Dr. Buttery's Public Health BLOG

On Web MD today is an expose of the use of 'colon cleaners' which are sold in $billions usually to those with poor education, as a substitute for expensive medical care (particularly on the radio on Sunday mornings) or those sucked in to the vitamin/additive field. As P.T. Barnum is supposed to have said "A sucker is born every minute." The more research done in the field on complementary medicine, the more we see people throwing their money, and possibly their health, away on worthless products. As practitioners interested in prevention we should pay more attention to helping people avoid these products.

Posted by at 11:38 AM | Permalink | Comments (0)

The WHO's 'Stop TB Partnership' announced today that its drug supply arm, the Global Drug Facility, has provided anti-TB drug treatments for 10 million people to 78 countries in the past six years. "This is an important milestone, because getting anti-TB drugs to people who need them and making sure they complete their treatment is the only way to break the back of the epidemic. It is also the best weapon we have for preventing a potentially massive new epidemic of drug-resistant TB", said Dr Marcos Espinal, Executive Secretary of the Stop TB Partnership. "Together with countries and partners we are moving steadily towards our target of treating 50 million TB patients between 2006 and 2015."

Posted by at 10:38 AM | Permalink | Comments (0)

On World Tobacco Day the WHO emphasizes the need for countries to make all indoor public places and workplaces 100% smoke-free with the release of its new policy recommendations on protection from exposure to second-hand tobacco smoke. "The evidence is clear, there is no safe level of exposure to second-hand tobacco smoke," said the WHO Director-General Dr Margaret Chan. "Many countries have already taken action. I urge all countries that have not yet done so to take this immediate and important step to protect the health of all by passing laws requiring all indoor workplaces and public places to be 100% smoke-free."

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

Unsurprisingly XDR-TB has finally made its way into the US by means of an air flight. The infected individual had travelled through Europe recently. The main issue is that he spent a number of hours in an evironment where the cabin air was recirculated. The CDC and other health authorities are tracking down potential contacts for follow-up. While indivdual risk may be low, a lot depends on the state of health of other passengers in the plane. We have seen TB spread on ships where crew were exposed to recirculated air, although often for days or weeks, not just a few hours.

Posted by at 10:19 AM | Permalink | Comments (0)

Today, Sednator Obama has weighed in on medical care access. Like most politicians he seems to think the only way to improve access is to increase taxes. Our politicians fail to review the history of health care access in all the other developed countries, where universal care is the norm, at lower cost, and better outcome than the U.S.

Posted by at 10:14 AM | Permalink | Comments (0)

A fascinating study in this week's Archives of Internal Medicine [Arch Intern Med. 2007;167:1026-1033] identifies an increase of Community Acquired MRSA (a different clonal entity from hospital acquired MRSA) from 24.0 cases per 100 000 people in 2000 to 164.2 cases per 100 000 people in 2005 (relative risk, 6.84 [2005 vs 2000]). This infection has emerged among Chicago’s urban poor. It has occurred in addition to, not in place of, methicillin-susceptible S aureus infection.

Posted by at 12:17 PM | Permalink | Comments (0)

Reported by Promed today after study by CDC is an increase in Acanthamoeba keratitis_ (AK).
This condition can casue blindess and is associated with contact lens wearers exhibiting risky behaviors such as improperly storing, handling, or disinfecting their lenses (e.g., by using tap water or homemade solutions for cleaning); swim, use hot tubs, or shower while wearing lenses; come in contact with contaminated water; have minor damage to their
corneas; or have previous corneal trauma are at increased risk for
infection.

Posted by at 11:25 AM | Permalink | Comments (0)

From the University of Nottinham (U.K.) researchers intend to develop bacteriophage-based treatments for the control of Campylobacter. Bacteriophages — the term literally means 'bacterium-eater' — are naturally occurring agents that target and destroy bacteria with a high degree of efficiency, and do so selectively and specifically, without affecting beneficial bacteria or gut cells. The term is commonly used in its shortened form, phage. Campylobacter — the commonest cause of infectious bacterial intestinal disease in England and Wales, according to the U.K. Health Protection Agency. Campylobacters are found in poultry and other animals and cause millions of cases of food poisoning worldwide.

