Dr. Buttery's Public Health BLOG

And we think a lot of people are Obese Now? According to new research from the Johns Hopkins Bloomberg School of Public Health “National survey data show that the prevalence of overweight and obese adults in the U.S. has increased steadily over the past three decades,” said Youfa Wang, MD, PhD, lead author of the study and associate professor with the Bloomberg School’s Center for Human Nutrition. “If these trends continue, more than 86 percent of adults will be overweight or obese by 2030 with approximately 96 percent of non-Hispanic black women and 91 percent of Mexican-American men affected. This would result in 1 of every 6 health care dollars spent in total direct health care costs paying for overweight and obesity-related costs.”

Posted by at 11:04 AM | Permalink | Comments (1)

While many are applauding the 'House', this is the usual political approach of appearing to do something that will accomplish little. Some health groups are happy with the bill but they have not done a good job of analysis.The FDA does not have, and will not have, the manpower to enforce any tobacco rules. There are insufficient staff for the agency to carry out its current responsibilities. The FDA is charged with ensuring that medicines prescribed by doctors are safe for patients. The FDA has never had the authority to approve poisons fort distribution to the public for over the counter sales. This has fallen to Tobacco, Firearms and Alcohol control agencies, where enforcement has the benefit of experience. The FDA does not even have the manpower to monitor the hundreds of over the counter 'nostrums' sold under the guise of improving health. This is the wrong agency, given the wrong task.

Posted by at 10:02 AM | Permalink | Comments (0)

In the New York Times's (7/29, F6) Well column, Tara Parker-Pope writes that a "growing chorus of discontent suggests that the once-revered doctor-patient relationship is on the rocks." This "relationship is the cornerstone of the medical system -- nobody can be helped if doctors and patients aren't getting along. But, increasingly, research and anecdotal reports suggest that many patients don't trust doctors." According to data from a Johns Hopkins study published this year in the journal Medicine, approximately "one in four patients feel that their physicians sometimes expose them to unnecessary risk." Sandeep Jauhar, M.D., director of the heart failure program at Long Island Jewish Medical Center, noted that one reason for patients' frustration is the fact that everything is so rushed these days, and "[n]obody is talking to the patients." Comment: This should not surprise anyone with the current emphasis on carrying out procedures and avoiding “wasting“ time talking to patients. This is specialism at its worst and is partly the result of rushed legislation that will not wait to evaluate any activity, and partly the result of inappropriate evaluation by the LCME which evaluates medical school curricula, and the ACGME which evaluates graduate programs. Neither has any focus on public awareness, only on technical proficiency..

Posted by at 10:48 AM | Permalink | Comments (0)

The FDA has released a warning about Paralytic Shellfish Poisoning (PSP), and warns against eating the liver (the green substance) of lobsters, and stick to the white meat. Remember that the dose makes the poison. We are not told what the level of PSPs is in the lobster livers, or how much you would have to eat to develop shellfish toxicity. This is one the troubles with trying to protect the public's health. Recommendations are often based on animal studies, or disease outbreaks. Still, prevention is pretty simple, just stay away from the green stuff in lobsters. I am surprised that there is no warning about crab livers. Crabs inhabit the same waters.

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

Now, after New York's lead. California has banned transfats in foods prepared in restaurants. This is not a clear cut health issue. There is research showing both hazards and benefits from using trans-fats. It is government intervention in an unproven area. Once more it gives the perception that government is protecting its citizens by intruding on commercial behavior.. The reason people are obese and have heart attacks is from too many calories and too little exercise. The ban is cosmetic. It would probably been more effective to require all food items to show caloric values. It will be interesting to review obesity, diabetes , heart attacks incidence in 5 years and see if there is any difference, and if so what evidence there is linking it to the ban. This is one more case of political emotion overiding data.

