First tobacco warning came 50 years ago

Saturday marks the 50th anniversary of the first Surgeon General’s report on smoking and health. 

On Jan. 11, 1964, Surgeon General Luther Terry identified smoking as a cause of lung cancer in men, a likely cause of lung cancer in women and a likely cause of emphysema and chronic bronchitis - now known as chronic obstructive pulmonary disease.  

This was a clarion call in the fight against tobacco use, which is the leading cause of preventable death and illness today in the United States. 

Harold Wimmer, president and CEO of the American Lung Association, has called for a "recommitment by the nation to end tobacco use, and free us from the terrible toll it takes on our health and future. We can’t afford another 50 years.”

In 1964, the American Lung Association was known as the National Tuberculosis Association. And just as the TV series "Mad Men" reminds us, smoking cigarettes in the office, in restaurants, almost everywhere, was not only not shunned, it was condoned and almost encouraged. 

I remember in my own childhood home, where no one smoked, we had ash trays on every end table and coffee table. And when I started working as a newspaper reporter in the early 1970s, nearly all of my colleagues smoked. Newsrooms smelled like bars, and no one said a thing.

Today, with smoking bans in most buildings and restaurants, the stalwart few are banished to outdoor smoking areas from the heat of summer to the cold of winter.

In the meantime, the American Lung Association reminds us that tobacco use remains the nation’s number one cause of preventable death, killing 443,000 Americans and costing the nation $193 billion in health care expenditures and lost productivity each year. 

More than 8 million premature deaths have been avoided and life expectancy has been extended for men by more than two years and for women by more than 1.5 years over the past 50 years due in large part to tobacco control efforts such as increased tobacco taxes, smoke-free air laws, marketing and sales restrictions and cessation treatment programs, according to a study in the Journal of the American Medical Association.

“We have made significant progress against tobacco use over the past half century, but there are still nearly 44 million smokers nationwide, more than 3,000 kids pick up their first cigarette every day, and more than 443,000 people in America will die from smoking-related diseases this year," said John Seffrin, CEO of the American Cancer Society.

"The main reason: The unscrupulous tobacco industry continues to oppose tobacco control efforts, challenge proven tobacco control policies in court, manipulate products to get around existing regulations, produce and promote new tobacco products and spend billions of dollars on marketing to deceive the public and to addict more kids."

More about Affordable Care Act

The federal website created by the Affordable Care Act is working better, but it's not yet perfect. That's the gist of Monday's story in the Charlotte Observer. I wrote it after talking with six Charlotte-area experts -- three insurance agents and three "navigators" who have been trained to help enroll consumers into insurance plans in the online marketplace.

That assessment of the status of enrollment -- by the people who are using the website -- drew criticism from one reader who called it a "puff" piece and referred me to some other recent stories about the roll-out of the new health care law.

I'll pass them along for the benefit of others who may have missed them.

The New York Times' Robert Pear wrote a piece about how premiums may be low on the health exchange, but other insurance costs can be high.

On Sunday, Chris Wallace of Fox News interviewed Ezekiel Emanuel about President Barack Obama's promise that Americans could keep their doctors and their insurance plans.

I'll add a couple of my own suggestions:

A week ago, the Times also published an interesting piece about what went wrong with the website and how slowly administration officials responded to the catastrophe.

The Observer was among the first to report -- on Nov. 7 -- about the phenomenon of consumers receiving letters from insurance companies announcing cancellation of their current health plans and suggesting new plans that would cost much more. This was what started the outcry by those who claimed Obama had broken his promise that you could keep your current plan if you like it.

Former JAMA editor: Hospitals are dangerous places

Dr. George Lundberg, past editor of the Journal of the American Medical Association, has long been an advocate for patient safety.

In 1994, he published the seminal article by Dr. Lucian Leape, "Error in Medicine," and was criticized by AMA members who did not believe it and called for Lundberg's termination.

"Whose side are you on?" they asked.

Lundberg replied, "The side of science, truth, and all patients."

He recounts this experience in a new article for his blog, At Large At Medscape, at www.medscape.com.

Here's an excerpt:

"Hospitals are dangerous places. I no longer work in a hospital, and I try never to go to hospitals even to visit, unless, of course, I or my family were to become really sick and would obviously stand to benefit from hospitalization. I feel almost the same about surgicenters, free-standing emergency rooms, and urgent care facilities."

Myths about Obamacare

I spent an hour today listening to a webinar for journalists writing about the roll out of the Affordable Care Act, also known as Obamacare.

The speaker was Angie Holan, editor of PolitiFact, a publication that checks claims about all things political, including both critical and complimentary claims about the health care overhaul.

Earlier this year, PolitiFact published an article about 16 Myths About Obamacare.

A couple of highlights: There are no death panels. And Muslims are not excluded.

Cholesterol guidelines: More on statins

New guidelines about cholesterol levels and treatment were supposed to clear things up, but I'm just more confused.

Should I be taking statin drugs every day just because my LDL cholesterol number is high, which is "bad," and even though my HDL cholesterol is also high, which is "good."

Under these new guidelines, nearly half the U.S. population would be using statins to stave off heart attacks and strokes, according to Dr. Nortin Hadler, a UNC Chapel Hill professor of medicine and microbiology/immunology.

In a recent article for Scientific American, Hadler and his co-author remind us that these drugs are not without potential side effects and will offer no substantive benefits to many.

The article, entitled "How Clinical Guidelines Can Fail Both Doctors and Patients," says the authors of the new guidelines "were faced with robust data that demonstrates a correlation between cholesterol level and clinical outcomes over time. But despite the substantive science behind the connection, the correlation is weak. The guideline neglects to emphasize this fact."

Hadler, widely known for writing books such as "Worried Well" and "Citizen Patient," is skeptical about much of the treatment that medical doctors recommend today, including such broad prescribing of cholesterol-fighting drugs.

Here's is a link to the piece co-authored by Hadler and Dr. Robert McNutt, a former editor at the Journal of the American Medical Association  and the Journal of General Internal Medicine. McNutt is a professor of Medicine at the University of Wisconsin and Rush University Medical Center.

Remember to figure health care costs in retirement

How much money does it take to retire?

Partly, it will depend on your health.

The New York Times recently probed this question through the story of Jeff Strack, a 61-year-old Charlotte sales manager who is considering retirement.

Fidelity Investments estimates that the average married couple retiring this year at age 65 will need $220,000 to cover health costs throughout retirement, the Times story said. That figure is less than last year’s estimate of $240,000 because of lower-than-expected Medicare spending, Fidelity said. Also, people have cut back on medical care during the lackluster economy, and increases in payments to doctors and health plans have slowed under the Affordable Care Act. But the number is still daunting.

The Times also quotes the Employee Benefit Research Institute, which estimates that a married couple retiring in 2013 at age 65 with traditional Medicare (with a prescription drug plan, a generous supplemental plan and median drug costs) will need $255,000 to have a 90 percent chance of having enough money for health care costs throughout their retirement.

Maternity coverage: Men have babies, too

Under the Affordable Care Act, certain essential benefits are required to be provided by every health insurance plan, and that's why some people are getting letters from their insurers notifying them that less comprehensive insurance plans are being cancelled.

Many people in their 50s and 60s have been asking why they have to pay for benefits they don't need, such as maternity coverage.

Here's a story from the Los Angeles Times that tackles that question.