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

A simple method of flash-heating breast milk infected with HIV successfully inactivated the free-floating virus, according to a new study led by researchers at the Berkeley and Davis campuses of the University of California. The findings, to appear in the July 1 print issue of the Journal of the Acquired Immune Deficiency Syndromes, but now available online, provide hope that mothers with HIV in developing nations will soon be able to more safely feed their babies.

Posted by at 11:08 AM | Permalink | Comments (0)

Professor Mark Bellis, Director of Liverpool's John Moore University's Centre for Public Health and colleagues found youths who receive more than £10 a week in spending money and who buy alcohol for themselves are more likely to become 'problem drinkers', a survey of over 10,000 teenagers reveals. The authors highlight a number of potential interventions including limiting and monitoring young people's funds, upping the cost of alcohol, providing and promoting participation in sports and social activities, and identifying and closing all retailers selling to those underage.

Posted by at 11:01 AM | Permalink | Comments (0)

To confoud those who push the use of mahuana: studies conducted at Swedish medical university Karolinska Institutet, with participation of scientists from Europe and the United States, are now published in Science and show that these endogenous molecules regulate how certain nerve cells recognize each other and form connections. Researchers believe that their findings will significantly advance our understanding of how cannabis smoking during pregnancy may damage the fetal brain.

Posted by at 10:56 AM | Permalink | Comments (1)

Published in the Spring 2007 issue of the Guttmacher Policy Review, “The Case for a New Approach to Sex Education Mounts: Will Policymakers Heed the Message?” by Heather Boonstra find that despite compelling evidence that abstinence-only programs do not stop—or even delay—teen sex, these programs are currently funded at a level of $176 million annually.

Posted by at 10:51 AM | Permalink | Comments (0)

Annonced today in "AMA News" is a coalition of health care, business and labor organizations intends to bring several unhealthy truths about chronic disease out of the shadows and into the spotlight of presidential politics. "We have a 'sick care' system, not a health care system in this country," said former U.S. Surgeon General Richard H. Carmona, MD, MPH a message many of us have been trying to push for a decade or more.
Note that:
Chronic diseases kill more than 1.7 million Americans each year.
They account for 75% of the nation's health care spending.
The vast majority of cases of chronic diseases can be better prevented or managed.

Posted by at 10:24 AM | Permalink | Comments (2)

From the University of Rochester, NY, early-stage research has found that a new gene therapy can nearly eliminate arthritis pain, and significantly reduce long-term damage to the affected joints, according to a study published today in the Journal Arthritis and Rheumatism. The study was done in mice genetically engineered to develop osteoarthritis like humans. It will be nice when all the studies performed in mice and trumpeted by research instituions prove ourt in humans, Perhaps we need another model?

Posted by at 10:04 AM | Permalink | Comments (0)

The Lancet lead editorial this week, on International Health Regulations, is worth reading as June 15, 2007, will mark an important milestone in public health. On this date the revised International Health Regulations (IHR 2005) will come into force, with the aim of preventing national public-health emergencies from spreading internationally. All 193 WHO member states have agreed to the IHR in principle and over 160 have nominated a centre to be their national focal point. [Volume 369, Issue 9575, 26 May 2007-1 June 2007, Page 1763]

Posted by at 7:39 PM | Permalink | Comments (0)

News from the Washington Post & Kaiser Family Foundation focus on recent reports on closing of midwifery based birth centers. The closures are the result of a combination of cost of malpractice insurance and delayed/ frugal payments for prenatal and delivery care by insurance companies. One more reason for universal access to care and limitation of lawsuits just because someone wants a different outcome.

Posted by at 1:20 PM | Permalink | Comments (0)

From the University of Nottingham we learn that Malaria infects around 400 million people every year and kills between one and three million, mostly children. Further researchers at The University of Nottingham believe they have made a significant breakthrough in the search for an effective vaccine. Using blood from a group of people with natural immunity to the disease, a team from the School of Biology refined and strengthened the antibodies using a new animal testing system which, for the first time, mimics in mice the way malaria infects humans. When injected into mice, these antibodies protected them against the disease. Hopefully we can move quickly from mice to poeple.

