Folklore Based Medicine?

Byoliveridley

Breast cancer theory supports African folklore – CNN.com

While they stressed that women should always get screening and quick treatment for breast cancer, they said their theory could also help explain the belief, widespread in parts of Africa and the United States, that removing a tumor can hasten death. “I must say that I am sure there is more to this than just a myth,” said Michael Retsky of Children’s Hospital and Harvard Medical School in Boston, Massachusetts. His latest hypothesis, which he admits is not supported by any new direct research, is published in the International Journal of Surgery. He stressed that any woman with breast cancer should get the tumor removed. And he noted that in the United States, the women who could be considered at risk of having their cancer spread now get chemotherapy anyway, which would stop cancer’s spread.

Note, no direct evidence, no double blind trial, just a story? C’mon, you’re a Doctor. Surely, you know that CNN and the other media will take your qualifications, reservations and cautions  and shove them up your you know what to get a nice headline. Most people don’t read past the first two lines anyway, so nothing you say about your reservations will be transmitted to the public.

I hope you get the funding to prove/disprove your contention. Race based differences in treatment outcomes are not well studied, and are potentially very important. It is vital that more people look at this issue. But speculation based on modeling studies does not belong on CNN.

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India at 60 – A Public Health Perspective

Byoliveridley

Well, at least I don’t have to take part in endless parades and listen to speeches any more. But India turned 60 today, and the head of the Indian public health foundation takes stock, and it is sobering.

The Hindu : Persisting public health challenges

Recent health indicators in India are a cause for both celebration and concern. While life expectancy at birth has risen to 63 years, infant mortality rate (IMR) and maternal mortality rate (MMR) are still at unacceptably high levels (57 per 1000 and 301 per 100,000 live births respectively). There is widespread disparity among States with Kerala being the star performer. Within States, the rural areas are way behind the urban segments. Even as our economy has grown rapidly, the nutritional status of children has remained stunted, suggesting that wide income disparities are preventing the poor from becoming the beneficiaries of growth.

Yes, I be the killjoy.

More from Amartya Sen

There is reason enough to celebrate many things happening in India right now. But there are failures as well, which need urgent attention. For example, there is still widespread undernourishment in general and child undernutrition in particular–at a shocking level. The failures include, quite notably, the astonishing neglect of elementary education in India, with a quarter of the population–and indeed half the women–still illiterate.

The average life expectancy in India is still low (below 64) and infant mortality very high (58 per 1,000 live births). It is certainly true that India has narrowed the shortfall behind China in these areas–that is, in life expectancy and infant mortality–but there is still some distance to go for the country as a whole. The problems are gigantic in some of the more “backward” states like Bihar and Uttar Pradesh. And yet there are other states in which the Indian numbers are similar to China’s.

he goes on…

If India has to overcome these failures, it has to spend much more money on expanding the social infrastructure, particularly school education and basic health care. It also needs to spend much more in building up a larger physical infrastructure, including more roads, more power supplies and more water. In some of these, the private sector can help. But a lot more has to be spent on public services themselves, in addition to improving the system of delivery of these services, with more attention paid to incentives and disciplines, and better cooperation with the unions, consumer groups and other involved parties.

Ah, basic and boring infrastructure building!

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Meanwhile, in the other India

Byoliveridley

While India prepares to spend many billions of dollars on fighter jets, it cannot provide clean water for its citizens.

Cholera-diarrhoea toll mounts to 164 in Orissa-India-The Times of India

Cholera and diarrhoea, having assumed epidemic proportions in three tribal dominated Orissa districts, have so far claimed 164 lives as officials confirmed five more deaths in worst-hit Koraput on Thursday.

The death toll, which had mounted to 159 on Wednesday, further rose to 164 with confirmation of five casualties in Dasmantpur block of Koraput district, Chief District Medical Officer (CDMO) R K Agarwal said.

While the toll in Koraput district went up to 73, the situation remained by and large unchanged in Rayagada with 64 casualties as the killer diseases claimed as many as 27 lives in Kalahandi, official sources said.

The water-borne diseases had assumed epidemic form in nine blocks of these three backward districts located adjacent to each other though separated by hills and the waterspread of the vast Indravati reservoir.

Despite state government’s claim to have effectively controlled the spread of the diseases, residents of the affected areas alleged that the administration had failed to provide adequate medical facilities to the patients.

This is disgusting and very symptomatic of the urban-rural divide that exists in India. Unless the government can provide basic infrastructure to its rural citizens, all those fancy malls and F16s mean little.

The Carrboro Citizen on the Smoking Ban

Byoliveridley

The Carrboro Citizen is a new local paper (less than a month old at this point in time!). It has a well written summary of the current state of North Carolina’s anti smoking bill.

