Philip Alcabes discusses myths of health, disease and risk.

Gun Violence: The Silence of the Officials

A week after the murderous fusillade in Aurora, Colorado, not one public health official has stepped forward to call for gun control.

Attribute the 9 deaths and dozens of injuries in Aurora to the rash act of an unbalanced man if you wish.  But what about the tens of thousands of other deaths caused by firearms in the U.S. each year?

If HIV infection (9,406 deaths in 2011) and painkiller overdose (estimated at 15,000 deaths per year, according to a report  by Trust for America’s Health and the Robert Wood Johnson Foundation) are public health problems worth discussion, why not firearms?  In 2009, the last year for which complete data are available, there were 31,347 deaths by firearm in the US, according to the US National Center for Injury Prevention and Control.

At The Pump Handle, Celeste Monforton — always worth reading — provides the data showing how out-of-scale America’s gun problem is on the global public health scene:  Our gun-violence death rates are an order of magnitude higher than those of other wealthy nations.

At CNN, Daniel Webster calls for America to wake up to the public health problem of guns.  “America’s high rate of gun violence is shameful,” Webster writes.  “When will we change?”

NYC Mayor Michael Bloomberg can be a tyrant when it comes to personal habits that he thinks impair the city’s health, but he has been courageously forthright on the need to control firearms.

But, like me, Monforton and Webster are academics.  And Mike Bloomberg is, well, Mike Bloomberg.

Where are the health officials?

Kathleen Sibelius, Secretary of Health and Human Services, has been silent.  She’s been vocal on healthcare fraud, and earlier this week announced a new public-private partnership to keep people with AIDS in care.   But not a word on guns.

Thomas Frieden, CDC director, can’t be accused of shying from the spotlight.  But he has said nothing about guns.

Under these corrupt officials, gun violence has been cleaned from the public health radar screen.

Try finding an entry on firearm violence at the Department of Health and Human Services website.  Or, go to the CDC’s “A-Z Index” (what other letters would bound an index, one wonders? well, anyway…).  There’s no entry for “guns” or “gun violence.”  Nor for “firearms.”  The entry on “violence” leads to a page on injury prevention that includes links to entries on Elder Maltreatment and Intimate Partner Violence — but not a word on guns.

At Salon, Alex Seitz-Wald wonders whether the NRA has suppressed research.  There’s some evidence for this:  Paul Helmke of the Brady Center to Prevent Gun Violence wrote to Secretary Sibelius over a year ago, asking whether it’s true that Frieden’s CDC has agreed to tip off the NRA when researchers who receive CDC monies are going to publish anything on gun violence.

Seitz-Wald might well be perfectly right.  Certainly, the NRA is unseemly, manipulative, and morally vacuous.  But it doesn’t have the power to program anyone’s thoughts.  It doesn’t cause our officials to be spineless in the face of the infestation of American homes and streets — and movie theaters, schools, colleges, and so on — by guns.

No, it can only be that Frieden and Sibelius — and a tremendous host of less prominent health officials — are all silent about  guns because, really, they aren’t concerned about 31,000 deaths and upward of 400,000 injuries from firearms each year.  Or, not as concerned about the carnage as they are about their jobs.

It’s self-evident that our health officials don’t care about the real health of Americans nearly as much as they do about their own continuation as officials.  More important than saving lives or limbs, apparently, is the officials’ capacity to mount the bully pulpit in order to decry other dreadful scourges.  Like big cups of soda, defrauding the insurance companies, or not exercising.

Our public health officials:  put to the test, and found to be feckless at core.

 

By Philip Alcabes | July 26th, 2012 | Categories: firearms, Health Professions, News, public health | Tags: , , , , , | Comments Off on Gun Violence: The Silence of the Officials

The Health Department at Work

I was pleased to receive a phone call from the NYC Department of Health and Mental Hygiene  and to be selected to participate in a “health survey.”  The questions offered a fascinating insight into the agency’s preoccupations — and what sorts of impropriety obsess its leadership nowadays.

It’s reassuring that the Department wants to be able to estimate how many New Yorkers lack health insurance and, separately, lack a regular health-care provider, and asked questions about those things.  And I was impressed that the survey designers thought to ask whether, the last time I sought help for a medical problem, it took a long time to get an appointment.