Posted by at 1:13 PM | Permalink | Comments (0)

From Diabetes UK today: Heart attacks claim as many lives of younger women as breast cancer, yet victims often fail to recognise their symptoms, doctors have warned. already show signs of cardiovascular disease at the time of diagnosis," said Simon O’Neill, Director of Care, Information and Advocacy Services at Diabetes UK. "Heart disease is the most common complication of diabetes. It is essential we take immediate steps to ensure people have access to the appropriate care and treatment. We want to see better information for the newly diagnosed as well as improved access to education courses and dietary and lifestyle advice.”

Posted by at 10:48 AM | Permalink | Comments (1)

The AAN has published a new clinical guideline on Lyme disease. The guideline finds that conventionally recommended courses of antibiotics are highly effective for treating nervous system Lyme disease. However, there is no compelling evidence that prolonged treatment with antibiotics has any benefit in treating symptoms that persist following standard therapy. The AAN also has a 60 second PSA on lymre disease on its web site

Posted by at 10:42 AM | Permalink | Comments (0)

I wonder why we keep re-inventing the wheel. Many studies over the last 20 years have shown that specialised procedures should be performed in higih volume centers where the problems occur with enough frequency to keep specialty skills sharp. This issue raises itself again today with the headlines about care for premature neonates, from Stanford University. Part of the problem comes from failure of the AAMC and its component schools to perform epidemiologic analyses of their products ( physicians), graduating too many with special skills uneeded by the public. The basics of medical care is primary care, but we keep producing specialists in excess of need, then use the demand for primary care as an excuse to train more specialists..

Posted by at 10:18 AM | Permalink | Comments (0)

The Food and Drug Administration (FDA) today approved Lybrel, the first continuous use drug product for prevention of pregnancy. The safety and efficacy of Lybrel as a contraceptive method were supported by two one-year clinical studies, enrolling more than 2,400 women, ages 18 to 49. Health care professionals and patients are advised that when considering the use of Lybrel, the convenience of having no scheduled menstruation should be weighed against the inconvenience of unscheduled bleeding or spotting. However, as this product will be used for decades long term effects, if any, have not had an oppodtunity to develop.

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

A diet rich in fruits, grains and low-fat dairy products has been shown to significantly lower blood pressure, but few Americans with high blood pressure are following it, according to research from Wake Forest University School of Medicine reported at the 22nd Annual Scientific Meeting of the American Society of Hypertension. Only 22 percent of hypertensives were following the Dietary Approaches to Stop Hypertension (DASH) diet.

Posted by at 2:33 PM | Permalink | Comments (0)

from the American Cancer Society; its Department of Epidemiology and Surveillance Research is inviting men and women between the ages of 30 and 65 years who have no personal history of cancer to join a historic research study. The ultimate goal is to enroll 500,000 adults from various racial/ethnic backgrounds from across the U.S. The purpose of CPS-3 is to better understand the lifestyle, behavioral, environmental and genetic factors that cause or prevent cancer and to ultimately eliminate cancer as a major health problem for this and future generations.

Posted by at 10:28 AM | Permalink | Comments (0)

Today the WHO published its 3rd World Health Statistics Update. All of us should examine this valuable resource, particularly the "Ten statistical highlights in global public health."

Posted by at 11:03 AM | Permalink | Comments (0)

The Environmental Protection Agency, on Tuesday announced that the agency will provide a $7.7 million grant to fund a five-year study at Duke University that will investigate the causes of premature birth and low birthweight among infants in Southern states. The study aims to reverse the recent rise in premature births and low birthweights reported in many Southern states. Researchers will work with community groups and local health clinics, examining how fetal growth is affected by genetics, socioeconomic factors and environmental factors, such as growing up in substandard housing or breathing polluted air.

