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.