Discussion Topic Week 7

The discussion topic this week is “Should people who willingly engage in behavior that can cause self-infliction of disease or conditions be required to take health promotion or disease prevention classes?

I do not believe that requiring these people to take a class will change their behavior. In the example of cigarette smokers, I’m confident they are aware that it is not healthy for them to smoke. There are scientific studies, warning labels on the packages, proactive campaigns to spread awareness of the health issues, and even laws prohibiting smoking in certain areas. This has been going on for long enough in this country for it to be considered common knowledge that smoking cigarettes is bad for your health, and yet there are still many people who smoke. I have never met a person who wasn't aware of the possible consequences of smoking, and yet they are able to rationalize a reason for not quitting. This is actually a common theme in people who are addicted, whether it is to smoking, alcohol, or other drugs. There is actually an entire scientific journal dedicated to studying this type of behavior “AddictiveBehavior”. People who are addicted to something cannot be convinced by educational materials or disease prevention classes. It takes psychological help to determine the root cause of the problem causing them to self-harm, and then a plan to bring them back to positive behavior. This goes beyond anything provided in a health promotion class.

There are times when providing more information to someone is no longer beneficial. We see this a lot in public health, and it is the reason why we resort to implementing policy rather than relying on outreach programs. In the case of addictive drugs it is more effective to make them illegal than to implement an educational outreach program and require users to take a health promotion class. In that context it is easy to see how restricting access is the right choice. When we are talking about the context of over-eating, it becomes more difficult since we all have to eat to live. Finding a balance between educational outreach and restricting particularly unhealthy foods seems to be the current way of thinking, and it remains to be seen how effective it is. Again, most people understand that a cheeseburger, large fries, and a large soda is not a healthy meal, but that doesn't stop millions of people from eating them every day. With the current education programs most people should be aware that eating these unhealthy foods can lead to diabetes, heart disease, and many other deadly conditions, but that still doesn't stop them. It’s going to take a radical change in policy to truly address this issue, because people will never make the choice for themselves.

Discussion Topic Week 6

This week’s discussion topic is about whether mandatory full body scans are a good idea for the population of Fort Worth. From the context of the original question I am assuming a full body scan refers to a CT scan.

First of all, what is a CT scan? According to the Envison Radiology website it is process that uses a series of X-ray images taken from various angles around the body. Computers then combine the images to make a 3D image of ones bones and soft tissues (Envision Radiology). How do doctors use this information? It is possible for doctors to view bone disorders, tumors, and internal injuries without having to do any invasive procedures. The ability to detect tumors and other disorders makes it a valuable tool for early cancer diagnosis.

That all sounds great, so it’s no wonder that physicians order them so frequently. There’s no harm in an early cancer diagnosis, right? Well, there is some conflicting information out there. A study found that childhood leukemia rates nearly tripled with exposure to CT scans (Pearce, Salotti, Little, McHugh, Lee, 2012). A review of the risks by Dr. Rita Redberg estimates there could be approximately 15,000 deaths resulting unnecessary CT scans that were performed in 2007 alone (Redberg, 2009). On the other hand, two doctors from the Mayo clinic believe that because the increase in radiation exposure is so low the the benefits outweigh the risks (Hara & McCollough, 2013). The one thing that became clear is that not everyone agrees on the dangers of scanning.

After conducting more research a trend emerged. The articles that promoted CT scans by saying they had minimal risk did not cite any specific scientific research to support their claims. Most were written by the medical community, but that could mean they have an agenda to profit from extra scans. All of the research that suggested increased exposure to radiation from CT scans resulted in an increased risk of cancer came from peer reviewed scientific journals. Finally I found a study that showed a clear correlation between CT scans and cancer rates (Smith-Bindman, Lipson, Marcus, Kim, Mahesh & Gould, 2009), and I made up my mind. I do not believe that full body scans should be mandatory. The increased radiation amounts do not provide enough benefit to the general population to be beneficial. I completely support their use in emergency situations, to support a diagnosis, and even if there is a strong medical history of cancer, but they should not be mandatory for healthy individuals, especially children.

