Kim’s public health blog

Simon Wessely in his review of the Textbook of Disaster Psychiatry in the British Medical Journal this week explains that before 1980 everyone assumed that people who were mentally robust before a disaster would recover smoothly afterwards. After 1980 some argued that long term disorders could arise even in the most robust individuals. The “result was an explosion of interest and research” in post traumatic stress disorder and <strong>the belief (now recognised to have been mistaken) that everyone who experienced a disaster needed help in the form of immediate psychological interventions</strong> such as debriefing. Yet, Wessely says, lessons learnt in the second world war remain true today: people in cities bombed into submission don’t necessarily cave in. Are we so different from the British? Or is it the tort lawyers and mental health activists who push this fad in the US?

A follow-up to a recent blog on childhood lead poisoning, new data from the U. Cincinatti published in PLoS Medicine today shows that Childhood lead exposure is associated with region-specific reductions in adult gray matter volume. Affected regions include the portions of the prefrontal cortex and ACC responsible for executive functions, mood regulation, and decision-making. These neuroanatomical findings were more pronounced for males, suggesting that lead-related atrophic changes have a disparate impact across sexes. This analysis suggests that adverse cognitive and behavioral outcomes may be related to lead’s effect on brain development producing persistent alterations in structure. This research provides biological plausability to the long standing belief that lead poisoning of children causes both learning deficits and antisocial behavior. It also provides evidence for an evironmental cause of behavioral deficits in children from slum areas where lead is most likely to be found. A follow-up to a recent blog on childhood lead poisoning, new data from the U. Cincinatti published in PLoS Medicine today shows that Childhood lead exposure is associated with region-specific reductions in adult gray matter volume. Affected regions include the portions of the prefrontal cortex and ACC responsible for executive functions, mood regulation, and decision-making. These neuroanatomical findings were more pronounced for males, suggesting that lead-related atrophic changes have a disparate impact across sexes. This analysis suggests that adverse cognitive and behavioral outcomes may be related to lead’s effect on brain development producing persistent alterations in structure. This research provides biological plausability to the long standing belief that lead poisoning of children causes both learning deficits and antisocial behavior. It also provides evidence for an evironmental cause of behavioral deficits in children from slum areas where lead is most likely to be found.

Don’ t trust what you read in the news media. In PLoS Medicine Gary Schwitzer reviews 500 stories published by major media. Among his conclusions were that:
The daily delivery of news stories about new treatments, tests, products, and procedures may have a profound—and perhaps harmful—impact on health care consumers.
That journalists usually fail to discuss costs, the quality of the evidence, the existence of alternative options, and the absolute magnitude of potential benefits and harms.
As a result even careful reading of news stories, without examining the source of the data may be harmful to readers, and those they care for. The internet will usually provide links to the original research where the reader can look for the quality of the data.

Many people do not realize that TB (Tuberculosis) is still a relatively common illness.  It is brought into the U.S. by travellers and immgrants. At present, two billion people worldwide are believed to have latent or dormant TB. Of those infected, but with no signs or symptoms of disease, eight to nine million will develop TB each year, of whom 1.6 million will die.  While Isoniazid therapy is 90 percent effective for those who complete it, in reality, fewer than 50 percent do. . The high attrition rate can have serious public heath effects, not only for the patients who fail to complete therapy, but also for the individuals they may later infect. Four months of Rifampin instead of the current nine months of Isoniazid costs significantly less for the healthcare system and is more likely to be completed by the infected person.

According to research from the University of TexasHealth Science Center at Houston a new study provides added justification that a thiazide-type diuretic is the best first-choice drug for hypertensive patients. Why do we have to keep reinventing the wheel? A study on Veteran’s completed 50 years ago showed similar findings. The public always wants New Technology or New Drugs in the mistaken belief that new is always better. Had we applied the information from the original VA study and the Framingham study as carefully as the ‘Joint National Committee on High Blood Pressure’ wants to do today we would have saved millions of lives, reduced disability and saved billions of dollars. As I have noted in other blogs population data often take years to collect. In the arena of chronic diseases, in particular, we should require that before new drugs are put on the market that the outcome of their use is evaluated in 10’s of thousands of people, as tends to be the case in studies in Europe before approval. We have to keep recalling new drugs not because they were ineffective, but once let out into the general population of 300 million people the deficits became evident. No new drugs should be approved without population based studies which could assure us that only useful drugs, with minimal side effects (all drugs have side effects), that perform better than current medicines be approved. Part of the problem can be laid at the doors of ‘research” universities and the publish or perish demand on their scholars, while drug companies are allowed to advertise prescription medicine to the public. We are one of only 2 countries that sllow such a travesty.

Some fascinating research published in the New England Journal of Medicine this week has identified social links may either enhance your likelihood of smoking or lead to quitting smoking. It all depends on your peer group. Both are important. The editorial [n engl j med 358;21 may 22, 2008] states that smoking behavior is marginalized to smaller peer groups, while larger peer groups have influenced their members to stop smoking, and that smoking is not accepted among their peers. The journal states that adult smoking is now down to 19%, a significant decrease over the last 30 years. Behavioral change occurs slowly, As we move to change behaviors that lead to chronic diseases, such as heart disease and diabetes from overeating we must realize that these are strategic policies that may take decades. We must not panic if change is not seen next year or the year after. This message needs to be translated for politicians who only want to fund programs that have results during their current incumbency.

A new study published in Nature Nanotechnology Online today suggests that it was not the chemical composition of asbestos but the physical characteristics, and that other chemicals may be just as bad. Carbon nanotubules are similar physically to asbestos and are now being reported a likely to cause lung cancer and mesothelioma, just as asbestos does. There have been similar suggestions about the physical effects for the last 20 years. This is one of the reasons that fibreglass insulation installers are required to wear masks as they work. The data from the past also show that asbestos was much more dangerous when used by smokers. We should expect similar results with physically similar compounds.

For those of us who had corneal tranplants years ago and have to use contact lenses , the new artificial corneas that will be available this year may be a solution, but it may be best to wait 2-3 years until there is more experience with their use. For those of us whose eye doctors have difficulty with obtaining the best fit for prescriptions a new automated system appears to be a significant option as it is introduced into the doctor’s offices.

According to a Cincinnati Children’s Hospital Medical Center study children are more vulnerable to the harmful effects of lead exposure at the age of 6 than they are in early childhood. For parents this means it is just as important to know about lead in your home and yard when your children reach school age as it was when they were toddlers. It also should raise the concern of parents everywhere to ensure their children are protected by community codes that require that all housing units are made lead safe, particularly rental units.
Approximately 310,000 U.S. children age 1 to 5 years have blood lead levels greater than 10 micrograms per deciliter, the level at which the Centers for Disease Control and Prevention recommends public health actions be initiated. But research has consistently shown that blood lead levels considerably lower than 10 micrograms per deciliter are associated with adverse effects.

A fascinating “Perspective” on autism,. the MMR vaccine, the National Advisory Committee on Immunization and the Vaccine Injury Compensation Program is presented in today’s New England Journal of Medicine (N. engl j med 358;20 may 15, 2008), which discusses the origin of the compensation program, and the failure of the program to follow a science base in its awards, opening the door to great injury to the vaccine program and setting the stage for another rush of pharmaceutical companies to flee from the vaccine field. If the current case in court is decided on feelings, rather than science, millions of people may die in the near future from lack of vaccines.