Paradigm shifts

The Supreme Court is primed in the next two weeks to deliver an opinion on Legal Marriage in America, and most pundits aver that they'll mostly duck the issue if possible.  But the sway of public opinion is clearly away from the 1996 Defense of Marriage Act.  The passage of California's 2008 Proposition 8, by a 52% majority, is now supported by just 36% of Californians while some 56% favor the right to same-sex marriage.  The Supreme Court, clearly set up to handle "Law", is persuadable by public opinion although they always try to make it appear otherwise.  Conservative forces still rule, but the court of public opinion is a strong one even against "Law".

Likewise, it'd be fun to imagine swaying public opinion on COPD.  For example, we might hope to shine some light on the intransigent stance of the AMA that COPD is only a smoker's disease.  My blog, breathecopd.blogspot.com, has presented some of the indicting evidence (at least to my mind) that suggests/hints/reveals/proves (pick your favorite) that something is amiss with the AMA 'answer' because lots of people who don't smoke die, in states where smoking is not prevalent, from COPD that shouldn't kill them there.

The simple truth is that smoking does kill -- it is not recommended by anyone to anyone -- but it is not the only, or even the most responsible, reason that people contract, and then die from, COPD (which stands for Chronic Obstructive Pulmonary Disease).  What is?  Fine grain particulate matter (which means less than 2.5 micron-sized particles) combined with a toxic molecular atmosphere (think sulfur dioxide from fossil-fuel power plants or nitrous oxides from automotive exhausts) is significantly implicated in studies from 1970 onward.  These multiple studies have been exhaustively re-analyzed and repeated because they were (a) so controversial, (b) so confrontative of the AMA thesis, and (c) so threatening to power plant operators.

The earliest "credible" publication, in the prestigious New England Journal of Medicine in 1993, is ONLY twenty years old.  The earliest citations trace, among others, to the Colorado Air Pollution Commission testimony in 1971 to the U.S. Senate Committee on Interior and Insular Affairs.  The most telling imagery appeared in the 2001 comparison of 805 Health Service Regions for America at the American Statistical Association annual meeting.  The fact that these multiple efforts, with remarkably consistent conclusions, are able to be ignored continues to amaze me.

And, unfortunately, the populace isn't polled about their attitude on this one -- people tend to give credence to their doctor, especially if faced with a dire diagnosis.  The Supreme Court, to my knowledge, has seldom been invoked to ask a professional group such as the AMA to change their wording and 'answers' for a general public.

Does this matter?  Well, unfortunately, YES, it does.  It affects the amount of money that the National Institutes of Health (NIH) dispenses for research into causes of disease, into money spent by EPA for monitoring of pollutants (whether for amounts, types and locales of emissions and 'clouds'), and into directed research on possible treatments.

And the answer, which I mentioned once before, is that AIDS, admittedly a worrisome disease, gets 350x as much money from NIH per death as does COPD.  Three hundred and fifty TIMES!.  So for every $300,000 spent on COPD per death (i.e. one researcher for a year), $100 Million is spent on AIDS per death.   Wild ratios, don't you think?  Insanity if the disease has much impact.

COPD has huge impact.  It affects an estimated 15,000,000 Americans.  It accounts for some $50 Trillion dollars of lost productivity in the American economic engine   And COPD kills.  It has no cure, no effective treatment (claims about Symbicort and Advair notwithstanding), and little research.  And it is the third largest killer of Americans, higher than strokes.

How do you mobilize public opinion?  Oprah and 60 Minutes come to mind.  Thoughts?