public health – watercress words by Dr Aletha

5 steps to understand statistics on cancer, COVID-19, and other health risks

But numbers need context. Statistics help us understand what has happened before, what is happening now, and what may or will happen in the future. And not only what, but how and why. Then we can act to change the outcome. And sometimes those outcomes involve life or death.

Recently I reviewed a journal article about breast cancer, and as most medical articles do, it started with statistics. You’ve been hearing and reading a lot of statistics about COVID-19 the past year; every television news report about the pandemic starts with the numbers -how many new cases, how many total cases, how many vaccinated, and unfortunately how many deaths.

Before the pandemic you probably weren’t too familiar with the medical science of epidemiology which uses lots of statistics.

Epidemiology is the branch of medical science that investigates all the factors that determine the presence or absence of diseases and disorders.
National Institutes of Health

Health data doesn’t help us much if it just ends up in medical journals or textbooks. Physicians and other healthcare clinicians use it to counsel patients and make medical recommendations about preventive care, and diagnosis and treatments of diseases.

How doctors use statistics to help patients

You might say we use them as “talking points” to convince people to do things we believe will help them and to avoid doing things we think might hurt them. You’ve seen the same thing happen when public health officials make recommendations about COVID-19 suppression. So a doctor might

recommend you do something -get a mammogram or wear a mask

a mammogram image — a mammogram revealing a breast cancer image source- National Library of Medicine, Open-i

caution you against doing something -smoking cigarettes or gathering in crowds

No Smoking sign with pumpkins — Ask your doctor about ways to help you stop smoking.

encourage a behavior-wearing sunscreen or keeping 6 feet distance

all based on knowing the epidemiology of breast, lung, and skin cancers, and COVID-19 based on statistics.

Breast cancer incidence and risk

So getting back to the breast cancer article, I think many women overestimate their risk of getting and dying from breast cancer. According to the article, in the

past 5 years, 2.3 million cases of breast cancer

in women have been diagnosed in the United States (breast cancer does occur in men but the number is so low it does not change this total significantly)

The mortality rate for breast cancer is 20 deaths/100,000 women. The most recent number for deaths in 1 year is 42,000. (United States)

chance of developing breast cancer by age 70-National Cancer Institute — Source: National Cancer Institute (NCI)

The majority of women have NORMAL BRCA.

COVID-19 by comparison

Since the onset of the pandemic there are been

27 million cases of COVID-19 (February 2020-February 2021)

diagnosed in both men and women in the United states. (And many experts suspect that thousands of cases have gone unrecognized.)

The current mortality rate for COVID-19 is approximately 134/100,000 people. The current number of deaths in the past year is 460,000. (These numbers are compiled by Johns Hopkins University and are current as of the published day of this post)

WHO, the World Health Organization, reports that 2.3 million new cases of breast cancer occurred last year, while in less than a year there have been 105 million diagnosed cases of COVID-19.

Did these numbers surprise you?

Did they cause you to change your mind about something?

Will you change behavior based on these numbers?

What does it matter?

Healthcare professionals use statistics to understand and predict health risks, then counsel their patients about maintaining health and preventing disease, disability, and early death. One way they do so is with screening tests, like mammograms, to detect early breast cancer when it is easier to treat. successfully.

a female physician talking to a male patient

Public health professionals do the same thing, but apply the knowledge to large populations of people, such as infants, children, adolescents, pregnant women, or the elderly. And sometimes to an entire neighborhood, town, state, or nation, as we’ve seen happen with the SARS-CoV-2 pandemic, recommending masking, social distancing, handwashing, and vaccination.

But when health, especially public health, becomes politicized these “talking points” can be used to

inflame rather than inform
manipulate not motivate
confuse rather than comfort
cause panic instead of instilling peace.

And this is more likely to happen when we don’t understand the statistics and reasoning behind the recommendations. I believe much of the misinformation that has been shared on social media is not intentional, but from misunderstanding of the message that was intended.

The Data Detective: Ten Easy Rules to Make Sense of Statistics

This is the title of a new book by Financial Times columnist Tim Harford in which he tries to answer the question

Why do we believe what isn’t true?

