A second look at the asthma epidemic

Copyright 1998 The Washington Times
April 16, 1998

There is a burgeoning asthma epidemic among poor children in our cities. For example, as reported by ABC News, some 300 of the 1,100 students at Bronx Public School have the respiratory disease. Estimates suggest there may be as many as 5 million children with asthma, and death rates from the disease have been growing. One prominent organization - the Children's Health Fund in New York city - is making asthma treatment a top priority. But that's the problem: The group is making treatment its priority, when prevention is what's called for. Why are these activists pushing for more after-the-fact management of a disease that is incurable when they could focus on keeping kids from contracting the condition in the first place?

Politics, that's why.

On April 3, the president of The Children's Health Fund, Dr. Irwin Redlener, issued a press release spelling out the details of his group's "New York Childhood Asthma Initiative." As a battle plan for "Winning the War on Childhood Asthma," Dr. Redlener's proposal is long on expensive medical treatment and almost silent on inexpensive preventive measures. "Most importantly," writes the doctor in his No. 1 point, "children who have asthma - no matter what else - need to be treated in a primary care setting that provides a comprehensive 'medical home.' " At least the second point mentions prevention: Dr. Redlener calls for those primary care-givers to use "state-of-the-art asthma diagnosis, treatment, prevention and education." The third point calls for a reduction in asthma fatalities, again by emphasizing "primary care" for asthmatics. The last of the doctor's recommendations is that "community-based providers" be educated in "the latest diagnosis and treatment."

From Dr. Redlener's press release, one would hardly suspect that there is a growing scientific consensus on what is causing the inner-city asthma epidemic. "While we may not have immediate solutions to all the factors that may exacerbate asthma," the doctor writes, "we do know that asthma is a treatable disease." Reading the Children's Health Fund press release, one would think that asthma is a mysterious affliction that can only be dealt with after the fact. It isn't.

In fact, last year The New England Journal of Medicine published a major study on the causes of childhood asthma in six cities. Of the three most-suspected causes - cockroach droppings, dust mites and cat dander - it was the roaches that proved to be the biggest problem. The explanation for high asthma rates in the inner city is as obvious as it is unpleasant: a combination of poor housekeeping practices with run-down, cockroach-infested housing.

"Asthma is a disease of the environment," says Dr. David Rosenstreich, primary author of the New England Journal article. "Prevention should be the mainstay of asthma treatment." For the most part, children with a tendency to get asthma will come down with the disease if they are exposed to large amounts of the allergens that trigger asthma. Cockroach droppings are highly allergenic; they seem to be the leading environmental cause of asthma.

That means Dr. Redlener was incorrect to say there are no immediate solutions to the asthma epidemic. Solution No. 1 would be a public health campaign to improve the housekeeping standards where children live. Solution No. 2 - in tandem with the first - would be to undertake massive cockroach eradication programs.

Neither of these solutions fits with the mission of the Children's Health Fund. The CHF was founded by Dr. Redlener together with the musician Paul Simon with the purpose of delivering medical care to homeless and indigent children. That's a worthy goal, but in this case one that appears to have skewed the CHF's approach to the asthma crisis. By focusing primarily on treatment, rather than prevention, the asthma epidemic is being used to raise private and public funds for new inner-city health clinics and in-school medical services.

For parents worried about their children's risk of asthma, the cockroach connection is crucial information: News parents can use, if you will. But that information is getting short shrift. Sunday, ABC's "World News Tonight" broadcast an alarming story about the inner-city asthma epidemic -a feature cribbed from The Children's Health Fund press release. In keeping with the source of his material, ABC reporter Anderson Cooper never mentioned that cockroaches are the major asthma culprit. "It is still a mystery exactly why the number of asthma sufferers is rising so dramatically," Mr. Cooper reported. Asked by The Washington Times editorial page why he didn't mention the threat from cockroach filth, Mr. Cooper says "We only had a certain amount of time" in the story. But that doesn't mean ABC News didn't have time to implicate one of the Left's favorite suspects: "Some blame environmental pollution," Mr. Cooper said. So, to the extent that ABC News allows that asthma is an environmental disease, the network blames "pollution," even though a slew of studies attempting to prove a pollution-asthma connection have come up short. "Air pollution is not closely related to classically defined asthma," says Dr. Rosenstreich. To blame air pollution "is political, not medical."

The politics of the asthma crisis are putting children's lives at risk. The bureaucratic politics of fund-raising leads to a focus on treatment rather than prevention. Environmentalist politics puts phony blame on air pollution. And perhaps most endemic of all, the insidious politics of political correctness makes it impolite to recommend that parents need to be more diligent with their Hoovers.

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