Dr. Buttery's Public Health BLOG

A story in Bioethics International notes that a simple cheek swab can tell you about your ancestry. A bit of blood can tell you how likely you are to get cancer or heart disease. The problem is whether anyone can interpret the test in a way that will help those tested make sense of the test. Too many private firms have swarmed into the field , Only a few are using the latest technology. Some of the testing firms are fraudulent. There is no seal of approval available for the public yet. If you really need (not want) a genetic analysis go to the genetics department of a medical school.

Posted by at 9:15 AM | Permalink | Comments (0)

This is the time of year in the USA when we are exhorted to give to the less fortunate. How often do we ask whether what we gives makes a difference. The helping agencies are full of anecdotes, but there is little evidence they make much difference. The behaviors which result in dependency rarely change. Now, this week is an editorial worth reading in the BMJ, which looks at evaluation of the $billions of international aid given out from western countries. Development aid is meant to help eradicate poverty through the stimulation of economic growth. A total of $2.3 trillion (£1.1 trillion; 1.6 trillion) has been spent on development aid over past five decades, and it has been the subject of vigorous debate among development economists. All the evaluations share former US Treasury Secretary Paul O’Neal’s sigh of exasperation that, "We’ve spent trillions of dollars on these problems and we have damn near nothing to show for it." Donors largely lack evidence based knowledge of the situation on the ground in poor countries, or of how to make aid effective. Whether giving aid locally, or through the international community, hard evidence is more important than political self importancr..

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

The latest version of "Health- United States" for 2007 has just been published. In its highlights the authors state "The United States spends more on health per capita than any other country, and U.S. health spending continues to increase, though the rate of increase has slowed for the third consecutive year. Spending increases are due to increased intensity and cost of services and a higher volume of services needed to treat an aging population." Repeatedly throughout its over 500 pages are data on the increasing problems of chronic idsease due to poor health behaviors.

Posted by at 9:28 AM | Permalink | Comments (0)

The Newsmedia are full of Ads. to recommend that you be screened for multiple conditions, with the intent that screening improves your health status. Now, from the the Royal Society of Medicine. Professor Wald questions the promotion, often by insurance companies, for screening tests which have no real benefit and which may even be harmful. “There is, emerging in Britain (and also in the USA - CMGB), a culture in which judgements on medical screening practice are being made in the absence of evidence….The culture needs to change, so that screening is subject to professional scientific assessment.” [Journal of Medical Screening 2007 Volume 11 Number 0]

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

In a 7 country survey of health system performance, as seen by recipients of care, the USA finished dead last. When will we some some sensible move toward change instead of the little steps recommended by most presidential contenders?

Posted by at 9:28 AM | Permalink | Comments (0)

Researchers at The Warren Alpert Medical School of Brown University have created a first-ever educational video on rapid HIV testing. The video – available for free online – is aimed at increasing testing rates and slowing the spread of HIV/AIDS, one of the deadliest epidemics in recorded history

Posted by at 9:37 AM | Permalink | Comments (0)

A new review just published in the American Journal of Respiratory Diseases shows that COPD from chronic bronchitis and emphysema is rising in women. They are catching up with and exceeding men as they continue to smoke while men are slowing down their smoking. Sometimes we need to learn from each other, not just repeat the same errors. Thank you Virginia Slims!

Posted by at 9:23 AM | Permalink | Comments (0)

There has been much international attention focused on MDG-4—to reduce under-5 mortality by two-thirds between 1990 and 2015. There is still a huge disparity between the industrialized countries and the rest of the world.

Posted by at 9:18 AM | Permalink | Comments (0)

Another study, published this week in the Annals of Internal Medicine [NIH-AARP Diet and Health Study; Arch Intern Med. 2007;167(22):2461-2468], again confirms the value of a mediterranean style diet and exercise in reducing the chance of death within the next 5 years.

