Archive for the ‘Health’ Category
Fascinating little study. Singing the blues is not so bad….
But that, of course, would require asking about them, something physicians seem loath to do. And one can understand their reluctance when you look at the questions that should be asked. They’re tough questions, but it’s important that the physician know the answers for effective treatment.
Michael Specter writes in the New Yorker:
Even in an era defined by profound technological advances, the practice of medicine remains an art as well a science—a fact that often frustrates both physicians and their patients. For many conditions, solutions are not simple and there are rarely easy answers. There are exceptions, of course; perhaps the most notable among them has been the success of vaccines.
Until recently, in the United States and other wealthy countries, diseases such as measles, pertussis and rotavirus—which kill hundreds of thousands of infants in the developing world each year—had virtually disappeared. Both measles and pertussis are now back, largely because increasing numbers of children remain unvaccinated. Vaccines are the most powerful public-health tool that pediatricians possess. Unfortunately, there are people (a minority, but a dangerous one) who just don’t care.
Many of these people don’t approve of the vaccine schedule set out by the Centers for Disease Control and Prevention, and they seek to spread the shots over a longer time period than the one recommended. This has presented American pediatricians with a stark new challenge to their Hippocratic Oaths. Which does more harm: delaying scheduled vaccines and reducing their effectiveness, or refusing to delay and running the risk that parents will simply not vaccinate their children at all?
It’s a terrible choice, forced almost wholly by the notion (which is demonstrably untrue) that if a child receives “too many vaccines too soon” it could overwhelm his or her immune system. A study published this week in the journal Pediatrics provides the best proof yet that a large majority of doctors agree to the delays. Ninety-three per cent of those surveyed for the study reported that they had been asked, at least once, to delay vaccines. The physicians acquiesce in overwhelming numbers—two thirds said they do so at least occasionally—even though most of them don’t want to, and even though they are aware that data clearly show that such delays put their patients (and those around them) at increased risk.
Nobody can dispute that the number of vaccines has grown significantly. A hundred years ago, children received a single vaccine: smallpox. By 1962, that number had grown to five (diphtheria, pertussis, tetanus, polio, and the M.M.R.). Today, the C.D.C. advises that children be vaccinated for fourteen diseases before age six, on a recommended schedule that usually includes twenty-nine shots, sometimes several at once. Vaccines worry parents, in part because of of an old, unfounded, and ultimately discredited theory that children who receive measles vaccines develop autism at higher rates than other children. (They don’t, as has been demonstrated in dozens of studies carried out throughout the world.)
That baseless concern, publicized by activists such as Jenny McCarthy, morphed into a movement to spread out the timing of vaccines in order to protect children from a possible shock to their immune systems. But there simply is no such threat. Because progress in molecular biology has made it possible to create vaccines with fewer antigens, children’s systems are now exposed to far less of a burden than was the case in the past. The smallpox vaccine, for example, contained two hundred proteins—all separate molecules. All together, the vaccines that children routinely receive today contain fewer than a hundred and fifty.
The number of bacteria that live on the nose of a newborn child or on the surface of his or her throat is in the trillions. “Those bacteria have between 2,000 and 6,000 immunological components and consequently our body makes grams of antibody to combat these bacteria,” Paul Offit, the chief of the infectious-diseases division at the Children’s Hospital of Philadelphia, has written. “The number of immunological challenges contained in vaccines is not ﬁguratively, it is literally a drop in the ocean of what you encounter every day.” Offit has long been one of the nation’s most prominent proponents of vaccines—and he has long been vilified for his stance.
Pediatricians spend, on average, less than twenty minutes with each patient—often far less—and they usually have to cover a lot of ground. . .
Ignorance persists because the ignorant really prefer the certainty of their convictions to gaining actual knowledge.
Tom Philpott writes at Mother Jones:
In 2004, Elsa Murano stepped down from her post as chief of the US Department of Agriculture division that oversees food safety at the nation’s slaughterhouses. Two years later, she joined the board of directors of pork giant Hormel, a company that runs some of the nation’s largest slaughterhouses. Murano received $238,000 in compensation for her service on Hormel’s board in 2014 alone.
This is a classic example of the “revolving door” that separates US government regulators from the corporations they regulate. It’s hardly the most shocking thing I gleaned from the whistleblower-protection group Government Accountability Project’s recent exposé of conditions at three hog slaughter facilities associated with Hormel. But it’s interesting to think about in light of GAP’s allegations, found in sworn affidavits filed by four USDA inspectors stationed in Hormel-owned plants. Three of the inspectors chose to remain anonymous; the fourth, Joe Ferguson, gave his name.
Their comments focus on three Hormel-associated plants, which are among just five hog facilities enrolled in a pilot inspection program run by the USDA. In the regular oversight system, USDA-employed inspectors are stationed along the kill line, charged with ensuring that conditions are as sanitary as possible and that no tainted meat ends up being packed for consumption. In the pilot program, known as HIMP (short for Hazard Analysis and Critical Control Points-based Inspection Models Project), company employees take over inspection duties, relegating USDA inspectors to an oversight role on the sidelines.