 
References:
CT Scans at Envision Radiology. (n.d.). CT Scans at Envision Radiology. Retrieved April 14, 2014, from http://www.envrad.com/services-ct-scans.html

Pearce, M., Salotti, J., Little, M., McHugh, K., & Lee, C. (2012, June 6). Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. The Lancet, 380, 499-505.

Redberg RF. Cancer Risks and Radiation Exposure From Computed Tomographic Scans: How Can We Be Sure That the Benefits Outweigh the Risks?. Arch Intern Med. 2009;169(22):2049-2050. doi:10.1001/archinternmed.2009.453.

Hara, A., & McCollough, C. (2013, May 31). Interview by Mayo Clinic. Mayo clinic experts provide some insight about radiation dose from ct imaging. Retrieved from http://www.news-medical.net/news/20130531/Mayo-Clinic-experts-provide-some-insight-about-radiation-dose-from-CT-imaging.aspx

Smith-Bindman, R., Lipson, J., Marcus, R., Kim, K., Mahesh, M., & Gould, R. (2009). Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer . Internal Medicine, 169(22), 2078-2086. doi: 10.1001/archinternmed.2009.427

Discussion Topic Week 5

For this post I am taking the role of a well-educated scientist at a biotech firm defending the use of genetically modified food (or GMO’s). 

First of all, it is important to understand what we mean by genetically modified food. In a strictly literal sense nearly all of our modern crops have been genetically modified over the centuries of farming to become what we now consider food. Through the basic technique of planting selected seeds from the best crops, we forever altered the natural progression of plant evolution. What we are discussing today, however, is selectively altering genes that would not happen naturally. We have come a long way from Mendel and his peas, and are now capable of inserting genes from other organisms that give us desired characteristics such as disease resistance, pest resistance, drought resistance, and increased nutritional value (James, 2012).

There are a few studies out there that show potential negative health effects of eating genetically modified foods. One study shows pigs that ate a diet of only GM food had a greater chance of stomach inflammation than pigs that ate a non GM food diet (Carman, Vlieger, Ver Steeg, Sneller, Robinson, Clinch-Jones, Haynes & Edwards, 2013). Another study looked at GM crops with genes that create toxins that make them resistant to insects and whether these toxins can be found in pregnant and non-pregnant women. The results showed that some of the women did show traces of the toxins (Aris & Leblanc, 2011). Even though these studies were done with relatively small sample sizes, their results should not be ignored. Globally, 75% of soybeans, 32% of corn, and 26% of canola is genetically modified (James, 2012). What this tells me as a scientist is that we need to have a more rigorous safety testing regiment for the foods we create. 

It also tells me that maybe we should be more creative with the genes we use. Instead of developing a corn that excretes pesticide, maybe we could develop a corn with a hard outer shell that insects cannot penetrate. Rather than have a soybean that excretes an herbicide, we could have it grow taller and with large flat leaves to block out the sun and prevent weeds from growing. There is a lot of room for innovation, and I believe the benefits will vastly outweigh any potential negatives that may exist. The population is growing and we need to be able to feed everyone in a cheap, sustainable way. At this point genetically modified foods show the most promise for being able to accomplish this goal.

References:

Carman, J., Vlieger, H., Ver Steeg, L., Sneller, V., Robinson, G., Clinch-Jones, C., Haynes, J., & Edwards, J. (2013). A long-term toxicology study on pigs fed a combined genetically modified (gm) soy and gm maize diet. Journal of Organic Systems, 8(1), 38-54. Retrieved from http://www.organic-systems.org/journal/81/8106.pdf

Aris, A., & Leblanc, S. (2011). Maternal and fetal exposure to pesticides associated to genetically modified foods in eastern townships of quebec, canada. Reproductive Toxicology, 31(4), 528-533. doi: 10.1016/j.reprotox.2011.02.004

James, C. (2012, 02 07). Isaaa brief 43-2011: Executive summary. Retrieved from http://www.isaaa.org/resources/publications/briefs/43/executivesummary/default.asp

Discussion Topic Week 4

The task for this assignment is to research the effects of disturbing or graphic images on cigarette boxes, and whether or not they are effective at reducing smoking. Currently in the U.S. smoking manufacturers are only required to put a small text based warning on the packages. Attempts by the FDA to require graphic images on cigarette boxes have been opposed by the cigarette companies, perhaps because they have seen the effects it has had in other countries. 

