Attempting to quantify the most common medical disorders in the Palmetto State brings to mind the tale arising from the ancient Indian subcontinent of the blind men describing a strange animal – an elephant.
One, who touched only the trunk, thought it was much like a snake; another, feeling the tail, thought it resembled a rope; a third, caressing the tusk, described the beast as much like a spear.
Only when a man with sight described the elephant completely did the others realize that their subjective observations, while accurate, were not necessarily complete.
So it goes when searching for definitive answers to which "illnesses," to use a generic term, are most prevalent in South Carolina.
Because record keeping at the Department of Health and Environmental Control is very thorough, it's not at all difficult to determine which medical conditions are responsible for the most deaths statewide.
The most recent complete compilation, for 2016, lists them in descending order from the No. 1 cause, malignant neoplasm, which was responsible for 10,349 deaths. Most of us are more familiar with its synonym – cancer. This statistic reports on mortality from all tumors that grow, invade and metastasize, regardless of where on the body they appear.
According to DHEC, the No. 2 cause of death is diseases of the heart, weighing in at 10,183.
The remaining items on the list are, in order: accidents; chronic lower respiratory disorders; cerebrovascular diseases – stroke; Alzheimer's disease; diabetes mellitus; kidney diseases; septicemia; and, at No. 10, suicide.
These are the specific conditions or circumstances with the highest number of recorded deaths in South Carolina. Yet they are far from the only causes of death in the Palmetto State. DHEC adds another category, "all other causes," which on its own would top the mortality list at 12,680. Within this catch-all designation, drug overdoses topped the 1,000 mark for the first time, coming in at 1,001 deaths.
Of course, these official numbers only delineate causes of death. There are many more medical conditions that are increasingly common and, while perhaps not all deadly in their own right, can make living miserable and be pathways to more serious problems.
The authoritative Medical University of South Carolina project, Hands on Health-SC, also lists many of the disorders on DHEC's roster as common concerns, adding dental and oral disease; family violence; HIV/AIDS; influenza; and metabolic syndrome, which is not a disease per se but the condition of having several health problems at the same time. Significantly, Hands on Health-SC also considers obesity to be a common medical condition.
Bear in mind that these lists focus on causes of death or serious illness, not on the host of very common, sometimes debilitating but more often simply painful or unpleasant conditions that are extremely common throughout the populace – everything from alopecia – hair loss – to zoster – shingles – and all the illnesses in between.
Finding medical professionals who can address such a catalog of conditions can be akin to consulting with those sightless men who described the elephant. With all due respect to the many outstanding medical specialists in South Carolina, concentration on their highly specific fields of expertise can sometimes "blind" them to the bigger medical picture.
Primary care physicians have a much greater exposure to an extremely wide range of disorders, from the purely physical to the mental, emotional and even "self-inflicted," such as alcohol and drug abuse. Yet they generally see only the individual patient who has sought their diagnostic skills and referral or treatment recommendations.
A medical specialty with a unique perspective on the scope of disorders is pediatrics. Like their adult-care colleagues, they see and treat the most common medical issues. But because their patients are children, they are rarely examined without at least one parent present. This offers a valuable opportunity to examine not only how a patient is ill but why. In other words, lifestyle counts.
In this sense, an experienced, dedicated pediatric physician can help serve as the medical equivalent of the sighted man, who was able to see the elephant in its totality.
Such a doctor is Dr. Elizabeth Mack, a pediatric critical care specialist and professor of pediatrics at MUSC.
"A much easier question to answer than 'what are the most common diseases,'" Dr, Mack said, "is what are the leading causes of death? Every human in South Carolina who dies gets a death certificate, so we can easily do a great deal of research on this subject."
More complex are the reasons why medical conditions develop as they do. Absent genetic underpinning that for some diseases allows only for treatment, not prevention, lifestyle can play a critical role.
In Dr, Mack's view, obesity is one of our state's most pressing medical concerns.
"I see a lot of obesity, even in very young patients. Obesity is far more common in South Carolina than the average for the rest of the nation. It can lead to a host of serious conditions, including heart disease and stroke, both leading causes of death here in what is called the 'stroke belt.'"
There are well-documented ways to prevent or manage obesity – improved diet and increased physical activity paramount among them.
However, in addressing an obesity problem, "You cannot just single out one member of a household who is overweight. Family members all have to set a better example, keeping junk food out of the home, avoiding sugar-sweetened beverages, drinking plenty of water, avoiding whole milk for milk drinkers, taking walks and becoming more active," she said.
Another well-documented precursor to numerous disorders in South Carolina, including heart disease and stroke, is tobacco use. An estimated 22 percent of adults smoke, ranking alongside states such as Maine and Florida but well above the low of 15 percent in California.
Dr. Mack cited hypertension – high blood pressure — as another major health concern that she sees creeping down to young children.
"We now understand that hypertension can be modified with better diet, more exercise and cutting back on salt, reducing its role in diabetes, heart attack and stroke," she explained.
She listed breathing disorders including COPD and asthma as common conditions in South Carolina. Among contributing factors are the state's heavy burden of pollen and other allergens, plus increased air pollution, all of which can trigger other common diseases such as eczema and allergic rhinitis.
With suicide the No. 10 cause of death in South Carolina, Dr. Mack views depression and anxiety as common disorders.
"These can lead not only to individual deaths but to public health crises such as mass shootings, which we see all too frequently, and even fatal car crashes we sometimes erroneously consider to be 'accidents,'" despite the fact that many are preventable.
In general, the most common medical issues are chronic conditions. Among acute conditions, Dr. Mack considers influenza to be common, preventable and dangerous.
"People most likely to get seriously ill from the flu and die are the very young, the very old and those with suppressed immune systems. Along with basic infection-prevention practices, flu vaccine is an excellent preventive measure and is recommended for anyone six months or older. Of note, the 'flu shot' cannot give you the flu," she added.
And, while a certain amount of Vitamin D is essential for good health, Dr. Mack reminded us that "because we also live in the 'sunshine belt,' we need to use sunscreen regularly and stay away from tanning beds to avoid common skin cancers, including potentially deadly melanoma."
When all's said and done, the most common diseases in South Carolina don't differ much from the most common across the United States. In the view of doctors such as Dr. Mack, it seems that one key to avoiding them or lessening their impact is to pay close attention to the whole "elephant" – lifestyle – and not be fooled into focusing only on what medical issues might arise.
That way, protecting ourselves and our loved ones from many preventable common diseases won't become that other pachyderm – the one we never talk about: the elephant in the room.