Yup, it is an interesting topic. A statistical study was made using USA data from 1997 to 2012. What is interesting is that they estimated the relative contribution of different factors to the rise in the maternal mortality rate.
Obesity was one of the most important, explaining 31% of the rise. Also at 31% was a change in the death certificate that more clearly identified death associated with pregnancy. This change began in 2003 but was adopted at different times by the individual states. Diabetes contributed to 17% of the rise, followed by low education (5.3%), poor prenatal care (4.9%), and African-American race (2%).
Don’t know how repeatable studies like this are, but this one suggests that racism is a detectable but not major factor.
The important question to me is why is maternal mortality in California so low, even when compared globally. What is California doing right?
As styled by Fox Noise, “The People’s Republic of California” only has a 27.6% obesity rate, ranking 46th in the country, vs many of the Shinier states having an obesity rate in the high 30s. CA’s poverty rate is 12.07%, slightly lower than many of the Shinier states. Being so Socialistical, CA has a lot of nutrition programs. US News and World Reports ranked CA #1 in Public Health, #5 in health care, #10 in mental health, #5 in low obesity rate, #2 in low mortality rate, #5 in low infant mortality rate, #2 in low smoking rate, and #5 in low suicide rate.
But, we are told, Cali is Socialistical, thus something to be hated, not emulated.
For giggles, I looked up Michigan, where the shiny faction had gerrymandered it’s way to a decades long grip on power.
#39 in public health, #35 in health care, #43 in mental health, #43 in low obesity rate, #37 in low mortality rate, #32 in low infant mortality, #39 in low smoking rate, #17 in low suicide rate.
Read an article about 20 years ago, Canadian cities near the USA border ship their high risk pregnancies across the border. Don’t know if that is still occurring but considering Canada doesn’t have the MRIs, PET scanners, etc., at the same rate as the USA, can easily assume that don’t readily have the machines/materials to treat all their micropremies. So numbers can easily be skewed.
Considering that organ transplants, while more commonplace than 10-20 years ago, is still a very short supply resource. You don’t walk into Walmart and pick your new kidney off the shelf. There are protocols that take into account various factors such as tissue match, distance from harvest to recipient, how sick the patient is, and other factors that contribute to success.
There was some severe blowback when Mickey Mantle got his transplant many accusing the MDs of choosing the celebrity to bring news and notoriety to the hospital when he was a poor candidate.
As with everything else, livers can be rationed by ability to pay.
iirc, Mickey, and actor Larry Hagman, both received new livers about the same time. Both killed their livers with years of alcohol abuse. At least, Hagman got several years of use out of his new liver.
At the time, my husband was a spokesman for the American Liver Foundations’s campaign to promote awareness of Hep C and quite strongly disagreed with the decision to give Mickey a new liver…based on the prospect of a poor clinical outcome/level of disease(not any moralizing about how he got sick in the first place). Larry Hagman was a different story and, as you said, demonstrated the value of transplants…and that heavy boozers can actually manage to stay away from the sauce.
Similar controversy with Georgie Best. Got his transplant at our (dh and me) alma mater in spite of repeated episodes of falling off the wagon and staying off.
Bad Habits…wouldn’t it be grand to refuse medical care to EVERYONE who’d transgressed from the Righteous Path😇
My husband doesn’t allow himself to judge whether his patients “deserve” a new liver based on whether it’s due to self inflicted disease or not (as best as he can)…quite possibly even someone with a BMI of 39.5. He’ll advocate quite strongly on behalf of a boozer who’s demonstrated sobriety for 6 months (per established protocol…including calls for random blood tests). Doesn’t mean he’s always successful since a wait list selection committee is about 20-25 strong including other hepatologists (with patients of their own), surgeons, nurses, PAs, social workers, psychologists etc who all have a voice…and their own prejudices. Not everyone knows this, BTW.
Woe betide them if they start boozing again or stop taking their anti rejection meds. They see a different side of him then. Not least because 2 people have to die to allow the recipient to get a second lease on life…the donor (obviously) and the #2 or further down on the wait list who didn’t get that about-to-be-wasted organ in time. Doesn’t hesitate to remind them of this
Give it a few years. I think it is reasonably doable now (and for more than kidneys), but the social moralizing doesn’t permit it (yet). The basic process has already been proven. It is just figuring out how to do it with human organs.
Well, if you read the link thoroughly, the explanation is right there. The wait list time in Tennessee at the time Jobs needed a liver was much shorter than the national average (dramatically so, according to the article) I fancy that, when patients are thinking about their own survival, their personal risk assessment might be skewed by the speed that they can actually get a new liver over their perceptions of the surgical center where the transplant is going to take place. Especially if the logistics of long distance care like this aren’t a burden.
IMO, Kamen is missing a key point. Creating viable organs from scratch is not yet within our technology. Some things might be doable given enough R&D, but what that would be is likely limited to soft tissues (and maybe muscles) without a defined structure. He is five-plus years too late to the party. Nobody has (except me, perhaps), as yet, figured out how to get what is needed to sustainably grow replacement organs. It would require a shift in societal norms for it to happen–and that does not happen quickly, unless, of course, it is YOUR life on the line. THEN things shift rapidly.
Like I mentioned upstream, this all came about during the early years of the ALF’s campaign to raise awareness of Hep C…he was also infected…and when I was nattering to dh about it, I think he mentioned that the hope was that the ALF would get some milage out of Mantle’s battle with the disease. The squandered resources being compensated for by greater awareness and testing etc.etc. Obviously didn’t turn out that way…
Husband’s research at the time was Hep B and C (didn’t move to translational/transplant medicine until the early aughts) so I didn’t know squat about MELD scores, transplant selection committees etc. Even less about Mickey Mantle. I recall asking if easy successful treatments for Mantle’s comorbidities ever became available, would it make a difference to getting a transplant. Of course, I didn’t get the yes or no I wanted. “That’s an interesting question…” launched a dive down a rabbit hole complete with tutorial.
No idea of the current state of play WRT newer anti cancer treatments on size of primary tumour or metastatic disease(and my morning will be shot if I ask the person who knows) but, back then, the prospect of successful treatment of HepC with those direct acting antivirals was almost unimaginable and has actually made a big impact. Transplantation of a high risk, Hep C infected liver is no longer contraindicated. Who knew?
Maybe Mantle was an unwitting guinea pig?
Another “who knew”…end stage liver disease due to NAFLD secondary to metabolic syndrome and the obesity epidemic has now taken over Hep C’s spot as cause/reason for transplant. Another ethical quandary if one were to ask “is this a deserving case?”
