Who needs a department of health?

30 September 2009 Who needs a department of health?




I correspond with people who fill much of the political spectra. Many of the people I fish with are Republicans or Libertarians. Others favor the mob becoming known as “tea baggers”

All of these folks will occasionally proclaim that some agency of the national government is illegal because it is not described in the 10th amendment to the Constitution. That’s the one the states’ rights and anti-tax mobs line up behind.

During the last several years, when we were watching the number of food-borne illnesses roll upward like an altimeter, one of my correspondents decided that the media was inflating the importance of the outbreaks. He chose to express the number of reported cases of salmonella as a percentage of the entire national population rather than focusing on the absolute number of reported cases. This correspondent is a salesman by trade and has no medical education. He’s capable of looking at statistical analysis of health related problems without necessarily understanding the nature of how the problem affects individuals and how such diseases spread.

For instance, where he sees an absolute number which represents a very small percent sample, I see an epidemiologic trail, often growing exponentially. I know that not all such infections are diagnosed and even fewer reported to epidemiologists.

My acquaintance believes that the free market will deal effectively with food-borne infections. I have no faith in the agri-business and food industry to take any action to provide safe, pathogen free food to the consumer that they are not required to take.

I have helped with epidemiologic tracking of two Hepatitis A outbreaks in S.W. MO. Both were spread by fast food employees.

One source case was a truck driver who acquired the disease at a “Rainbow Family” gathering. He infected a friend who infected several workers at the fast food shop where she worked. One co-worker carried the disease up the nearest US highway to another fast food shop in the next small town. The trucker spread it along another highway. Within a week of the 1st cross infection, the disease had spread to 200+ adults and was present in two school systems. The state health department had notified CDC and the tracking then became their responsibility. What I recall as crucial was the reluctance of the local fast food shops to help in tracking employees who were infected and the difficulty in obtaining the names of students and their parents from local doctors who were seeing the suspect and new patients. I eventually convinced the chief of medical staff to request that all hepatitis testing be directed to the hospital lab rather than drawn in the local clinic and sent to a commercial lab for analysis.

The second outbreak was centered in another small town. The source was the well in a religious compound/church. All the young women in the compound were required to work as fast food workers in surrounding towns. The church leader refused to allow any members/residents to be tested or to be given prophylactic gamma globulin.

These were both small outbreaks and I don’t recall any deaths related to them.



The most recent food-born outbreaks to make headlines involved spinach, peanuts, jalapenos, and recurrently, E. coli contaminated beef.

When I was young most counties required food service workers be tested for enteric pathogens before being allowed to work. Shrinking public health budgets, high turn-over among food workers, and lack of public concern have ended nearly all such programs. Now we test reactively.

My acquaintance and many like him feel that if CDC were eliminated, the states would somehow find the extra dollars to take over CDC functions. I might have a winning lottery ticket tomorrow, too. I never buy lottery tickets but there is a better chance I’ll go to bed a millionaire than that the states could fiscally and technically replace CDC.

I suggest that you make sure your immunizations are up to date before eating in a restaurant or fast food shop. Take the admonition to wash fresh produce seriously. The challenge of delivering safe food is becoming more difficult every day.

Also of concern is the growing reluctance to immunize children for childhood diseases among people who should know better.

The rush to blame immunizations for the increase in autism flies in the face of reason. Numerous studies have failed to find any connection between immunizations and autism.

I suspect that there is an effect of aging similar to that which causes an increase in the frequency of Down syndrome infants among older mothers. With social and cultural patterns tending toward more women giving birth later in life, and with better diagnostic markers and awareness of such disorders; it is likely that both factors lead to more children being diagnosed.

There is also reluctance to provide the vaccine for human papilloma virus to many young women. The vaccine may prevent death by cancer but parents allow such low risk side effects as fainting – not uncommon in young women receiving injections for other purposes- and pain to prevent protecting their daughters. My daughters are adults. But were they not, they’d have been vaccinated for HPV. They were vaccinated for all the usual childhood diseases. I had light cases of most of them. I was lucky.

Gloria and I were both in the early groups to receive the Salk polio vaccine. My mother volunteered at my grade school, showed up in her starched RN’s cap and white uniform to help immunize that batch of children. The last iron lung patient just died. Polio has been greatly reduced in frequency. But we are now faced with religious leaders who oppose polio immunization for one stupid reason or another.

So many brilliant researchers work so diligently to help mankind; only to have their gifts to humanity ignored or rejected for no valid reason.

They even reject such services because they are not defined in the 10th amendment by founders who were fully aware that the documents of government would need to be changed, carefully and thoughtfully in order to maintain a viable nation. The founders did not envision many things, telephones, satellite communication, germ theory, blood transfusion, and a thousand other things we take for granted. But they were flexible men, scholars of the enlightenment. Just as they knew a state religion was wrong, so would they, today, know that the time for states’ rights as perceived, even as late as 1865 had passed.

We are a single nation and we should behave as one. We have national passports. The time is now for national drivers’ licenses, national education standards, and a host of other changes that will be needed to keep this nation on track through the 21st century.

My fishing acquaintance, well he doesn’t know it, will never realize it; but he’s wrong.



Who needs a department of health, who needs CDC? We do, now more than ever.