Dr. Buttery's Public Health BLOG

Colon cancer survival rates are worse for blacks than whites, and that may largely be due to social and economic factors, according to a new research review. The reviewers, who work in Houston at the University of Texas Health Science Center, included Xianglin Du, MD, PhD. They note that colon cancer killed 27 per 100,000 blacks compared with 19 per 100,000 whites from 2000-2003 in the U.S. During the same period, the five-year colon cancer survival rate was almost 55% for blacks, compared with 65% for whites. Adjusting for socioeconomic factors and for colon cancer treatment erased much of the black-white race gap in colon cancer survival rates.
The reviewers conclude that closing the social and economic gaps may narrow the colon cancer survival race gap.

Posted by at 2:10 PM | Permalink | Comments (0)

Web MD has consolidated a number of guidelines and tips for health care resources by condition. This link may be worthwhlie placing on your web sites.
http://www.webmd.com/a-to-z-guides/health-topics/default.htm

Posted by at 1:55 PM | Permalink | Comments (0)

In today's Telegraph from the UK, the Secretary for Health announces that primary care trusts ( the organized groups of physicians who render care by contract to the NHS) are refusing orthopedic surgery to the obese and coronary bypass to smokers until they change their habits.

Posted by at 10:35 AM | Permalink | Comments (0)

An editorial in today's BMJ discusses research from Dr. Cook and colleagues reporting the long term effects of reduced dietary sodium on cardiovascular disease in people participating in the controlled randomised trials of hypertension prevention follow-up studies. The results show that people originally allocated to either sodium reduction group had a 30% lower incidence of cardiovascular events in the next 10-15 years, irrespective of sex, ethnic origin, age, body mass, and blood pressure. As most salt in our food comes from processed foods ways must be found to lower the salt content in prepared foods.

Posted by at 4:03 PM | Permalink | Comments (0)

Several days ago I noted the first genetic intervention for Type 1 Diabetes. Today scientists from the Broad Institute of Harvard and MIT, Lund University and Novartis today announced the discovery of three unsuspected regions of human DNA that contain clear genetic risk factors for type 2 diabetes, and another that is associated with elevated blood triglycerides. While these findings have not reached the stage of clinical testing they suggest that with more genetic research there may be points of intervention to prevent or ameliorate diabetes, heart disease and lipid levels which lead to much of today's chronic diseases. The scientists worked together with two other groups that performed similar genomic analyses of type 2 diabetes: the Wellcome Trust Case Control Consortium/U.K. Type 2 Diabetes Genetics Consortium (WTCCC/UKT2D), led by Mark McCarthy and Peter Donnelly of Oxford University and Andrew Hattersley of Peninsula Medical School; and the Finland-United States Investigation of NIDDM Genetics (FUSION) led by Francis Collins of the National Human Genome Research Institute and Michael Boehnke of the University of Michigan.

Posted by at 3:37 PM | Permalink | Comments (0)

A fascinating editorial in this week's NEJM discusses the issues of coexistence of other chronic diseases, such as cardiovascular disease, now that HIV infection has been converted into chonic disease status, volume 356:1773-1775 April 26, 2007, number 17 and the need for aggressive treatment of HIV infection.

Posted by at 10:15 AM | Permalink | Comments (0)

U.S. health care needs to change from its traditional focus on disease and medical intervention to a new and innovative model that focuses on maintaining health, says Emory University professor Michelle Lampl, MD, PhD, Emory University professor of anthropology and associate director of Emory's Predictive Health Initiative. Dr. Lampi is an anthropologist. However, it is not necessary to coin a new word for prevention.

Posted by at 9:55 AM | Permalink | Comments (0)

The IOM Study "Nutrition Standards for Healthy Schools: Leading the Way toward Healthier Youth" recommends that drinks should be limited to water, low or non-fat milk, and 100-percent fruit juices; and, snacks should be low in fat, sugar and salt, and be primarily fruit, vegetables or dairy."

Posted by at 9:47 AM | Permalink | Comments (0)

In the Arch Dis Child 2007; 95: 416-22 authors suggest that rather than doing what seems right to do what the evidence shows. They are concerned that all the screening for obesity in schools does nothing for children. Long term studies suggest that there are currently no effective programs to reduce weight in obese chlidren. It has long been a tenet of public health surveillance that we do not screen when there is no evidence to show we have effective interventions. Yet we keep intervening in childhood obesity, found in schools, as though we made a difference.

Posted by at 11:41 AM | Permalink | Comments (0)

As you might expect, as soon as this study from Duke was published the tort lawyers started warning about law suits if obese people are treated differently. With the cost of health care limiting the capability of employers to care for their workers it is necessary to put road blocks in the way of obesity. Obesity, despite claims about genetic links, is still a choice for most people, who fail to change their diet and exercise patterns. Why shouldn't insurance coverers charge more for those who put themselves at greatest risk? Why not cost sharing between employers and their employees? Has responsibility vanished in the U.S.?