Posted by at 9:44 AM | Permalink | Comments (0)

In a study from The University of Texas Health Science Center at San Antonio researchers found A genetic variation that may have protected people of African descent against a pandemic of malaria long ago now appears to increase their susceptibility to HIV infection, a report published this week shows that a variation, described in the journal Cell Host & Microbe, is one of the first genetic risk factors for HIV to be identified only in those of African descent, and puts a spotlight on the differences in our genetic makeup that play a critical role in susceptibility to HIV-AIDS. It is fascinating that a genetic variation that protects individuals from Malaria now has beconme a factor the enhances infection with HIV

Posted by at 9:58 AM | Permalink | Comments (1)

The president is reported ready to veto the Tobacco Bill if passed as currently formulated. This bill, favored by Phillip-Morris is flawed in several ways. First the FDA already has too much on its plate. While Congress has increased its appropriations it is not nearly enough to manage its current responsibilities. That is a reason for the President to Veto it. Further Congress has refused to amend an exception for Menthol based cigarettes despite research from the Harvard School of Public Health showing that "Menthol cigarette brands have been rising in popularity with adolescents, and the highest use has been among younger, newer smokers."
The paper, "Tobacco Industry Control of Menthol in Cigarettes and Targeting of Adolescents and Young Adults," appears in the online "First Look" section of the American Journal of Public Health in advance of publication in the September 2008 issue. "For decades, the tobacco industry has carefully manipulated menthol content not only to lure youth but also to lock in lifelong adult customers," said Howard Koh, Professor and Associate Dean for Public Health Practice at HSPH and a co-author of the paper.
Further, an analysis by the American Association of Public Health Physicians raises concern that if the bill were enacted the tobacco companies would use the FDA oversight to declare that cigarettes had been found safe. There is nothing safe about cigarettes. They contain poisons. The FDA has no mandate to certify poisons safe for non-medical use.

Posted by at 9:26 AM | Permalink | Comments (0)

In a story if today's Dallas Morning News is an article decrying increasing waiting time in doctor's offices. There are two problems with the story, if true. First, the comcern is about waiting times of more than an hour. There is no excuse for waiting times in either the waiting room or examining room of more than 5-10 minutes. Anything more is an example of poor management and should bring penalties from third party payers. Second, a reason given is a shortage of doctors. This is another misconception foisted on the public. There is no shortage of doctors, only a shortage of primary care doctors due to the training policies of medical schools, abetted by federal granters who favor specialty training programs, Medicare which pays for procedures rather than advice, and the medical school accreditors who are for the most part either PH.Ds. or medical specialists. This may well be one of the side efects of good intention which has recently focused on quality of care using procedures to measure quality, not outcomes desired by the public.

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

In a paper published in the Journal of the American Medical Association this week the authors recommend that "immigrants to the U.S. from Africa and Southeast Asia should be tested and treated for tuberculosis (TB) before they arrive, to prevent importing the disease. For example "screening immigrants and refugees from the Philippines and Vietnam would have detected almost half the average 250 TB cases brought into the U.S. each year from 2001 to 2006. The authors found that "over 50 percent of all cases of TB among foreign-born persons occurred among 20 percent of the overall foreign-born populations, especially persons born...in Southeast Asia [particularly the Philippines and Vietnam] and sub-Saharan Africa."
[JAMA. 2008;300(4):405-412.]

Posted by at 10:30 AM | Permalink | Comments (0)

Reported in the July 8 issue of the Proceedings of the National Academy of Sciences, Neuroscientists at MIT's Picower Institute for Learning and Memory found that a previously unsuspected set of genes links nature and nurture during a crucial period of brain development.
Researchers believe autism spectrum disorders are tied to brain changes that occur during critical periods of development. Different but overlapping critical periods are thought to exist for various cognitive functions affected in autism, such as language and social behaviors. "Autism is a strongly genetic disorder: genes set up risk factors but by themselves simply make proteins," Sur said. "Genes work together with other influences. In the case of autism, these influences are unknown but could be molecules made by other genes or chemicals from the environment." Comment: Despite research which ha repeatedly shown lack of a link between immunization and autism, parents of such children are not yet ready to accept genes as causative of autism, and prefer to blame vaccines.

