The End of the United States

The threat of admitting another patient stopped at 4 AM this morning and there is not much more work to be done on those we have already admitted. Usually I will use this time wastefully, cycling impulsively through several news websites. I stopped at the New England Journal of Medicine and an article about obstructive sleep apnea caught my eye, probably because I was thinking about one of my primary care patients with malignant hypertension, OSA who needs to be referred again since he lost his CPAP machine (this is a mask that delivers pressured air to the wearer to treat OSA). I was not suprised to see that 1 in 4 adult men and 1 in 10 adult women are diagnosed with OSA, and a Google search of CPAP machine prices shows a range of $500-$1000 for a new machine. The general math, made with plenty of assumptions and generalizations goes on to show that somewhere between ten to thirty billion dollars is likely to be spent on OSA, dealing with adult males only.

There are several different ways to look at this money. You can look at it as a great reason to invest in a CPAP company. You can look at how CPAP machines reduce the serious complications of congestive heart disease and save money by reducing hospitalizations. You can think about how this is billions of dollars funneled to a disease that is almost always caused by overeating and underexercising.

I don't think as a doctor I can stop people becoming obese. I think that we are only trained to treat its bountiful manifestations like obstructive sleep apnea. The influences to become obese are things I'm not sure we can stop. Food is constantly becoming better tasting and prices are cheaper. Transportation is becoming easier, jobs are less labor intensive. Passive entertainment is getting better and better with more immersive video games, more movies made every year, and more channels for any inclination someone would want. How is medical training equipped to deal with this? I don't really know.

This was fun to type up and put out there for, in theory, almost anyone in the world to read. If you read this and have some thoughts I would be happy to hear them at jpmax7 at g mail. -644 AM, 6/24/2013