Dr. Buttery's Public Health BLOG

In a new study, an international team of heart experts at Johns Hopkins and elsewhere report that rats fed 10 milligrams daily of folate, also known as folic acid or vitamin B9, for a week prior to heart attack had smaller infarcts than rats who took no supplements. On average, researchers say, the amount of muscle tissue exposed to damage and scarred by the arterial blockage was shrunk to less than a tenth. The team's findings, set for publication in the April 8 edition of the journal Circulation, come just weeks after other international studies in humans suggested that low-dose folic acid supplements may prevent dementia in the elderly and premature births.
While people are not rats, study after study has shown that folic acid, found in green leafy vegetables, is one of the few consistent findings about the human diet. Further, this naturally occurring dietary supplement continues to show its value not only during the perinatal period but throughout life. Broccoli and other greens really are worth eating.

Posted by at 9:58 AM | Permalink | Comments (0)

Congress and the media are again hounding the FDA. All drugs (medicines) are dangerous. This statement is one that the media and politicians need to learn. One cannot test a medicine in more than a few thousand people at a time, before it is released to the practicing physicains. Once it is released for use and millions are exposed to the medication rare events, a number of the including death, may occur. Some of these are coincidental but the activists want cause and do not undestand the issue of coincidence.. How many adverse events are acceptable? Should millions of people be denied use of a useful drug because one in a million has a serious adverse eevnt. How many sheets of advice must a scienitifically untrained person read before a prescription is written? How many of you read the small print of every document you sign? Not many I bet! Perhaps we need to stop advertising prescription drugs as this pressures physicians to use drugs that might not otherwise be recommended. Then when patients have adverse effects they run to a lawyer rather than accept blame for their own behavior. One more reason for the rapidly increasing cost of the health care system.

Posted by at 10:38 AM | Permalink | Comments (1)

A very useful paper from MIT discusses recent research on the humane genome and its potential for identifying contributors to disease, which may lead to preventive interventions. Despite the ballyhoo in the newsmedia much work remains to be done before the research is translated to useful practice. The authors note that "a dramatic increase in the number of genome-wide association studies, in which the genomes of many people are scanned to locate genetic variations that contribute to disease." Also, "work published last year by Broad researchers and others in the Diabetes Genetics Initiative identified several genetic changes that influence a person’s level of cholesterol — a known risk factor for heart disease.." A key Issue is "to prove that their model has real value in the clinic. “There’s an assumption that predicting risk automatically means health will improve,”

Posted by at 9:34 AM | Permalink | Comments (1)

Although advances in genomic medicine for common adult chronic diseases such as heart disease, diabetes, and cancer hold promise for improved prevention, diagnosis and treatment, health professionals and the public are not prepared to effectively integrate these new tools into practice, according to a study released today by researchers from the Department of Veterans Affairs and the RAND Corporation.
Researchers say the findings demonstrate a need for a large-scale effort to educate both health professionals and the public about genomic medicine, and to develop and evaluate new ways to deliver genetic services.

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

With all the newest information about the prevalance of STDs among teen girls, nothing new to the public health community although we had to discuss it "sotto-voce", we not only need to be sure that children are taught about problems of sexiual intimacy early, but that they undestand the value of condoms. Certain parents think it irresponsible to teach children about sexual behavior, so they let them get misinformation from their peers, while failing to educate their children themselves. Then they wonder about how the teens became infected with an STD. While condoms may occassionly fail (much rarer than activists would have you believe) they are still the next best thing to abstinence which is rare in today's environment. I can remember back to my youth just after the end of WW2 when girls would not go out with a boy if they did not see the outline of a condom in his back pants pocket. Maybe we need to resurrect this habit Since the advent of "birth control pills' all the onus for sexual outcomes has been placed on the girl instead of the boy.