The Carrboro Citizen

The fierce behind-the-scenes battle continues over legislation to protect people from deadly second-hand smoke at workplaces, restaurants and bars. Despite his best efforts, House Majority Leader Hugh Holliman has been unable to convince a majority of House members to support his comprehensive plan to protect the public health.

The opposition has coalesced around a soundbite in this case masquerading as a philosophy, that somehow protecting workers on their jobs is an infringement of private-property rights. Holliman points out that he owns a small business that complies with all sorts of government regulations, including fire safety inspections every year.

The regulations are designed to protect the health and safety of workers, just like Holliman’s ban on smoking in the workplace. No one is arguing that businesses should be able to refuse the fire inspections and let people who object find other jobs, but that’s what the smoking ban opponents are saying.

Yes, seems obvious to me, but as I may have mentioned before, property rights is just the catchall excuse here, following the money trail leads to the tobacco industry and to various other entrenched interests represented (as the article points out) by the National Association of Tobacco Outlets! Chris Fitzsimon who wrote this article makes the same point.

Here’s a nugget tucked away in the middle of the article:

The latest version of Holliman’s proposal would ban smoking at all restaurants and most bars that serve food, exempting only establishments that function almost entirely as bars and only admit customers above age 21. The bill would not affect smoking at workplaces, but would overturn the 1993 law that prohibits local governments from passing their own anti-smoking regulations.

This means that private “clubs” like the dead mule (a smoke filled horror that I frequent!) would be exempt. On the other hand, the Chapel Hill and Carrboro local governments could act anyway to ban smoking in these clubs, which to me is a compromise I could live with!

The Citizen is off to a good start. I have only seen their website (and blogs), looking forward to picking up a copy of the paper version.

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California Ban on Diacetyl?

Byoliveridley

Flavoring-Factory Illnesses Raise Inquiries – New York Times

For a good background on flavoring-factory lung disease (formerly known as popcorn worker’s lung), check out the Pump Handle’s many posts, especially this recent one. Short primer, diacetyl is the chemical that gives popcorn its so called buttery taste (and smell, it’s fake!!). Well, there’s pretty good evidence that diacetyl causes bronchiolitis obliterans. Some symptoms…

Bronchiolitis obliterans renders its victims unable to exert even a little energy without becoming winded or faint.

“The airways to the lung have been eaten up,” said Barbara Materna, the chief of the occupational health branch in the California Department of Health Services. “They can’t work anymore, and they can’t walk a short distance without severe shortness of breath.”

OSHA has been unwilling to seriously regulate diacetyl, so California, as it is wont to do, is considering banning this killer chemical.

But in California, which has 28 flavoring plants known to use diacetyl, some legislators and government officials seem unwilling to wait. A bill to ban diacetyl in the workplace by 2010 has passed two committees in the State Assembly and could be taken up by the full body this summer. It is the first proposal of its kind in the nation. Assemblywoman Sally Lieber, the author of the bill, said she introduced it because of what she said was the slow response by the flavoring industry, which is largely self-regulating on occupational safety. “What we’ve heard is that the flavoring industry has known for years that this is potentially a problem, and they haven’t taken action,” said Ms. Lieber, a Democrat.

I am all for California’s regulation. But as written, this law will only protect workers in California. They should also consider going one step further by restricting the use of diacetyl in food sold in California. Only then can the giant market that is California exert its influence on the diacetyl manufacturers and users.

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Chemical agency ties under review – Los Angeles Times

Byoliveridley

As I mentioned a couple of days back, Sciences International has some conflicts of interests in this bisphenol A issue. I am glad that NIEHS is taking note.

Chemical agency ties under review – Los Angeles Times

The National Institute of Environmental Health Sciences has begun a review of ties between a federal health center that evaluates the risks of chemicals to reproductive health and a consulting firm funded by companies that produce chemicals linked to reproductive disorders.

The investigation follows a Times report on Sunday that Sciences International, an Alexandria, Va., firm funded by more than 50 industrial companies, helps manage the federal Center for the Evaluation of Risks to Human Reproduction.

Among the firms with financial ties to Sciences International are two that produce bisphenol A, a chemical in polycarbonate plastic bottles that has been linked in animal testing to prostate and breast cancer and reduced fertility.

Since 1998, Sciences International has helped manage the federal reproductive health center and prepared draft reports analyzing bisphenol A and 16 other chemicals. The company has a $5-million contract with the center.

The center’s scientific advisory panel was scheduled to decide today whether bisphenol A endangers reproductive health in humans.

But on Tuesday, director Michael Shelby announced that the panel, after two days of reviewing the 372-page report that Sciences International prepared on bisphenol A, known as BPA, still had too many unresolved questions and was postponing its decision for six weeks.

Good investigative journalism still makes a big difference.

As always, as I was writing this post, I noticed that the ever excellent folks at the pump handle read my mind and posted about it (2nd time in 3 days!), so I will stop writing (and thinking about Bisphenol A) and direct your attention to their post!