Garth Rattray | It’s not about ‘coughs and colds’ anymore

Shockingly, the other day, someone uttered an extremely inaccurate, anachronistic, and belittling misconception. He said that family physicians/general practitioners/primary-care physicians mainly see “coughs and colds”! We see everything from head to toe, physical and psychological.

The medical landscape has changed tremendously in a relatively short time. The leading causes of death in 1900 were infections like pneumonia, tuberculosis (TB), and diarrhoea /enteritis. By 2000, the leading causes of death were non-infectious entities like heart disease, [most] cancers, and cerebrovascular diseases.

The average human lifespan grew from a mere 31 - 32 years in 1900 to 76.9 years by 2000. The advent of ‘modern medicine’ played a huge roll. Antibiotics saved incalculable billions of lives. Vaccines played a major role in eliminating and controlling several of the deadly childhood and adult diseases that used to [literally] decimate entire populations.

Human beings improved their living conditions, hygiene and sanitation. Advances in public health doubled our lifespan. Discoveries in the medical sciences, in our knowledge of biology, chemistry and physics all coalesced to give us the academic and technical know-how to prevent, detect and initiate early treatment of hitherto deadly diseases. The biophysics involved in system support and temporary organ replacement machines prolonged the lives of many human beings.

NOT FAR-FETCHED

There is current thinking that getting human beings to an average lifespan of 150 years is not as far-fetched as it might appear. We are seeing so many geriatric patients that perhaps we should redefine ‘elderly’ and ‘geriatric’. Professor Denise Eldemire-Shearer stated that the ‘old elderly’, people over 75-years-old, forms the fastest-growing segment of the Jamaican population.

Modern-day family practitioners never saw, and do not see, a preponderance of coughs and colds. In fact, when distancing, sanitising, and wearing masks were mandatory at the height of the COVID-19 pandemic, there was a sharp decline in coughs, colds, respiratory infections, and allergy-related illnesses. However, since the wearing of masks became voluntary, and people went back to life as if COVID-19 no longer exists, coughs and colds are making a steady comeback to previous levels. Obviously, an indeterminate number of mild COVID-19 cases are masquerading as coughs and colds. As was forecast by the epidemiologists, COVID-19 is expected to become as endemic as the [common] influenza.

Aside from dealing with a multitude of ailments, medical practitioners are heavily involved in screening for, educating about, reducing the risk of, and intervening in the non-communicable diseases (NCDs). NCDs remain a major killer of human beings everywhere. The top listed NCDs are cardiovascular diseases (heart disease and stroke), cancer, diabetes and chronic lung disease.

Interestingly, to a lesser or greater extent, the NCDs are also lifestyle diseases … meaning that they are somewhat either lifestyle preventable or lifestyle modifiable. There is a direct relationship between the ageing process and NCDs. The older we become the more likely we are to get them … after all, something has to take us out of this world. What physicians aim to do is to delay their onset and/or effect … in other words, to prevent premature morbidity and mortality.

BANE OF OUR EXISTENCE

In Jamaica, hypertension, diabetes, high levels of the bad cholesterols, and cancer are the bane of our existence. Approximately one-third of Jamaicans are hypertensive, but about four out of 10 of them are not aware of the silent killer lurking within them. About 12 to 16 per cent of adults are diabetic; but one in three of them don’t know it. A little more than one in 10 have high-cholesterol levels. High cholesterol often accompanies hypertension and diabetes. Recent Jamaican cancer statistics reveal that, in 2020, there were 7,191 new cases registered in our population of about 2,961,161. Obviously, many other cases were either not registered or undetected at that time.

In 2020, the number of new cases of cancers, according to gender, was, in males, prostate (42.8 per cent), colorectum (13.1 per cent), lung (10.5 percent), stomach (4.2 per cent), non-Hodgkin lymphoma (3.9 per cent), and all other cancers (25.5 per cent). And in women, they were breast (34.1 per cent), the body of the uterus (11.9 per cent), uterine cervix (10.9 per cent), colorectum (9 per cent), lung (4.3 per cent), and all other cancers (29.9 per cent).

As far as the NCDs are concerned, the main challenges encountered by physicians in their effort to preserve their patients’ quality of life and to save their lives lie with the patients themselves. Most people avoid health-care personnel. Many people-hate taking medications and they despise making lifestyle modifications. They see medications as foreign substances and they focus on the [possible] side effects without realising that, if left untreated, the NCDs will have serious and eventually lethal ‘side-effects’. Being a cardiac invalid, becoming blind, needing kidney dialysis, having a disabling stroke, or losing a limb or two is no joke.

A cancer diagnosis is not necessarily a death sentence. Several cancers can be detected and treated early; and some can be avoided with timely screening or surveillance (if warranted).

We should all be aware of our NCD numbers vis-a-vis our blood pressure, blood glucose, cholesterol, and some other essential blood results. Screening for cancer is essential when indicated. We should seek out medical professionals and adhere to their guidance to avoid unnecessary suffering and premature death. Ignorance, fear, complacency, and non-adherence are your enemies; don’t allow them to kill you.

Garth A. Rattray is a medical doctor with a family practice. Send feedback to columns@gleanerjm.com and garthrattray@gmail.com.