The Year of Moving Forward

The Year of Moving Forward
At our 4 person wedding reception in DC

Tuesday, July 24, 2012

Smoking and guns

I have written several times about guns and gun control. I live in Bessemer, AL, on what was once described by a local television station at "the most dangerous street in the state." Here are some thoughts from that period in 2007, after a spate of murders occurred just blocks from here.

I want to present a suggestion that we change the dialogue around gun violence. I wrote just the other day following the Aurora mass murders about some changes that I believe would benefit society. But just talking about these changes still leads to the same arguments about 2nd amendment rights and such.

Let's look at this from a public health standpoint. I am not presenting results of research or offering interventions, rather I want to generate some questions and change the dialogue.

Let's treat gun violence like the pubic health issue that it is. What we want to do is change people's behavior.

But first let's look at how society has handled another public health issue: youth smoking and smoking in general; and how we changed people's behavior regarding that issue.

Let’s do a simple review.

In 1965 about 45% of Americans smoked, and kids could go into stores and buy their parents cigarettes (and buy for themselves out of machines or from stores as well). My father often sent me into Shelby County where cigarette taxes were lower to the Smoke Shop to by his cigarettes. My friends and I would go to movie theaters and buy cigarettes out of the machines in the lobby. I saw the Marlboro man and wanted to be like him (and be with him, but that is a different story).

Picture credit:

Research proved the dangers of smoking and over the years efforts were undertaken to counter the high number of young people that took up the habit.

Some of the efforts included a ban on minors buying tobacco, restrictions on advertizing, public service announcements regarding smoking dangers, movies shown in health classes showing damaged lungs and sick people, warnings on cigarette packs, even more graphic public service announcements showing tracheotomies and such, absence of smoking in movies and on television, and more recently, smoking bans in public places.

Results; smoking is currently practiced by around 20% of adults, and less young people are smoking (leading to less adults smoking).

Now, think about murders. 

The homicide rate in the United States is basically the same as it was in the 1960’s:  5.1/100,000 in 1960 and 5.0/100,000 in 2009 (you see different statistics depending on how the data are categorized. The number is not really important here; this is not the beginning point of a study).

There is a perception that violent crime is rising, but the reality is that now violent crime is reported, and sensationalized, to such an extent that we think it is more common than it is. Micheal Moore's movie Bowling for Columbine points that out (linking news and entertainment shows such as COPS as guilty in over reporting crime and pointing toward dark people as the criminals).

Regardless, if we treated it as a public health issue we might come up with a plan to reduce it.

Let’s just do what we learned could work with regards to smoking, another public health issue.

 Lets reduce access (like they did with cigarettes), reduce advertising (like they did with cigarettes), create public service announcements (like they did with cigarettes), show movies in middle school and highs school of the dangers of gun ownership (like they did with cigarettes), put warnings on ammunition (like they did with cigarettes), create graphic public service announcements with pictures of dead people shot up (like they did with cigarettes), reduce gun violence in movies and tv and video games (like they did with cigarettes), and ban guns in public places (like they are doing with cigarettes).

Picture credit: London Metropolitan University

Use this as a starting point. Set some objectives, develop interventions (plans) to reach those objectives. 

Someone in public health needs to take this and run with it.
Within a few years we will begin to see the gun murder rate drop, and within 40 years we would see a significant drop.

We know that nothing is going to cause an immediate drop in gun violence. And we realize that certainly, some bad people would still obtain guns and use them in spite of laws and restrictions, just as young people continue to get cigarettes. But we need to look at trends and statistics and projections and start somewhere.

The current dialogue and discussion is getting us nowhere. Take it out of the political arena and put it in the public health arena.  Of course, the CDC has some information about gun violence and statistics. But they are weak on developing and implementing a plan to significantly reduce deaths.

This is unscientific, and done with very little research. It is just an idea I had and wanted to share.

Saturday, July 21, 2012

Nothing more beautiful than death

"Nothing can happen more beautiful than death."

This line from poet Walt Whitman was quoted at a memorial service that I attended yesterday, for Steven Rudd.

But a dozen families in Aurora, CO, are struggling with the deaths of their young family members, and dozens of others in that same town and in Tuscaloosa are struggling with "that could have been me" and "why was I spared?"

Whenever a shooting of this type occurs, it is inevitable that calls for stricter gun control will follow, and it is also a surety that gun ownership advocates will respond by saying that if a person in the theater was "carrying" that the shooter would have been stopped after the first shot or two.

But here is what is really going on. We are a species that thrives on violence. Every species of higher animal (at least the carnivores) thrives (literally) on violence, depending on killing their prey for nutrition.

Humans thrive on violent killing for their nutrition also. Killing, and then eating, an animal, is violent.

We also thrive on control: of lands, of oil, of water rights.

We have an inner need, an instinct, for violence. We try to control it with religion, but history shows us that doesn't work. We try to control it with laws, but there will always be people with a disregard for the law. We try to control it by defining morals, but people rebel against morality.