Posted by at 2:47 PM | Permalink | Comments (0)

The Agency for Healthcare Research and Quality and the AARP today released two new checklists designed to help men and women over the age of 50 learn how to stay healthy and prevent disease.
AHRQ and AARP also released an accompanying wall chart, the Staying Healthy at 50+ timeline, that provides information about recommended preventive services and can be posted in both clinical and community settings. These three publications Men: Stay Healthy at 50+, Checklists for Your Health; Women: Stay Healthy at 50+, Checklists for Your Health;and the Staying Healthy at 50+ timeline show at a glance the evidence-based recommendations from the U.S. Preventive Services Task Force regarding screening tests, preventive medicines and healthy lifestyle behaviors for people 50 and older.

Posted by at 10:01 AM | Permalink | Comments (2)

The problems of antibiotic resistant bacteria including Methycillin resistant Staph, C.Difficile and Multiple drug resistant TB are discussed in this week's journal "Science". The medical professison has been telling patients and peers that too many antibiotics are used. In many countries they are used without much, if any, oversight. Because of the poor return on investment few pharmaceutical companies are willing to invest in necessary research. Law suits do not help. Governments, as usual, are day late and a penny short. This issue (July 18) and its main topic are so important any who have in interest in public health and infectious dseases should read the articles. The problems of an unlikely flu pandemic pale into comparison beside the damage already being done by antibiotic resistance. This is a much more important topic both in the US and wordwide than a possible flu pandemic.

Posted by at 6:22 PM | Permalink | Comments (0)

Even though America spends more than $2 trillion annually on health care—more than any other nation in the world—tens of millions of Americans suffer every day from preventable diseases like type 2 diabetes, heart disease, and some forms of cancer that rob them of their health and quality of life.
Keeping people healthier is one of the most effective ways to reduce health care costs. This study, which was developed through a partnership of the Trust for America’s Health (TFAH), The Urban Institute, The New York Academy of Medicine (NYAM), the Robert Wood Johnson Foundation (RWJF), The California Endowment (TCE), and Prevention Institute, examines how much the country could save in health care costs if we invested more in disease prevention, specifically by funding proven community-based programs that result in increased levels of physical activity, improved nutrition (both quality and quantity of food), and a reduction in smoking and other tobacco use rates. After five years the return on investment will be $5.6 for each dollar invested.

Posted by at 3:53 PM | Permalink | Comments (0)

The main focus of the law was to prevent cuts to Dr's payments to prevent them from ditching Medicare patients. We are also told that it will pay for checkups. Unfortunately there is little data to show routine check-up make a difference to patients' health (although it improves Dr's income) once they have had an initial screening. It would have been better to pay for counselling about adverse behaviors such as failing to take prescribed medicines correctly.

Posted by at 9:40 AM | Permalink | Comments (0)

Headlines in the media are all agog at a small experiment in Israel. A study of weight loss using three types of diet, among three groups of less than 100 people, resulted in weight loss of 5 lb a year for two years. There was constant health education and dietary advice given by the researchers, a condition that will not occur among the public at large. This might have been a useful practical study for a master's course, but not something worth reporting in the New England Journal of Medicine, and the subsequent media 'feeding' frenzy. Do not be taken in by the stories about this poorly designed experiment. Fewer calories and more exercise are the key to loosing weight. There is no substitute.

Posted by at 9:25 AM | Permalink | Comments (0)

The AP (7/16) reports, "Healthcare costs could be cut substantially if Americans stopped smoking, stopped overeating, and got in shape, a national expert told lawmakers from 11 Midwestern states on Tuesday." The Centers for Disease Control and Prevention (CDC) "estimates that if Americans adopted such a healthy lifestyle, 80 percent of heart disease and stroke could be prevented," according to Kenneth E. Thorpe, chairman of the Department of Health Policy and Management at Emory University. "Diabetes and cancer also would be reduced dramatically," Comment: Why can’t we learn? This outcome was first validated by research from Anne Somers and Lester Breslow in the late 70’s in their Alameda County Survey. [Breslow L, Somers AR. The lifetime health-monitoring program. A practical approach to preventive medicine. [N Engl J Med. 1977 Mar 17;296(11):601-8.]

