Here's an interesting news item (within the quotation marks) that was recently brought to my attention:

WASHINGTON (Reuters) - Even breathing in a little ozone at levels found in many areas is likely to kill some people prematurely, the National Research Council reported. The report recommends that the U.S. Environmental Protection Agency consider ozone-related mortality in any future ozone standards, and said local health authorities should keep this in mind when advising people to stay indoors on polluted days.

The report looks at ground-level ozone, a component of smog, as opposed to the ozone found in the high atmosphere, which protects the earth from ultraviolet rays. Ozone is a form of oxygen formed by the reaction of sunlight on air containing other pollutants such as hydrocarbons and nitrogen oxide. It is a powerful oxidizer, meaning it can damage cells in a process akin to rusting.

Ozone is known to cause respiratory problems and worsen heart disease. Children and the elderly are at special risk. The EPA asked the National Research Council, part of the advisory National Academies of Science, to analyze the link between ozone and early death.

A committee appointed by the council found that deaths related to ozone exposure are more likely among people with pre-existing diseases and other factors that could increase their susceptibility. But they said premature deaths are not limited to people who are already within a few days of dying. They looked at studies that linked deaths directly with variations in ozone levels, as well as animal studies that examined whether there was a biological explanation for ozone causing death.

The committee looked at studies done in several cities across the United States as well as in Canada and Europe. They took into account differences in temperature and humidity that may affect the ozone level. The EPA toughened standards for ozone pollution in March but outside experts complained its new requirements were more lax than the EPA's own scientists recommended. The new standards are 75 parts per billion in ambient air in the United States. The previous standard was 80 parts per billion. The EPA's Clean Air Scientific Advisory Committee recommended a standard of 60 to 70 parts per billion."

As it is difficult to conceive of wilderness medicine without the wilderness, I absolutely believe that environmental issues should be featured from time to time within this "Medicine for the Outdoors" blog. Indeed, it is well accepted that the outdoors is in need of the equivalent of medical attention. Certainly, for those of us who venture outdoors frequently, and who choose to exercise in urban locales in preparation for our wilderness excursions, air quality is a very high priority. It appears that accumulations of ozone at low altitude are increasing, and that they will have a deleterious effect upon human lungs, even in the absence of our immediate appreciation of pain, shortness of breath, or decreased exercise tolerance.

Knowledge about air quality on a day-to-day basis is becoming a necessity for persons who live, work, and play in the outdoors. It is crucial that these people, and those responsible for them, know what published ozone levels mean. The Environmental Protection Agency posts these data daily, with a U.S. map showing elevated-ozone areas, via http://airnow.gov/; these reports are also published on the weather pages of many daily newspapers. But how many of us look at them, and with what intensity are they reported? If people have access to this information, they can make informed choices about whether and how hard to exercise, how much time to spend outdoors, etc. Just as the heat index is a very useful guide for people to avoid being afflicted by heat illness during heat waves, the Air Quality Index (AQI) is essential for determining when it is safe to be exposed to atmospheric air. It is a sad fact of life, but a fact nonetheless, that AQI should be known and advertised to promote good health, and to avoid bad health.

With Baby Boomers aging and all Americans living longer lives, the question of long-term care is on a lot of people’s minds. You may be surprised to know that the average cost of one year in a nursing home now exceeds $70,000. Even more daunting, though, is the fact that the average net worth of 65 year olds today is only $110,000.

The U.S. continues to have the highest cost per capita – twice what other major industrialized countries spend – for health care, and has dropped to last among 19 countries on a measure of mortality amenable to medical care. So reports the Commonwealth Fund Commission on a High Performance Health System in its recent report, titled “Why Not the Best?” Overall performance did not improve in this country from 2006 to 2008, compared to gains recorded in other countries. Why not the best, indeed?

Just this month, on July 1st, Iowa went "smoke-free." That means no smoking in many public places, including restaurants, bars and even in one's own car in the parking lot of a school, as the Des Moines Register put it.

Those who wait, ever hopefully, for real health reform might want to take a deep breath and take stock of a few realities.

First, think about the fact that when the Democrats retook Congress, they tweaked but did not fundamentally change the lobbying rules that trade money for influence over policy. In fact, most contributors have now adjusted their contributions to favor the current, rather than the past, majority party. As it turns out, Democrats, like Republicans, are only too eager to allow special interests to trump the common interest, so long as the transactions fetch a good price.

By Mike Magee, MD

Have you ever been a patient in an emergency department?  If your visit to the ED didn’t require an admission, that’s good news.  After being told by the ED doctor that you could go home and armed you with discharge instructions, you most likely want to high tail it out of there as fast as you can.

By Mike Magee, MD

The emphasis on the obesity epidemic by health care experts has generated widespread media coverage.  Obesity across all age groups is rampant in America and has grave consequences for our health and longevity.  While this problem continues to be studied and multi disciplinary approaches towards interventions have been developed, a parallel microcosm within our culture has taken a separate approach towards the fostering of healthy eating habits and the appropriate use of food.

By Mike Magee, MD