Missing the forest for the trees: The world around us and surgical treatment of endocarditis

摘要: Abstract There has been a dramatic increase in intravenous drug abuse (IVDA)–related deaths midlife Americans. Nowhere is this more profound than rural Appalachia, with Kentucky the midst of epidemic. The causes finding are multifactorial and likely related to social, economic, legal, population factors. Evidence suggests that economic middle class shrinking. traditionally white demographic used comprise 80% US now accounts for less 60%. Along shrinking come inevitable trappings poverty, including abuse. Population-based data reveal associated significant rise made up class; is, white, In Kentucky, choice changed during past 2 decades, largely law enforcement political efforts. Efforts control have, however, suppressed availability use 1 substance only have another move forefront. For example, time shifted from methamphetamine at turn century narcotic pills early 2000s injection heroin beginning around 2010. shift came an alarming trend mortality IVDA, both nationally, need surgical correction IVDA-related endocarditis. Thoracic surgeons tended avoid or ignore greater problems caused epidemic Perhaps it thoracic give stronger voice societal issues loom background