Posted by at 11:05 AM | Permalink | Comments (0)

From the Wall Street Journal: Killings by home-care providers remain rare, but they are only the most extreme examples of what prosecutors and advocates for the elderly say is a growing number of cases of abuse, neglect or fraud in which home caregivers take advantage of the frail and the ill. And that's prompting calls for better oversight of an industry that's expanding fast as more Americans age and try to avoid nursing homes. Health aides are often certified nursing assistants, who are generally licensed and regulated. But the bulk of the abuse cases involves caregivers hired to provide nonmedical assistance. These caregivers, who aren't required to receive specialized training, are only loosely overseen. Comment: With the increasing size of the elderly population, many of whom need assistance, but are not willing to go into nursing homes, there needs to be stringent oversight for any person willing to provide home assistance services.

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

University of British Columbia researchers have invented a sports helmet that reduces direct impact to the neck by up to 56 per cent, according to preliminary tests. “Existing helmets are not designed to protect the neck and the cervical region of the spine, which happens to be the weakest,” says co-inventor Peter Cripton, a Mechanical Engineering assistant professor in the Faculty of Applied Science. Comment: There are many head and neck injuries in sports leading to paralysis, particularly from two wheeled vehicles, horse riding, off road racing for example, all of which would benefit from an improved helmet

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

Many lIberals get choleric when anyone suggests that certain families seem to breed delinquents. While the current research won't change their attitudes it does add to depth to the debate. In one of the first studies to link molecular genetic variants to adolescent delinquency, sociological research published in the August issue of the American Sociological Review identifies three genetic predictors--of serious and violent delinquency--that gain predictive precision when considered together with social influences, such as family, friends and school processes. Sociologists from the University of North Carolina-Chapel Hill explored the interaction of genetics and social influences and identified three genetic polymorphisms that--when examined in the context of modulating social controls--are significant predictors of delinquency.

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

According to the new report—Fertility Regulation Behaviors and Their Costs: Contraception and Unintended Pregnancies in Africa and Eastern Europe and Central Asia — 35 poor countries in Sub-Saharan Africa and other regions (Timor-Leste, Afghanistan, Djibouti, and Yemen) have the world’s highest birth rates (more than five children per mother) while also reflecting some of the world’s poorest social and economic results, with low levels of education, high death rates, and extreme poverty. Moreover, many poor women turn to abortion as a last-resort means of birth control. Some 68,000 women die each year as a result of unsafe abortion, while another 5.3 million suffer temporary or permanent disability as a result.
The report also says that pregnancies which are less than 15 months spaced apart more than double the risk of the mother dying. Children born 3 years after a previous birth are healthier at birth and more likely to survive. Teenage pregnancies carry a higher risk of obstetric complications such as obstructed labor, eclampsia and fistula formation, and yet teenagers are less likely to receive antenatal or obstetric care, making them twice as likely to die during childbirth as women over the age of 20.

Posted by at 11:34 AM | Permalink | Comments (0)

Do not believe most of the reports in the media that tell us there are important changes in health behaviors. A number of media such as ABC News and Health Day tell us that the latest CDC report "America\'s Children, in Brief" highlight increases in teen births and low birth weight. The data do not show this. A 'change of 1 birth/1000 teens is probably nothing more than a statistical fluctuation. What you should look for is changes in five year trends, not single year numbers. However politicians and activists continually take such data out of context while the news media fail to validate the data, usually because the reporters have no training in use and abuse of data.

Posted by at 11:18 AM | Permalink | Comments (0)

This month's Journal "Pediatrics" contains an excellent article on the safety of current vaccines and the need for further research, measurement and publicity about the safety and effectiveness of vaccines to enhance the public's trust. The authors note the amount of effort physicains have to spend to encourage parents to immunize theri children. in the short time available during routine visits. [Pediatrics 2008;122:149–153]

Posted by at 5:45 PM | Permalink | Comments (0)

In today's BMJ Dr. Olshansky and others suggested a new model for research on Health Promotion and Disease Prevention in which he states"The potential of fundamental research into ageing to contribute practical benefits to improve health at all ages, but particularly at older ages, has been under-recognised by most of the scientific establishment" and "The pursuit of extended healthy life through slowing ageing has the potential to yield dramatic simultaneous gains against many if not all of the diseases and disorders expressed in later life. The most efficient approach to combating disease and disability is to pursue the means to modify the key risk factor that underlies them all—ageing itself."

