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Archive for Public Health

The FDA and Personalized Genetic Testing

The company 23andMe provides personal genetic testing from a convenient home saliva sample kit. Their home page indicates that their $99 genetic screening will provide reports on 240+ health conditions in addition to giving you information on your genetic lineage. The benefits, they claim, are that you will learn about your carrier status and therefore the risk of passing on genetic diseases to your children. The information will also inform you about health risks so that you can change your behavior to manage them. Finally the genetic information will tell you about how you might respond to different drugs so that you can “arm your doctor with information.”

The home page also contains a link to testimonials about how their DNA testing has changed people’s lives.

This all sounds great – the promise of genomics that we have been hearing about now for about two decades. Isn’t this exactly what we were led to expect once we mapped the human genome?

Why, then, has the FDA recently sent a warning letter to 23andMe instructing them to discontinue marketing their Personal Genome Service (PGS)?

The primary reason appears to be a lack of documentation for the validity and reliability of the tests, but I have concerns that go even deeper. (more…)

Posted in: Public Health

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The new Surgeon General nominee and CAM: Is there a problem here?

Our fearless leader, Steve Novella, has informed me that he is traveling today. Unfortunately, I am preparing a talk for later today, and no one else seemed able to come up with a post; so I decided to adapt a recent post from my not-so-super-secret other blog and see what a different readership thought of it. I realize that I’m risking subjecting you all to Gorski overload, but, hey, if the world needs more Mark Crislip, why wouldn’t the world need more David Gorski too? Steve will return next Wednesday, as usual.

I don’t normally give a lot of thought to the Surgeon General because, quite frankly, in recent years it hasn’t been a position of much authority or influence. That’s why I didn’t noticed late last week that President Obama had nominated a new Surgeon General. Normally, my failure to notice isn’t such a big deal, because there really hasn’t been a Surgeon General who has really been particularly well-known or had much of an impact since Dr. C. Everett Koop, although back when President Obama first took office Dr. Sanjay Gupta’s name was floated as a possibility for the position. Obviously, he didn’t get it. (I’m guessing that being a neurosurgeon and CNN’s chief medical correspondent probably pays much better than being Surgeon General.) To be honest, I didn’t even know that the prior Surgeon General had stepped down, but apparently she did in July, leaving the position filled by an interim Surgeon General until a new one could be nominated.

The other day, I learned whom President Obama nominated to be her successor, Dr. Vivek Murthy, a faculty member at the Harvard Medical School:

President Obama will nominate Dr. Vivek Murthy of Harvard Medical School and Brigham and Women’s Hospital as surgeon general of the United States, the White House announced Thursday night.

Murthy is a hospitalist at the Brigham and is co-founder and president of Doctors for America, a Washington, D.C.-based group of 16,000 physicians and medical students that advocates for access to affordable, high quality health care and has been a strong supporter of the Affordable Care Act.

If he’s confirmed by the Senate, Murthy would replace acting surgeon general Boris Lushniak. The surgeon general serves a four-year term and the post is essentially a bully pulpit to speak out on public health issues.

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Posted in: Acupuncture, Politics and Regulation, Public Health, Science and the Media

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Monochloramines in Tap Water

I recently had a clogged drain requiring the services of a plumber. While discussing the details of the job, he took out brochures and a “fact sheet” prepared by his company explaining that my city tap water was going to kill me. Fortunately, they could provide a solution – a home-wide water filtration system.

The plumber seemed naively sincere, and genuinely fearful of the cancer-causing contaminants found in drinking water. He invited me to read through the material he provided while he unclogged by drain. I did better than that. I took the time to do a quick search for some more objective information on the topic.

Monochloramines

The focus of this particular scaremongering is the additive monochloramine, which is added to city water. According to the Environmental Protection Agency (EPA):

Chloramines are disinfectants used to treat drinking water. Chloramines are most commonly formed when ammonia is added to chlorine to treat drinking water. The typical purpose of chloramines is to provide longer-lasting water treatment as the water moves through pipes to consumers. This type of disinfection is known as secondary disinfection. Chloramines have been used by water utilities for almost 90 years, and their use is closely regulated. More than one in five Americans uses drinking water treated with chloramines. Water that contains chloramines and meets EPA regulatory standards is safe to use for drinking, cooking, bathing and other household uses.

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Posted in: Public Health, Science and Medicine

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Dietary supplement industry says “no” to more information for consumers (again)

Once again, the dietary supplement industry is fighting efforts to give consumers more information about the safety and effectiveness of dietary supplements.

Big Supp is very clever. It sells consumers on the phony idea that they need dietary supplements for good health. Even as the evidence continues to mount that consumers don’t need supplements and shouldn’t take them, the industry continues to convince the public otherwise. And in 2011 they raked in $30 billion.

The state and federal governments have served as handmaidens to the industry in this clever marketing strategy. Congress’s gift to the supplement industry, the Orwellian-named Dietary Supplement Health and Education Act (DSHEA) “effectively excludes manufacturers of these products from virtually all regulations that are in place for prescription and over-the-counter drugs, and puts the requirement to demonstrate harm on the FDA, rather than the onus on the manufacturer to show a product is safe and effective,” as SBM’s Scott Gavura pointed out. DSHEA allows supplements to make “structure and function” claims, although no one seems to know what that means, including the FDA.