What’s more, the HIMP plants get to speed up the kill line—from the current rate of 1,100 hogs per hour to 1,300 hogs per hour, a jump of nearly 20 percent. The five plants rolled out the new inspection system around 2002, USDA spokesperson Aaron Lavallee said. That’s when Murano, now on the Hormel board of directors, ran the USDA’s Food Safety and Inspection Service. If the privatization-plus-speedup formula sounds familiar, it’s because the USDA ran a similar experimental program for chicken slaughter for years. After much pushback by workplace and food safety advocates and media attention (including from me), the USDA decided not to let poultry companies speed up the kill line when it opened the new system to all chicken slaughterhouses last year (though it did green-light turkey facilities to speed up the line from 51 to 55 birds per minute).
All four affidavits offer blistering critiques of the hog version of the pilot program. Three themes run through them: (1) company inspectors are poorly trained and prepared for the task of overseeing a fast-moving kill line involving large carcasses; (2) company-employed and USDA inspectors alike face pressure from the company not to perform their jobs rigorously; and (3) lots of unappetizing stuff is getting through as the result of (1) and (2).
The testimony of Inspector 3, affidavit here, is full of choice nuggets, though not of the sort you want to sample before lunch. Here are a few:
- “Not only are plant supervisors not trained, the employees taking over USDA’s inspection duties have no idea what they are doing. Most of them come into the plant with no knowledge of pathology or the industry in general.”
- “Food safety has gone down the drain under HIMP. Even though fecal contamination has increased under the program (though the company does a good job of hiding it), USDA inspectors are encouraged not to stop the line for fecal contamination.”
- “HIMP was initially designed for the kill of young, healthy animals. This hasn’t always been the case. A lot of the animals the plant has killed were too old. Some also had different diseases. They didn’t even slow down the line for the diseased carcasses.”
- “The company threatens plant employees with terminations if they see them condemning too many carcasses or carcass parts.”
For its part, Hormel insists . . .
Continue reading. Later in the article:
. . . However, the USDA’s and Hormel’s rosy assessment of HIMP presents a stark contrast to a scathing 2013 report from yet another USDA agency, the Office of the Inspector General, which found HIMP plants—which it did not name—made up three of the top 10 US hog plants earning the most food safety and animal welfare citations in the period of fiscal years 2008 to 2011. Moreover, by far the most-cited slaughterhouse in the United States over that period was in the program—it drew “nearly 50 percent more [citations] than the plant with the next highest number.” The OIG also concluded that that the Food Safety and Inspection Service “did not provide adequate oversight” of HIMP over its first 15 years, and as a result, “HIMP plants may have a higher potential for food safety risks.”Not all company-employed inspectors “understand and have the ability to execute the proper procedures needed to make sure pathogens don’t spread to other carcasses” when “fecal matter or ingesta spills out of one of the animal’s organs.”
Ted Genoways, who in 2012 wrote a harrowing account in Mother Jones of what accelerated line speeds have meant for workers slaughterhouse workers, rejects Hormel’s sunny assessment. Genoways’ reporting, later expanded into the superb 2014 book The Chain, focused on the Quality Pork Processors plant in Austin, Minnesota, which supplies its meat solely to Hormel and is one of the three Hormel-associated plants among the five in HIMP. He recently told Food Safety News, “Yes, I think the line speeds [at the HIMP plants] are too fast. When you see the workers on the line say the speeds are too fast, the inspectors say the lines are too fast, the suppliers at the farm level say the lines are too fast, there’s such a unanimity of opinion that I don’t think you can come to any other conclusion.” . . .
The obesity and diabetes conferences served a lot of candy bars and junk food…
Extremely interesting article by Elizabeth Kolbert in the New Yorker:
The black rat—also known as the ship rat, the roof rat, and the house rat—is actually gray. It has large ears and a tail that’s longer than its body. The black rat (Rattus rattus) probably evolved in tropical Asia, and then was spread around the world by humans—first by the Romans and later by European colonists. According to Juliet Clutton-Brock, the author of “A Natural History of Domesticated Mammals,” it has been blamed for causing “a greater number of deaths in the human species than any natural catastrophe or war.” But perhaps the rat has gotten a bad rap?
A paper published the other day in the Proceedings of the National Academy of Sciences, which quickly made headlines all around the world, argues that the prevailing theory of how the Black Death spread is unfair to rats. Really, the authors of the study contend, the animal responsible was a Central Asian species like the great gerbil. (Great gerbils are only distantly related to the fuzzy rodents that American kids keep as pets, though they may look a lot alike to parents.)
