Kim’s public health blog

Obese adolescents have the same risk of premature death in adulthood as people who smoke more than 10 cigarettes a day, while those who are overweight have the same risk as less heavy smokers, according to research published on bmj.com [BMJ 2009;338:b496] today. Conclusions Regardless of smoking status, overweight and obesity in late adolescence increases the risk of adult mortality. Obesity and overweight were as hazardous as heavy and light smoking, respectively, but there was no interaction between BMI and smoking status. The global obesity epidemic and smoking among adolescents remain important targets for intensified public health initiatives.
.

Most newspapers today are carrying stories about today’s research paper in the New England Journal of Medicine. What they leave out is the intensive supervision of the participants, which due to poor reimbursement by insurers could not be provided in a local medical practice, lack of blinding, and minimal effect over 2 years with losses being between 5 to 12 lbs. It did not matter which diet was used, they spanned the range of the popular diets, and they all required minimal exercise. The main finding the research proved is how difficult it is to lose weight. They again reinforce that it is the eating and exercise behaviors of participants that make the difference. An accompanying editorial points to a current experiment in France where an entire community changed their eating and exercise habits, but is this replicable in the US?

From today’s AMA Morning News we learn than an article published in today’s JAMA [JAMA. 2009;301(8):831-841.] reports that “that “heart disease is among the most studied illnesses in all of medicine, yet just 11 percent of more than 2,700 recommendations approved by cardiologists for treating heart patients are supported by high-quality scientific testing,” according to a study published in the Feb. 25 edition of the JAMA.” How can anyone know which to select from among so many recommendations, especially when so many arte of poor evidentiary quality?

Ivan Illich could use the latest study on alcohol use and cancer as an example of medicalisation of behavior.  In a study reported in the AMA’s morning news today (as well as many national daily newspapers) we are told about a UK study that lasted 7 years. The study was large enough that there were statistically significant findings. However a 7 year study showing an association is not the same as a study that lasted long enough to cover the period of incubation of cancers and changes in behaviors that occur over 20-30 years.. The investigators stated that taking more than 2 alcoholic drinks a week was associated with a significant increase in cancers. While other reviewer stated that alcohol in any amount was hazardous (a finding that contrary to studies of the lifelong benefits of moderate use of alcohol) in any amount.  This discussion of the study seems more like an outburst from the Temperance League than from a group of sober epidemiologists and reminds me of past studies of coffee and its associations.

Parents of children with genetic conditions may avoid the need to choose whether to undergo pre-natal testing or to abort future pregnancies by simply avoiding subsequent pregnancy altogether, a study has found. Parents are ‘choosing not to choose’, researcher Dr Susan Kelly, who is based at the Egenis research centre at University of Exeter,the suggests, in a ‘reflection of deep-seated ambivalence’ about the options and the limitations of new reproductive technologies. According to ‘Choosing not to choose: reproductive responses of parents of children with genetic conditions or impairments’ published in the journal Sociology of Health and Illness, more than two-thirds of parents in the USA-based study chose not to have any more children rather than accepting tests to identify or avoid the birth of an affected child. Of the parents who did have further children, a majority chose not to make use of prenatal screening or testing.

Is another issue favored by ‘health’ activists nothing more than bad research? ScienceDaily (Feb. 18, 2009) — For more than 40 years, the prevailing explanation of why we get old has been tied to what is called oxidative stress. This theory postulates that when molecules like free radicals, oxygen ions and peroxides build up in cells, they overwhelm the cells’ ability to repair the damage they cause, and the cells age. An industry of “alternative” antioxidant therapies — such as Vitamin E or CoQ10 supplements in megadose format — has sprung up as the result of this theory. However, clinical trials have not shown that these treatments have statistically significant effects. And now researchers at McGill University, in a study published in the February issue of the journal PLoS Genetics, are calling the entire oxidative stress theory into question. Their results show that some organisms actually live longer when their ability to clean themselves of this toxic molecule buildup is partially disabled. Collectively, these molecules are known as reactive oxygen species, or ROS for short.

A well-off professional who smokes has a much lower survival rate than a non-smoking low-paid worker of the same sex concludes new research published on the British Medical Journal website [BMJ 2009;338:b480]. The study, one of the first to examine the long-term impact of smoking on older men and women, shows that smoking itself is a greater source of health inequalities than social position. Among both men and women, smokers of all social classes had a much higher risk of premature death than non-smokers from even the lowest social classes. Surprisingly, non-smoking women in the lowest social classes had one of the lowest death rates. The research also found that the survival advantage that women normally have over men is cancelled out by smoking.

You may be wondering at this point whether to toss those vitamins into your mouth or into the trash. That’s not surprising since several recent reports have called the value of vitamins into question, leaving people to wonder if it’s time to ditch their supplements all together. “People are so confused,” says Elisabetta Politi, the nutrition director at the Duke Diet and Fitness Center. “But vitamins are like insurance, and there’s no evidence that taking them is harmful.”
“While vitamins are not meant to be magic bullets of prevention, most Americans have poor eating habits and don’t get the daily recommended allowance of most vitamins and minerals,” Politi adds. “That’s why we continue to recommend a well-balanced multi-vitamin.” Comment: Then the whole message gets lost as this dietician start talking about “servings”. A nutritional term that mesn anything or nothing to the lay public. Such useless jargon should be extirpated from our language.

Second Thoughts: Fewer than one percent of American teens may need statins.
A few months ago a policy recommendation from the American Academy of Pediatrics recommending that nearly all children be put on statins. Now we have a second look at the issue as reported in today’s AMA Morning News:[Feb17] “fewer than one percent of American teens are likely to need cholesterol drugs,” according to a study published in the journal Circulation. Investigators “looked at data from about 10,000 children who took part in a national government health survey from 1999 to 2006. Of those, about 2,700 in the 12-to-17 group had LDL levels measured.” Approximately “five…to seven percent of these youth had elevated LDL.” The investigators then “checked those numbers against the pediatric academy guidelines, advising other factors that should be weighed in recommending medication.” Approximately “0.8 percent fit the profile of those needing treatment with cholesterol-lowering drugs to ward off future heart problems.” Thus, “based on 25 million Americans in that age group, the findings translate to about 200,000 young people.”

Second Thoughts: Fewer than one percent of American teens may need statins.
A few months ago a policy recommendation from the American Academy of Pediatrics recommending that nearly all children be put on statins. Now we have a second look at the issue as reported in today’s AMA Morning News:[Feb17] “fewer than one percent of American teens are likely to need cholesterol drugs,” according to a study published in the journal Circulation. Investigators “looked at data from about 10,000 children who took part in a national government health survey from 1999 to 2006. Of those, about 2,700 in the 12-to-17 group had LDL levels measured.” Approximately “five…to seven percent of these youth had elevated LDL.” The investigators then “checked those numbers against the pediatric academy guidelines, advising other factors that should be weighed in recommending medication.” Approximately “0.8 percent fit the profile of those needing treatment with cholesterol-lowering drugs to ward off future heart problems.” Thus, “based on 25 million Americans in that age group, the findings translate to about 200,000 young people.”