The NIH budget it not $6k per capita per year, but rather just
$80 a year. The $6K a year is what we spend on US medical care based on the $80
in gov research. And a little more than that in private research.
It’s not formally the NIH’s job to prevent at least half
of accidents. There are 180,000 accidental deaths a year, for example, and
a sixth of these are due (each) to
automobiles, firearms, unintentional falls, poisonings
(usually accidental, but also includes suicides), and the rest are mainly
misadventures with alcohol poisoning (this doesn’t include injury), and other
drugs (both legal and illegal). Most of these come in contact the
medical system only in treatment, as there’s not much medicine can do about
prevention (the NHTSA handles autos, for example, and OSHA and other
agencies handle falls).
The other causes below are indeed skewed as to cause.
Most renal failure in the US is due to uncontrolled hypertension, but this
is listed separately. The NIH’s NIDDK likes that, as they get the
money and not the NHLBI. These alphabets are little institutes that make up
the National Institutes of Health (NIH). The NIDDK stands for National
Institute of Diabetes, Digestive, and Kidney diseases, and NHLBI is
National Heart, Lung and Blood Institute.
Hypertension contributes sizable chunks of stroke and heart
disease, also and the appropriate fraction of those deaths should be listed with
hypertension, not the final outcome of it. After all, we
don’t list people with cancer who die of pneumonia with “pneumonia” deaths, as
we realize the cancer caused the pneumonia and the NCI (cancer
institute) claims them, not the NIAID (infectious diseases). But we do a
lot of other stuff that is about as bad. Multifactorial diseases need to be
split up into the major causes we know about.
All of this is too bad, as hypertension is one of the
simplest, easiest, and cheapest medical conditions to treat and publicly
fund. The consequences of it, however are organ failures that are very
resistant to doing anything about.
Smoking is also ignored in this table. Isn’t that
odd? Some 90% of COPD is due to smoking, yet COPD is listed as a
separate cause of death (which keeps the NHLBI happy, again) instead of the
smoking that caused it. With significant contributions of smoking to cancer and
cardiovascular disease, ignored smoking causes 19% of total US deaths (!).
Alcohol-death, by contrast, is listed under the
poisoning and drug-related deaths, but the 19% of total US deaths due to
smoking are somehow neither considered drug-related OR accidents. Why? The NIH
has its own branch for alcoholism (NIAAA), and that may be part of the
reason. But there is no NIH institute for smoking!
Smoking certainly deserves its own category of causality,
since it causes (in the US) about 480,000 deaths a year, and on that number
alone properly should be the THIRD leading cause of death behind cancer and
heart disease (each about 600,000 per year). Worse still, if you subtract the
cancers and heart disease caused by smoking
(roughly 100,000 each) you get the three causes of death in the US all at
about the same number each (half a million a year). So the three leading causes
(non-smoking cancer, non-smoking cardiovascular (CV) disease, smoking and the
diseases it causes) are neck-and-neck in numbers, and the all other causes are
far behind these three leading horses of the death apocalypse.
These numbers (quite independent of aging) are necessary
to document correctly, as they tend to skew perception. For example, we all know
that some of the worst life expectancies in the US as in the states where
tobacco is grown, and in fact smoking explains 50% of the discrepancy in life
expectancy between the US North and South. But all of this discrepancy has been
blamed on racism, bad medical care, and other factors. An understanding that
tobacco actually does kill as many people every year as 1) non-tobacco related
CV disease and 2) non-tobacco related cancer, would mean that smoking-cessation
would receive top government research priority along with CV and cancer, and
e-cigarettes and the more powerful personal vaporizers (PVs) would get as
much funding as we spend on cancer and heart disease. We know how to stop most
smoking. An all out war is needed. It doesn’t happen.
Some of the same is true of dollars spent on fighting cancer
and heart disease. Cancer subtracts about 2 years from the US life span, while
cardiovascular diseases takes at least 10 (mostly because CV strikes in
middle age, while nearly all cancer strikes late). Yet we spend about equal
money on both. Even assuming both CV disease and cancer are equally hard
problems, we should get 5 times the bang per buck preventing CV disease. So we
should be spending more money there. We know that cancer is a hundred different
diseases anyway, while CV disease is only a few. That’s just another reason to
spend more research dollars on CV until we whip it.
What about aging? We’re all agreed that cancer is probably a
proxy for aging, and so is a lot of CV disease, and that if we slowed aging we
could slow the others at the same time. The problem with this argument is that
it fails to come to grips with the fact that aging is a really, really hard
problem, far harder than cancer. Clearly a lot of money spent gives little
program on aging. Since we do not know how much harder it is to slow aging
than to slow or cure cancer (only that we can sometimes do the latter, but not
the former in humans) we don’t really know what the correct ratio of money spent
But for the end-diseases discussed above, we’re clearly
not doing very well. Smoking cessation and hypertension control are the ugly
stepchildren of American medical care, neglected in research and in care, left
to the badly-paid primary care people (themselves ugly ducklings). While the
largest bucks of the $2.4 trillion medical care system, and even the
research dollars, are spent on scientists who study, and specialists
who treat the *consequences* of hypertension and smoking. Go