Posted by at 12:29 PM | Permalink | Comments (0)

After yesterday's note about how to cook broccoli, today from U. Oregon we find out that fresh broccoli soprouts are even better for your long term health. researchers at the Linus Pauling Institute at Oregon State University have found that sulforaphane – a compound found in cruciferous vegetables such as broccoli, bok choy and brussels sprouts – has strong anti-cancer properties.The researcher said “I would say if you’re at all worried about cancer or at high risk of cancer, especially of prostate or colon cancer, then increasing your dietary intake of broccoli and other vegetables could be a good idea,”

Posted by at 10:53 AM | Permalink | Comments (0)

Should Public Health agencies act as "Health Police" rather than as health educators? Look at the editorial in today's NEJM, on New York's passage of banning of trans fat containing cooking oils in food service places. [n engl j med 356;20, May 17, 2007] We currenlty have agencies called "Behavioral Health Agencies" who are policing individual behavior based on their beliefs rather than science. How much further do we have to go before we are live in the Brave New World? Is this just politics in the North East

Posted by at 12:39 PM | Permalink | Comments (0)

Researchers at the University of Warwick have found that the standard British cooking habit of boiling vegetables severely damages the anticancer properties of many Brassica vegetables such as broccoli, Brussel sprouts, cauliflower and green cabbage. Professor Thornalley said: "If you want to get the maximum benefit from your five portions-a-day vegetable consumption, if you are cooking your vegetables boiling is out. You need to consider stir frying steaming or micro-waving them."

Posted by at 11:27 AM | Permalink | Comments (0)

Fascinating new research from George Cotsarelis and -colleagues at the University of Pennsylvania describe in today's issue of Nature how they reawakened follicle-forming genes in mice, previously thought to operate only in the developing embryo. This may lead to early intervention tn prevent baldness and provide a model for genetic intervention

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

Another reason to loose weight: Having a body mass index (BMI) in the overweight or obese range increases the risk of traumatic workplace injury, according to researchers at the Johns Hopkins Bloomberg School of Public Health’s Center for Injury Research and Policy. Of the 7,690 workers included in the study, 29 percent were injured at least once between January 2, 2002, and December 31, 2004. Approximately 85 percent of the injured workers were classified as overweight or obese. More than 28 percent of injuries occurred among employees classified as overweight, 30 percent in the obese I and II category and almost 34 percent in the obese III category.

Posted by at 11:10 AM | Permalink | Comments (0)

From from Cancer Research UK today figures – calculated by Professor Michel Coleman and his team at the London School of Hygiene and Tropical Medicine – show that while survival varies widely between different types of cancer, on average a patient with cancer now has a 46.2 per cent chance of being alive ten years after diagnosis* . This compares with 23.6 per cent 30 years ago** . Overall five-year survival is now 49.6 per cent. The charity is setting ten ambitious new goals to achieve by the year 2020.

Posted by at 9:57 AM | Permalink | Comments (0)

When I was at medical school more than 50 years ago I was told to expect the end of syphilis with the advent of Penicillin. Now from New South Wales in Australia we learn of a doubling of Syphilis between 2002 and 2005. Ocular syphliis which used to be rare is becoming more commonplace, particularly in the Gay Community, where prevention of STDS occurs rarely, Reported at http://www.promedmail.org

Posted by at 7:34 PM | Permalink | Comments (0)

From the Commonwealth fund today: despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance. This report, which includes information from primary care physicians about their medical practices and views of their countries' health systems

Posted by at 12:59 PM | Permalink | Comments (3)

Researchers at the University of Manchester (U.K.) found proof that the origins of modern medicine lie in ancient Egypt and not with Hippocrates and the Greeks. Medical documents, first discovered in the mid-19th century, showed that ancient Egyptian physicians treated wounds with honey, resins and metals known to be antimicrobial. "Many of the ancient remedies we discovered survived into the 20th century and, indeed, some remain in use today, albeit that the active component is now produced synthetically," said Dr Campbell.