Posted by at 2:18 PM | Permalink | Comments (0)

The continued decline of the nursing home — once the mainstay care for the frail elderly — and an upsurge in popularity of assisted living will lead to many dramatic changes in long-term care, according to a University of Florida expert and editor of a new book on the subject. “The American public has expressed a strong distaste for going to a nursing home because it smacks of a hospital-like, institutional way of living and receiving care,” said Stephen Golant, a UF geography professor and expert on elderly housing. “Assisted living has emerged as a highly attractive option for older persons who have experienced some physical or cognitive decline and feel less secure about receiving care in their own home.” Comment: Having visited many Nursing Homes while a State Health Commissioner I and my wife have decoded we will never be placed in a nursing hmne and have so noted in our living will. However we cannot affoird the vast majority of assisted living centers, nor can the majority of elderly Americans. We are moving into a two tiered elder care system as the population ages, just as we have with medical care. While 16% of Americans cannot afford medical care we are looking at 80-90% who will be unable to afford assisted living. It is important to stay healthy as one ages. Staying healthy starts in adolescence. It is too late once you are diagnosed with a chronic disabling disease.

Posted by at 10:00 AM | Permalink | Comments (1)

The study, conducted by Kaiser Permanente's Center for Health Research in Portland shows addition to keeping food diaries and turning them in at weekly support group meetings, participants were asked to follow a heart-healthy DASH diet rich in fruits and vegetables and low-fat or non-fat dairy, attend weekly group sessions and exercise at moderate intensity levels for at least 30 minutes a day. After six months, the average weight loss among the nearly 1,700 participants was approximately 13 pounds. Comment: The average weekly wieght loss was half a pound. Weight loss goals are more likely to be maintained than when using a faster method. However, while the study shows short term success we need to know the participant's status after 2 years.

Posted by at 9:40 AM | Permalink | Comments (1)

Vaccinating infants and toddlers is an almost universal practice in the United States. Vaccines to prevent flu are a regular part of medical care for senior citizens and at-risk patients. But, according to a study published in the August 2008 issue of the American Journal of Preventive Medicine, the US healthcare system is not very effective in getting vaccines to the adolescent population. The traditional role of the primary care physician to administer vaccines may not be effective for adolescents, who tend to enter the healthcare system only for acute problems. Additional healthcare settings that can provide additional access include pharmacies, family planning and sexually transmitted infection clinics, obstetrician–gynecologist offices, emergency departments, teen clinics and health departments.

Posted by at 11:06 AM | Permalink | Comments (0)

NBC Nightly News reported that "when the pediatricians in this country start talking about cholesterol-lowering medications for children,...it may be one indicator of a very big problem." ABC World News added that U.S. pediatricians have put forth "a new and quite controversial proposal,...calling for an early approach and aggressive approach toward high cholesterol" in children. The Washington Post reports that the "American Academy of Pediatrics (AAP) Committee on Nutrition has updated its 10-year-old cholesterol screening and treatment guidelines." The new guidelines were published in the July issue of Pediatrics. Comment: This a perfect example of “medicalisation’ of health. To start putting 30-40% of youngsters on medicine for the rest of their lives, rather than holding parents responsible for oversight of their children, is the easy way out and very profitable for the drug companies involved. It seesm like a conflict of interest for the pediatric society.

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

Do the media promote fear in the U.S. or are the British more phlegmatic? In a report from Dr. Richard Williams, professor of mental health strategy at the University of Glamorgan he analysed the psychosocial impact of terrorism and disaster on individuals and groups. He has analysed research literature to understand why certain people cope better in the aftermath of such trauma than others. Most importantly he drew a distinction between distress – a perfectly understandable reaction to a traumatic event – and a post-traumatic stress disorder (PTSD) and said that it was important not to medicalise, ‘ordinary processes’ such as bereavement. Comment: It may well be that our rush to provide 'bereavement counsellors' to anyone near the scene of a tragedy may be misguided.

