Kim’s public health blog

From ScienceDaily researcher from the Northwestern University Feinberg School of Medicine has developed a new oral vaccine using probiotics, the healthy bacteria that are found in dairy products like yogurt and cheese. He has successfully used the approach in a preclinical study to create immunity to anthrax exposure. He also is using the method to develop a breast cancer vaccine and vaccines for various infectious diseases. This new generation vaccine has big benefits beyond eliminating the “Ouch!” factor. Delivering the vaccine to the gut — rather than injecting it into a muscle — harnesses the full power of the body’s primary immune force, which is located in the small intestine.

Reported today in the AMA Morning News as well as a number of newspapers and in the NEJM today, “Interim results from two of the most rigorous studies to date on prostate-cancer screening have failed to bring any clarity to one of the most contentious issues in men’s health.” The results “come after 15 years of study of 240,000 men, [but] don’t resolve a longstanding argument about whether all older men should be regularly screened.” The first study, “conducted in Europe, has so far found modest screening benefits in lowering death rates, but with the high cost of side effects. The other, in the US, hasn’t found any benefit.” The studies “were published online by the New England Journal of Medicine and presented at a urological conference in Stockholm.”

An excellent article from today’s JAMA [JAMA. 2009;301(11):1166-1169] is worth reading by all, as is the accompanying editorial on health disparities [JAMA. 2009;301(11):1169-1171.] The author, one of our faculty members, Steven H Woolf MD MPH, says that “The health consequences of social policies warrant greater attention from the health policy community.” Comment: One can only hope that the politicians responsible for improving the health/medical care system in the US will read these articles and learn from them, but that is unlikely based on past performance.

ScienceDaily (Mar. 17, 2009) — For every gram of salt that Americans reduce in their diets daily, a quarter of a million fewer new heart disease cases and over 200,000 fewer deaths would occur over a decade, researchers said at the American Heart Association’s 49th Annual Conference on Cardiovascular Disease Epidemiology and Prevention. A 3-gram–a-day reduction in salt intake (about 1200 mg of sodium) would result in 6 percent fewer cases of new heart disease, 8 percent fewer heart attacks, and 3 percent fewer deaths. Even larger health benefits are projected for African Americans, who are more likely to have high blood pressure and whose blood pressure may be more sensitive to salt. Among African Americans, new heart disease cases would be reduced by 10 percent, heart attacks by 13 percent and deaths by 6 percent.

The Economist provides an opinion piece [How to stop the drug wars Mar 5th 2009] on the failure of the war on drugs. The opinion is written as ministers from around the world gather in Vienna to set international drug policy for the next decade. The Econmist states that “the war on drugs has been a disaster, creating failed states in the developing world even as addiction has flourished in the rich world. By any sensible measure, this 100-year struggle has been illiberal, murderous and pointless.” That is why The Economist continues to believe that the least bad policy is to legalize drugs. Legalization would not only drive away the gangsters; it would transform drugs from a law-and-order problem into a public-health problem, which is how they ought to be treated. Governments would tax and regulate the drug trade, and use the funds raised (and the billions saved on law-enforcement) to educate the public about the risks of drug-taking and to treat addiction. Comment: Is not this what we are doing with tobacco and alcohol?

Global elimination of this disease appears to be possible, according to a team which includes scientists from McMaster University, Britain and the United States. During a rabies outbreak in northern Tanzania, the team of scientists was able to directly trace case-to-case transmission of rabies. From this data, they generated a detailed analysis of rabies transmission biology and found evidence for surprisingly low levels of transmission. “Achieving vaccination coverage of 60 per cent or more in dog populations in Africa is both logistically and economically feasible through annual vaccination campaigns,” the scientists said in the PLoS paper. The cost of rabies both in terms of the 55,000 deaths a year and post exposure vaccination treatments is very significant, Dushoff said. “If it really is a disease that can be eliminated, our group believes we should go and get it.

In the Proceedings of the Royal Society [Proc. R. Soc. B, 2009; DOI: 10.1098/rspb.2009.0064] an experiment seems to show that a single viral particle can cause infection in an insect., Now the press will probably mislead us into one more mass fear of viral infection. Insects are not primates, nor humans. Nothing the experiment tells us whether an infection by one or few particles of a virus leads to disease or antibody development and prevention of disease. Another experiment that probably should not reach the general media.

In today’s Lancet two editorials describe the findings of several European studies showing that far too many individuals with heart diseases still smoke without being warned to stop by their physicians, whether cardiologists or primary care physicians. The physicians were more concerned with lipids or, hypertension than behaviors such as smoking or obesity [Volume 373, Issue 9667, 14 March 2009-20, Page 867], Further The results from the EUROASPIRE study give three messages. First, helping patients with coronary heart disease achieve a healthy lifestyle should be mandatory and have high priority for doctors and health authorities. Second, therapeutic targets in guidelines need to be continually discussed. Blood pressure and lipid targets that are too ambitious might take focus away from important lifestyle issues. Finally, secondary risk prevention is not enough. Political action is needed to reverse the negative trends of obesity and sedentary habits, ranging from fighting against the fast food and sugar industries to safe bicycle paths and healthy school meals

Children born extremely prematurely are at high risk of developing learning difficulties by the time they reach the age of 11. The researchers found extremely preterm children had significantly lower reading and math scores than classmates. Also extremely preterm boys were more likely to have more serious impairments than girls. Overall, just under half of the extremely premature children have serious disabilities, such as learning difficulties, cerebral palsy and impaired vision or hearing. Comment: One more reason for an increased emphasis to prevent premature deliveries.

ScienceDaily (Mar. 14, 2009) — Within five years innovative ’smart’ sensing systems that will help the UK’s 700,000 dementia sufferers live independently at home could be available commercially. Once installed, the systems are designed to closely monitor people’s movements and actions around the home. As well as providing voice-prompts (e.g. reminders to turn off a tap or cooker), they can also directly switch lights or appliances on and off in order to eliminate potential dangers. Comment. Just as many of the institutional providers of care are finding specious reasons to fight changes to the health care system (as their ox is gored) we can expect the nursing home industry to fight these innovations if introduced by home builders.