The first recorded school killing in the United States took place in Pennsylvania at the Pontiac Rebellion School on July 26, 1764 when four Lenape American Indians entered a schoolhouse and killed schoolmaster Enoch Brown and nine or ten children (there are varying reports). Three children survived.

Throughout the 19th and 20th centuries and carrying over into this enlightened age school (and workplace, and barroom) shootings have continued.

But this is not the case in other countries. What are the differences? Gun ownership, religion and attitudes are the first things that come to mind.

By far we are the most gun owning country of the modern world. The National Rifle Association has framed the conversation making people (and elected officials) afraid to admit they want more gun control. Polls show about 44% of Americans want stricter gun laws. We claim the Second Amendment is being violated whenever there is a proposal to restrict gun ownership. In recent years, the conversation has been around "assault rifles" like the ones used in Aurora and in Tuscaloosa. At one time there was a ban on the particular weapon used in those shootings. Currently they are legal. Had the ban still been in place, it might have been more difficult or impossible for these shooters to possess the weapons they used for their crimes.

As for religion, history shows us that most wars and much killing has been directly or indirectly related to religious beliefs. The Crusades, Hitler, all the Middle East unrest, the Civil War, the KKK, Eric Rudolph, murders of LGBT people, are all reflective of religion.

And social attitudes in this country allow us to feed on violence. Movies, television shows, and video games all celebrate violence. Prior to the modern age (like when I was a kid), we played army and cops and robbers using toy guns and would "pretend" shoot and kill our best friends during these games.

Of course, we don't all grow up to be mass killers. There is obviously something wrong with an individual who would rig his apartment with explosives, then leave and go to a theater and begin shooting randomly. And no gun control laws are going to stop someone from snapping and carrying out plans that they have (often) documented in notebooks or offered clues about on facebook.

But we do need to have a serious conversation about gun control. A serious conversation involves not being adamant that the Second Amendment means every American has the right to own an assault weapon. And on the other side, a serious conversation means not demanding laws that curtail ownership of guns used for hunting or self defense by responsible citizens.

My input into this conversation is:
  • there is no reason for people to own the type of assault weapons used in Aurora and Tuscaloosa.
  • there is no reason that guns should not be registered to their owners.
  • there is no reason that ammunition should not be registered and identifiable (even after being fired).
  • there is no reason a person should be able to walk into a gun show and buy a weapon without a waiting period and check into that buyer's background.
  • there is no reason that people should walk around, into businesses and into political rallies, with a weapon on their hip or an assault weapon at their side.
The Tuscaloosa shooter walking the street with the assault weapon he used in the shooting.

I hope that the people of this country will come to their senses and realize that we have a problem, and that in order to address this problem, solutions must be found.

Right now, sensible people are being intimidated by Tea Party members and the NRA.

Gun control/rights needs to be part of the presidential debate. Those who abhor the violent nature of society need to speak up.

It's not too late for the human race to evolve. Or at least act like it has.

Thursday, July 19, 2012

Michelle Obama in Birmingham

I am fortunate to have seen Michelle Obama twice now. She is a passionate speaker, and a lovely lady. Bobby and I first saw her in Las Vegas on the day before the 2008 election, as we were asked to stand on the risers behind the speakers that day.

She returned to Birmingham for a fundraiser yesterday, but also to revisit as promised after  the tornadoes of last year. She visited Camp Noah in Pratt City where the kids loved her!

As with all presidential events security was tight, and lines were long. I ran across these two nice looking gentlemen holding a painting of the First Lady that they had created together. Good work, men.

Tavaris and Torris Daniel with their painting of Michelle Obama.

Tavaris and Torris have a web site, but that is off the subject.

I didn't see the painting inside the event, so I guess they weren't allowed to carry it in.

UPDATE: Tavaris tells me they did take the painting in and it was presented to the First Lady and was kept backstage. 

Birmingham Mayor William Bell spoke. State Representative Merika Coleman spoke. Congresswoman Terri Sewell (AL-07) spoke, "I am the only person in congress that knew both Barack Obama and and Michelle Obama before they knew each other." (paraphrase)

Then, in somewhat of a surprise, the daughter of former Alabama Governor George Wallace, Peggy Wallace Kennedy (wife of Justice Mark Kennedy, Chair of the Alabama Democratic Party) introduced the First Lady. Here is the uncut raw video of Michelle Obama's remarks to the crowd.

Here is a cute video of a video they showed prior to the event. I didn't get the entire thing, but this is the lady that started the "Fired Up, Ready to go" chant.

Sunday, July 8, 2012

More on Obamacare - Providers and Patients

Be sure and read my previous post about Obamacare and children.

A supposed concern about The Affordable Care Act (Obamacare) is that there are not enough doctors to handle all the new patients. My immediate thought is that the most important thing is that all Americans have access to quality health care. It is not right that you or I should have better access to care than the next person based on our social status or income.

