Dr. Buttery's Public Health BLOG

Reporting on a major success in preventing children from being born with one form of mental deficiency UNICEF has just released a report of international efforts to ensure that all salt, worldwide, is iodized. Similarly flour has had folic acid added to it while early detection of PKU allows nutritional intervention to prevent mental deficiency in children. We do not tell enough about our successes in nutritional intervention, but the media focus in supposed benefits (usually spurious) of over the counter nutritional supplements

Posted by at 9:34 AM | Permalink | Comments (0)

In the USA and other developed countries we tale access to safe drinkable and cooking (potable) water for granted. Today the WHO released a new booklet calling for attention to this need to save millions of people world wide from disease and death because of lack of access to potable water. We have been working to ensure such access for everyone in the U.S.for 200 years, but we still have many families in rural areas without access to safe drinking water.

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

Those With A Specific Gene Mutation, and cat exposure at birth, may increase a child's risk of developing eczema during their first year according to a new study by researchers from University Hospital, Copenhagen, Denmark. Eczema runs in families and evidence suggests it is caused by genetic and environmental factors. The same researchers recently discovered that two common "loss-of-function" variants in the gene encoding filaggrin (FLG) predispose people to eczema. Filaggrin is a protective protein normally found in skin. It acts as a physical barrier to potentially harmful substances in the environment.

Posted by at 10:31 AM | Permalink | Comments (1)

The AP reports that "Google, Inc., Microsoft Corp., and a hodgepodge of healthcare providers and insurers have agreed on ground rules for protecting the privacy of the sensitive information" contained in personal health records (PHRs). The companies are "hoping to persuade more people to store their medical records online," by "reassuring patients that they can enjoy the convenience of keeping their medical histories in online filing cabinets, without worrying that will open a door for outsiders to peruse the data without their knowledge." Comment: It is unfortunate that so many physicians are Luddites, using every excuse they can dredge up to avoid using technology to improve practice outcome, prevent medication errors, and limit E.R. access to patient records. No other developed nation is as far behind the use of PHR as tHe U.S. We should not have to wait for Google and Microsoft to manage patient records for us.

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

From the Wall street Journal we learn that an increasing array of Americans, many with health insurance, are delaying or forgoing medical care because of concern about cost, according to a report from the Center for Studying Health System Change. About 20% of the respondents in a 2007 survey of 18,000 people said that they had put off or gone without needed medical treatment at some point in the year earlier, up from 14% in a 2003 survey. Comment: The longer we wait to fix our disabled health care system the worse the problem will get. The experience in Massachusetts shows we cannot do this state by state, or just by increasing the reimbursement system.

Posted by at 9:35 AM | Permalink | Comments (2)

In the Journal of Abnormal Child Psychology, Benjamin Lahey and his team from the University of Chicago examined how much mothers stimulated their baby intellectually, how responsive they were to the child’s demands, and the use of spanking or physical restraint. Child conduct problems in later childhood included cheating, telling lies, trouble getting on with teachers, being disobedient at home and/or at school, bullying and showing no remorse after misbehaving. The findings support the hypothesis that “interventions focusing on parenting during the first year of life would be beneficial in preventing future child conduct problems…Greater emphasis should be placed on increasing maternal cognitive stimulation of infants in such early intervention programs, taking child temperament into consideration.” Comment: This finding should not be surprising and should encourage better training for child rearing in schools, and possibly for better assistance for new mothers by a team of public health and child care workers similar to the family visitors in the UK system.

Posted by at 10:33 AM | Permalink | Comments (0)

A move in the right direction ot reduce complexity of vaccine schedule. The UPI (6/24) reports that the "Food and Drug Administration has licensed a vaccine against five childhood ailments in a single dose." Sanofi Pasteur's Pentacel vaccine, the "first five-in-one pediatric combination vaccine," is "approved for use in infants and children six weeks through four years of age." The vaccine provides protection "against invasive disease due to Haemophilus influenza type b, diphtheria, tetanus, pertussis, and poliomyelitis."
Presently, "children in the United States receive up to 23 injections by the time they're 18 months old, as recommended by the Centers for Disease Control and Prevention," HealthDay (6/23) noted in its Health Highlights section. The use of Pentacel could reduce that number of shots by as many as seven