Posted by at 9:38 AM | Permalink | Comments (8)

The remaining candidates have it all wrong. The Republican candidate make no pretense of caring for the uninsured and has no idea that the health care system is imploding. The Democratic contenders, while aware there are problems seem to think all they have to do is provide insurance coverage! The Massachussetts program is in deep financial trouble. The California program died in committee. The New Jersey plan is unlikely to go anywhere as it only focuses on insurance, mainly for children. Until the plans stop looking at hospital costs and freedom of choice for anything one wants, and focuses on a primary care home for everyone, and sets limits to interventions there will be nothing except sets of new unfulfilled promises. It is time we learn from every other nation in the world that access to health services has to start in the primary care arena, with a single practice responsible for comprehensive care, acting as a gate keeper. Further. such care has to place an emphasis on preventing disease, not just intervening after symptoms occur. There is no way any system can pay for everything. There must be be evidence that interventions work, particularly in the realm of all the "me-too" prescriptions, many of which are overpriced and undereffective. Prescription advertising has to stop.. Any program that ensures population wide access must include a system that precludes some interventions as too expensive and inneffective. This is even more important with all the new research in genetics that will translate into useful inteventions within the next decade, and the associated population boom..

Posted by at 10:58 AM | Permalink | Comments (6)

Advances in genetics and genomics are revolutionizing biomedical science and providing great promise for the future of clinical practice. This is the opening sentance in the lead editorial in today's JAMA., It is well worth reading, as are many of the accompanyng articles which demonstrate how understanding the individual genome and the study of genetics can lead us to prevention of many diseases and amelioration of others.

Posted by at 5:25 PM | Permalink | Comments (0)

More than 90% of patients with sinusitis-like symptoms are managed entirely in family practice without recourse to further investigations apart from point-of-care testing such as for C-reactive protein, which is commonly used in Scandinavia and some other European countries. As with many other common infections, sinusitis is challenging for clinicians because many patients expect antibiotic treatment and associate the drug with recovery. At the same time, evidence mounts that antibiotics confer little average benefit. However, a possible benefit in subgroups has not been ruled out. This article from today's Lancet may not be applicable to the US because too few patients have family doctors and are more likely to expect antibiotic use than in the UK. (Volume 371, Issue 9616, 15 March 2008-21 March 2008, Pages 874-876 )

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

Colorectal Cance interventions have worked well. Death and diability is prevented in most cases when found among asymptomatic individuals. The two new tests, added to five others, are CT colonography (CTC), also known as virtual colonoscopy, and stool DNA-testing. Stool DNA-testing will mainly aid the detection of cancer, similar to testing for faecal occult blood, but without the need for multiple stool samples and without reliance on the non-specific and intermittent occult bleeding. CTC is minimally invasive, allows examination of the entire colon and rectum, and takes only about 10 min to acquire images. Patients undergoing CTC still require full bowel preparation. The Cancer society says the real issue of successful screening, however, remains the dismal uptake—about 30% for colonoscopy and 15% for faecal occult blood-testing in the USA. Colorectal cancer can only be prevented and mortality reduced if all screening tests are offered widely and people are made aware of the importance of screening. If the use of these screening tests is to increase then the discomfort associated with the preparation must decrease. (Volume 371, Issue 9616, 15 March 2008-21 March 2008, Page 872 )

Posted by at 10:54 AM | Permalink | Comments (0)

Those few who might be swayed by recent stories about linkages between vaccines and autism should look at the report that Hib meningitis has been virtually eliminated in young children in Uganda just five years after the country introduced Haemophilus influenzae type b (Hib) vaccine nationwide, according to an independent study. Each year, Hib kills approximately 400,000 children under five years of age, most of them in the developing world. It is also responsible for approximately three million cases of serious illnesses resulting in long-term consequences such as deafness, paralysis, mental retardation and learning disabilities. One should be suspect of claims by the 'ME' generation, and their attorneys, that an individual is more important than the population as a whole.

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

The study, by researchers from Imperial College London and the University of Oxford, shows that doctors can determine that a patient does not have tuberculosis with 99% accuracy when using the new blood test, ELISpot-Plus, in conjunction with a skin test known as tuberculin skin testing, already in use. The new study showed that ELISpot-Plus alone was accurately able to determine TB infection in 89% of cases and tuberculin skin testing alone was able to determine TB infection in 79% of cases. However, using both tests together was able to rule out TB infection with an accuracy of 99%.
This would lead to much better evaluatioof TB status than Chest X-rays and be particularly useful for screening iimmigrants, Professor Ajit Lalvani, from the National Heart and Lung Institute at Imperial College London, who led the study team, said: "Our new test could revolutionise the way we manage people with suspected TB."

