Dear Politicians and Elected Officials,
Our oceans are in peril. There is too much plastic in them. Plastic suffocates and strangles marine wildlife who consume it, thinking it is food.
The oceans have far too many chemicals in them; recklessly dumped with abandon.
We have removed and/or finned too many sharks and fish. Ecosystems are in danger. We are testing the oceans' ability to sustain life.
Carbon, methane, and nitrous oxide emissions are released into the atmosphere daily from transportation, energy, agriculture, and animal agriculture. These emissions not only affect global temperatures and the atmosphere, they also affect the pH of the oceans, and the ecosystems that existed long before humans came along.
Look, I know you're busy working on other important issues. I know you've been working on issues of "green energy," endangered species protections, and transportation improvements. But, what about the oceans? Over the years, most of your focus has been directed towards land, land animals, and fossil fuels.
I get it, we live on land, we understand land. Yet, even here, we are "missing the boat." After all, there are only 25,000 Rhinos left, and elephants are brutally murdered every 15 minutes! I get it. Something's gotta give.
But, moving forward, I do ask; please spend as much time and effort on our oceans; rather, more time! They sure do seem to get the short shrift.
FACTS ABOUT OUR OCEANS:
Did you know that our oceans cover 70% of the earths surface? Did you know that the oceans account for 90% of all habitable space on earth? Yet, did you know that less than 1% of our oceans are currently protected?
The oceans absorb nearly 50% of the carbon we emit, and produce nearly 50% of Earth's oxygen.
The oceans give us air to breathe, and water to drink (though indirectly.) We have removed more than 80-90% of our large fish. Many whale populations remain threatened and still hunted by some (Japan, Iceland, Norway, Faroe Islands).
We have dumped agricultural wastes, chemicals, and pollution into our oceans, creating dead zones where marine-life cannot live! These chemicals have
also affected marine-animals ability to reproduce!
Instead, we need to spend more effort, time, resources, and conservation dollars to protect this most vital of ALL resources. We need to protect the
oceans; or, at the very least, think about them and act on them, as much as we do our lands and the animals that live there. Protecting only 1% of our
oceans is NOT enough.
In fact, we need to do BETTER! Both on land, and in the oceans!
We lose more and more species every year. There will be more plastic than fish in the oceans by 2048.
The reason I set out to write this letter to you is because, in 2048, my son will be my current age. But I fear the planet will not look as it does today, at my current age.
I fear we will lose the life-support system that our oceans provide us. I fear we will lose too many species.
WHAT CAN YOU DO?
As an elected official, you can work towards policies and guidelines that protect our oceans by:
If we want the oceans to survive and protect the livelihoods of the billions of people who depend on them for food, money, life, and climate stability, you, our elected officials, must do more to help now.
I would gladly fill your seat, in congress or the senate or in local government, and work on plans to save our oceans, and our planet. But, since it will likely take me many years to get into your seat, I implore you, do something, do it now. Protect our oceans and wildlife. Don't wait another moment. That moment may be too late.
Thank you, and respectfully,
Dana Ellis Hunnes PhD, MPH, RD
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Semipalmated sandpipers
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This story originally appeared on the Conversation and is reproduced here with permission.
A report published in May from researchers at the Johns Hopkins School of Medicine claims that medical errors are the third leading cause of death in the U.S., behind only heart disease and cancer.
According to the researchers, medical errors account for 251,454 U.S. deaths each year—and they regard this figure as an underestimate.
That's the sort of finding that makes headlines. Indeed, you might have read about this report in the newspaper or even seen it reported on the evening news.
But as we'll argue, the methods the researchers used to draw this conclusion are flawed, and that means the conclusion that medical error is the third leading cause of death is highly questionable.
When a report like this gets broad media coverage, it can foster unwarranted mistrust of medicine, which could prevent people from seeking needed care—a concern for everyone who takes care of patients.
A medical error can be defined as a decision or action that results in patient harm, one that experts agree should have been made differently given the information available at the time. But applying such a definition in reviewing patient records is fraught with difficulty.
The study's authors argue that death certificates should be redesigned to recognize that more deaths are attributable to medical error. That's a reasonable suggestion. But the implication of many media reports that these findings prove hundreds of thousands of people are dying each year due to medical errors is highly problematic.