Posted by at 10:05 AM | Permalink | Comments (0)

June 24, 2008 -- Diabetes now affects nearly 24 million people in the United States, an increase of more than 3 million in approximately two years, according to new 2007 prevalence data estimates released today by the Centers for Disease Control and Prevention (CDC), which provide estimates for every county in the US..Comment: How much of this is related to more overweight? How much is due to earlier diagnosis? How much is due to increased sensitivity of tests? How much is due to increased push for doctors to diagnose diabetes earlier? How much is due to improved access of Medicaid? Probably some or all. This is a disease which can be treated and for many people prevented, if we take rsponsiblity for our own behaviors.

Posted by at 9:56 AM | Permalink | Comments (1)

Another Editorial in today’s Lancet quotes Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases (NIAID), said that the number of new HIV infections per year in the USA was closer to 50 000 than 40 000. Fauci does not talk about diagnoses but new infections. He says that 52 000 is a new number that will soon become an official statistic. the figure shows that US efforts to prevent HIV have failed dismally. The CDC must not fail US citizens further by delaying the release of the data behind this fact.

Posted by at 10:55 AM | Permalink | Comments (0)

In an editorial in the Lancet today: The cost of allergic rhinitis in the USA is nothing to be sniffed at. According to a report published last week by the Agency for Healthcare Research Quality, in 2005, Americans spent $11bn on doctors' bills, prescription drugs, and other medical care to relieve allergy symptoms. Although there is no consensus on the reasons for the increased prevalence of allergies, the “hygiene hypothesis” has solid support. First proposed by David Strachan in the 1980s, this hypothesis suggests that children exposed to poor hygiene and increased infections in early life have lower levels of IgE sensitization and allergic diseases. In other words, squeaky-clean modern life could be a contributing factor, and may indeed be harmful to children. Comment: All the activists who rail about dangers from exposures to compounds considered harmful, may be causing the entire population harm . Remember how infections brought from Europe to North American decimated a number of indigenous populations. We need to reconsider how clean our environment should be and whether too clean is harmful.

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

Jack Colwill, professor emeritus of family and community medicine in the MU School of Medicine, and his research team found that the U.S. could face a shortage of up to 44,000 family physicians and general internists in less than 20 years, due to a skewed compensation system that rewards specialists increasingly more than primary care practitioners. The researchers are more optimistic about the future supply of general pediatricians. The wait to see a doctor could get a lot longer if the current number of students training to be primary care physicians doesn't increase soon, according to a new study. The U.S. could face a shortage of up to 44,000 family physicians and general internists in less than 20 years. Comment: Note that there is probably no shortage of specialists. To emphasize the problem the Wall St. Journal today reported that that medical professionals who "really want to do well, [should] become a nurse anesthetist." They "typically receive an undergraduate nursing degree, have experience working as registered nurses, and complete two to three years of post-graduate training." By one estimate, "nurse anesthetists recruited" over the past year "through the staffing firm Merritt Hawkins & Associates landed salaries that averaged $185,000." The nurses' salaries exceeded the salaries of "family-practice docs hired through the firm, who averaged $172,000, and internists, who averaged $176,000." If we want access to health care we need to change the rewards system to encourage primary care practice.

Posted by at 5:23 PM | Permalink | Comments (1)

In a wonderful article published in JAMA today, [Ezekiel J. Emanuel; Victor R. Fuchs:JAMA. 2008;299(23):2789-2791] Victor Fuchs describes the overselling of medical services to the public and excess desire for new technology by both health care professionals and the public. Also how rewards and punishment in the system has affected the Health Care system driving up its costs. This article should be read by everyone, both health care professionals, students and the public.

Posted by at 5:24 PM | Permalink | Comments (0)

Which is more important; rights or social responsiblity? Pennsylvania motorcyclists suffered large increases in head injury deaths and hospitalizations in the two years following the repeal of its motorcycle helmet law, according to a University of Pittsburgh study. Even after accounting for increases in motorcycle registrations that occurred during this period, study authors noted a 32 percent increase in head injury deaths and a 42 percent increase in head injury-related hospitalizations, raising concerns about motorcyclists' safety and the impact of this trend on health care costs. "Our study shows that since the repeal of Pennsylvania's motorcycle helmet law, helmet use has gone down, while head injuries from motorcycle crashes have gone up, even after increased motorcycle registration," said Kristen Mertz, M.D., M.P.H., study lead author and assistant professor, Department of Epidemiology, University of Pittsburgh Graduate School of Public Health.

