In the mid-1990's I served as the Chief Executive Officer of Pentagon City Hospital which as the name suggests is adjacent to the Pentagon located in Arlington, Virginia. This is just on the opposite side of the Potomac River from Washington, DC. Although I served well after the event it was never far from my mind that my hospital was the receiving hospital for the fortunate survivors of an airline accident. On January 13, 1982, Air Florida Flight 90 crashed into Washington, DC's 14th Street Bridge and fell into the Potomac River shortly after taking off. A total of 70 passengers and 4 crew died and four motorists on the bridge.

Air Crashes really make an impression on all of us and we remember them with vivid detail. It may be the randomness, the unfairness, the sudden calamity or maybe the process of group death in a common event. For whatever the reason, it sticks with us. Even as a practiced air passenger I regurgitate these feelings each time I fly; more so if my travel is infrequent and the opposite if frequent. I know I am not alone in contemplating how such a grisly death could play out. We play the odds however and usually go on with our travel plans.

We play the odds every day in just about any activity we choose to engage. In the case of commercial air travel even the slowest of us can pretty much understand the odds of success and we know that big sweeping changes usually occur after such tragic events. With Air Florida's crash it was about anti-ice systems; other air crashes brought on expected major changes based on lessons learned from these tragedies.

When we learn more about the air traffic system and specific airlines operations we can modify the odds as we go along. If you have just bought the cheapest ticket available on an already oversold flight the odds of you getting bumped at the gate just went up, but you choose to play these odds. I once boarded a flight departing late at night from Dulles International Airport and all was going well until we determined one member of the flight crew couldn't get out of the back galley restroom as a result of food poisoning and the flight was canceled. This was a bad result that I certainly had not counted on.

We know and expect big change after these events, how do we go about accounting for the day to day changes? If I figure out the guy I just watched knock back several vodka laced watermelon shooters at the terminal restaurant bar ends up as my pilot, I figure my odds of having a bad flight were drastically modified and I would need to make a decision based on this new information. In this case, a personal decision is required based on new insight to how the odds might change; this might be a life or death decision for me.

We can understand the impact on our imagination and the actions taken as a result of the Air Florida crash killing 74 human beings. Can you begin to imagine the public furor if we were to have 18 Air Florida crashes each and every day? If you heard that 1,332 people died yesterday in an air crash and that we expected another 1,332 people to be killed in an air crash today, would you actually be willing to get on an airplane? And, if we had such an air crash every day, in a year's time we would we would record 6,756 Air Florida crashes killing 500,000 people. We would demand and expect big changes to take place to avoid these deaths.

Heart disease, killed more than 700,000 Americans in 2001 and is the mathematical equivalent of over 6,000 Air Florida air crashes, accounted for 29% of all deaths in the United States. In 2001, the rate of death from heart disease was 31% higher among blacks than whites and 49% higher among men than women. In 2001, heart disease cost the nation $193.8 billion. About 66% of heart attack patients do not make a complete recovery which places an even greater burden on families, budgets and human misery.

The usual first sign of heart disease is death. Heart disease is the nation's leading cause of death. Much of the burden of heart disease could be eliminated by reducing the prevalence rates of its major risk factors: high blood pressure, high blood cholesterol, tobacco use, diabetes, physical inactivity, and poor nutrition. Modest reductions in the rates of one or more of these risk factors can have a large public health impact.

We are committing "Epigenomic Suicide". Where is our outrage? Where is our self control? Where are the big changes? When do we say it is enough already? How do we get ourselves and others to think in new ways about the outcomes of our day to day decisions? We aren't dying together in common groups. We appear to be voluntarily agreeing to individual private grisly death scenes played out in hospital emergency rooms, nursing homes and the back of ambulances; all 1, 332 of us, each and every day in America.