposure”, although these are the most prevalent threats to anyone’s health at present. Contrast this with wall-to-wall coverage of swine flu: although 25% of the pediatric population is obese, “concerned” parents are rushing their children to local emergency rooms for evaluation and treatment of a transitory infectious disease. Swine flu lasts approximately two weeks. Diabetes and obesity can reduce life expectancy by four or more years. Which seems more serious to you?

In 1976 swine flu became front page news after an outbreak at Fort Dix. A mass inoculation program was rapidly put into effect as thousands of people swarmed to medical offices and hospitals to protect themselves against certain death. Unfortunately, the opposite occurred, as can be illustrated by the story of Stuart Fischer, medical student at Maimonides Hospital. As a dedicated health care worker, I was lucky enough to receive swine flu vaccination thanks to the generosity of the hospital administration. Upon returning home right after the injection, I put on the television news and saw that the entire inoculation program had been abruptly terminated that day.

As it turned out, the vaccination provoked an illness called Guillien-Barre Syndrome. At its worst, this resulted in respiratory arrest and sudden death. Such was the fate of 25 otherwise healthy individuals. In fact more people died from the vaccination than from swine flu itself. Needless to say, I have been extremely suspicious of government health programs since then and have not taken or recommended any flu vaccinations, unless the individual has severe pre-existing cardiovascular conditions.

Influenza epidemics are a fact of life, a necessary evil in a world filled with microbes of every type. Periodically our immune systems need a workout just like our muscles do. If we need a vaccination for every known infectious disease, how will we be ready to fight off other health challenges? Cancer, for example, may be partially due to viral infections.

Now that Americans have been made aware of an impending crisis in healthcare (due to obesity) and health insurance (due to overrun costs) we may need to consider cost-effectiveness on a national level. Simply put, and not unlike your budgeting household expenses, should we be spending millions of tax dollars on a recurrent, seasonal mild infectious disease or utilizing the money for hospital clinics, nursing homes, low cost medication, prenatal care, and ambulances?

By all means, protect yourself and your family as best as possible from viral respiratory illnesses every year. Practically this means hand washing, sanitizing surfaces, avoiding ill people, and covering your mouth when sneezing or coughing. But keep a sense of perspective. Swine flu and its mischievous friends will outlast us all. On the other hand, obesity will shorten your life. Don’t buy a pig in a poke.