Posted by at 10:52 AM | Permalink | Comments (4)

California Public Health regulators have just taken to task 13 firms advertising genetic analysis to the public. The state Department of Public Health sent the cease-and-desist letters last week following an investigation spurred by consumer complaints about the tests' accuracy and cost, a department spokeswoman said Monday. The New York State Department of Health issued similar notices to nearly two dozen testing companies in April. The FDA has not issued notices at all. I have recommended avoiding any genetic testing offered outside teaching hospitals, because of the poor underlying science, and the likelihood of false positive tests; also the inability of the medical profession to know what to do with the results of such tests. They are innapropriate at best and dangerous otherwise.

Posted by at 9:53 AM | Permalink | Comments (2)

The New York Times (6/14, A10, Cave) reported that "for Floridians, prescription drugs are increasingly a far more lethal habit" than use of illicit drugs. According to "[a]n analysis of autopsies in 2007 released this week by the Florida Medical Examiners Commission,...the rate of deaths caused by prescription drugs was three times the rate of deaths caused by all illicit drugs combined." The Commission's "report analyzed 168,900 deaths statewide. Cocaine, heroin, and all methamphetamines caused 989 deaths, it found, while legal opioids -- strong painkillers in brand-name drugs like Vicodin (acetaminophen and hydrocodone) and OxyContin (oxycodone) -- caused 2,328." The Florida "report's findings track with similar studies by the federal Drug Enforcement Administration, which has found that roughly seven million Americans are abusing prescription drugs. If accurate, that would be an increase of 80 percent in six years, and more than the total abusing cocaine, heroin, hallucinogens, Ecstasy (3,4 methylenedioxymethamphetamine), and inhalants." Comment: This is only the tip of the iceberg because so few deaths are followed by autopsies.

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

In a study presented at the Annual meeting of the Endocrine Society, Roshney Jacob-Issac, M.D., of George Washington University Hospital, and colleagues, "used 2,690 male diabetic veterans in VA [Veterans Administration] hospitals, most of whom were overweight or obese based on their body mass index (BMI)." Participants "were categorized as having low, moderate, or high fitness level, depending on their performance on a standard treadmill exercise tolerance test." The authors "found that the higher the man's level of fitness, the lower his risk of dying during the study period." Dr. Jacob-Issac concluded that people with diabetes "should improve their fitness level or exercise capacity to at least a moderate level, by being physically active." Comment: I wonder how often we have to repeat research establishing the value of physical fitness in preventing disease and delaying development of disabily.

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

From the New York Times today is a story about government action that would be howled down in the US. where we are more interested in 'right' than 'responsibility." Under a national law that came into effect two months ago, companies and local governments must now measure the waistlines of Japanese people between the ages of 40 and 74 as part of their annual checkups. That represents more than 56 million waistlines, or about 44 percent of the entire population. To reach its goals of shrinking the overweight population by 10 percent over the next four years and 25 percent over the next seven years, the government will impose financial penalties on companies and local governments that fail to meet specific targets. Compare this to the US/State efforts to curb obesity (particularly in children) which is mainly health education, which rarely works without back up penalties.

Posted by at 10:06 AM | Permalink | Comments (3)

Each year about 1700 cases of malaria occur in the United Kingdom, 1300 in the United States, and 3000 in France. Less than half of travellers who acquire malaria have taken advice before travelling. Using intervention strategies for travelers visiting friends and relatives—such as increasing awareness in the community, dispelling myths about immunity or subsidizing antimalarials—could considerably reduce imported malaria. From the BMJ [BMJ 2008;336:1362-6]

Posted by at 8:46 PM | Permalink | Comments (0)

In this week's British Medical Journal, Professor Winkler of London Metropolitan Unversity complains about lack of enforcement of the EU laws prohibiting all forms of misselling, including false health claims on foods and other products. However, this impressive sounding legislation will have little effect on the real world unless it is enforced proactively and comprehensively. It would be welcome to have such legislation in this country with the deluge of false claims about so many products.

