Tuesday, May 15, 2007

Self-inflicted diseases are ignored

PLoS Medicine has an essay about chronic obstructive pulmonary disease (COPD) and how it's becoming more widespread.

Chronic Obstructive Pulmonary Disease: A Growing but Neglected Global Epidemic

Chronic obstructive pulmonary disease (COPD) is a major and increasing global health epidemic that has received insufficient attention from the health-care profession, governments, and the pharmaceutical industry. Urgent action is now required to recognise the disease, predicted to soon become one of the major causes of death and disability, and to develop more effective prevention and treatment strategies.

COPD is one of the major causes of death (fifth commonest cause of death among diseases) worldwide, and is the only disease that's a common cause of death, that has increased it's rate in the US over the last 40 years (HIV/AIDS haven't been along for that long, so it cannot be compared to COPD).

All of this would make it worth mentioning, but what really caught my attention was the reason why COPD has gotten so little attention from researchers and doctors.

Despite growing recognition as an important international health problem, COPD has suffered neglect from clinicians, researchers, and the pharmaceutical industry [8]. This is largely because COPD is viewed as self-inflicted (by smoking) and also because the underlying disease process is generally perceived to be irreversible.

HIV/AIDS is also generally perceived to be irreversible, yet a lot fo research goes into that disease, so it would seem that there is more to it than this. However, I think the general point is probably pretty correct. Just look at how the media talk about other "life-style" related diseases - it's quite clear that there is less calls for research into diseases that are perceived as being self-inflicted. See how HIV/AIDS was ignored in the US while the victims were predominatly homosexual - something many still think of as a choice - yet there was a call for a cure, when it began to spread among heterosexuals.

Ignoring the moral objects for a moment, I find it irresponsible to ignore diseases when they are only related to a given group. Given what we know about the behaviour and evolution of diseases, we know that any disease that't limited to a group of people, might very well start spreading to other people at any time.

Hopefully diseases like COPD will get more attention in the future, and less weight will be put on how "self-inflicted" they are.

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Blogger Kaethe said...

Careful. Big caution sign should go up when ever you see someone use the words "growing epidemic"unless referring to an infectious disease.

is the only disease that's a common cause of death, that has increased it's rate in the US over the last 40 years

Only because we succeeded in decreasing deaths from infectious diseases, heart attacks, cancer, and stroke. As long as we keep knocking down the rates of the top killers, others will be moving up the list. No matter how long we keep people alive they will still die of diseases of age: guess who dies of COPD? The elderly.

I'll never deny the tendency to blame the victim, but WHO has a number of COPD-related efforts, and pharmaceuticals companies are quite keen to develop medications for chronic conditions, so the accusation that it is neglected is odd.

From the CDC factsheet

In the United States, tobacco use is a key factor in the development and progression of COPD, but asthma, exposure to air pollutants in the home and workplace, genetic factors, and respiratory infections also play a role. In the developing world, indoor air quality is thought to play a larger role in the development and progression of COPD than it does in the United States.

Simply, COPD is not one disease that can be definitively diagnosed with a blood test. It is a name given to decreased function which can be caused by a number of diseases and environmental factors, of which only one is possibly self-inflicted. A miner dying of black lung, for example, would be diagnosed with COPD.

This particular article is as needlessly overwrought as all the articles about the obesity epidemic or the autism epidemic. I don't doubt that the writer would like to see more attention focused on his research, but as research, his essay bites.

May 16, 2007 6:57 PM  
Blogger Kristjan Wager said...

Interesting Kaethe. I took the article at face value, and it seems I was wrong to do so.

My general points still stand, but they might not really be relevant after all, since I addressed the behaviour described in the essay.

May 16, 2007 7:44 PM  
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November 27, 2015 3:28 AM  

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