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If you've been paying attention to recent news, you might think that we're entering a time when leaps forward in health care only happen at great expense. That misses the point. It also, once again, confirms the incorrect impression that we can only make leaps through advances in technology. As I said in previous episodes, people are more important than technology. To illustrate this point, we'll discuss the guinea worm.

This is adapted from a piece Aaron wrote for the NYT. Links and references are embedded in that piece: http://www.nytimes.com/2014/08/12/upshot/lessons-from-the-low-tech-defeat-of-the-guinea-worm-.html?abt=0002&abg=1

John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics

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If you’ve been paying attention to recent news, you might think that we’re entering a time when leaps forward in health care only happen at great expense. That misses the point. It also, once again, confirms the incorrect impression that advances can only through great leaps in technology. As I've said in previous episodes, people are more important than technology. To illustrate the point, I'd like to tell you the story of the guinea worm - that's the topic of this week's Healthcare Triage.

(Intro reel)

(0:30) The guinea worm is a parasite that plagues humans, and only humans. People get infected with them when they drink water that's infested with their larvae, which then mate inside our GI tracts, and then start to grow.

Eventually, female worms burrow their way out to our skin, where they can create incredibly painful sores, by which they can exit the body. They exit very slowly, causing a burning pain as they do so. There's no treatment for guinea worms, there's no vaccine. The best we can do is wrap the part of the worm that's exposed around a stick and slowly pull it out. That can take weeks, and it's not pleasant at all.

What if the only thing that soothes the pain is to submerge the worm and sore in water? Which is of course exactly what you DON'T wanna do, as it allows the worm to release its larvae and start the cycle all over again.

People who are infected are incapacitated, it's hard for them to work, it's hard for them to care for their families, it rarely kills, but it can leave people ill for months. Those who are afflicted can easily develop secondary infections. Rupturing the worm can lead to severe allergic reactions, depending upon where the worm emerges, it can lead to life-long disability.

In 1986, it was estimated that more than 3.5 million people in Africa and Asia were infected with guinea worms. This year, so far, there have been only 17 cases worldwide. SEVENTEEN! It's thought that very soon guinea worm disease will be only the second human disease eradicated in human history. Smallpox was the first.

HOW?! There's been no technological breakthrough, there are no new medicines, there are no new therapies. Guinea worm infection has been beaten almost entirely through behavioral change, at a shockingly low cost.

Two things needed to happen to achieve this feat. The first is that people needed to be taught to filter their drinking water and keep it clean, often with something as simple as a cloth filter. Second is that people had to learn NOT to go near drinking water sources once they were infected.

I'm not trying to make light of how hard it was to accomplish. Getting so many people to change their behavior took decades, and it took a lot of wrangling, political maneuvering and a LOT of boots in the ground to get the message across.

The Carter Center founded by former president Jimmy Carter in 1982 has been instrumental in these efforts. Many doubted that you could eradicate a problem like this without some sort of medical breakthrough, they were wrong. Clean your water! Practice hygiene. Quarantine the infected. These ideas sound simple, they sound like common sense, (whispers) they also work.

These general problems are are all too common in developed healthcare systems as well. The CDC estimates that about 48 million Americans get sick from food-borne illnesses  each year. More than 125,000 hospitalizations are caused by food-borne illnesses, and about 3,000 deaths. Many, if not most of these illnesses could be prevented if people properly stored, cleaned, cooked and refrigerated their food.

Between 1976 and 2007, deaths in the United States from influenza ranged from 3,000 to 49,000 people a year. The vast majority of those deaths occur in people who are 65 years of age or older. Proper hygiene and staying home during the infectious stage of the illness are STILL mainstays of flu care.

We even have a VACCINE for influenza, but too few people get it. It's estimated that two years ago, if we had just gotten the influenza vaccination rate up to 70%, we could've prevented 4.4 million illnesses and 30,000 hospitalizations.

Physicians know how important hand-washing is, but we fail to do it correctly the majority of the time. This is in spite of the fact that patients in the hospital get more than 700,000 infections a year, and that hand-hygiene is thought to be one of BEST ways to prevent that from happening.

We spend so much time focusing on the new, the flashy and the innovative, it's important not to neglect the simple things that matter. Eradicating the guinea worm didn't require research, new technology, or billions of dollars of investment. It took determination, focus, and dedication. It required people and talking and educating.

Those things are still important in every healthcare system, they can save millions of lives. We need to invest in them, too, now and in the future.

(Outro)