First, the authors of the Johns Hopkins report did not collect any new data. Instead, they based their conclusions on studies performed by other authors. There is nothing wrong with that, in principle.
But in this case, the results are highly misleading because they are based on large extrapolations from very small data sets: The authors based their conclusions on four studies that included a total of only 35 deaths attributable to medical error—out of nearly 4,000 hospital admissions. Extrapolating from 35 deaths to a population of 320 million is quite a leap.
In addition, these studies frequently do a poor job of distinguishing between adverse events and errors. They are not the same thing.
An adverse event is defined as any undesirable outcome after a drug or treatment is administered to a patient. Every medical test and therapy, from antibiotics to surgery, is associated with some risk of an adverse outcome. Adverse events can include death, although that is rare. While every adverse outcome is regrettable, it does not prove that an error was made—that based on what was known at the time, a medical professional should have made a different decision or acted in a different way.
Physicians typically cannot know in advance which patients will experience such reactions, so attributing such deaths to error is misleading.
There is another problem with the Hopkins report: Two of the four studies it draws on use Medicare data, which generally include patients advanced in years, in relatively poor health, and being treated in the hospital. Sad to say, many such patients are at substantially increased risk of death to begin with. Many will die during their hospitalization no matter how well they are cared for. To attribute such deaths to error is to fail to account for the inevitability of death.
In fact, one of the studies on which the Hopkins report is based even includes a prominent correction factor. The author estimates the number of deaths due to medical error at 210,000. Then, based on the fact that the tools used to identify errors are imperfect, the author chooses to double his estimate of the number of deaths due to error to 420,000.
The sort of medical chart review used in these studies is radically different from caring for patients. The uncertainty and stress associated with caring for the very sickest patients are often invisible to hindsight. Seriously adverse patient outcomes are associated with a greater tendency to blame someone. When a patient has died, we want someone to be responsible even if every action taken appeared justifiable at the time.
This isn't the first study to try to assess how often medical errors can lead to death. Other studies paint a very different picture of the number of deaths attributable to error.
In one study responding to claims of very high death rates due to medical error, physicians reviewed 111 deaths in Department of Veterans Affairs hospitals by attempting to determine whether such deaths were preventable with “optimal care.” VA patients are generally older and sicker than the U.S. population, and thus somewhat comparable to studies based on Medicare data. Also, by using “optimal care,” the study may catch even more deaths than the “medical error” standards, resulting in a tendency to overestimate the number of deaths due to error.
At first, the researchers estimated that 23 percent of deaths could have been prevented. But when they were asked whether patients could have left the hospital alive, this number dropped to 6 percent. Finally, when the additional criterion of “3 months of good cognitive health after discharge” was added, the number dropped to 0.5 percent. Preventable deaths should be viewed in context, and there is a big difference between preventing death and restoring good health.
Applying the rates from the VA study to U.S. hospital admission data, medical error would drop down to No. 7 of the top 10 causes of death in the United States. Applying the additional criterion of three months of good cognitive health, medical error would not even rank in the top 20. Of course, doing so runs the same risks as the Johns Hopkins study; namely, extrapolating from a small study to the entire U.S. population.
To produce a truly balanced account of medicine's role in causing death, it would be necessary to account not only for the risks but also the benefits of medical care. Many patients with heart disease, cancer ,and diabetes whose deaths such studies attribute to medical error would not even be alive in the first place without medical treatment, where its benefits vastly outweigh its risks.
Looking at medicine from this point of view, we are fortunate to be living in an era of unsurpassed medical capabilities, when the profession is doing more to promote health and prolong life than at any time in the past.
Perhaps the strongest evidence that such studies overestimate the role of medical error is that the fact that, when causes of death are ranked by authoritative organizations such as the U.S. Centers for Disease Control and Prevention, medical error is not even included in the top 10. Would adding medical error to death certificates change this? We doubt it.
There is no doubt that mistakes occur in medicine every day, and if we take appropriate steps, error rates can be reduced. But inflated estimates of the number of deaths associated with error do nothing to advance understanding and may in fact make many patients more reluctant to seek care when they need it. A blinkered focus on error without corresponding accounts of medicine's benefits contributes to a distorted understanding of medicine's role in health and disease.
Nick Scobel posted a photo:
Crocodylus acutus
A hatchling explores a mangrove estuary on a remote key in south Florida.
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