In an interview by Erica Pandey, Harford encourages us to be curious and open-minded, and ask the right questions with a desire to understand. When you read or hear some new and perhaps disturbing information about the pandemic, cancer, or any other hot topic, ask yourself if the teller is trying to make you smarter or trying to win an argument. (AXIOS Today podcast February 5, 2021)

(This is an affiliate link, meaning it may pay a commission to this blog is a sale occurs.)

If we can toss aside our fears and learn to approach them clearly—understanding how our own preconceptions lead us astray—statistics can point to ways we can live better and work smarter.
The Data Detective listing on Amazon

My 5 guidelines for making sense of information

RECOGNIZE any bias, inconsistencies, contradictions; does it confirm what you already know? If not, why not? What is it trying to make you believe?
RESEARCH other sources and other media, what do they say about the topic, and are they credible ?
REVIEW all the information you find trustworthy; do you have all the information you need to make a conclusion?
RECONSIDER when new information becomes available or circumstances change; if significant, you may need to start the process all over.
REMEMBER almost everything is subject to reinterpretation; as the numbers change, so may the conclusions. Statistics give us a chance to learn and understand, but aren’t the best way to prove a point or to win arguments .

final thoughts-Know Your Chances

(an affiliate link)

How to see through the hype in medical news, ads, and public service announcements

be a healthy skeptic. That doesn’t mean you have to be a cynic, simply disbelieving all the health messages you hear.
Instead, it means approaching messages critically: looking out for—and seeing through—common tactics used to exaggerate the importance of health problems or actions you can take to address them.
These tactics include emphasizing unimportant outcomes, avoiding numbers, or presenting statistics in ways that make them seem more important than they really are.
Know Your Chances: Understanding Health Statistics, by Steven, Woloshin, Lisa M. Schwartz, and H. Gilbert Welch. © 2008 by the Regenets of the University of California. Published by the University of California Press. (Read free at this link)

sharing the HEART of healthcare statistics

Find up-to-date information about breast cancer from The American Cancer Society and in Breast Cancer Clear & Simple (an affiliate link)

Fighting disease at the CDC-from malaria to COVID-19

Our country and the world are confronting a new and serious health challenge which just a few weeks ago we knew little about but are learning more every day- the COVID-19 disease outbreak. This crisis presents a unique opportunity for us as citizens to watch the private and the public healthcare sectors work together to control and contain the spread of this disease.

Since the start of 2020, you’ve probably heard and learned more acronyms than ever before. Medicine, chemistry, computer science, the military, and government use acronyms- abbreviations formed from the initial letters of words to create new words. Acronyms make it easier to write and say complicated names. But in medicine, sometimes they represent serious and dangerous diseases-

MI-myocardial infarction, heart attack
CVA-cerebrovascular accident, stroke
DM-diabetes mellitus
HIV-AIDS-human immunodeficiency virus-acquired immunodeficiency syndrome
SARS-CoV-sudden acute respiratory syndrome (due to coronavirus )
SARS-CoV-2 sudden acute respiratory syndrome(due to coronavirus 2)

SARS-CoV-2

In an online article on March 3, 2020, three physicians from Johns Hopkins School of Public Health reported a December 2019 outbreak of viral pneumonia in Wuhan China, a city of several million people, a place I had never heard of. Scientists determined they were infected with a novel (new) coronavirus which they called SARS-CoV-2, which was soon shortened to COVID-19-corona virus disease 2019. The World Health Organization, WHO, declared this a Public Health Emergency of International Concern. The authors concluded

it is clear now that COVID-19 will spread widely in the world, including in the U.S….health care and public health systems need to move quickly forward in their efforts to be ready to confront this disease around the country
Drs. Adalja, Toner, Inglesby,March 3, 2020, JAMA, The Journal of the American Medical Association

symptoms of COVID-19-fever, cough, shortness of breath

I don’t remember if I had seen that article, but I had been reading about COVID-19 on several medical websites. On March 5, 2020 I spoke at my local DAR–Daughters of the American Revolution-meeting as chair of the Women’s Issues Committee, which focuses on family, career, and health. By mid April when I looked back at my notes , I was stunned to realize how much had happened and how much our lives had changed in a mere 6 weeks. Here’s what I reported to the group that day.