And then came some predictable How Are We Doing? questions:  Have I had a flu immunization in the past 12 months? (No, thank you, I’m not convinced that it works…  Okay, I didn’t say that, the survey taker seemed young and too earnest for serious critique, so I just said “No.”)  At least two doses of hepatitis B vaccine at some time in the past?  When did I last have a colonoscopy?

But there was the question about whether I have used oxocodone or hydrocodone (OxyContin or Vicodin) without a prescription, or outside of the prescribed dosage.  The Department has just announced a new campaign to stop people from using pain killers too much.

There was the question about whether I’m exposed to cigarette smoke in my household.

There was a question on whether my household has a disaster plan.  No, we don’t.  We have a couple of flashlights, some water, and a bottle of scotch.  Will that do?  We’re grown-ups, we don’t have pets or little children to look after.  We’ll work something out.

(But I didn’t say that to my earnest interviewer, either.  I have a feeling they don’t find whiskey to be humorous, over there at the health department.  In fact, they had some very specific questions about alcohol consumption, amount and frequency.)

There were questions about how often I exercise vigorously.  How often I exercise moderately.  How often I exercise lightly.  How long I engage in said exercise when I do do it.  Very interested in exercise, our health department.

There was the question as to how many servings of fruit or vegetables I ate yesterday.

And then, onward to mayor Mike Bloomberg’s white whale:  sugar-sweetened beverages!  Mayor Mike is going to ban serving soda or other sweet beverages in large sizes — and he’s not asking for a new law (which might not pass), just a go-ahead from the city’s eleven-person Board of Health, all appointed by the mayor, chaired by the city’s cheerleader for “healthy lifestyles,” health commissioner Thomas Farley.   A restaurant trade association, the Center for Consumer Freedom, responded to news of the mayor’s intention with an amusing ad in today’s NYT, portraying Bloomberg as The Nanny.

The survey questions:  How often do I drink soda or bottled iced tea?  What about beverages to which I add sugar myself, like tea or coffee?

And, now that we were deep into the zone of health officials’ self-stimulation:  how many (a) women and (b) men had I had sex with in the past year?  Did I use condoms?  And, had I used the Internet to meet a sex partner in the past 12 months?

So much for health.  Now we know what haunts the dreams of the self-righteous mayor and his bluenose health commissioner:

Pain relief.

Fat people.

Vigorous exercise.

Pleasurable foods.

 Sex.

Reading this list, you would have to be forgiven for thinking that these men, Bloomberg and Farley, have been living in a monastery since, say, the 14th century.  In fact, if they were really clergymen instead of officials, they would leave us alone about how we eat and sweat and screw.  At least in between sermons.

But thanks for calling.

 

 

 

By Philip Alcabes | June 2nd, 2012 | Categories: Behavior, flu, Health Professions, News, obesity, public health, tobacco | Tags: , , , , , , , , | 2 comments

W.H.O. and the Medical Industry

At EP-ology, Carl Phillips has a new post on the World Health Organization’s failure to care about suffering.   It’s worth reading — especially if you (still) believe that the WHO’s main aim is promoting health.

Phillips’s focus in that post is on a new WHO Atlas on headaches

and the problem that headaches cause people to stay home from work, or work less productively.   The agency estimates that Europe-wide, the lost productivity from migraines alone is worth 155 billion euros each year.  It isn’t that you feel crummy when your head hurts, and that chronic headache makes your life miserable.  It’s that you might not perform your expected per-capita service to the expansion of wealth.

Here’s how EP-ology assesses the agency:

The WHO is not the humanitarian organization that many people might think it is.  It is a special-interest medical-industry-oriented organization with an emphasis on the interests of governments, not people.  Its emphasis on productivity in looking at headaches … ignores people’s welfare…

Now, I can’t agree with Phillips’s analysis that the WHO’s ethical system is either “communist” or “fascist.”  For self-described public health agencies like the WHO to be concerned primarily with productivity and the generation of wealth — and only secondarily, if at all, with suffering — has been a hallmark of capitalism since the British Parliament passed the world’s first Public Health Act in 1848.

In fact, the laws institutionalizing public health in Britain in the late 1840s were passed by the Whig (liberal, more or less) government of Lord John Russell.  Public health was a legacy of efforts not by the nascent socialist and communist movements, but by radical capitalists — who sought to secure a moderately hale labor force to serve British industry with little cost to the factory owners.  And aimed to blame individuals for their own misery.