States have done their part in granting chiropractors and naturopaths the authority to give “nutritional” advice and recommend dietary supplements, sometimes on the basis of dubious diagnostic testing purporting to reveal imagined nutritional deficiencies. This gives them carte blanche to sell supplements to their patients, a clear conflict of interest.

And when proposed regulation threatens their profits, the dietary supplement industry and its surrogates enlist the very public it duped to join the battle. The industry convinces the public that someone is trying to take away their access to supplements they never needed in the first place. This threat is dressed up in terms designed to push all the buttons of a public already primed to be leery of “the government” – their “health freedom” may be taken away. Actually, freedom to choose among health care practices is most threatened by withholding readily-available information which would adequately inform health care decisions. (more…)

Posted in: Herbs & Supplements, Legal, Politics and Regulation, Public Health

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I refute it thus

Reality is one honey badger. It don’t care. About you, about your thoughts, about your needs, about your beliefs. You can reject reality and substitute your own, but reality will roll on, eventually crushing you even as you refuse to dodge it. The best you can hope for is to play by reality’s rules and use them to your benefit. Combined with a little luck (nothing quite as beneficial as being a white, middle class male in the US) you might have a reasonably healthy health.

The most reliable way to understand reality is science and the scientific method. Used wisely you may have a shot at minimizing morbidity and mortality. Deny or ignore it and reality don’t care. Reality will get us all.

We all have our biases, recognized and unrecognized. I often see the world in terms of infectious diseases. When I read Team of Rivals: The Political Genius of Abraham Lincoln I enjoyed the politics and personalities but I was struck by how people constantly died young of infectious diseases. We don’t see mortality in the young anymore for a variety of reasons: better nutrition, an understanding of the pathogenesis of disease, clean water, flush toilets and vaccines.
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Posted in: Epidemiology, Public Health, Science and Medicine, Vaccines

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Danger Zones of Parental Vaccine Refusal

Back in 2009 I wrote a story entitled, “The New Plague”, about my experiences as a pediatrician with the frightening trend of parental vaccine refusal in New York City. In that post I discussed some of the complex social factors contributing to this phenomenon, and some of the common vaccine myths to which many parents fall prey. I recommend that you read that post, as it is (unfortunately) as timely today as it was then. Now I’m a pediatrician in Amherst, Massachusetts, and I find it necessary to revisit this dangerous trend in parenting.

As I described in my previous post on the subject, my old practice was at an interesting crossroads of several communities that seemed to perfectly embody the socioeconomic and cultural characteristics commonly found in communities with high rates of parental vaccine refusal. Ironically, these tend to include people who are educated and socially privileged; those empowered to question authority. In 2010, I left New York City and moved to Western Massachusetts to take a job at Baystate Children’s Hospital in Springfield. There I was in charge of the teaching clinic where pediatric residents are trained in the outpatient care of children. The children we took care of in Springfield comprised a very high-risk, underprivileged population. Our patients were significantly below the poverty level, with high rates of developmental and educational disability, a high teen pregnancy rate, and high rates of domestic violence, drug use, and gang involvement. Children who were not up to date with their vaccinations were behind because of poor continuity of care, with many missed appointments and gaps in follow-up. I now work at a private practice further north in the Pioneer Valley of Central Massachusetts. Here, my experiences with vaccine lapses are starkly different. Now, when I encounter a child who is not fully vaccinated or is completely unvaccinated, it is the result of a parental decision. A very flawed, dangerous, and misinformed parental decision.
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Posted in: Public Health, Vaccines

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California Acupuncturists Don’t Need to Know English!

English proficiency is not a necessary precursor to becoming a contributing citizen in California’s economy and should not be used by the Board to discriminate against talented and skilled individuals who seek to provide high-quality acupuncture services in California.

— State Senators Curren D. Price Jr. and Darrell Steinberg, letter to the California Acupuncture Board, March 22, 2013.

To appreciate the recklessness of this statement, and to illustrate the Senators’ disconnect with the reality of Oriental medicine, let’s take a look at a consummate example of services provided by acupuncturists. The following video features the “Master” Kim Nam-soo demonstrating his moxibustion technique. He conducted a similar workshop for future acupuncturists in 2010 at Emperor’s College of Traditional Oriental Medicine in Santa Monica, CA. Make sure you do not miss the part where the Master is skillfully adding his own spit to the treatment!

Kim Nam-Soo (also known as “Gudang”) is a 97-year-old acupuncturist from South Korea. In this video, he is teaching a form of moxibustion (burning of a mugwort cone on or near the skin). He is first preparing a wad of mugwort (Artemisia vulgaris), he is then placing it on an acupuncture point and burning it with an incense stick. Note that he is using his own saliva to make the mugwort more malleable before sticking it to the patient’s skin!