What I knew about COVID-19

The public health response is coordinated by President Donald Trump –POTUS-and the U.S. Department of Health and Human Services (HHS). The Secretary of Health and Human Services, Alex Azar ,serves in the President’s cabinet.

avoid contact with sick people, do not touch your eyes, nose, mouth; wash hand often

“effective Health and Human Services”

The mission of the U.S. Department of Health and Human Services (HHS) is

“to enhance and protect the health and well-being of all Americans by providing for effective health and human services and by advances in the sciences underlying medicine, public health, and social services.”

The Constitution doesn’t mention health or medical care but maybe the department’s creation was inspired by the preamble to the Constitution which pledges to “promote the general welfare.”

In terms of spending, HHS is now the largest government agency, surpassing even the Department of Defense-DoD. The 2121 budget proposal includes $94.5 billion in discretionary funds and $1.3 trillion in mandatory funding for HHS. (This was prior to the 2020 COVID-19 response.)

This HHS budget funds multiple agencies including

CMS- Centers for Medicare and Medicaid
ACA- the Health Insurance Marketplace for the Affordable Care Act
FDA-the Food and Drug Administration
IHS- the Indian Health Service
NIH, the National Institutes of Health, which includes the National Institute of Allergy and Infectious Disease (NIAID) directed by Dr. Anthony Fauci
Head Start and other services to children
Services to disabled and elderly people
Mental health and substance abuse programs
USPHS- the US Public Health Service including the Surgeon General (OSG)
CDC-the Centers for Disease Control and Prevention

What is the CDC ?

The CDC’s mission is

“to work 24/7 to protect America from health, safety and security threats, both foreign and in the U.S.”

The Communicable Disease Center (CDC) opened on one floor of a small building in Atlanta Georgia in 1946, with a simple yet challenging mission: prevent malaria from spreading across the nation, from the southern states, the heart of the malaria zone.

With a budget of $10 million and 400 employees, the agency acquired trucks, sprayers, and shovels to wage war on mosquitoes, whose bite transmits malaria.

CDC Founder Dr. Joseph Mountin advocated for public health issues and for CDC to extend its responsibilities to other communicable diseases. He was a visionary public health leader with high hopes for this small and insignificant branch of the Public Health Service.

This image was created by Centers for Disease Control and Prevention (CDC) Public Health Advisor, Cleopatra Adedeji, RRT, BSRT, while the CDC’s 2014, Domestic Training Course for healthcare workers was underway. Outside the mock Ebola Treatment Unit (ETU), under the tutelage of CDC Medical Officer, Dr. Satish Pillai (center, behind gurney), and lead by Epidemic Intelligence Service (EIS) Officer, Dr. Mary Choi, this group of three students, was in the process of assembling, and properly disinfecting a transport gurney they had used in this simulated Ebola patient care scenario.
**Additional Information:**
The 3-day courses took place at the U.S. Federal Emergency Management Agency Center for Domestic Preparedness in Anniston, Alabama. Training participants included physicians, nurses and other providers who were to be deployed to countries affected by the Ebola epidemic, thereby, providing direct patient care. “The primary purpose of the course was to ensure that clinicians intending to provide medical care to patients with Ebola have sufficient knowledge of the disease, and its transmission routes in order to work safely and efficiently in a well-designed ETU.” CDC/ Cleopatra Adedeji, RRT, BSRT, public domain

In 1947, CDC paid Emory University $10 for 15 acres of land in Atlanta that now serves as CDC headquarters. Since then, its focus has expanded to include all communicable diseases, safety, traveler’s health, environmental health issues, prevention of chronic diseases, and to provide practical help to state health departments when requested.

The CDC and COVID-19

Since February 15, 2020, led by Director Dr. Robert Redfield, the CDC has been studying, monitoring, researching, and reporting the status of the SARS-CoV-2 virus and the disease that apparently first entered the U.S. in January 2020, COVID-19. Both the general public, healthcare professionals, and government officials depend on the agency for up-to-date and accurate information.

Knowledge about COVID-19 grows and changes daily, and what we thought was true yesterday may be far different tomorrow. I have never seen the medical community acquire and apply knowledge about a disease process so quickly in the 42 years I have been in healthcare.

Dr. Mountin and the other professionals who started out with the goal of eliminating the threat of malaria likely never imagined that their future colleagues would face such a formidable foe. The $10 spent on a plot of land in Atlanta is proving to be one of the best investments our country has made.