Posted by at 12:40 PM | Permalink | Comments (0)

In today's Lancet the editors note that just over 20 years ago, John Morgan, an American pharmacologist, coined the term opiophobia to describe the analgesic-prescribing habits of physicians he had studied. The recent study from the US National Hospice Outcomes Project, which compared opioid use and survival at the end of life, is thus welcome, as it represents the largest and most sophisticated examination of the issue to date. A systematic review of previous (albeit smaller) studies, from palliative-care services in various countries, found no significant difference in survival according to either absolute morphine dose or change in morphine dose. These results are consistent with widespread clinical experience with morphine for analgesia. Only in the US does the tort system reduce physician willingness to care for patients with chronic pain.

Posted by at 6:41 PM | Permalink | Comments (0)

From the Lancet today - death and injury on the road is a pandemic, especially in young people. Road planners can make a difference, by building in traffic-calming measures and separating motorised vehicles from pedestrians and cyclists. The police can make a difference by enforcing road-safety laws, particularly those to do with driving under the influence of alcohol, and the wearing of helmets. But the individual solution lies with what is perhaps one of the hardest things to change—human behaviour. Road accidents disproportionately affect young people. Being taught about road safety from a very young age must become a priority, with adults setting a good example at all times.

Posted by at 6:37 PM | Permalink | Comments (0)

The new CDC home page is worth examining and may well be easier for the public to navigate, making it worth linking to all local health department web sites.

Posted by at 10:37 AM | Permalink | Comments (0)

Vaccine for pancreatic cancer developed by researchers at the University of Pittsburgh School of Medicine has successfully stalled the disease from progressing in a handful of patients three years post-vaccination. Vaccines for speciifc cancers are starting to emerge. Hopefully they may become as successsful as vaccines against infectious diseases.

Posted by at 10:07 AM | Permalink | Comments (0)

During 2004, an unvaccinated Wisconsin patient received a new medical treatment and became the first documented survivor of rabies who had not received preexposure vaccination or postexposure prophylaxis. In today's MMWR is a report of three additional cases treated with the 'Wisconsin protocol' who failed to survive. Rabies should still be considered deadly and after any unprovoked bite, specially from a bat, rabies prophylaxis should be started immediately.

Posted by at 9:57 AM | Permalink | Comments (5)

An important first step in responding to knowledge about the role of immune response in development of type 1 diabetes has been taken and is discussed in an editorial in today's JAMA [ Jay S. Skyler: JAMA. 2007;297:1599-1600 ] reflecting on a study by Voltarelli et al. ....stem cell transplantation in newly diagnosed type 1 diabetes mellitus. JAMA. 2007;297:1568-1576. FREE FULL TEXT. This editorial is well worth reading, as is the article. If further similar research can be translated into succesful clinical intervention, we may be on the edge of an intevention for Diabetes, and its complications that may be as important as the development of vaccines,.

Posted by at 11:50 AM | Permalink | Comments (0)

According to a study by Dr. Juni of the University of Bern, who reviewed 20 studies of the use of Chondroitin, this nutritional supplement failed the test of effectiveness, except that the studies were not devised to focus on severe pain. Most of the studies used to back up the claims used small numbers and were poorly designed. Three recent large studies covering 40% of all the patients studied failed to support claims for chondroitin's effectiveness. I remain convinced that the only recent for advertising pharmaceutical/nutritional products is to separate suckers from their money.

Posted by at 11:12 AM | Permalink | Comments (0)

From the FDA today we learn that Olives are the newest food danger. They might cause Botulism. The FDA wants:
Importers of these olives to discontinue distribution, isolate held stocks and notify customers to take similar actions to prevent the products from reaching consumers. Importers should contact their local FDA office for assistance in implementing the recall.
Food manufacturers who have repacked the olives for sale under different names or who have used them in the production of other food to contact their local FDA office.
Restaurants, delicatessens, and other food service providers should discontinue using the olives, to dispose of their opened containers.

Posted by at 11:54 AM | Permalink | Comments (0)

A study on children in Crete suggests that children who eat a Mediterranean diet, high in fruit and vegetables and low in saturated fat, are less likely to develop asthma and allergies, according to new research. But is this because the children live in a different environment from children in inner cities who seems to be most prone to asthma, and whose families may not be able to afford the diet? This diet needs testing in environments where childhood asthma is most likely to occur.