Posted by at 8:38 PM | Permalink | Comments (0)

June 11, 2008 | Ann Arbor, Mich. – Strong bones, a healthy immune system, protection against some types of cancer: Recent studies suggest there’s yet another item for the expanding list of Vitamin D benefits. Comment: Now the media circus for another Vitamin. We went through this with Vitamin C twenty years ago. After a couple of years we will find that what we knew, we still know, and that it will still remain an essential vitamin, but not the cure all now being toted. Of course the vitamin manufacturers will have a field day!.

Posted by at 10:35 AM | Permalink | Comments (1)

Reuters (6/12, Fox) reports that a team of Baxter International researchers led by Hartmut J. Ehrlich, M.D., has developed Celvapan, a "new-style bird flu vaccine," which is "made using" African green "monkey cells instead of chicken eggs," according to a research published in the June 12 issue of the New England Journal of Medicine. The use of "cells in a lab dish" is an important element in creating the vaccine, "because the right type of chicken eggs are difficult to obtain." Furthermore, "H5N1 kills chickens rapidly." The process also "could cut production time roughly in half, to as little as 12 weeks," Comment: First you have to be sure you have the outbreak, then define the type & subtypes, then after production is started the product has to be tested, then it has to be distributed, all of which will extend the 12 weeks to at least 24 weeks, by which time the ‘pandemic’ will have saturated the population. Also see next snippet.
Genome Of 150 Different Avian Influenza Viruses Released (June 11, 2008) -- The complete genetic coding sequences of 150 different avian influenza viruses have been released. The information improves scientific understanding of avian influenza, a virus that mainly infects birds but that can also infect humans.

Posted by at 10:27 AM | Permalink | Comments (0)

The Washington Post (6/12, A4, Brown) reports that "Americans' life expectancy reached a record high of 78.1 years in 2006, with disparities among ethnic groups and between the sexes generally narrowing," according to findings published in the June 11 issue of the Centers for Disease Control and Prevention's (CDC) National Vital Statistics Reports. Notably, the "death rates from most diseases went down, with influenza mortality falling steeply, and AIDS mortality marking its 10th straight year of decline." Furthermore, "infant mortality in 2006 also fell from the previous year, continuing a trend stretching back nearly 50 years." Melonie P. Heron, Ph.D., a demographer at the National Center for Health Statistics, said, "This report has a lot of good news." The increase to 78.1 years "is due mainly to falling mortality rates in almost all the leading causes of death,"

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

In the New York Times's (6/9) City Room blog, Sewell Chan wrote that "[m]ore than one-fourth of adult New Yorkers -- 26 percent, compared to the national average of 19 percent -- are infected with herpes simplex virus 2, the virus that causes genital herpes," according to a study published this month in the journal Sexually Transmitted Diseases. City health officials are "concerned about the prevalence of the condition because it facilitates the spread of HIV, and can also be transmitted to newborns, though such cases are rare."
Comment: The NYC Dept of PH has a strong STD program which may well being finding more STDs than the average community. STDs of all types have always been under-reported. One more reason for using “Safe Sex Practices.”

Posted by at 9:41 AM | Permalink | Comments (1)

In an article in this week's JAMA [JAMA. 2008;299(21):2543-2549. ] the authors report that the majority of "diabetes studies fail to track the results patients care about the most, including pain, ability to function, and survival," according to lead author Victor M. Montori, M.D., who conducted an analysis "of clinical trials planned or under way," he and "found that 77 percent were designed to report on levels of glucose, or sugar, in the blood, cholesterol levels, kidney function, and other laboratory tests." In contrast, the researchers found that "stroke, myocardial infarction, amputation, visual disturbance or blindness, end-stage renal disease, hypoglycemic events, delayed wound healing, infection, pain, and functional status," were most important to diabetes patients, Comment: This is the problem with Academic studies that rarely reflect the real world. This phenomenon of performing research on the small fraction of patients who enter teaching hospitals has been criticized for more than 40 years, without a response from most Academics. The first report was published by Kerr White MD as "The Ecology of Public Health" NEJM 1961:263: 18, 885 - 892. Much more research needs to be performed at primary care sites, not in teaching centers.

Posted by at 9:43 AM | Permalink | Comments (1)