Posted by at 10:51 AM | Permalink | Comments (2)

We learn, from anthropological studies at the U. Texas today that Tb may have been around for 500,000 years. It just won't go away.

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

Today, only 9 percent to 12 percent of physicians in the United States have access to full-fledged electronic medical records. Among advanced nations, the use of medical information technology here ranks among the “worst of the worst,” Crounse said. The United Kingdom spends 10 times as much as the United States on health IT, said Bradford Hesse, chief of the Health Communication and Informatics Research Branch at the National Cancer Institute.
“We have clearly failed to keep our population healthy,” said Bosworth of Google, who noted that tracking the advance of obesity and diabetes in the United States has been “like watching an alien virus spread across the country.”

Posted by at 9:39 AM | Permalink | Comments (0)

In the BMJ, 8 December 2007, Volume 335 is an excellent article worth reading by all who are interested in health as oppossed to disease, from Harald Schmidt. He is concerned that rights often trump responsibilities. We need to balance the two with more emphasis by policy makers and potential users of medical systemns on health promotion and disease prevention, instead of focusing on treatment..

Posted by at 9:11 AM | Permalink | Comments (0)

A 'Perspective' article in today's NEJM [Volume 357:2321-2324 December 6, 2007 Number 23] expresses concern about the inabiity of the FDA to stop the marketing of products determined to be useless, compared to placebo, but dangerous to children, and is worth reading carefully. In recent weeks, over-the-counter cough and cold medications for children have received unprecedented attention from regulators, physicians, the media, and parents. This scrutiny represents a long-overdue reassessment of products that were purchased by 39% of U.S. households during the past 3 years.1 It also reflects an important evolution in the standard of evidence for medications used in children.

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

Cancer stands as the leading disease-related cause of death for U.S. children, the Centers for Disease Control and Prevention said in a report. Better treatments are improving survival rates, the CDC said. The cancer death rate for U.S. children was 34.2 per million for children up to age 19 in 1990, but fell to 27.3 per million in 2004, the CDC said. This death rate has declined 1.7 percent per year during this period, according to the CDC. "It's not that we're having less cancer diagnosed. The incidence rates, the new-case rates are the same. It's just that we're getting better survival," the CDC's Dr. Lori Pollack said in a telephone interview.

Posted by at 1:46 PM | Permalink | Comments (0)

Saint Louis University School of Nursing and a member of the university's Pandemic Response Planning Committee say you should:
Get a flu shot
Wash your hands often
Avoid touching your eyes, nose and mouth
Avoid close contact with people who are sick
Get plenty of sleep, eat nutritious food, drink plenty of water and other fluids and learn how to manage your stress
Cover your nose and mouth. If you're about to sneeze or cough
If you're sick - stay home,!

Posted by at 9:43 AM | Permalink | Comments (0)

In a new evidence-based paper, the American College of Physicians (ACP) analyzes health care in the United States and 12 other industrialized countries and identifies lessons that could be applied to the particular political and social culture of the United States to achieve a high performing health care system, including achieving universal health insurance coverage for all Americans. It recommends:
1. Provide universal health insurance coverage
2. create incentives to encourage patients to be prudent purchasers by having access to health information necessary for informed decision-making;
3. avert a collapse of primary care by developing a national workforce policy that ensures an adequate supply of physicians trained to manage care for the whole patient;
4. redirect federal health care policy toward supporting the patient-centered medical home, an innovative practice system designed to strengthen the physician-patient relationship by having a primary care physician coordinate a team of health care professionals as they address the full range of a patient’s needs;
5. provide financial incentives for physicians for care coordination, disease prevention, and achievement of evidence-based performance standards;
6. reduce the costs of health care administration by creating a uniform billing system for all services;
7. support with federal funds an inter-operable health information technology infrastructure;
8. encourage public and private investment in medical research and assessments of the comparative effectiveness of different medical treatments;

Posted by at 12:30 PM | Permalink | Comments (0)