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How Obama can learn from Bush's health-care missteps

All political affiliations aside, I hope Barack Obama is a better health-care president than the departed George W. Bush.

In October 2002, I received a packet of letters from the U.S. COPD Coalition, whose motto is "Helping Americans Breathe Free." COPD stands for Chronic Obstructive Pulmonary Disease, and it primarily includes two disorders: chronic bronchitis and emphysema.

The obstruction part of COPD develops when the airways of the lung become damaged and narrowed. All of us inhale by creating a vacuum, a negative pressure that sucks air into our lungs and naturally pulls these airways open. We exhale in reverse, by generating positive chest pressure that forces the inhaled air out; but this positive pressure can cause damaged airways to collapse, thereby obstructing the flow of air out of the lung.

Adding to the fray, in chronic bronchitis the cells lining these small airways secrete excessive amounts of mucus, causing further blockage. All of this leads to the hallmark symptoms of COPD: a chronic productive cough and progressive shortness of breath with exertion. It can be a slow, crippling process.


The packet proclaimed November 2002 as COPD Awareness Month and Nov. 20 as World COPD Day. It included a cover letter from President Bush, printed on yellow paper of an important thickness, and emblazoned with the White House seal. The president's personal signature was reproduced in sprawling Texas-sized script at the bottom.

Eliminating the banter promoting COPD Awareness Month, the president's letter included three important sentences. "Approximately 16 million Americans suffer from this progressive disease of the lungs that is associated mainly with chronic bronchitis and emphysema. Every year an estimated 100,000 individuals die from COPD….Through the National Heart, Lung, and Blood Institute at the NIH [National Institutes of Health], we are supporting research to better understand the causes of COPD, and to improve prevention and treatment."

That sounds good. Who wouldn't want to help 16 million people feel better? The problem was that the entire presidential message didn't mention smoking, which is the cause of 80 to 90 percent of COPD. Pollutants, occupational dust exposure, and conditions such as alpha1-antitrypsin deficiency, cystic fibrosis, bronchiectasis and bronchiolitis make up the balance of COPD causes.

Missing the 'S' word
One can excuse the president for his ignorance in this medical matter, but accompanying letters from GlaxoSmithKline and the U.S. COPD Coalition (whose partners include some very esteemed medical organizations) never once mentioned the "S" word. This is the kind of thing that gives the public the impression that the health-care industry is secretly in cahoots with the tobacco companies, because they're good for business.

When you get a signed, computer-generated letter from the White House, you feel as though it's your patriotic duty to respond. I and a friend of mine who is a University of Minnesota medical school professor drafted a reply to President Bush, thanking him for his letter and concern, but pointing out that he forgot to mention smoking.

In quasi-diplomatic terms, we reminded him that if he were really working to "bring hope to countless citizens, and create a brighter future for all Americans," that brightness wouldn't come from the orange glow of a burning cigarette. I can't remember the exact wording (I've asked the Secret Service for copies), but in an attempt to appeal to the president's ranching roots, we closed by bending on a rural adage. We pointed out that talking about COPD without talking about smoking is like closing the barn door after the horse has been shot: Anyway you look at it, it doesn't make any sense.

Three months later, in February 2003, we received a reply, wherein the presidential software system thanked us for our "kind words of support." President Bush said he was honored to lead our country, and that he was pleased with the progress the country was making "as we continue to reform domestic programs [but not smoking], secure our homeland, and work to extend peace and freedom around the world."

If President Obama is serious about reforming our health-care system, he won't send out letters that talk about highway fatalities but don't mention cars, that talk about hunting safety but don't mention guns or falling out of tree stands, that espouse wiping out diabetes but not its principal cause in adults — obesity.

Be it the U.S. COPD Coalition or President Obama, we'll need to stick to the old fishing axiom, "Ninety percent of the fish are in 10 percent of the water." We'll need to focus our health-care dollars on that 10 percent of the lake. We're down to just oars, and we don't have the resources to paddle all over.

Smoking, obesity and physical inactivity (in that order) are the leading causes of preventable deaths in our country. Let's start there.

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Comments (3)

Thank you for your post and your concern. Not sure who your secret doctor friend is, but it would seem obvious the S word you're referring to, is what we used to know as smog, not smoking. Keeping in mind, smog as a cause of death has been illegal since the 1950's. There are those who have taken the time to review the studies on smoking that wonder how the investigators chose Birmingham, AL, a top 10 polluted city, to do their studies. I hope you and your secret doctor friend will provide readers with your source for your conclusion, "Smoking, obesity and physical inactivity (in that order) are the leading causes of preventable deaths in our country. Let's start there."

Mr. Poe,
In this piece the "S" word is smoking (though smog certainly isn't healthy either).
The leading cause of preventable deaths comes from a CDC/JAMA report from 2004. Here are a couple of links:
http://jama.ama-assn.org/cgi/content/abstract/291/10/1238
http://www.cdc.gov/od/oc/media/pressrel/fs040309.htm
In the discussions relating to these pieces, the term "obesity" is used interchangeably with "poor nutrition."
Thank you for reading.
Craig Bowron MD

Also, to Mr. Poe,

Have you heard of heart disease, stroke and diabetes? Smoking, obesity and inactivity are each common risk factors associated with these 3 diseases. The aforementioned risk factors were not invented by Dr. Bowron, but are in fact, brought to you by The American Heart Association, The American Stroke Association and The National Institute of Diabetes and Digestive and Kidney Diseases.

The risk of heart disease itself, can well be reduced by quitting smoking and weight reduction. Certainly stroke as well. In fact, losing weight, exercising and quitting smoking can almost certainly control blood sugar to where medication is not necessary in some instances for people who have diabetes...

And what do you mean smog as a cause of death is illegal....take a look around, floating atop every suburban city in America is a fine, misty layer of air pollution, which does not seem to go away in spite of our efforts of going green. Furthermore, smog is one of the causes of Asthma and COPD. Asthma kills kids and COPD is actually the fourth leading cause of death in this country Mr. Bush, therefore was right about one thing, and that is the lethal statistics surrounding COPD. What he failed to mention is that smoking is it's #1 cause as Dr. Bowran so kindly acknowledged in his informative article.

All I can say, is, you must be a smoker and I would like to help you quit. Go to www.quitsmoking.about.com. There you will find a wealth of information, as well as guidance and support to help you quit smoking.

Kind Regards,

Deborah Trendel, RN, BSN, PHN
Guide to COPD
www.copd.about.com