Kim’s public health blog

And we think a lot of people are Obese Now? According to new research from the Johns Hopkins Bloomberg School of Public Health “National survey data show that the prevalence of overweight and obese adults in the U.S. has increased steadily over the past three decades,” said Youfa Wang, MD, PhD, lead author of the study and associate professor with the Bloomberg School’s Center for Human Nutrition. “If these trends continue, more than 86 percent of adults will be overweight or obese by 2030 with approximately 96 percent of non-Hispanic black women and 91 percent of Mexican-American men affected. This would result in 1 of every 6 health care dollars spent in total direct health care costs paying for overweight and obesity-related costs.”

While many are applauding the ‘House’, this is the usual political approach of appearing to do something that will accomplish little. Some health groups are happy with the bill but they have not done a good job of analysis.The FDA does not have, and will not have, the manpower to enforce any tobacco rules.  There are insufficient staff for the agency to carry out its current responsibilities. The FDA is charged with ensuring that medicines prescribed by doctors are safe for patients. The FDA has never had the authority to approve poisons fort distribution to the public for over the counter sales. This has fallen to Tobacco, Firearms and Alcohol control agencies, where enforcement has the benefit of experience. The FDA does not even have the manpower to monitor the hundreds of  over the counter ‘nostrums’ sold under the guise of improving health. This is the wrong agency, given the wrong task.

In the New York Times’s (7/29, F6) Well column, Tara Parker-Pope writes that a “growing chorus of discontent suggests that the once-revered doctor-patient relationship is on the rocks.” This “relationship is the cornerstone of the medical system — nobody can be helped if doctors and patients aren’t getting along. But, increasingly, research and anecdotal reports suggest that many patients don’t trust doctors.” According to data from a Johns Hopkins study published this year in the journal Medicine, approximately “one in four patients feel that their physicians sometimes expose them to unnecessary risk.” Sandeep Jauhar, M.D., director of the heart failure program at Long Island Jewish Medical Center, noted that one reason for patients’ frustration is the fact that everything is so rushed these days, and “[n]obody is talking to the patients.”  Comment: This should not surprise anyone with the current emphasis on carrying out procedures and avoiding “wasting“ time talking to patients. This is specialism at its worst and is partly the result of rushed legislation that will not wait to evaluate any activity, and partly the result of inappropriate evaluation by the LCME which evaluates medical school curricula, and the ACGME which evaluates graduate programs. Neither has any focus on public awareness, only on technical proficiency..

The FDA has released a warning about Paralytic Shellfish Poisoning (PSP), and warns against eating the liver (the green substance) of lobsters, and stick to the white meat. Remember that the dose makes the poison. We are not told what the level of PSPs is in the lobster livers, or how much you would have to eat to develop shellfish toxicity. This is one the troubles with trying to protect the public’s health. Recommendations are often based on animal studies, or disease outbreaks. Still, prevention is pretty simple, just stay away from the green stuff in lobsters. I am surprised that there Ia no warning about crab livers. Crabs inhabit the same waters.

Now, after New York’s lead. California has banned transfats in foods prepared in restaurants.  This is not a clear cut health issue. There is research showing both hazards and benefits from using trans-fats.  It is government intervention in an unproven area.  Once more it gives the perception that government is protecting its citizens by intruding on commercial behavior.. The reason people are obese and have heart attacks is from too many calories and too little exercise.  The ban is cosmetic. It would probably been more effective to require all food items to show caloric values.  It will be interesting to review obesity, diabetes , heart attacks incidence in 5 years and see if there is any difference, and if so what evidence there is linking it to the ban. This is one more case of political emotion overiding  data.

In a study from The University of Texas Health Science Centerat San Antonio researchers found A genetic variation that may have protected people of African descent against a pandemic of malaria long ago now appears to increase their susceptibility to HIV infection, a report published this week shows that a variation, described in the journal Cell Host & Microbe, is one of the first genetic risk factors for HIV to be identified only in those of African descent, and puts a spotlight on the differences in our genetic makeup that play a critical role in susceptibility to HIV-AIDS. It is  fascinating that a genetic variation that protects individuals from Malaria now has become a factor the enhances infection with HIV

The president is reported ready to veto the Tobacco Bill if passed as currently formulated. This bill, favored by Phillip-Morris is flawed in several ways. First the FDA already has too much on its plate. While Congress has increased its appropriations it is not nearly enough to manage its current responsibilities. That is a reason for the President to Veto it. Further Congress has refused to amend an exception for Menthol based cigarettes despite research from the Harvard School of Public Health showing that “Menthol cigarette brands have been rising in popularity with adolescents, and the highest use has been among younger, newer smokers.”
The paper, “Tobacco Industry Control of Menthol in Cigarettes and Targeting of Adolescents and Young Adults,” appears in the online “First Look” section of the American Journal of Public Health in advance of publication in the September 2008 issue. “For decades, the tobacco industry has carefully manipulated menthol content not only to lure youth but also to lock in lifelong adult customers,” said Howard Koh, Professor and Associate Dean for Public Health Practice at HSPH and a co-author of the paper.
Further, an analysis by the American Association of Public Health Physicians raises concern that if the bill were enacted the tobacco companies would use the FDA oversight to declare that cigarettes had been found safe. There is nothing safe about cigarettes. They contain poisons. The FDA has no mandate to certify poisons safe for non-medical use.

In a story if today’s Dallas Morning News is an article decrying increasing waiting time in doctor’s offices. There are two problems with the story, if true. First, the comcern is about waiting times of more than an hour.  There is no excuse for waiting times in either the waiting room or examining room of more than 5-10 minutes. Anything more is an example of poor management and should bring penalties from third party payers. Second, a reason given is a shortage of doctors.  This is another misconception foisted on the public. There is no shortage of doctors, only a shortage of primary care doctors due to the training policies of medical schools, abetted by federal granters who favor specialty training programs, Medicare which pays for procedures rather than advice, and the medical school accreditors who are for the most part either PH.Ds. or medical specialists. This may well be one of the side efects of good intention which has recently focused on quality of care using procedures to measure quality, not outcomes desired by the public.

In a paper published in the Journal of the American Medical Association this week the authors recommend that “immigrants to the U.S. from Africa and Southeast Asia should be tested and treated for tuberculosis (TB) before they arrive, to prevent importing the disease. For example “screening immigrants and refugees from the Philippines and Vietnam would have detected almost half the average 250 TB cases brought into the U.S. each year from 2001 to 2006. The authors found that “over 50 percent of all cases of TB among foreign-born persons occurred among 20 percent of the overall foreign-born populations, especially persons born…in Southeast Asia [particularly the Philippines and Vietnam] and sub-Saharan Africa.”
[JAMA. 2008;300(4):405-412.]

Reported in the July 8 issue of the Proceedings of the National Academy of Sciences, Neuroscientists at MIT’s Picower Institute for Learning and Memory found that a previously unsuspected set of genes links nature and nurture during a crucial period of brain development.
Researchers believe autism spectrum disorders are tied to brain changes that occur during critical periods of development. Different but overlapping critical periods are thought to exist for various cognitive functions affected in autism, such as language and social behaviors. “Autism is a strongly genetic disorder: genes set up risk factors but by themselves simply make proteins,” Sur said. “Genes work together with other influences. In the case of autism, these influences are unknown but could be molecules made by other genes or chemicals from the environment.” Comment: Despite research which ha repeatedly shown lack of a link between immunization and autism, parents of such children are not yet ready to accept genes as causative of autism, and prefer to blame vaccines.