Posted by at 9:46 AM | Permalink | Comments (0)

With all the concern about autism and John McCain injecting himself into the debate, politics takes another low road. Politicians will do anything to get a few extra votes. The problem occurs when a rare incident is used as representing a common occurrence. Clinical investigation and analysis is a difficult enough task to perform properly. My belief is that less than 10%, probably a lot less, of published articles meet good scientific evidence. If this is the case among careful educated scientists, how on earth can we expect laymen to understand all the ins and outs of such research. Then we have the lawyers and activists who rush in and say "You haven't proved nothing happened". There is no way to prove the absence of an effect, only its presence. Study after study, performed at great effort and with great cost has failed to prove that immunization has any common bad outcomes. When any action is performed millions of times injury may occur concurrently, just by chance. This is not to say that 'A" causes "B", although activists, politicians and lawyers rush to judgement. We should be very concerned that the current belief of many people that no one should be harmed by anything", or that "the individual is more important than the population" may lead us down the road to the point where we can do nothing to prevent a disease in case the preventive intervention might harm one person in one million.

Posted by at 5:48 PM | Permalink | Comments (0)

While changes in biopsy practice patterns have improved cancer detection, these very changes “have negatively influenced the predictive value of PSA in men with a normal digital rectal exam such that, using current biopsy practice patterns, PSA no longer correlates with positive biopsy rate,” note the authors. They cite the urgent need for new blood or urinary markers to better determine who needs a prostate biopsy, adding that aside from family history or prior atypical biopsy findings, there is little other information available to help physicians decide who needs a biopsy and who does not.
From Article: “Negative Influence of Changing Biopsy Practice Patterns on the Predictive Value of Prostate-specific Antigen for Cancer Detection on Prostate Biopsy.” Michael J. Schwartz,et al. CANCER; Published Online: March 10, 2008 (DOI: 10.1002/cncr.23353);

Posted by at 11:13 AM | Permalink | Comments (0)

From the University of Michigan better medical care and more education—not positive life-style changes—are the major reasons for a decades-long decline in disability rates among older Americans according to a new study funded by the National Institute on Aging that provides one of the first comprehensive looks at the factors fueling the welcome trend. according to a new study funded by the National Institute on Aging that provides one of the first comprehensive looks at the factors fueling the welcome trend."
A substantial share of the decline in disability can be accounted for by changes in cardiovascular disease, musculoskeletal conditions, and vision problems. These conditions are less likely to result in disability presumably due to improvements in treatment, especially for the first two conditions, which have become more common among older adults. Further:
• Education had a major impact. "Half of the decline in disability can be accounted for by the rise in educational attainment of older Americans,"

Posted by at 11:03 AM | Permalink | Comments (2)

From Emory Medical School is a fascinating glance into potential future prevention of Fragile X-syndrome and some forms of Autism. Dr. Warren led an international group of scientists that discovered the FMR1 gene responsible for fragile X syndrome in 1991. Fragile X syndrome is caused by the functional loss of the fragile X mental retardation protein (FMRP). Currently there is no effective drug therapy for fragile X syndrome, and previously no assays had been developed to screen drug candidates for the disorder. "Our discovery of glutamate toxicity in the Drosophila model of fragile X syndrome allowed us to develop this new screen for potential drug targets," notes Dr. Warren. "We believe this is the first chemical genetic screen for fragile X syndrome, and it highlights the general potential of Drosophila screens for drug development.
"Most importantly, it identifies several small molecules that significantly reverse multiple abnormal characteristics of FMR1 deficiency. It also reveals additional pathways and relevant drug targets. These findings open the door to development of effective new therapies for fragile X syndrome."