A study comparing Australia and Canada (countries that require graphic images) to the United States and the United Kingdom (which do not require graphic images) showed that the graphic warnings had greater impact on awareness and avoidance of cigarettes than the text only warnings (Borland, Wilson, Fong, Hammond, Cummings, Yong, Hosking & Hosking, 2009). Another study assessed the perceived value of a pack of cigarettes and found that the ones with graphic images were consistently valued less (Thrasher, Rousu, Anaya-Ocampo, Reynales-Shigametsu, Arillo-Santillan & Hernandez-Avila, 2007). The reasons these measures are significant are because they are indicators for quitting smoking in populations. So why hasn’t smoking cessation increased drastically in the countries that have graphic images on the boxes?

Some argue that the studies are flawed or that there is a psychological response that encourages people to continue smoking when faced with the disturbing images (Ruiter & Kok, 2005). I believe that the images do not go far enough, and that improvements could be made. I propose making changes to the texture of the box to affect more than just an emotional sense. If the box was very sticky, or slimy, people would be much less likely to carry them around. Some people enjoy the smell of tobacco so I propose making the boxes smell like rancid or rotting flesh, which would elicit a powerful sense of revulsion. Changing the color and shape of cigarettes could also have an effect, perhaps in the shape of a slug or some other repulsive creature. I hypothesize these changes would have a drastic impact on reducing the number of smokers, and more importantly reducing the number of new smokers. 

 

References:

Borland, R., Wilson, N., Fong, G., Hammond, D., Cummings, K., Yong, H., Hosking, W., & Hosking, W. (2009). Impact of graphic and text warnings on cigarette packs: findings from four countries over five years. Tobacco Control, 18(5), 358-364. doi: 10.1136/tc.2008.028043

Thrasher, J., Rousu, M., Anaya-Ocampo, R., Reynales-Shigametsu, L., Arillo-Santillan, E., & Hernandez-Avila, M. (2007). Estimating the impact of different cigarette package warning label policies: The auction method. Addictive Behaviors, 32(12), 2916-2925. Retrieved from http://www.sciencedirect.com/science/article/pii/S0306460307001682

Ruiter, R., & Kok, G. (2005). Saying is not (always) doing: cigarette warning labels are useless. European Journal of Public Health, 15(3), 329. doi: 10.1093/eurpub/cki095

Discussion Topic Week 3

Generic disclaimer: This blog post is from the perspective of a state epidemiologist who has been tasked by their supervisor to write a position statement on the department’s stance on the ramifications of legalization. It is part of an assignment and not meant to be a reflection of the author’s beliefs or opinions. Carry on.

The legalization of marijuana may lead to an increase in respiratory disease (Mehra, Moore, Crothers, Tetrault, Fiellin, 2006), addictions (Hughes & Budney, 2006), cardiovascular disease (Jones, 2002), vehicle crashes (Drummer, Gerostamoulos, Batziris, Chu, Caplehorn, Robertson & Swann, 2003) and mental health issues (Hall, 2006). A conservative estimate of 8% of the population using marijuana means there were about 782,000 Texans in 2012 using the drug (Hall & Degenhardt, 2009). A study in Canada estimated the health cost of marijuana users at $20 per user (Thomas & Davis, 2009). This would put the cost of healthcare for marijuana users in Texas at approximately $15.6 million dollars a year. One would assume an increase in users if marijuana became legal, which would lead to an increase in health costs.

On the other hand, Texas spent an estimated $330 million to incarcerate people for marijuana related charges (Miron & Waldock, 2010). If legalized, this cost would more than offset the increase in health costs. With the proper design and implementation for a legalization program, the income from taxation could generate many more millions of dollars (Caulkins, Kilmer, MacCoun, Pacula & Reuter, 2011). This profit could be used for medical research, education, and outreach programs that would greatly benefit Texans.


After careful consideration, this department recommends the legalization of marijuana. The health implications are clear, but the economic benefit will help to deliver higher quality healthcare to all Texans.


