Known Pieces of the Medical Science Puzzles - Part 3

Here is yet one more "forward looking" statement. An honorable one, that no one would really question.

"We are driving toward a 25 percent reduction in coronary heart disease, stroke and risk by the year 2010. This is an ambitious goal — but attainable. We’re seeing lives saved along the way, and we see the drive culminating in 2010 with an additional 192,000 lives saved in that year alone. » How are we getting there? » The answer begins with organizational effectiveness. We are focused on the areas of greatest impacton heart disease and stroke. We’re disciplined to say “NO” but willing to take prudent risks. " [Page 7, letter from CEO]

It's backed by their only other statement of science in the report.

"Research — discovering scientific truth ....... Scientific inquiry is the starting point for medical advances and improved patient treatment. Good science has the potential to reduce the physical and financial cost of heart disease and stroke. It also confirms our credibility as a voluntary health organization and is central to our professional and public education initiatives. That’s why we enthusiastically help investigators begin their careers while also supporting established researchers’ ongoing scientific projects. ...... We have a research program nationally and at each of our 12 affiliates. We gave 1,057 new awards in 2003–04, representing an investment of more than $130 million. We also continued to offer scientists and physicians unique professional growth opportunities through our 13 scientific councils and three interdisciplinary working groups." [Page 11]

The problem is that good science, no matter how good, has both risk and the need for self-criticism. Something that is lacking in the new AHA voluntary health organization. While there is a promotion on the amount they spent on ("invested" in) research, they neglect to state how much they didn't spend on research (40% of their income at a minimum). Their enthusism to "help investigators begin their careers while also supporting established researchers' ongoing scientfic projects" - is muted when a new funding formula, that meets all the concerns pointed out in the journal Science, is presented. This means that unless science research meets their standards, no funding is provided. If fact, the AHA no longer pro-actively seeks new scientists, but has place barriers to is now restricted reseach investment (just 20% of their income).

The question that needs to be asked, is one of the lacking self analysis. An analysis that will begin at the public website - where we see;

1. " Could you be the next face of stroke? Each year there are 700,000 new and recurrent strokes. For each of these 700,000 faces of stroke there are many more who feel the effect as a family member or friend of a stroke survivor. Find out now if you or a loved one is at risk for stroke and take action now."

2. Statistics from the AHA Heart and Stroke 2005 update;

a. "Yearly totals of out-of-hospital death (ICD/9 codes: 390–398, 402, and 404–429) in people ages 15 to 34 rose from 2,719 in 1989 to 3,000 in 1996. Alarmingly, though the numbers are very small, the death rate increased by 30 percent in young women. Death rates were also higher among young African Americans than among Caucasians. (Sudden Cardiac Death in U.S. Young Adults, 1989–96, CDC, 2001)" [Page 6]

b. "Age-adjusted death rates for Diseases of the Heart from 1990 to 1998 declined 15 percent for non-Hispanic whites, 11 percent for non-Hispanic blacks, 17 percent for Hispanics, 14 percent for Asian or Pacific Islanders and 8 percent for American Indians or Alaska Natives. In 1998 the rate for non-Hispanic blacks was 2.8 times the rate for Asian or Pacific Islanders. (Healthy People 2000, Statistical Notes, No. 23, CDC/NCHS, Jan. 2002)" [Page 6]

c. "Among adults age 18 and older, the prevalence of 2 or more risk factors increased from 23.6 percent in 1991 to 27.9 percent in 1999. It increased significantly for both men and women and for all race, ethnic, age and education groups. (BRFSS, CDC/NCHS, Arch Intern Med 2004;164:181–8)
— Among persons with 2 risk factors in 1999, the most common combination was HBP and high cholesterol (23.9 percent).
— Among those with 3 risk factors, the most common combination was HBP, high cholesterol and obesity (32.5 percent).
Among those with 4 risk factors, about 43 percent had the combination of HBP, high cholesterol, obesity and smoking. Another 40 percent had HBP, high
cholesterol, obesity and diabetes. These risk factor combinations were also the most common combinations in earlier years."

From this brief review of statistics, problems quickly arise - (a) supports (c), but (b) contradicts (c). The problem is that the statistics are confusing and "adjusted", but are showing a worsening problem, not the promoted improvement. What is actually occuring, will have to be studied further. To do this we will have to go to the source of statistics. While it appears that the statistics come from a variety of sources, there is a common source - the CDC. However, for now, the general picture provided by these pieces is a picture of serious problems and failure. This means that the puzzle of the AHA has to be added to the "to-do list".