Kim’s public health blog

One in every 10,000 Californians who contracted H1N1 died, statistics from the State Department of Health show.  Out of 13 million Californians who were vaccinated for H1N1, three people died. In one case, the patient already had the flu and a streptococcus infection when vaccinated. One was a cardiac patient whose death the coroner ruled was related to pre-existing heart problems. And the final case is still being reviewed by health officials.  Comment: Yet the anti immunization activists continue to get Media space, despite study after study showing how much safer immunizations are than the diseases they control.

From the Maryland University Center for vaccine development ( with cooperation with several other major research groups we learn that a study on effectiveness of a new vaccine against Falciparum Malaria, the most common and most dangerous strains,  appears to be successful in stimulating antibody protection as great or greater than that of adults who have survived many years of exposure to become resistant to malaria.  While this is good news for the millions of children who would otherwise die from malaria each year the international community must ensure that agricultural productivity in increased in developing countries so that further generations of children no longer killed by malaria do not survive just to die from starvation.

Serving Size Snafu- today’s NYT video is well worth watching as it discusses how poorly caloric and other information appears on packages of food, and bears little relation to what people actually eat.  This may well contribute to today’s obesity as people become frustrated with packing ;labels.  The FA is planning new labeling criteria where the calorie, salt etc content of portions people actually eat will be placed on packages, instead of labeling a portion as 6 potato chips or half a bran muffin which few if any are likely to follow. Comment: I applaud thus move but note we might have been better off if Congress had not written in stone almost 2 decades ago what a portion should be.  This is the difference between making laws and giving advice. Congress should require guidance from appropriate advisory bodies such as the I.O.M. rather than trying to set science on stone. .

In today’s NEJM [V362:377-379,2-4-2010] A perspective on the growing demand for relevant outcomes in the Medicare population is important reading bearing in mind the concurrent news that current medical spending is over 17% of the GNP, mainly driven by medical care for chronic disease among the elderly. This should mean more translational research into effectiveness of prevention and care for chronic diseases. Instead of researching the value complementary medicine (which so far has been dismal) and activist causes, we should focus on the issues that drive the budget.  The more we spend on medical care, the less we can spend on education and job creation. Although we do not like the term rationing, we cannot provide everything that everyone wants. We should focus on providing care where outcomes, fewer deaths, better daily function and reduced disability are validated by careful epidemiologic studies..

At least one-third of all cancer cases are preventable. Prevention offers the most cost-effective long-term strategy for the control of cancer. Tobacco is the single largest preventable cause of cancer in the world today. It causes 80-90% of all lung cancer deaths, and about 30% of all cancer deaths in developing countries, including deaths from cancer of the oral cavity, larynx, esophagus and stomach. A comprehensive strategy including bans on tobacco advertising and sponsorship, tax increases on tobacco products, and cessation programs can reduce tobacco consumption in many countries. The WHO Framework Convention on Tobacco Control, adopted in May 2003, aims to curb tobacco-related deaths and disease.  Other cancers are preventable by changes in diet, exercise, alcohol use, and by immunizations. Comment: The problem is that the prevention techniques call for changes in behavior, which the health profession manages poorly.

A valuable article in today’s JAMA[JAMA. 2010;303(5):448-449] appropriately questions the rush for legal restriction of food content by certain states.  Most recently the plan to restrict sodium in New York.  The authors of the article note that the law is based on belief rather than a solid scientific foundation where a large cohorts  representative of the U.S. populations has been followed long enough to evaluate outcomes. The authors note that similar restrictions of Trans Fats and Post Menopausal Hormone Therapy have not had  the scientific base that epidemiology should have required. Comment: There is a continuing problem of activist public health practitioners believing that legal enforcement of behaviors is better than an educational approaches.  It is harder to change laws when they are found wanting, compared to changing an educational message in response to new data. A new law may provide good political sound bites but we have a long way to go before we know how to change behavior, and many question whether laws should be to change behavior.  This smacks of the Brave New  World of Aldous Huxley….

This was just a theory until quite recently, but two recent studies now provide strong evidence. The first study compared children formally diagnosed with ADHD to controls, and found that the children with the disorder had slightly higher levels of lead in their blood. This study showed a link only between blood lead and hyperactivity/impulsivity symptoms, not inattention. But a second study showed a robust link between blood lead and both parent and teacher ratings of ADHD symptoms, including both hyperactivity and attention problems. In both studies, the connection was independent of IQ, family income, race, or maternal smoking during pregnancy. Comment: I do not know how many time we have to ask ”when will we get lead out of children’s environments, rather than testing the blood before we intervene?”

In an editorial, the Wall Street Journal (1/30, A14) criticized the FDA’s recent pronouncement on bisphenol A, saying that the compound is very common and protects people from exposure to more harmful substances. In 2007, the environmental activists organized a “baby rally” where they equipped mothers and toddlers with signs reading “Don’t Pollute Me.” In response to the public outcry, confused and panicked retailers tossed plastic baby bottles and other BPA-containing products from their shelves. When the head of Health Canada’s investigation of BPA Mark Richardson let slip in a speech to a medical group in Arizona that “exposures [to BPA] are so low as to be totally inconsequential, in my view,” antichemical crusaders pressed the government to investigate Mr. Richardson’s bias. He was abruptly reassigned. In its January update the FDA notes that BPA does not pose a risk at low levels of human exposure. Yet it goes on to recommend ways to limit exposure. Antichemical crusaders are likely to drive years of opposition through that crack of suspicion.  Comment: Is this another case of political correctness overcoming scientific knowledge?  How often do we have to repeat history. Following the Love Canal hysteria in New York, the dioxins in oil in the  northwest, and the DDT in Triani, Alabama.  In every case, after years of study no relationship was found between the supposed exposures and human diseases after spending millions of dollars..

In the Lancet today is a valuable article on ”swine flu backlash” [Volume 375, Issue 9712, 30 Jan, 2010, Page 367] where the author considers whether the recent pandemic is the weakest on record, and how much the pharmaceutical industry and power politics caused needless waste of medical resources, engendering unnecessary fear. The author also asks “how was it that a new virus turned out on closer inspection not to be so new after all? Epidemiologists  knew it was likely to be mild almost from the beginning, but we feared that because it was ‘new’ it would spread widely and kill a lot of people by virtue of the sheer numbers infected. Comment:  It is always easy to second guess recent events, but science was overwhelmed again by politics as it was for Mad Cow Disease and the  outbreak of ‘swine flu’ forty years ago. In both instances the flu outbreak was use to divert the public from a national problem, in this case the economic collapse. Once again the media, politics and the lobbyists trumped science. Instant response was demanded for a problem that needed some careful analysis first.

From the Guttmacher Institute today we find that for the first time in more than a decade, the nation’s teen pregnancy rate rose 3% in 2006, reflecting increases in teen birth and abortion rates of 4% and 1%, respectively.. But, for the first time since the early 1990s, overall rates of pregnancy and birth—and, to a lesser extent, rates of abortion—among teenagers and young women increased from 2005 to 2006. It is too soon to tell whether this reversal is simply a short-term fluctuation, a more lasting stabilization or the beginning of a longer-term increase. Preliminary data on births for 2007 show a further increase in the birthrate among all women, including teenagers and those aged 20–24. The data presented here indicate that there are still large and long-standing disparities in rates by race and by state. These disparities echo those seen among unintended pregnancy rates, which are several times higher for women of color. Comment: In media reports some question whether this increase is related to the federal government’s initiatives to push abstinence programs (part of the current health care plan)  that have been repeatedly shown to fail.