Kim’s public health blog

The Wall Street Journal (11/10, Dalton) reports that some countries’ governments have stopped focusing on individual discipline to combat obesity, and instead are working to make entire communities more healthy by reducing the opportunities to live unhealthily. Laura Kettel Khan, an obesity expert at the CDC, says that “people are finally acknowledging that the obesity problem is so pervasive that it isn’t just because people are making bad choices.” The Journal describes obesity programs across Europe and in the US, noting that these initiatives are taking off because obesity has become too expensive a problem to handle on an individual basis.

 Drawing on years of experience in cancer research and patient care, The University of Texas M. D. Anderson Cancer Center released today the most comprehensive, risk-based screening guidelines publicly available to date for breast, cervical and colorectal cancers (also see the MDAC Screening Guides). The new recommendations represent the first wave of an effort by M. D. Anderson to improve the effectiveness of efforts to prevent and detect cancer at its earliest, most treatable stage by reconstructing and expanding its screening, risk reduction and diagnostic guidelines across eight disease sites. According to the American Cancer Society

• New cases of breast cancer will be diagnosed in 192,370 women and 40,170 will die from breast cancer
• 11,270 new cases of cervical cancer will be diagnosed in women and 4,070 women will die from cervical cancer
• New cases of colorectal cancer will be diagnosed in 106,100 men and women and 49,920 men and women will die from colorectal cancer

In a report issued by the  Institute of Medicine “It’s clear that smoking bans work,” said Lynn Goldman, professor of environmental health sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, and chair of the committee of experts that wrote the report.  “Bans reduce the risks of heart attack in nonsmokers as well as smokers.  Further research could explain in greater detail how great the effect is for each of these groups and how secondhand smoke produces its toxic effects.  However, there is no question that smoking bans have a positive health effect.” The full report is available on line and clearly supports the new legislative ban in smoking in restaurants in Virginia. .

The Los Angeles Times (10/14, Stein) “Booster Shots” blog reported that as bicycles ride a wave of popularity, “cyclists may be suffering more injuries,” according to University of Colorado researchers. After looking at “accident rates and severity from 1996 to 2006,” they noted that “among 329 bicycle accident cases admitted to the Rocky Mountain Regional Trauma Center at Denver Health Medical Center, the length of stay increased substantially over those years.” What’s more, “an increase was seen in chest injuries (up 15 percent), and abdominal injuries tripled over the last five years of the study. About one-third of 118 patients had head injuries.” Comment: Cycling is certainly more dangerous in the US than Europe where most roads have dedicated bicycle lanes, There are very few such lanes on US roads, particularly in housing areas.  This absence in planning oversight contributes to obesity by limiting opportunities for exercise, the same neighborhoods usually lack sidewalks for walking safely, as well.

In this week’s NEJM a team of prominent doctors, scientists and policy makers says ”it could be a powerful weapon in efforts to reduce obesity, in the same way that cigarette taxes have helped curb smoking.” Authors of the report include “the New York City health commissioner, Thomas Farley, and Joseph W. Thompson, Arkansas surgeon general.”  Comment: There is too much of a rush by public health behaviorists to rush into punitive measures to change population behavior.  There seems to be no sense that this leads toward Huxley’s Brave New World.

In this week’s BMJ we find that despite all the medical, public health, social, economic, and political changes over the 20th century, patterns of poverty and mortality and the relations between them remain firmly entrenched. There is a strong relation between the mortality levels of a century ago and those of today. This goes beyond what would have been expected from the continuing relation between deprivation and mortality and holds true for most major modern causes of death. Comment. Most of these deaths are related to chronic diseases and individual behaviors, which have always had an adverse impact on low income groups that have had poorer education

From the  Institute of Medicine: Local governments play a crucial role in the fight against childhood obesity by creating environments that make it either easy or hard for children to eat healthier diets and move more. A new report from the Institute of Medicine and National Research Council provides local officials with action steps that hold the greatest potential to reduce obesity rates among children, such as zoning restrictions on fast-food restaurants near schools, community policing to improve safety around public recreational sites, and publicly run after-school programs that limit video game and TV time.

The AP reports that six cases of childhood lead poisoning “in Maine last year came from an unusual source — lead dust tracked into the family car.” Officials from the CDC and the Maine Department of Health and Human Services said that the cases were “the first ever attributed to lead dust on childhood safety seats. The car seats themselves weren’t the source; the inside of family cars were contaminated through a parent’s workplace.” The CDC explained that children’s parents, who worked in paint removal or metals recycling, did not change and shower before going home, and so tracked lead dust into their cars and onto children’s car seats. Then, “Kids chew on the sides of those seats … Or they put a cookie down” on the seat and then eat it, Mary Jean Brown, chief of the CDC’s Lead Poisoning Prevention Branch said. “Maine officials said they now include checks of cars and child safety seats in their lead investigations.”

In this morning’s Richmond Times Charles Krauthammer rails against the use of preventive interventions based on cost effectiveness in reducing chronic diseases.  His argument is based on a CBO study but he lacks knowledge of epidemiology and appropriate interventions.  At the same time we hear about a new report in the Journal of the National Cancer Institute (2009, August 18) that the public overestimates the value of screening. The authors found that the majority of participants have a dramatic overestimation of the benefits of such tests, and that doctors and other sources of information appear to have little impact on improving knowledge of the level of benefit. Ninety-two percent of women overestimated the benefit of mammography screening by at least one order of magnitude or reported they did not know; 89% of men overestimated the benefit of prostate-specific antigen screening or did not know. “Knowing the benefit of a treatment is a necessary condition for informed consent and rational decision making,” the authors write.