References:

Mehra R, Moore BA, Crothers K, Tetrault J, Fiellin DA. The association between marijuana smoking and lung cancer: A systematic review. Arch Intern Med.2006;166(13):1359-1367. doi:10.1001/archinte.166.13.1359

Hughes, J., & Budney, A. (2006). The cannabis withdrawal syndrome. Current Opinion in Psychiatry, 19(3), 233-238. doi: 10.1097/01.yco.0000218592.00689.e5

Jones, R. T. (2002), Cardiovascular system effects of marijuana. Journal of Clinical Pharma, 42: 58S–63S. doi: 10.1002/j.1552-4604.2002.tb06004.x

Drummer, O., Gerostamoulos, J., Batziris, H., Chu, M., Caplehorn, J., Robertson, M., & Swann, P. (2003). The involvement of drugs in drivers of motor vehicles killed in australian road traffic crashes. Accident Analysis & Prevention, 36(2), 239-248. doi: http://dx.doi.org/10.1016/S0001-4575(02)00153-7

Hall W (2006) The mental health risks of adolescent cannabis use. PLoS Med, 3(2), e39. doi:10.1371/journal.pmed.0030039

Miron, J., & Waldock, K. (2010). The budgetary impact of ending drug prohibition. (pp. 5-6). Washington, D.C.: CATO INSTITUTE. Retrieved from http://www.cato.org/sites/cato.org/files/pubs/pdf/DrugProhibitionWP.pdf

Thomas, G., & Davis, C. (2009). Cannabis, tobacco and alcohol use in canada: Comparing risks of harm and costs to society. Visions, 5(4), 11. Retrieved from http://www.heretohelp.bc.ca/visions/cannabis-vol5/cannabis-tobacco-and-alcohol-use-in-canada

Caulkins, J., Kilmer, B., MacCoun, R., Pacula, R., & Reuter, P. (2011). Design considerations for legalizing cannabis: lessons inspired by analysis of california’s proposition 19. Addiction, (107), 865-871. doi: 10.1111/j.1360-0443.2011.03561.x

Hall, W., & Degenhardt, L. (2009). Adverse health effects of non-medical cannabis use. The Lancet,374(9698), 1383-1391. doi: 10.1016/S0140-6736(09)61037-0

Discussion Topic Week 2

This week’s discussion topic is about the relevance of multivitamins. Some popular opinions are that multivitamins can help prevent disease like cancer, heart disease, and other chronic illnesses, but what does the science say? There is no clear answer about the effects of taking multivitamins and chronic diseases. Another popular opinion is that multivitamins fill in the nutritional gaps that we may be missing with our normal diets. This may be true for some, but research suggests most people who take multivitamins already get adequate intake from their diet (Bailey, Gahche, Lentino, Dwyer, Engel, Thomas, Betz & Sempos, 2010).

One study reviews clinical trials and observational studies to try and determine a correlation between multivitamins and chronic disease and provides an excellent break down of the problems associated with the current research (Prentice, 2007). One of these issues relates to study design, which is people who are in the study groups (people who take multivitamins) aren’t an accurate representation of the general public because they tend to be in the same demographic (older, white, college educated, healthy weight individuals). The studies that determine correlation between taking vitamins and chronic disease prevention may not consider these factors.

The people who need multivitamins the most are people who do not absorb vitamins normally or women who are pregnant ("Multivitamins," 2010). In these cases a doctor will prescribe a multivitamin and provide details on how often to take them. For most healthy people, multivitamins do nothing (Mulholland & Benford, 2007). I would recommend using your money to by fruits and vegetables instead of multivitamins.

References

Prentice, R. (2007). Clinical trials and observational studies to assess the chronic disease benefits and risks of multivitamin-multimineral supplements. The American Journal of Clinical Nutrition, 85(1), 3085-3135. Retrieved from http://ajcn.nutrition.org/content/85/1/308S.long

Bailey, R., Gahche, J., Lentino, C., Dwyer, J., Engel, J., Thomas, P., Betz, J., & Sempos, C. (2010). Dietary supplement use in the united states, 2003–2006.The Journal of Nutrition, 141(2), 261-266. doi: 10.3945/​jn.110.133025

Multivitamins. (2010, September 01). Retrieved from http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682882.html