Posted by at 10:57 AM | Permalink | Comments (0)

In ScienceDaily today is a report from the Department of Family Medicine at the Medical University of South Carolina, researchers found that middle-aged non-drinkers who began consuming moderate amounts of alcohol saw an immediate benefit of lower cardiac disease morbidity with no change in mortality after four years. Even more interesting When comparing non-drinkers to wine-only drinkers, drinkers of other types of alcohol, and heavy drinkers, the wine-only drinkers had the most significant reduction in cardiovascular events. Drinkers of other types of alcohol also had an advantage over non-drinkers, but the difference did not reach statistical significance.

Posted by at 10:49 AM | Permalink | Comments (0)

In ScienceDaily today Case Western Reserve University School of Medicine researchers published a study identifying the hereditary components of colorectal cancer (CRC.) The genome-wide scan used in this study will help physicians elucidate the genetic factors in CRC in the future. Once the genes are identified, physicians will be able to use these genetic markers to identify "at risk" patients and to develop better cancer screening strategies, such as colonoscopies well before standard screening begins at age 50. Currently, without new gene tests, family history is the only tool to determine a person's risk for CRC. Knowing the exact gene will allow physicians to better take care of CRC patients and lead to earlier screening.
While the translationof this research into practice will be a major step forward for CRC and other cancers, It will be years before we know how many false positives and false negatives will occur.

Posted by at 10:43 AM | Permalink | Comments (0)

Secondary Prevention of Sickle Cell crises occur because of failure to use medication. As reported by the AP today. Ten years after government approval of the first sickle cell treatment, only a tiny fraction of patients use the drug — despite new research showing the disease is far more painful than doctors ever suspected.
Ignorance on the part of both physicians and patients is to blame for underuse of hydroxyurea, concludes an expert panel convened by the National Institutes of Health.
Worse, there's no other treatment in the pipeline for a disease that afflicts up to 100,000 Americans, most of them black — not only shortening their lives but causing regular pain.ttacks so severe that they frequently require long hospitalizations. "It's sort of amazing how ignored this disease is," says Dr. Sophie Lanzkron of Johns Hopkins University in Baltimore, which this month opened a special clinic to handle those pain crises that already has begun reducing ER visits. "The whole idea that the first genetic disease described to man has just one FDA-approved medication, it's just amazing."
Hydroxyurea, which costs "less than $100 a month," is the only FDA-approved treatment for the disease. It has been shown "to dramatically reduce sickle cell pain crises, hospitalizations, and some organ damage."

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

The issue of vitamin use, along with other dietary suplplements gets murkier and murkier. Look at the following headlines from studies of vitamin use
Certain Vitamin Supplements May Increase Lung Cancer Risk, Especially In Smokers
Vitamin Supplement Use May Reduce Effects Of Alzheimer's Disease
Task Force Finds Little Evidence To Support Use Of Vitamin Supplements To Prevent Cancer Or Heart Disease
Widespread Vitamin And Mineral Use Among Cancer Survivors: Benefits Of Such Use Remain Unclear
Vitamins May Decrease Pancreatic Cancer Risk Among Lean People
The one thing in common is that all these studies use memory recall over years. Memory recall over weeks has been shown to be faulty. But the NIH and other grantors keep shovelling out money for inconsequential studies that feed the supplementary diet producers. Too costly a fellowship!

Posted by at 9:48 AM | Permalink | Comments (4)

The hardy characteristics of the pathogen Escherichia coli O157:H7 "have prompted food microbiologists to rewrite the rule book on food safety," according to the Institute of Food Technologists'. This is due to its low infectious dose, its unusual acid tolerance, and its apparent special but inexplicable association with ruminants [cattle, deer, and sheep] that are used for food," wrote Robert L. Buchanan, Ph.D., and Michael P. Doyle, Ph.D., the document's authors. Less than ten E. coli O157:H7 cells may cause foodborne illness in people. Ionizing radiation is a promising technology because it can eliminate E. coli O157:H7 while maintaining the raw character of foods. The only way to eliminate E. coli O157:H7 is by cooking ground beef and venison to at least 160 F at home and in foodservice kitchens.

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