Posted by at 11:46 AM | Permalink | Comments (0)

The American Academy of Pediatrics (AAP) is alarmed that the soaring costs of vaccines. Often payments are below the cost of the vaccine. Gardasil, the new cervical cancer vaccine, costs physicians $360 for the recommended series of three doses per person. RotaTeq, the vaccine against diarrhea-causing rotavirus, costs $190 for the recommended three doses. Even the routine measles, mumps and rubella (MMR) vaccine costs $86 for the recommended two doses. In addition to the cost of the vaccine, additional costs of ordering, storing, inventory control, insurance and spoilage expenses need to be considered. Once more the long term effects of law suits are interferring with good medical care.

Posted by at 11:40 AM | Permalink | Comments (0)

Cleveland Clinic researchers have discovered a new biochemical pathway that is essential for the reproduction of the animal virus, vesicular stomatitis virus (VSV), a virus belonging to the family that causes rabies, measles, Marburg Disease, and Ebola, and many others. “Finding small molecules that can disrupt VSV mRNA capping activity could lead to discovery of antivirals not only against VSV but other viruses belonging to this class of viruses that are highly pathogenic,” Dr. Banerjee said

Posted by at 11:33 AM | Permalink | Comments (0)

Due to increasing resistance to some antibiotics the CDC has just issued updated recommendations for treatment of GC and associated infections.

Posted by at 11:30 AM | Permalink | Comments (0)

Scientists from the Peninsula Medical School, Exeter, and the University of Oxford first identified a genetic link to obesity through a genome-wide study of 2,000 people with type 2 diabetes and 3,000 controls. The study found that people carrying one copy of the FTO allele have a 30 per cent increased risk of being obese compared to a person with no copies. "This is an exciting piece of work that illustrates why it was so important to sequence the human genome," says Dr Walport. "Obesity is one of the most challenging problems for public health in the UK. The discovery of a gene that influences the development of obesity in the general population provides a new tool for understanding how some people appear to gain weight more easily than others.

Posted by at 11:19 AM | Permalink | Comments (0)

From Imperial College. London a new monovalent vaccine against type 1 polio has been developed. Type1 is the most prevalent polio virus in India. To get 80% protection against this virus needs 14 doses of the current vaccine. The new vaccine will give the same results with 3 shots!

Posted by at 11:14 AM | Permalink | Comments (0)

While there continue to be stories in the media about the future costs of medical care, some states are focusing on interventions to reduce the impact of chronic disease, the only solution to controlling health & medical costs in the future. In Pennsylvania The Governor has just announced new intiatives ro improve access to care as well as reduction of chronic disease impact..

Posted by at 10:58 AM | Permalink | Comments (0)

The 6th Annual Johns Hopkins/Healthways Disease Management Outcomes Summit brought together more than 200 practicing physicians, physician executives, thought leaders and subject matter experts from across the country
with the goal of defining tools and systems to promote health and prevent disease. The goal of healthcare should be not only to control and manage risk factors, but to prevent the onset of risk factors in the first place. The group concludethat a degree of wellness is attainable by every individual at any stage of life. The entire report is worth readng by all.

Posted by at 10:36 AM | Permalink | Comments (0)

Researchers at the Miami Institute for Human Genomics at the Miller School found that smoking and caffeine may influence dopamine levels in the brain, but they are not a simple preventative. "There are over 4,000 components in cigarette smoke, and we assume it might be nicotine that is impacting the disease, but it might be other things," Scott says, noting that the nicotine anti-smoking patch does not significantly improve symptoms in Parkinson's patients. "If we could find out whether it was truly caffeine or nicotine and how it acts on the brain, that might help us develop better treatments for Parkinson's patients." The message is that this research does NOT support starting to smoke tobacco to avoid Parkinson's disease.

Posted by at 10:12 AM | Permalink | Comments (0)

From U.Cincinnati research shows the older population may soon be facing a medical care crisis as numbers of students studying geriatric medicine continue to decrease rapidly, say researchers at the University of Cincinnati. It is estimated that by the year 2030, there will be more than 70 million people over the age of 65 in the United States. According to the data collected over the last decade, the number of certified geriatricians in the United States has declined from 8,800 to 7,100.

Posted by at 11:15 AM | Permalink | Comments (0)

From UCLA we find dieting does not work. Traci Mann, UCLA associate professor of psychology and lead author of the study says"the majority of people regained all the weight, plus more. Sustained weight loss was found only in a small minority of participants." "We decided to dig up and analyze every study that followed people on diets for two to five years. We concluded most of them would have been better off not going on the diet at all." "Diet studies of less than two years are too short to show whether dieters have regained the weight they lost, Mann said. "Even when you follow dieters four years, they're still regaining weight," she said.
Perhaps Behavioral Science should be labelled the "Dismal Science". There is little evidence that we can make a difference, yet, in people's behaviors.