Mulholland, C., & Benford, D. (2007). What is known about the safety of multivitamin-multimineral supplements for the generally healthy population? theoretical basis for harm. The American Journal of Clinical Nutrition, 85(1), 3185-3225. Retrieved from http://ajcn.nutrition.org/content/85/1/318S.long

Discussion Topic Week 1

Vaccinations are one of the greatest achievements by modern medicine, but that does not mean they are the best thing for human evolution. I have read many blogs, read research papers, and have decided for this assignment to argue against vaccinations. This decision has nothing to do with the evidence put forth by popular media, bloggers, or scientific research. I believe that evidence supports the long term effectiveness of vaccinations (Aronson, Santosham, Comstock, Howard, Moulton, Harrison, 2004)(Crotty, Felgner, Davies, Glidewell, Villareal, Rafi, 2003). I found that the arguments made by bloggers against vaccinations are full of logical fallacies and misinformation ("Mommypotamus", 2013). There is also evidence to support that attempting to change the mind of someone who is against vaccinations by presenting logical, well informed arguments actually makes them more likely to forgo vaccinations (Nyhan, Reifler, Richey, Freed, 2014). My reasoning comes down to a belief system that puts what is best for the species ahead of what is best for an individual.

In the field of environmental science there is a concept known as overpopulation, which occurs when the number of a species can no longer be sustained by its environment. When this occurs the species suffers catastrophic losses due to a lack of resources (nutrition, living space, etc.), and the population numbers fall to a point at or below the sustainable level for the environment. Overpopulation is usually kept in check by predators, but since humans have developed weapons there are no natural predators. In environments where no natural predators occur, disease may play a role in limiting populations. Since humans have developed such excellent vaccinations and medicines, diseases are unable to significantly impact population levels. The human population continues to grow, and will eventually reach a point where there is not enough water for growing crops, proper sanitation, or manufacturing. Modern science will develop ways to postpone this for many years, but it is a future inevitability if the population increase continues at this rate. Eliminating vaccine distribution could help prevent this scenario from occurring.

Another approach is to look at this from an evolutionary standpoint. Adapting to change, including disease, is essential for a species to survive. Introducing vaccines to the population may be restricting our ability to adapt to naturally occurring diseases. A recurring argument is that no child should suffer from a preventable disease (Vara, 2013). This is a logical fallacy that appeals to emotion rather than an argument to support vaccinations. It is difficult to accept the idea of allowing a loved one to suffer, but when compared to the long term survivability of the species, an individual is relatively insignificant. If society moves toward an understanding and acceptance of this practice it may become much easier for the individual to cope.

The current popular opinion seems to be that vaccines lead to an increase in the quality of life for people around the world. I argue that they are only increasing the quantity of life for the current generation, and that eliminating vaccinations will increase our species’ natural resistance to disease which will improve the quality of life for all future generations.


References

Aronson, N., Santosham, M., Comstock, G., Howard, R., Moulton, L., & Harrison, L. (2004). Long-term efficacy of bcg vaccine in american indians and alaska natives a 60-year follow-up study. The Journal of the American Medical Association,291(17), 2086-2091. doi: 10.1001/jama.291.17.2086.

Crotty, S., Felgner, P., Davies, H., Glidewell, J., Villareal, L., & Rafi, A. (2003). Cutting edge: Long-term b-cell memory in humans after smallpox vaccination.The Journal of Immunology, 171(10), 4969-4973. Retrieved from http://www.jimmunol.org/content/171/10/4969.short

Nyhan, B., Reifler, J., Richey, S., & Freed, G. (2014). Effective messages in vaccine promotion: A randomized trial. American Academy of Pediatrics, 133(4), 1-10. doi: 10.1542/peds.2013-2365

Mommypotamus, H. (2013, August 26). [Web log message]. Retrieved from http://www.mommypotamus.com/should-parents-who-dont-vaccinate-be-prosecuted/

Vara, C. (2013). Victims of vaccine-preventable disease. Retrieved from http://www.vaccinateyourbaby.org/why/victims.cfm

Intro Post

I am Matthew and this is my first post for Epidemiology 5300. Hopefully I will learn about the foundations of epidemiology and its application in the health professions. This is my second class towards the Professional Option MPH. I am the Director of the Safety Office at UNT HSC, and this degree will build on my work experience.