But putting that aside, here is what Obamacare does to address the problem. These items went into effect in 2010, so even though their full effect is not being seen yet, they are already being addressed. Some of this information comes from

To strengthen the availability of primary care, there are new incentives in the law to expand the number of primary care doctors, nurses and physician assistants, including funding for scholarships and loan repayments for primary care doctors and nurses working in underserved areas.  Doctors and nurses receiving payments made under any state loan repayment or loan forgiveness program intended to increase the availability of health care services in underserved or health professional shortage areas will not have to pay taxes on those payments.

Here is how some of the money is being spent.

  • Creating additional primary care residency slots: $168 million for training more than 500 new primary care physicians by 2015;
  • Supporting physician assistant training in primary care: $32 million for supporting the development of more than 600 new physician assistants, who practice medicine as members of a team with their supervising physician, and can be trained in a shorter period of time compared to physicians;
  • Increasing the number of nurse practitioners trained: $30 million will train an additional 600 nurse practitioners, including providing incentives for part-time students to become full-time and complete their education sooner. Nurse practitioners provide comprehensive primary care;
  • Establishing new nurse practitioner-led clinics: $15 million for the operation of 10 nurse-managed health clinics which assist in the training of nurse practitioners. These clinics are staffed by nurse practitioners, which provide comprehensive primary health care services to populations living in medically underserved communities.
  • Encouraging States to plan for and address health professional workforce needs: $5 million for States to plan and implement innovative strategies to expand their primary care workforce by 10 to 25 percent over ten years to meet increased demand for primary care services.
 And the reality is that hospitals depend on patients to keep their doors open. In Alabama, hospitals have closed, meaning certainly more patients could be seen. In Birmingham, in recent years, Lloyd Nolan and Carraway Hospital have closed. In North Alabama, Woodland Hills in Cullman and Hartselle Hospital have closed, and others are reducing their services.

Notice that there are also jobs being created with this part of Obamacare.

Obamacare also will provide for the construction and upgrading of community health centers (this is already taking place). This will allow the centers to serve 20 million more patients across the country.

One other benefit is that the new Community First Choice Option allows states to offer home and community based services to disabled people through Medicaid rather than institutional care in nursing homes. This went into effect in 2011.

So access to care improves, the number of doctors and physicians assistants and nurse practitioners and nurses increases, with the bottom line being patients benefit.

Obamacare - Good for children, good for our future

We often hear (or use to promote) certain things about the Affordable Care Act, or Obamacare. (I love that 50 years from now, we will all be using the term "Obamacare", like we use the term "Medicare" today, but I digress).

We hear about young people being able to stay on their parents' insurance until age 26. We hear about children no longer being denied coverage due to pre-existing conditions, and that soon that will hold true for everyone. We hear about We hear about insurance companies no longer being able to drop you after you develop a condition.

These are all good reasons to keep Obamacare in place.

But there are other reasons to support this particular health care reform.

Dr. Carden Johnston is a Birmingham pediatrician who has been past president of the American Academy of Pediatrics. He has published an editorial in today's Birmingham News in which he gives his reason for supporting the ACA. Please read the entire article. But if you can't, here is a summary.

Prevention of childhood illnesses and injuries has been a lifelong vocation for me. That is why I support the Affordable Care Act, or as it's commonly known, "Obamacare." 

Dr. Johnston goes on to point out that our current health care system is designed to treat the ill and injured and not to prevent, but that will change with Obamacare.

The Affordable Care Act will bring preventive health care into reality. Breast and cervical cancer screenings will become much easier to obtain. All adults will get body mass index measurements as part of their checkups. And their checkups will be supported by this legislation. Education programs to promote health will be supported.

Adult diseases begin in childhood. So, during our checkups of young children, we will be more able to talk about the hazards of childhood that impact life as we mature. Obesity with its complications is easy to conceptualize. 

He writes that psychological  impairments, some cancers, heart disease and osteoporosis all have origins in childhood. These will begin to be addressed at an earlier age, thus preventing later onset. He gives an example of how seat belt laws have reduced deaths of adolescents, and even though it is impossible to say which teens are alive today because of that, we know it is so. That is how it will be with other diseases, once prevention of adult diseases during childhood begins.

In addition he says that the Department of Health and Human Services, along with the American Academy of Pediatrics has developed a program called Bright Futures.

A program developed by the Department of Health and Human Services and the American Academy of Pediatrics called Bright Futures gives guidelines to pediatricians, health care educators and families about preventive aspects of environmental, psychological and physical health. Obesity, injury and violence prevention activities are included. (Yes, bullying recognition and prevention is, as well.) Positive aspects of child-rearing are emphasized in an effort to have every child obtain optimal mental, physical and social health and well-being. 

He closes by stating that most would agree that the prevention opportunities for children, whom he says represent the most important segment of our population. "Most would agree," he says.

Here is some more information about Obamacare as it relates to health care providers.