But it’s impossible to disagree with the main point of Phillips’s post:  WHO’s aim is to serve industry.

As further evidence, consider this follow-up note on Tamiflu by Helen Epstein, published in the May 26th issue of NY Review of Books (I discussed Epstein’s main article in a post last month).  It seems more and more apparent that potential dangers of Tamiflu (oseltamivir) in children were ignored.  Epstein reports that

the risks of delirium and unconscious episodes were indeed significantly elevated in children who took Tamiflu, especially if they took the drug during the first day or so after influenza symptoms appeared….  If these results are confirmed, they are especially worrying, since the World Health Organization and the US Centers for Disease Control both recommend that Tamiflu be taken as soon as possible after symptoms appear.

I was not the only one unaware of this important study; neither, apparently, were the World Health Organization, the US Food and Drug Administration, and the US Centers for Disease Control. When I contacted these agencies in January and February 2011, their spokespeople assured me that there was no evidence that Tamiflu causes neuropsychiatric side effects in children. [emphasis added]

In the rush to move taxpayer monies into the hands of wealthy private corporations, the WHO (with CDC and other agencies) proclaimed a flu emergency in 2009.  And ignored evidence on possible dangers of the products they were touting as part of the “preparedness” response.

By Philip Alcabes | May 9th, 2011 | Categories: Disease, flu, Health Professions, public health, Uncategorized | Tags: , , , , , , | 1 comment

Life Expectancy Goes Up but Risk-reduction lectures Continue

Bravo! to Rob Lyons at Spiked. Since it’s now apparent that life expectancy has increased almost everywhere and is at historic high levels in much of the developed world, Lyons asks the logical question:  why is the public health system still scolding everyone about what people eat and how fat the average person is?

A paper by David Leon in this month’s International Journal of Epidemiology showed the dramatic increase in life expectancy — the median age at death, that is.  It has reached over 85 years for women in Japan, but it’s high even in countries where longevity was relatively low a generation ago.  Cheeringly, US life expectancy at birth is now 78 years; in the UK it’s 80.  And it’s even higher in some countries of western continental Europe.  Here are the graphs for different parts of the world from Leon’s paper, showing trends since 1970:

Life expectancy since 1970

Lyons has gone after the anti-obesity crusaders before (as well as related topics at his smart blog on contemporary food confusion, Panic On A Plate).  Now, he’s particularly disturbed by the sermonizing about eating. “You can’t even have a pie and a pint without someone telling you it will kill you, it seems,” Lyons writes at Spiked.

And, really, it’s even worse than that — because it’s not just eating that’s the subject of the lecturing.  It might be true that you will live longer if you give up smoking, cut your salt intake, drop your BMI down to 24.99, exercise four times per week for at least 20 minutes each time, get immunized against flu and human papillomavirus, drink in moderation, and take naps.  But unfortunately there’s not a bit of evidence that any of that — apart from the decline in smoking — has contributed to increasing longevity.

And of course, even with smoking cessation, there’s no telling whether it would make any difference to you — only on average.

So why are the public health messages so far away from what really matters — basically, prenatal care, postnatal care, and wealth (with its concomitant, standard of living)?  Well, there’s a puzzle.

What’s the point of having an industry whose main aim is to make sure that people are constantly in fear that they are doing something that will kill them — even as it becomes apparent that most of what people do is only making us live longer?   Lyons calls it Good News Omission Mentality Syndrome (GNOMES).

I ask you:  could it have something to do with control?  And the desire to sell products?

By Philip Alcabes | March 25th, 2011 | Categories: Behavior, Health Professions, obesity, public health, Risk | Tags: , , , , , , , , , | 8 comments

Vaccine Crusaders Arm for Battle

I’m not sure I want to feel sorry for Andrew Wakefield — a nudnik, possibly even a charlatan.   And although I worry that MMR vaccine, especially as part of the intense dosing schedule for childhood vaccination overall, might have bad effects on some kids’ immune systems,  I’m not categorically opposed to immunization.

Still, it’s hard to avoid wondering:  is Wakefield right when he alleges that he’s being persecuted by the vaccine industry?

Last week, I discussed the BMJ article by Brian Deer asserting that Wakefield’s research was fraudulent, and the accompanying editorial supporting immunization.  At that point, I thought that the BMJ pieces were, together,  a one-off.

