Blood Clots, Health policy

If everything is called a ‘crisis’ or ‘epidemic’, is anything?    What gets the most attention (and funding) isn’t what is most likely to kill you.

Crisis.  Epidemic.  Public health treat.   These words are routinely bandied about to describe a host of conditions that can kill you.  A quick Google news search of January 6, 2017 returned nearly 4 million results of headline making ‘epidemic’ articles; the top 4 topics:  opioids, flu, stress and gun violence.

Google news search results 1/6/17
Google news search results 1/6/17

Without reading a single word, intuition alone tells us that anything called ‘epidemic’ or ‘threat’ surely must be a bad thing and ‘crisis’ denotes an urgent peak of activity that should not be ignored.  The mental fear seed is planted.

headline-nytTo get the public to rally around a public health issue—and to accept why it warrants government effort and funding—the case if often made in terms of how many Americans are killed by

  • Example:  In December, the CDC announced that opiods now kill 52,000 Americans annually, prompting CDC Director Thomas Frieden to describe it as a “crisis” and an “epidemic”. “It is urgent and critical that we rescue people whose lives are at immediate risk,” wrote Frieden in a Fox News opinion piece, adding “More providers need to be trained and offer this evidence-based, life-saving treatment.”headline-rs
  • In November, when the health topic-du-jour was the HIV/AIDS epidemic on World AIDS Day, a giant red ribbon was hoisted up on the White House’s North Portico to draw attention to the condition attributed to 6,721 annual deaths. President Obama issued a video statement and proclamation calling upon people to  “rededicate ourselves to ending this epidemic once and for all”headline-medscape
  • In October, when the White House was illuminated all in pink for breast cancer awareness, it honored the 40,860 Americans who die annually from the condition because as a Presidential Proclamation said “too many are touched by the pain and hardship caused by breast cancer.”
  • Per the CDC, gun violence killed 10,945 Americans in 2014. In a January 7, 2016 op-ed for the New York Times, President Obama said  in the first sentence “The epidemic of gun violence in our country is a crisis.”

These highly visible PR efforts are fine and proper to rally the public’s attention so we all will agree ‘wow, that’s huge, let’s throw some funding towards fighting that’.   But there is a dark reality: for every potential cause of death which rises to the top of the public health PR playbook, it is at the cost of other preventable conditions which get no attention or funding, some which kill far greater scores of citizens.

Now, this next part involves fun with statistics and science, but hang with me a tad and you might not be so alarmed by the next fear-inducing health headline you read about what’s going to kill you.

Consider one condition:  venous thromboembolism (VTE).  Don’t let the name scare you…it’s just a big medical term for a blood clot that occurs in a vein.  It includes, among others, clots you may have heard about like deep vein thrombosis (DVT) and pulmonary embolism.

VTE is fairly common.  The Center for Disease Control and Prevention (CDC) says it impacts upwards of 900,000 Americans each year.

And it’s also deadly.  According to the Agency for Health Care Research and Quality—that would be the government agency who produces evidence to make healthcare safe and equitable—VTE is “the most common preventable cause of hospital death.”

Betcha didn’t know that factoid the last time you were lying in a hospital bed more worried about whether the doctor washed her hands than if a clot was growing in your leg.

CDC says VTE “can happen to anybody at any age and cause serious illness, disability, and in some cases, death.”

Egads!  Healthy, young people get clots too!

The Surgeon General way back in 2008 said VTE “represent a major public health problem, exacting a significant human and economic toll on the Nation.”


So three government sources have cast VTE as serious, deadly and common.  But where do VTE deaths rank among the conditions which have received the ‘crisis’, ‘epidemic’ and ‘threat’ labels?

VTE  is, in fact, the #3 cause of overall death in America—more than opiods, AIDS and gun violence combined. Yet it is excluded from benchmark federal vital statistics reports.  No reporting = no funding.

According to a 2015 CDC study, exact figures are difficult to come by because there is no national surveillance system for VTE.  In other words, since we’re not formally counting, we don’t know. But estimates from the various government funded researchers place VTE deaths anywhere from as few as 100,000 to as much as 600,000 annually.  The consensus estimate is around 300,000 preventable deaths.  If accurate, then VTE would be the #3 cause of overall death in America—more than opiods, AIDS and gun violence combined.  It’s even more than stroke, diabetes, Alzheimer’s disease, breast cancer and the flu.

If VTE were included, it would be the 3rd top cause of death
If VTE were included, it would be the 3rd top cause of death

Yet you’ll never see this acknowledged in any government-issued report on what’s killing Americans.  Why?  Because the benchmark CDC National Vital Statistic Report includes only 113 ‘select’ causes of death and VTE is not one of them.  Since VTE is excluded from the source dataset as a defined cause of death, it doesn’t make it into the final reporting.

The implications of VTE being excluded are enormous.  Public health policy is being made based upon bad data.  Funding decisions are based on reports which policymakers assume are a complete and accurate report of public health needs.  It isn’t.

As a result, VTE get $0 named funding allocation in the federal budget.  Zero. By comparison, a condition such as AIDS gets $31.7 billion.  The recently passed 21rst century’s cures act included $1 billion expressly for opiods.

This inequity must stop if we are to truly allocate limited resources in the most efficient way possible to address the preventable causes of death causing the greatest public harm. It is nothing short of a statistical abomination that the #3 cause of death in America is intentionally not reported in taxpayer funded reports to policymakers who determine the nation’s public health priorities.

While VTE is a common and serious condition, effective evidence-based prevention and treatment strategies exist.  Yet these life-saving measures cannot be implemented if both the public and clinicians aren’t adequately educated about them.  Knowledge alone cannot save lives without action; we can’t act upon that which is kept from us.

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