Posted by at 1:43 PM | Permalink | Comments (0)

From the Proceedings of the Mayo Clinic sales of herbal dietary supplements have skyrocketed by 100 percent in the United States during the last 10 years, but most people don't consider evidence-based indications before using them. The study found that only one-third of this population took the herbal preparation for a known scientific indication. Dr. Bardia cautions that further study is warranted as the efficacy of herb use evolves and says much more needs to be learned about the clinical indications for individual herbs.

Posted by at 12:14 PM | Permalink | Comments (0)

In this month's Journal of Preventive Medicine is a fascinating article on why/how restaurant chains plan menus and how to get "healthy foods" onto the menu [Vol. 32, #5, Pp 383-388 (May 2007)]. The bottom line, apparently to the surprise of the researchers, was that chains provide what their customers demand! Labelling food as healthy is the 'kiss of death' to an item's survival on a menu.

Posted by at 11:27 AM | Permalink | Comments (0)

"Although ACOG, the Centers for Disease Control and Prevention (CDC), and the US Preventive Services Task Force recommend annual screening for chlamydia of all sexually active women age 25 and younger, as well as other asymptomatic women at high risk for infection, studies show it isn't happening," said Stanley Zinberg, MD. About 75% of chlamydial infections in women don't produce symptoms or if they do, they are often vague, causing women to delay seeking medical care and treatment. If not treated, up to 40% of women infected with chlamydia may develop pelvic inflammatory disease (PID), which can lead to ectopic pregnancy and infertility. One in five women with PID becomes infertile.

Posted by at 10:57 AM | Permalink | Comments (1)

With all the debate about mandating use of HPV vaccine, this week's issue of the NEJM has 2 articles showing it is 98-100% effective. Further in a study of 12000 women 15-26 years old 93% had been sexually active on entry into the study and 27% had been infected by at least one type of HPV. Editorials in the same issue note that there are more than 100 types of HPV and 17 are thought to cause cancer. WIll other types fill lhe cancer niche if the vaccine knocks out two of the variants? The pros and cons are well debated in the journal and should be read.

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

Look for a media blitz. The U.S. Food and Drug Administration (FDA) today cleared for marketing the first respirators that can help reduce the user's exposure to airborne germs during a public health medical emergency, such as an influenza pandemic."While the exact nature and concentration of the biological agent or germ may not be known in a public health medical emergency, we believe that minimizing exposure will help reduce risk," said Daniel Schultz, M.D., director, FDA's Center for Devices and Radiological Health. "These respirators are only one part of a combination of approaches that can be used to help reduce the spread of infection between individuals during such events." So, who will determine when the wearing of these masks is essential? Who will determine the real hazard? Are we going to be seeing those driven by media reports wearing the masks all the time, just in case? What will they cost? Who will sell them?

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

From the University of Medicine and Dentistry of New Jersey researchers demonstrate that the season of the year, age and race are factors that affect blood lead levels and vitamin D deficiency in children who live in urban areas. Young African-American children were more likely to be deficient in vitamin D and have higher blood lead levels when compared with their Hispanic counterparts. In addition, increases in blood lead during the summer were associated with increases in blood vitamin D levels in the four to 8-year-old children studied.

Posted by at 11:35 AM | Permalink | Comments (0)

From Cincinnati Children's Hospital researchers find that despite an epidemic of obesity that has resulted in calls for pediatricians to plot a patient's body mass index (BMI) at least once a year, less than six percent of physicians appear to be doing it. "It's easy and inexpensive to screen for obesity, and we should be doing it at every well child visit to screen for overweight and obesity," says Jennifer Hillman, MD, a fellow in the division of adolescent medicine at Cincinnati Children's and the study's lead author.

Posted by at 11:23 AM | Permalink | Comments (0)

From Ohio State University researchers have linked GIS technology and genetic analyses of avian flu to demonstrate the spread of this disease in the far East and Africa and suggest potential paths for further spread.

Posted by at 10:21 AM | Permalink | Comments (0)

Almost 500,000 low-income, uninsured and underinsured women are expected to receive breast and cervical cancer screenings this year through an early-detection program President Bush agreed to extend last month.
The National Breast and Cervical Cancer Early Detection Program Reauthorization Act of 2007 authorizes a gradual funding increase from today's $202 million to $275 million by 2012. This would allow an additional 130,000 women to be served, according to the American Cancer Society Cancer Action Network.