I was wrong.  In fact, it looks this week like the vaccine industry has armed some of its main warriors and sent them out to do battle.

The Battle Against Anti-Vaccinationism

In the Jan. 13th issue of the New England Journal of Medicine, two powerful chiefs, Gregory Poland and Robert M. Jacobson, claim that there’s an “age-old struggle” to make vaccines available.  Their aim is to vilify the “antivaccinationists” who “have done significant harm to the public health.” [Note the use of the holy article in this phrase, to signal just how sacred these warrior-priests hold “the” public health to be.]

The Poland-Jacobson piece is pure propaganda.  Theirs is a tale of heroic struggle on the part of ever-embattled Believers against the satanic forces of Antivaccationism — who have been trying “since the 18th century” to shake people’s faith in the vaccine gospel.  And nowadays the nasty antivaccinationists are using scarily modern forms of communications, such as TV and the Internet, in order “to sway public opinion and distract attention from scientific evidence.”

Wow:  TV and the web.  Sounds satanic alright.

I guess I shouldn’t be surprised that a couple of crusaders make their own work sound salvationist.  What troubles me is that they make it sound like they’re disinterested do-good-ers.

In fact, Poland and Jacobson are in bed with Big Pharma.  Poland runs the Mayo Clinic’s Vaccine Research Group.  Although as far as I can tell, Poland and Jacobson are not currently in the direct pay of the vaccine manufacturers, they and the VRG have benefited handsomely from vaccine makers’ largesse.

For instance, Poland’s and Jacobson’s work on human papillomavirus vaccine, as they acknowledge in a 2005 Mayo Clinic Proceedings paper, was funded by Merck, and their co-workers were Merck employees.  Later, in conjunction with a continuing medical education module on meningococcal vaccine in 2009, Poland disclosed the following ties:

Sources of Funding for Research: Merck & Co, Inc, Novavax, Inc, Protein Sciences Corp; Consulting Agreements: Avianax, LLC, CSL Biotherapies, CSL Limited, Emergent Biosolutions Inc, GlaxoSmithKline, Merck & Co, Inc, Novartis Vaccines, Novavax, Inc, PowderMed Ltd

And on his disclosure form for this week’s NEJM article Poland acknowledges funding from Pfizer and Novartis for vaccine studies.

So when Poland and Jacobson write that our society “must continue to fund and publish high-quality studies to investigate concerns about vaccine safety,” they’re really talking about preserving their livelihood.  It’s very much in their interest to ensure a steady flow of such funding.

And when they say that “society must recognize that science is not a democracy in which the side with the most votes or the loudest voices gets to decide what is right,” they’re being completely disingenuous.  Because Poland and Jacobson know quite well why science is not a democracy:  in the type of research they do, it’s the big money that decides what is right.

A High Priest of Vaccine “Science”

Then there’s Paul Offit making the rounds.  Offit has been the subject of lots of attention by Age of Autism, most recently as a “denialist.” Offit probably profited somewhat from the licensing of Rota Teq vaccine, which he helped invent — although AofA’s allegation that he is therefore beholden to Merck seems unsubstantiated.

What’s obvious about Offit is that he is contemptuous of people who don’t agree with his version of truth.

Offit appeared on Lenny Lopate’s radio show in New York yesterday, and presumably will be appearing elsewhere.  His aim is to explain the “grave public health problem of vaccine avoidance.”  The “anti-vaccine movement threatens us all,” he says.  In fact, that’s the subtitle of his new book, Deadly Choices.

Where Poland and Jacobson are militant and sanctimonious, Offit sounds a note at once sentimental and officious.  It’s “tragic” that there have been measles outbreaks because of parents refusing to have their kids vaccinated, he says.  And the problem is that people just don’t understand science.  In fact, Dan Olmsted at AofA gets it quite right when he critique’s Offit’s blinkered version of science:

Anyone concerned about [possible harms of vaccination] fits Offit’s definition of anti-vaccine, because vaccines don’t cause any of them, because Paul Offit says so, a solipsism that is really quite breathtaking: “[B]ecause anti-vaccine activists today define safe as free from side effects such as autism, learning disabilities, attention deficit disorder, multiple sclerosis, diabetes, strokes, heart attacks, and blood clots — conditions that aren’t caused by vaccines — safer vaccines, using their definition, can never be made.”