Besides acupuncture and moxibustion, the other services these “talented and skilled” individuals provide consist of massage, cupping, breathing techniques, and the use of herbal, animal and mineral products. In most states, bloodletting is not part of their scope of practice — except for Arkansas.
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Posted in: Acupuncture, Politics and Regulation, Public Health, Science and Medicine, Traditional Chinese Medicine

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Preventing autism? Not so fast, Dr. Mumper…

Dug the Dog strikes again, as he did three weeks ago. I had a couple of ideas for a post this week, but none of them were time-sensitive or timely. Then, over the weekend, I saw a post on the antivaccine crank blog Age of Autism by Dan “Where are the Autistic Amish” Olmsted entitled Weekly Wrap: Another Medical Practice with a Sane Vaccine Schedule – and No Autism. Given the tendency towards a—shall we say?—lack of accuracy of Olmsted’s previous reporting, it’s no surprise that he’d latch on to this study. I’m also seeing it appear around other antivaccine websites. I had gotten wind of it late last week, a few of my readers having sent it to me but hadn’t decided yet whether to blog about it. Then it appeared on AoA. Thanks, Dan.

So let’s see how this study is being spun by the antivaccine movement:

When we at Age of Autism talk about ending the epidemic, the “to do” list seems almost overwhelming – funding a vax-unvaxed study, getting mercury out of flu shots, proving the HepB shot is nuts, wresting control of the agenda from pharma, fixing Vaccine Court (this time in the good sense of “fix”), establishing that biomedical treatments help kids recover, and on and on.

But there’s a shortcut to all this, and it goes straight through pediatricians’ offices. The evidence is growing that where a sane alternative to the CDC’s bloated vaccine schedule is offered, and other reasonable changes adopted, autism is either non-existent or so infrequent that it doesn’t constitute an epidemic at all.

The latest example comes from Lynchburg, Va., and the pediatric practice of Dr. Elizabeth Mumper. She noticed a frightening rise in autism in the 1990s. Concerned that vaccines and other medical interventions might be playing a role – concerned in other words that SHE was playing a role — Mumper changed course.

Fewer vaccines. Fewer antibiotics. No Tylenol. Breast-feeding. Probiotics. Good, pesticide free diets.

Since then, hundreds more children have been seen in her practice, Advocates For Children. But no more autism.

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Posted in: Neuroscience/Mental Health, Public Health, Vaccines

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E-cigarettes: The growing popularity of an unregulated drug delivery device

This post is not about vaccines (for a change).

However, I deem it appropriate to mention that one of the topics that I blog most frequently about is vaccines and how the antivaccine movement pushes pseudoscience and quackery based on its apparently implacable hatred of vaccines. (You’ll see why very shortly.) It seems almost as long as my interest in the topic since I first noticed that the antivaccine movement acquired its very own celebrity spokesperson in Jenny McCarthy, who at least since 2007 has been promoting outrageous quackery and pseudoscience associated with her antivaccine views. To her, vaccines are chock full of “toxins” and all sorts of evil humors that will turn your child autistic in a heartbeat and in general “steal” your “real” child away from you the way she thinks vaccines “stole” her son Evan away from her. Indeed, among other “achievements,” she’s written multiple books about autism in which vaccines feature prominently as a cause, led a march on Washington to “green our vaccines” and has been the president of the antivaccine group Generation Rescue for the last few years. None of this stopped ABC from foolishly hiring her to join the regular cast on The View beginning in a few short weeks.

Because I occasionally check on what Jenny McCarthy is up to, I noticed a couple of weeks ago that she had been hired to be a celebrity spokesperson for blu™ e-cigarettes. Here she is, hawking the blu™ Starter Pack:

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Posted in: Cancer, Medical devices, Politics and Regulation, Public Health

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Prenatal Mercury and Autism

Mercury in unequivocally a neurotoxin. It is especially damaging to the developing brain. But it’s the dose that makes the toxin, and so a low enough exposure even to something known to be potentially harmful may not be. Further, the body has mechanisms for dealing with toxins, and toxins in the body may not be reaching the cells they can potentially damage in significant amounts. Therefore if we want to know if a potential toxin is actually causing any harm to people we need to do some type of epidemiological study – correlating exposure to possible adverse outcomes. All the studies in petri dishes and with cell cultures just won’t answer the question of harm.

The question of whether or not mercury in vaccines has caused neurological harm, specifically autism, has been largely answered. Numerous studies have shown no association between the amount of mercury exposure from vaccines and the risk of developing autism. A separate mercury-related question, however, is whether or not there is any risk of harm from mercury exposure from seafood. Mercury is methylated by bacteria into methymercury, and through them gets into the food chain in the oceans. Fish that eat other fish then concentrate the mercury in their tissues, and so predatory fish and sea mammals tend to have high concentrations of methymercury.

This has led to some precautionary recommendations, including that pregnant women should not eat tuna or other fish with high mercury levels. This makes sense, but what is the actual risk? The precautionary principle can also cut both ways. Fish contain many high-quality nutrients important for a developing brain, such as polyunsaturated fatty acids. Removing this food source from the diet of pregnant women may have unintended negative consequences.

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Posted in: Neuroscience/Mental Health, Public Health

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