The authors of the study were trying to address one of the mysteries about the Black Death. Why, after killing something like twenty-five million people in Europe in the mid-fourteenth century, did outbreaks of plague keep flaring up and then dying down again? (The Great Plague of London, in the mid-seventeenth century, killed roughly a fifth of the city’s population.) The prevailing theory is—or was—that bacteria responsible for the plague, Yersinia pestis, lived on Europe’s black-rat population. The rats transmitted the bacteria to fleas, which, episodically, transmitted them to humans. But the scientists who conducted the PNAS study concluded that there were no “permanent plague reservoirs in medieval Europe.”
Instead, they posit, the plague bacterium kept being reintroduced to Europe from Asia, where it lived on the native rodent populations. They came to this conclusion after comparing tree-ring records from Europe and Asia with records of plague outbreaks. What they found was that plague seemed to show up at port cities in Europe several years after climate conditions favored a burst of population growth among rodents in Central Asia. (This theory does not completely exonerate black rats, as they would still have helped their Asian rodent brethren spread the disease once it reached Europe.)
“We show that, wherever there were good conditions for gerbils and fleas in Central Asia, some years later the bacteria shows up in harbor cities in Europe and then spreads across the continent,” one of the authors of the study, Nils Christian Stenseth, a biologist at the University of Oslo, told the BBC.
Plague is no longer a worry in Europe, although there are still occasional outbreaks in other parts of the globe. What’s perhaps the most important insight from the study has little to do with Yersinia pestis or giant gerbils. It’s that climate and human health are, in significant though often roundabout ways, related. As the climate changes, this has important—and, at the same time, hard to predict—implications.
The list of diseases (and disease vectors) that could potentially be affected by climate change is a long and various one. It includes tick-borne diseases, such as Lyme disease, and mosquito-borne diseases—dengue fever, West Nile virus, malaria. It also includes waterborne diseases, such as cholera, and fungal diseases, such as valley fever. An upcoming issue of Philosophical Transactions B, a journal of Britain’s Royal Society, is wholly devoted to the subject of “climate change and vector-borne disease.”
Rising temperatures may already be contributing to the spread of some diseases, like . . .
You may recall that Dana Perino, Press Secretary to George W. Bush, assured us that global warming would reduce illnesses overall because winters would not be so severe. I wonder if she is helping out with this research.
They’ve changed their recommendations in light of evidence, but no apologies for the years of bad advice they previously disseminated. Nina Teicholz writes in the NY Times:
FOR two generations, Americans ate fewer eggs and other animal products because policy makers told them that fat and cholesterol were bad for their health. Now both dogmas have been debunked in quick succession.
First, last fall, experts on the committee that develops the country’s dietary guidelines acknowledged that they had ditched the low-fat diet. On Thursday, that committee’s report wasreleased, with an even bigger change: It lifted the longstanding caps on dietary cholesterol, saying there was “no appreciable relationship” between dietary cholesterol and blood cholesterol. Americans, it seems, had needlessly been avoiding egg yolks, liver and shellfish for decades. The new guidelines, the first to be issued in five years, will influence everything from school lunches to doctors’ dieting advice.
How did experts get it so wrong? Certainly, the food industry has muddied the waters through its lobbying. But the primary problem is that nutrition policy has long relied on a very weak kind of science: epidemiological, or “observational,” studies in which researchers follow large groups of people over many years. But even the most rigorous epidemiological studies suffer from a fundamental limitation. At best they can show only association, not causation. Epidemiological data can be used to suggest hypotheses but not to prove them.
Instead of accepting that this evidence was inadequate to give sound advice, strong-willed scientists overstated the significance of their studies.
Much of the epidemiological data underpinning the government’s dietary advice comes from studies run by Harvard’s school of public health. In 2011, directors of the National Institute of Statistical Sciences analyzed many of Harvard’s most important findings and found that they could not be reproduced in clinical trials.
It’s no surprise that longstanding nutritional guidelines are now being challenged.
In 2013, government advice to reduce salt intake (which remains in the current report) was contradicted by an authoritative Institute of Medicinestudy. And several recent meta-analyses have cast serious doubt on whether saturated fats are linked to heart disease, as the dietary guidelines continue to assert.
Uncertain science should no longer guide our nutrition policy. Indeed, cutting fat and cholesterol, as Americans have conscientiously done, may have even worsened our health. In clearing our plates of meat, eggs and cheese (fat and protein), we ate more grains, pasta and starchy vegetables (carbohydrates). Over the past 50 years, we cut fat intake by 25 percent and increased carbohydrates by more than 30 percent, according to a new analysis of government data. Yet recent science has increasingly shown that a high-carb diet rich in sugar and refined grains increases the risk ofobesity, diabetes and heart disease — much more so than a diet high in fat and cholesterol.
It’s not that health authorities weren’t warned. “They are not acting on the basis of scientific evidence, but on the basis of a plausible but untested idea,” Dr. Edward H. Ahrens Jr., a top specialist at Rockefeller University and prominent critic of the growing doctrine on dietary fats and cholesterol, cautioned back in the ’80s. In the face of urgent pressure to offer a solution to the rising tide of heart disease, however, he turned out to be the Cassandra of his day.
Today, we are poised to make the same mistakes. . .