You know what I hate about prevention? If you do it right, nothing happens. Like, my house has a burglar alarm, but does that make me safe, or is it just that that some thief already looked in my window and said to himself, “Let’s see: VCR, half a bottle of white zinfandel, velcro wallet. Nope.” But you just watch. The day I forget to turn on the alarm the street value of VCRs will skyrocket.
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Does my burglar alarm prevent break-ins or am I not worth robbing?
Sometimes, of course, you know prevention is working. Tobacco control efforts over the last decade, for example, have led to significant declines in adult and childhood cigarette use, although smoking remains the single greatest cause of preventable death in the US today. According to the just-released State Of Tobacco Control report from the American Lung Association, states all over the country responded to the resounding success of their smoking prevention efforts by, you guessed it, undoing them.
To quote the restrained language of the report, most states in 2011 “failed miserably” at tobacco control policy. New Hampshire, whose stunning child health statistics drive Tarheel pediatricians like me wild with envy, took a step closer to our part of the county by actually cutting their cigarette tax by ten cents. Now if we can just get them to subsidize pork rinds.... But we here in North Carolina are determined to win the race to the bottom, completely defunding our own tobacco control foundation, the Health And Wellness Trust Fund. It will heretofore be known as the HAWEBA (Health And Wellness Empty Bank Account). Take that, Yankees!
If you think that convincing a state that garners $431 million in revenue from tobacco sales to discourage tobacco sales is tough, you should try getting teens to wear sunscreen! According to a new study in Pediatrics, kids’ rates of sunscreen use drops from a disappointing 50% in fifth grade to a just-plain-sad 25% by eighth grade. The problem here is obvious: the only 14-year-olds who can spell melanoma, much less envision dying of it, are hypochondriacs. Kids simply cannot imagine having the sort of leathery skin I’m just now coming to enjoy, much less conceptualize how last summer’s sunburn might prove lethal in two or three decades. I have only one message for those kids: if Heidi Klum and Seal can divorce, anything can happen!
Finally, a study in the Journal of Pediatrics should give pediatricians a moment of smugness: when it comes to suspecting child abuse, we’re not racist! Nope, we’re classist. Pediatricians presented with a hypothetical case of a toddler with a suspicious leg fracture cared not about the color of the parents’ skin when it came to investigating child abuse. But if the parents seemed more likely to live across our lawns than to mow our lawns, we had a harder time imaging they might hurt a child. To those pediatricians I have only one message: in a world where Wikileaks founder and international fugitive Julian Assange can host a televised talk show, anything can happen.
Okay, one thing can’t happen. The movie Extremely Loud And Incredibly Close cannot, in anyone’s wildest imagination, win an Oscar. But when it comes to prevention, you can never be too careful.