Currently Happening Presently Now: PUBLIC HEALTH

Low birth weight in the United States
Am J Clin Nutr February 2007 vol. 85 no. 2 584S-590S.

<sub>Pregnancy outcomes in the United States and other developed countries are considerably better than those in many developing countries. However, adverse pregnancy outcomes are generally more common in the United States than in other developed countries. Low-birth-weight infants, born after a preterm birth or secondary to intrauterine growth restriction, account for much of the increased morbidity, mortality, and cost. Wide disparities exist in both preterm birth and growth restriction among different population groups. Poor and black women, for example, have twice the preterm birth rate and higher rates of growth restriction than do most other women. Low birth weight in general is thought to place the infant at greater risk of later adult chronic medical conditions, such as diabetes, hypertension, and heart disease. Of interest, maternal thinness is a strong predictor of both preterm birth and fetal growth restriction. However, in the United States, several nutritional interventions, including high-protein diets, caloric supplementation, calcium and iron supplementation, and various other vitamin and mineral supplementations, have not generally reduced preterm birth or growth restriction. Bacterial intrauterine infections play an important role in the etiology of the earliest preterm births, but, at least to date, antibiotic treatment either before labor for risk factors such as bacterial vaginosis or during preterm labor have not consistently reduced the preterm birth rate. Most interventions have failed to reduce preterm birth or growth restriction. The substantial improvement in newborn survival in the United States over the past several decades is mostly due to better access to improved neonatal care for low-birth-weight infants.

"For unknown reasons (!), belonging to various racial and ethnic groups is very strongly associated with both preterm birth and growth restriction. For example, in the United States, black women are approximately twice as likely to have a preterm birth and are 3 to 4 times as likely to have a very early preterm birth as women are from most other racial or ethnic groups. East Asian women typically have low rates of preterm birth, as do Hispanic women. Women from South Asia and especially the Indian subcontinent have very high rates of fetal growth restriction and low birth weight.Among all the various groups living in the United States,the very high preterm birth rate in black women stands out and to this date remains mostly unexplained.

Hhhhmmm.</sub>

The Black Stork : Eugenics and the Death of "Defective" Babies in American Medicine and Motion Pictures Since 1915
By Martin S. Pernick, 1996, pp. 175-76.

_{"It is regard to goals that this study finds the most important continuities between past and present. First, the specific values that converted past eugenics into a rationale for genocide are still alive and killing...The effort to keep current genetics and euthanasia 'objective' is in part a well-meaning recognition of the continued danger from such lethal values...this attempt to keep science value-free may be recreating one of the most dangerous aspects of early eugenics.
Defining genetic health and disease can never be a purely objective technical question, because defining sickness and health always requires an evaluative judgment... 
Thus trying to make any medical science 'value-free' can never succeed; explicit or implicit values will always be needed. Pretending that medicine can be purely objective only repeats the most flawed aspect of...eugenics. It permits subjective values to claim the moral authority of scientific truth, while delegitimating the kinds of political and ethical scrutiny that alone can enable a culture to debate and evaluate these value judgments intelligently."}

M S Pernick.  Eugenics and public health in American history.
American Journal of Public Health November 1997: Vol. 87, No. 11, pp. 1767-1772.

<sub>Supporters of eugenics, the powerful early 20th-century movement for improving human heredity, often attacked that era's dramatic improvements in public health and medicine for preserving the lives of people they considered hereditarily unfit. Eugenics and public health also battled over whether heredity played a significant role in infectious diseases. However, American public health and eugenics had much in common as well. Eugenic methods often were modeled on the infection control techniques of public health. The goals, values, and concepts of disease of these two movements also often overlapped. This paper sketches some of the key similarities and differences between eugenics and public health in the United States, and it examines how their relationship was shaped by the interaction of science and culture. The results demonstrate that eugenics was not an isolated movement whose significance is confined to the histories of genetics and pseudoscience, but was instead an important and cautionary part of past public health and a general medical history as well.

Eugenicists urged the "segregation" of defectives in institutions, isolating them from society and from members of the opposite sex to prevent their reproduction and the consequent spread of hereditary disease. Such eugenic segregation directly echoed the centuries-old effort to stop the spread of infections through quarantine. The term segregation itself first was used medically in the mid-19th century to mean "selective isolation" or "quarantine." Infectious germs and bad germ plasm could also be stopped from spreading by a new method called sterilization. In both eugenics and bacteriology, to sterilize meant to eliminate the agents that reproduced disease.

Forcible sterilization of the unfit likewise drew on both the values and the example of infection control laws. The main legal precedent cited in Buck v Bell, the 1927 Supreme Court decision upholding involuntary eugenic sterilization, was Jacobson v Massachusetts, the 1905 case allowing mandatory smallpox vaccination. As Justice Oliver Wendell Holmes explained in Buck v Bell, 'The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian."In making this connection, the Court identified three key values that compulsory sterilization shared with vaccination laws. First, preventing disease was better than coping with its consequences. Second, the collective well-being of society could outweigh the interests of individuals who posed an alleged health menace. And third, state power could compel compliance with health measures when persuasion alone appeared inadequate.</sub>

In the name of public health--Nazi racial hygiene
The New England Journal of Medicine [2004, 351(5):417-420]

_{In 1946 and 1947, the American military tribunal at Nuremberg tried 20 German physicians and 3 lay accomplices for medical experiments using prisoners of Nazi concentration camps. But most of the German scientists and physicians who had helped to legitimize and implement Nazi racial hygiene policies were not prosecuted or called to a moral accounting of any kind, and many went on with their careers.}

Allan M. Brandt. 1978. Racism and research: The case of the Tuskegee Syphilis study. The Hastings Center Report 8(6): 21-29.