I had the same reaction to Offit’s self-important — and, to my mind, unscientific — claims.  Offit shows no interest in the open inquiry that marks science.  People who don’t agree with him are uneducated, poorly informed, maybe just stupid.  And, of course, dangerous.

“Tragic” Consequences of Unbelief

On the Lopate show, Offit resorted to the now-common formula of the “tragic” consequences of parents’ belief in Andrew Wakefield.

What’s the tragedy, exactly?   It’s true that there have been outbreaks of measles in the British Isles that have been traced to parents’ refusal to have their children immunized.  An excellent review in BMJ in 2006 provided some of the data for the U.K. — including that one child died in a 2006 measles outbreak that was related to poor immunization coverage.  A few children died in Ireland in 2000.  A CDC account of a measles outbreak in California in 2008 reports that it hospitalized a few children, although none died.

It would be great if nobody ever died from an infection that could be prevented in any way.  It’s surely tragic to the parents of a child who dies from a preventable infection.   The sympathies of each of us should go out to such parents, as to those whose kids are killed by bad drivers, sports injuries, or infections for which there’s no vaccine.

But in what sense is one child’s death more of a collective “tragedy” for all of us than the other deaths that go unremarked every day?   Why is it tragic when one child dies of a vaccine-preventable infection and not when a lot of them die of poorly regulated handguns or as troops fighting wars that never endanger our leaders, only our young?

The Ramp-up of Aggression by the Vaccine Crusaders

Why are the vaccine warriors rampant now?  Perhaps the vaccine makers are terrified that the low uptake of H1N1 flu vaccine despite all the hype in 2009, along with low MMR compliance in some places (the U.K. especially), means that their profits are going to slide.  Maybe their friends, like Offit and Poland, are worried that reduced uptake of vaccines will translate into diminished research funding or fewer conferences in delicious places.

Or maybe the vaccine industry finds Wakefield so obstreperous that they can’t rest until he is destroyed. Wakefield’s no choir boy, but he might not have realized just how much control the pharmaceutical industry can exert in the U.K.

In a review essay in last week’s New York Review of Books, Simon Head points out that Big Pharma is “the only major segment of the British economy that is both world-class and an intensive user of university research,” and implies that it exerts control over both the substance and volume of U.K. research productivity, especially in medicine.  Head sees reason to believe that Pharma will “tighten its hold over scientific research in the UK” in the future.

It’s Not a War

There need be no either-or about vaccines.  If our society can live with guns and automobiles (together accounting for roughly 50,000 American deaths a year), if we tolerate alcohol, processed foods, acetaminophen, high-rise construction, and all the other things that occasionally cause harm but mostly contribute to the way of life we prefer — then we can stop calling it “tragic” when a few parents don’t have their kids immunized.

Because to call one measles death “tragic” is to further the vaccine warriors’ campaign — the campaign that pretends to be on behalf of science or healthy kids, but is really fought to protect the fortunes of vaccine makers.

The campaign protects the power of shiftless public officials who claim to be protecting the public from harm when they serve up millions of taxpayer dollars to vaccine manufacturers for barely useful vaccines (H1N1 2009), or for vaccines that are undoubtedly helpful but might be harmful in some cases and haven’t been thoroughly examined (HPV vaccine).  And who, to this day, won’t even consider the very good question that Andrew Wakefield posed in the 1990s:  is it a good idea to give kids three immunizations in a single preparation?

I had my child immunized when she was the right age for that.    But I’m not certain that absolutely everyone has to do the same.  Neither are the courts, which is why they allow exemptions from immunization for personal belief.

I don’t think measles is a menace to civilization.  I know that only a very tiny percentage of children who contract measles get dangerously sick from it, that flu vaccine doesn’t work for everyone (and isn’t an effective public health measure to stop flu outbreaks even though it can protect individuals from illness), and that varicella vaccine can make the problem of shingles worse even though it reduces the problem of chicken pox.  And so forth.

I mean that immunization is complex and fraught.  Not everyone can be expected to agree with every vaccine recommendation.   Even while some people are opposed to vaccination and refuse to immunize their kids, life will go on, and society will continue to thrive, and Paul Offit can continue to say arrogant things about “science.”

So, could someone please call off the crusade?

By Philip Alcabes | January 14th, 2011 | Categories: autism, Disease, epidemics, Health Professions, Outbreaks, Physicians, public health, science | Tags: , , , , , , , , | 2 comments

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