Posted by at 9:51 AM | Permalink | Comments (0)

Despite the media feeding frenzy on tomatoes the U.S. Food and Drug Administration’s Food Protection Plan Progress Report, released today in conjunction with the Interagency Working Group on Import Safety Action Plan Update, shows significant areas of activity to further improve the safety of America’s food supply since unveiling its Food Protection Plan in November 2007. The plan focuses on Prevention, Intervention and Response. The FDA is setting up standards agreements with major importers, devloping rapid detection methods for common biological contaminants, identifying best practices and increasing surveillance.

Posted by at 9:39 AM | Permalink | Comments (1)

July 2, 2008 -- The Centers for Disease Control and Prevention (CDC) posted on Wednesday two reports from its work related to assessing the levels of formaldehyde in the indoor air of travel trailers used by the Federal Emergency Management Agency (FEMA) for emergency housing of Gulf Coast residents.
Comment: The two reports should be required reading for anyone buying a mobile home (trailer) and for primary care physicians who care for families who live in such units. At the same time we need to beware of activists who condemn anything that can be measured. Remember, it is the dose than makes a poison.

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

The Boston Globe reports that "Sen. Edward Kennedy's (D-Mass.) office [began] convening a series of meetings involving a wide array of healthcare specialists to [start] laying the groundwork for a new attempt to provide universal healthcare, according to participants. Comment: We can only hope that he learns from the Massachusetts experience and is advised how complex the system is. Just trying to provide financial access will only make the system worse, unless it is restructured on a primary care/prevention base. One stumbling block is that too many interest groups will be focused on ensuring their specialty is not diminished.

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

The Wall Street Journal reports that Daniel Carpenter, "[a] Harvard University professor, defended research suggesting the Food and Drug Administration (FDA) was making overly hasty approval decisions on medicines -- an analysis the agency has criticized as mistaken." The revised analysis indicates that "between 1993 and 2005, the 88 drugs approved near the FDA's deadline had a 15 percent chance of being flagged for severe safety problems," while the "rate was just five percent" for "226 other drugs." The FDA "has maintained that its own internal database showed only a modest increase in the rate of safety problems for such drugs." Comment: One more case of legislating in haste to regret the outcome at leisure. Several years ago activists complained the FDA took too long to make decisions., Congress leaned on the FDA to be quicker, without looking at the downside. No additional money was provided so the FDA had to cut corners. The results are a number of high profile drugs be let loose and then having to be withdrawn. The US syndrome of “want an answer immediately” does not work in science, but Congress will not learn. All of us who have managed large agencies have had to listen to legislators tell us what to do without the freedom to respond or discuss.

Posted by at 10:45 AM | Permalink | Comments (0)

This months Johns Hopkins Public Health Magazine is devoted to Sexual Behavior and its ramificatioris for personal health. Some of the topics worth review are:
Are Abstinence-only Programs Effective?
What happens when politics and scientific research collide?
Time for the Male Pill?
You can find them in the Magazine

Posted by at 6:55 PM | Permalink | Comments (0)

From Harvard School of Public Health, researchers found that 30% of the recent decline in cigarette sales may be offset by the robust sale of small cigars, snuff and roll-your-own products. The major factor in the apparent switch to non-cigarette products by smokers appears to be price -- with the federal tax on other forms of tobacco 1/10th that of cigarettes -- and the heavy attention given to campaigning against cigarette use but not against other forms of tobacco products in recent years. Price increases have proven to be the single most effective form of curbing tobacco use in the U.S. population. Tobacco kills, no matter if it's in a cigarette, a cigar, a snuff can or a roll-your-own.

Posted by at 6:47 PM | Permalink | Comments (0)

From "Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help, 2008 Update," Commonwealth Fund we find that Almost 14 million young adults lacked coverage in 2006. Young adults often lose insurance when they age out of eligibility for their parents' coverage or public insurance, or when they graduate from college. Jobs available to this population frequently are low-wage or temporary and often don't offer health benefits. Young adults from low-income households are most at risk for going without coverage.

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