<sub>In 1932 the U.S. Public Health Service (USPHS) initiated an experiment in Macon County, Alabama, to determine the natural course of untreated, latent syphilis in black males. The test comprised 400 syphilitic men, as well as 200 uninfected men who served as controls. The first published report of the study appeared in 1936 with subsequent papers issued every four to six years, through the 1960s. When penicillin became widely available by the early 1950s as the preferred treatment for syphilis, the men did not receive therapy. In fact on several occasions, the USPHS actually sought to prevent treatment. Moreover, a committee at the federally operated Center for Disease Control decided in 1969 that the study should be continued. Only in 1972, when accounts of the study first appeared in the national press, did the Department of Health, Education and Welfare halt the experiment. At that time seventy-four of the test subjects were still alive; at least twenty-eight, but perhaps more than 100, had died directly from advanced syphilitic lesions.
 In August 1972, HEW appointed an investigatory panel which issued a report the following year. The panel found the study to have been "ethically unjustified," and argued that penicillin should have been provided to the men.

This article attempts to place the Tuskegee Study in a historical context and to assess its ethical implications. Despite the media attention which the study received, the HEW Final Report, and the criticism expressed by several professional organizations, the experiment has been largely misunderstood. The most basic questions of how the study was undertaken in the first place and why it continued for forty years were never addressed by the HEW investigation. Moreover, the panel misconstrued the nature of the experiment, failing to consult important documents available at the National Archives which bear significantly on its ethical assessment. Only by examining the specific ways in which values are engaged in scientific research can the study be understood.</sub>

Brown ER., Public health in imperialism: early Rockefeller programs at home and  abroad.
Am J Public Health. 1976 Sep;66(9):897-903.

<sub>The professional public health field today owes much of its growth and development during the twentieth century to the needs of colonialism and neo-colonialism. Imperialist powers were severely hampered by disease. Tropical diseases decimated the ranks of "mother country" personnel and reduced the efficiency of native populations as imperialism's workforce.

By examining these programs-in particular, the Rockefeller Sanitary Commission for the Eradication of Hookworm Disease and the Rockefeller Foundation's International Health Commission-in the light of other programs and interests of the foundations and their trustees and directors, we can see their connection to early twentieth century imperialism. We can also better understand the interests that led the Rockefeller philanthropies to help professionalize public health work, encouraging the formation of local public health departments, the hiring of full-time public health officers, and the funding of the first schools of public health in the U.S. as well as others abroad.

The Rockefeller programs, however, did not concern themselves with workers's physical productivity alone. They were also intended to reduce the cultural resistance of "backward" and "uncivilized" peoples to the domination of their lives and societies by industrial capitalism. Whether in the jungles of Latin America or the isolated islands of the Philippines, the Rockefeller Foundation discovered what the missionaries before them understood: that medicine was an almost irresistible force in the colonization of nonindustrialized countries.</sub>

A review of the evidence concerning the impact of medical measures on recent mortality and morbidity in the United States
Int J Health Serv. 1989;19(2):181-208.

A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care
Journal of Patient Safety: September 2013 - Volume 9 - Issue 3 - p 122–128.

<sub>Objectives: Based on 1984 data developed from reviews of medical records of patients treated in New York hospitals, the Institute of Medicine estimated that up to 98,000 Americans die each year from medical errors. The basis of this estimate is nearly 3 decades old; herein, an updated estimate is developed from modern studies published from 2008 to 2011.

Methods: A literature review identified 4 limited studies that used primarily the Global Trigger Tool to flag specific evidence in medical records, such as medication stop orders or abnormal laboratory results, which point to an adverse event that may have harmed a patient. Ultimately, a physician must concur on the findings of an adverse event and then classify the severity of patient harm.

Results: Using a weighted average of the 4 studies, a lower limit of 210,000 deaths per year was associated with preventable harm in hospitals. Given limitations in the search capability of the Global Trigger Tool and the incompleteness of medical records on which the Tool depends, the true number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year. Serious harm seems to be 10- to 20-fold more common than lethal harm.

Conclusions: The epidemic of patient harm in hospitals must be taken more seriously if it is to be curtailed. Fully engaging patients and their advocates during hospital care, systematically seeking the patients’ voice in identifying harms, transparent accountability for harm, and intentional correction of root causes of harm will be necessary to accomplish this goal.</sub>

!!!!!!

Some perspective is in order here.
According to the "Authoritative Source" of the CDC:

<sub>Leading Causes of Death
^{(Data are for the U.S. and are final 2010 data)
Number of deaths for leading causes of death}

Heart disease: 597,689
Cancer: 574,743
"PATIENT HARM": 400,000+  (This should be here!)
Chronic lower respiratory diseases: 138,080
Stroke (cerebrovascular diseases): 129,476</sub>

How many are aware:
One, that this is even a problem;
Two, that the numbers could be so high?
Think about how many people that is.
Is it really happening?