Posted by at 11:06 AM | Permalink | Comments (62)

In yesterday's New York Times, Dr Levy from the Framingham Heart study program said that for a 50-year-old man who does not have diabetes and does not smoke and keeps his cholesterol and blood pressure in the range recommended by national guidelines, over the next 45 years, his chance of ever having a heart attack or symptoms of heart disease, like chest pain, is just 5 percent. The same goes for a 50-year-old woman with those risk factors under control. Her chance of symptomatic heart disease is 8 percent, slightly higher than the man’s because women live longer. Yet, it is hard to change people's behaviors and reduce the phenomenal cost of care in later life.

Posted by at 10:55 AM | Permalink | Comments (1)

Yesterday the The Food and Drug Administration (FDA) urgently reminded the public that contact with baby turtles can pose a serious health risk to infants, small children, and adults with impaired immune systems as they can be natural hosts to Salmonella, a group of bacteria that can cause severe illness and death. Recently, a four-week old infant in Florida died of infection traced to Salmonella pomona, a bacteria that was also found in a pet turtle in the home

Posted by at 10:01 AM | Permalink | Comments (0)

Dr. Keith Klugman of Emory University , in this week's journal Science, recommends that as part of the pandemic flu prevention program that when individuals are vaccinated aginst flu they should also be vaccinated against pneumonia and meningitis. Dr. Klugman notes that bacterial infections, in particular pneumococcal disease, can follow a viral illness such as flu and cause secondary infections that worsen flu symptoms and increase influenza-related morbidity risk.

Posted by at 9:55 AM | Permalink | Comments (0)

IS HPV really worth the current furore. The article this week in the BMJ [Coombes R:2007;334:721-723] is worth reading for highlighting unanswered questions in the international rush to immunize. Has Merck had too much influence? Is the science clear enough for a vaccine that has only had a 5 year trial but is proprosed for all females?

Posted by at 10:17 AM | Permalink | Comments (0)

Today the Robert Wood Johnson Foundation announced a major program to combat childhood obesity. The skeptics should take a look at the RWJF website to review what is known, what works, models that can be used, and how your organization can benefit from this proposal.

Posted by at 10:50 AM | Permalink | Comments (0)

Are we getting nearer to an HIV vaccine? Scientists at Jefferson Medical College in Philadelphia have used a drastically weakened rabies virus to ferry HIV-related proteins into animals, in essence, vaccinating them against an AIDS-like disease. According to Dr. Schnell, the study demonstrated a “proof of principle” – that is, that the method used is technically possible. He says that the results indicate the need for future studies in larger groups of animals.

Posted by at 10:40 AM | Permalink | Comments (0)

With all the myths about ill effects of foods, promoted by activists, the American College of Sports Medicine provides facts about ten nutritional myths. Well worth your time to review.

Posted by at 10:34 AM | Permalink | Comments (1)

Researches need to think about the way the media will misinterpret their results. The Women's Health Initiative inital findings came out with all kinds of media hoopla about the dangers of hormone therapy. Now as time passes analysts have taken a closer look at the data, [see: JAMA. 2007;297:1465-1477.] paticularly at how women were recruited into the study. They discovered many biases and confounders not evident in the first rush to publication. Now it appears that many women can benefit from a tailored course of hormones at menopause and that wholesale declarations of their hazards were overdone by a media wanting sensationalism. We have seen the same problem with IUDs aand breast implants among other issues,

Posted by at 10:09 AM | Permalink | Comments (0)

If you are not aware of the controversy, Michael Chrichton's novel "State of Fear" is worth reading. Pay particular attention to the science debate in the epilogue.

Posted by at 10:07 AM | Permalink | Comments (0)

Katherine A. Poehling, M.D., a pediatrician at Brenner Children’s Hospital, part of Wake Forest University Baptist Medical Center found that, during the time that vaccine (pneumococcal conjugate vaccine) coverage increased, the number of vaccinated children who developed frequent ear infections and/or received ear tubes declined by 16 percent in Tennessee and 25 percent in New York. While most children have at least one ear infection by their second birthday, 25 to 30 percent of children will develop frequent ear infections or about three or four each year,” Poehling said.

Posted by at 10:01 AM | Permalink | Comments (0)

A new study from the Harvard School of Public Health (HSPH) provides the strongest association to date between trans fat and heart disease. It found that women in the U.S. with the highest levels of trans fat in their blood had three times the risk of CHD as those with the lowest levels. The study was published online on March 26, 2007, and will appear in the April 10, 2007 print issue of Circulation: Journal of the American Heart Association.

Posted by at 10:41 AM | Permalink | Comments (0)

A report in New Scientist says that researchers in Denmark may have found a way to remove A & B antigens from blood making all donated blood universally available.

Posted by at 10:16 AM | Permalink | Comments (0)