Posted by at 10:14 AM | Permalink | Comments (0)

CDC has just released a recommendation on use of facemasks during a flu pandemic. Are we supposed to be stockpiling these at home? What is the real likelihood of a pandemic? Is this a public relations activity? Unfortunately, much written about the flu epidemic has gone from science to politics and CDC is no more immune than any other government agency. This is a response to the media after they have finally lost interest. The best solution is not to wear facemasks, but to encourage anyone with symptoms during a flu outbreak [not just a pandemic] to stay home until better and not infect all those with whom they come into contact.

Posted by at 1:00 PM | Permalink | Comments (0)

In the daily report from the Kaiser Family Foundation Senator Bennett is endorsing a bill introduced in January by Sen. Ron Wyden to provide universal health insurance using the current private insurers and expects to save more than $1.48 trillion over 10 years

Posted by at 12:52 PM | Permalink | Comments (0)

FDA today announced two new initiatives to enhance online communications. A Web page, "Consumer Health Information for You and Your Family, provides comprehensive and timely consumer information. A free monthly e-newsletter, FDA Consumer Health Information, will alert consumers to content contained on the page.

Posted by at 12:46 PM | Permalink | Comments (41)

While we do not know as much as we would like about genetic testing and potential disease onset, the NIH is about to embark on a study of how younger adults respond to genetic knowledge. Called the Multiplex Initiative, the study will also look at how people who decide to take the tests will interpret and use the results in making their own health care decisions in the future. The test being used is designed to yield information about 15 different genes that play roles in type 2 diabetes, coronary heart disease, high blood cholesterol, high blood pressure, osteoporosis, lung cancer, colorectal cancer, and malignant melanoma.

Posted by at 12:42 PM | Permalink | Comments (0)

Public Health agencies have spent millions of dollars on studies activists have persuaded legislators needed to be performed. Money was diverted from programs that could,have prevented infant deaths, childhood disabilities, and chronic diseases. Among these studies have been numerous ones on the supposed ill effects of Electro-Magnetic Fields. None have shown any evidence of ill effects. Now in an article in Occup Environ Med (a BMJ publication) researchers used the health and employment records of more than 22,000 utility workers at 99 different electrical energy supply companies in Denmark. Their conclusion: electromagnetic fields do not pose a health hazard to workers in the electrical energy supply industry,

Posted by at 12:28 PM | Permalink | Comments (0)

An interactive, Web-based asthma education management program developed by Henry Ford Health System to target African-American teens has shown promise for dramatically improving their asthma outcomes.
A study conducted by Henry Ford to examine the effectiveness of the program, dubbed Puff City, found that the teens self-managed their asthma better after one year of use than those who used four nationally recognized asthma education Web sites. The Puff City users:
• Made 50 percent fewer visits to the emergency department.
• Required 50 percent fewer hospitalizations.
• Missed 60 percent fewer schools days.

Posted by at 12:19 PM | Permalink | Comments (0)

A fascinating story in today's BMJ from Dr. James Goldacre in the U.K. is about the failure of the media to pick up on well documented improvements on the social behaviour of children as rhe result of training parents. This is just as much a problem in the US as in the UK, yet we keep looking for a magic pill, while the media and the mental health public interest groups ignore the role of parents.

Posted by at 11:59 AM | Permalink | Comments (0)

This issue keeps coming up in medicine ,but we never seem to follow up. In a new study presented at the American Academy of Neurology meeting, April 29-May 5, Max Hietala, MD, PhD (Sahlgrenska University Hospital, Goteborg) and James Kelly, MD (visiting professor of neurosurgery, University of Colorado) discussed new evidence of the dangers of amateur boxing even when using well padded protective headgear. They note that 15 blows to the head can be the equivalent of a stroke. Few amateurs have less than this in a single fight while professionals are much worse off, as they fight without protection. Again, it is time to stop this avoidable brain damage. Boxing at school and university should be banned.