Is Chronic Occupational Pain a Class Issue?

Byoliveridley

Americans in households making less than $30,000 a year spend nearly 20% of their lives in moderate to severe pain, compared with less than 8% of people in households earning above $100,000

Millions of Americans in Chronic Pain – TIME

Based on a study published in the Lancet (much moolah required to read, funny that the authors of an article on the class/money based nature of pain would publish in a journal that requires all kinds of money to read, heard of PLOS?), one would have to say yes. People in low paying service jobs don’t have the luxury of mid afternoon yoga, or that once a week massage, or being able to take a “mental health” day, or any such luck. Also, the work is physically demanding, long hours of standing, heavy lifting, and repetitive motions the body was not designed for.

Krueger notes that the type of pain people reported typically fell on either side of the rich-poor divide. “Those with higher incomes welcome pain almost by choice, usually through exercise,” he says. “At lower incomes, pain comes as the result of work.” Indeed, Krueger and Stone found that blue-collar workers felt more pain, from physical labor or repetitive motion, while on the job

It is very sad, but a lot of this pain is avoidable. Next time you go to the grocery store, notice that the people at the check out counter stand all the time. Why? What about their job requires continuous standing? I’ve been to other countries, Germany for instance, where they are provided with high chairs that help them move the items from the conveyor through the scanner to the bagging area with much less effort. How many chairs have you seen in a grocery store lately?

Why can’t this very simple system be implemented? It would provide much relief. Three major issues:

  1. Lack of bargaining power: Unions are a dirty word. Last I heard, the unionization rate in the states was 12%. No one speaks for the cashier. It is considered a low paying, low skill occupation where people can be replaced easily and without “pain”. So, you’re on your own, ask for a chair, and you’ll be seated in one very soon (at home, your ass fired and tired).
  2. Money: And this is linked to point 1. Implementation of any programs designed to make workers’ lives a little easier costs money up front. Since workers are expendable and have no voice, it’s easiest to steal from them and deny them basic comforts.
  3. The American notion of individualism: You deserve what you get based on how hard you work and how intelligent you are. Grocery store cashiers must be lazy and dumb to be where they are. they “deserve it”

I don’t see it changing at all. But next time you walk into a grocery store and find a rather sullen clerk, it’s not that she’s lazy or has a bad attitude, she may just be in a lot of pain.

Happy Sunday!

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Circumcision and AIDS – Revisited

Byoliveridley

condom.jpg

A post I wrote quite a while back on circumcision and AIDS remains my most commented post ever. In it (if you’re too lazy to click) I said that while research indicating a reduction in HIV infection in circumcised men was promising, there were a couple of concerns. One, that this could be a distraction from the single most effective prevention measure (no, not abstinence!), condom use. And two, that in certain cultures, especially among Hindus, this would be an absolute no no because circumcision is identified with being Muslim.

Anyway, in a review article, the Cochrane Centre in South Africa summarizes results from a meta analysis of a number of trials indicating a 50% reduction in HIV incidence among circumcised males. At this point in time, it is clear that circumcision is effective in reducing HIV incidence among heterosexual males. Based on this, the institute encourages the widespread use of circumcision as an AIDS prevention strategy.

So, am I still circumspect? Absolutely. I am still concerned that this research will be misinterpreted in a way that discourages condom use. In fact, the authors note that circumcised men indulged in more risky behaviour. Also, the incidence of HIV in the women these men were sleeping with increased from 9.6% to 13.8%, a 40% uptick. This increase was not statistically significant. No arguing with that, though the study was stopped early once it was clear that the men were helped, never mind the women, or reaching statistical significance in their case.

Given that it is very unclear what the effects of circumcision are on anything other than circumcised penises, which are only one half of the equation (or less!), I don’t think it is responsible to call for widespread use of circumcision as a public health strategy for the prevention of HIV until its effects on the other parties are known. While people are aware of this issue, I don’t think the science or the cultural landscape promote the use of circumcision as a HIV prevention strategy until its proven that women are not at risk from increased HIV incidence either biologically from a yet unknown mechanism, or socially from increased risk taking.

Men have more power in most societies to demand and receive sex on their terms. So the male centric nature of this research, and the conclusions drawn are disturbing. How irresponsible is it to encourage a public health strategy that appears to increase risk taking behaviour among men when the effects on the women are yet unknown, with only a statistically “insignificant” 40% increase in HIV incidence among women being observed?

I am. for very good reason, still circumspect on circumcision.

Whisky flavoured condoms courtesy bruno  girin’s photostream used under a creative commons license. Now how’s that for a turn on, whisky!

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FDA decides to breed super bugs

Byoliveridley

Well, what else can you say about it. This is insanely moronic. Read this sierra club release about the overuse of antibiotics brought on by the overcrowding of animals in food production factories (aka “farms”). Read the whole article and see how much everyone will be endangered so that Intervet, Inc. can make money.

FDA Rules Override Warnings About Drug – washingtonpost.com

The government is on track to approve a new antibiotic to treat a pneumonia-like disease in cattle, despite warnings from health groups and a majority of the agency’s own expert advisers that the decision will be dangerous for people. The drug, called cefquinome, belongs to a class of highly potent antibiotics that are among medicine’s last defenses against several serious human infections. No drug from that class has been approved in the United States for use in animals.

Note, a powerful and potent antibiotic that works well, but is not used much because it’s the last line of defense. But the drug company that manufactures this product cares little about long term efficacy. Their only goal is to maximize short term shareholder value. I don’t blame them, I blame the government for not doing its job, that is, to balance these short term and long term goals and protect the people that pay them a lot of money for this protection.

The wording of “Guidance for Industry #152” was crafted within the FDA after a long struggle. In the end, the agency adopted language that, for drugs like cefquinome, is more deferential to pharmaceutical companies than is recommended by the World Health Organization.

Cefquinome’s seemingly inexorable march to market shows how a few words in an obscure regulatory document can sway the government’s approach to protecting public health.

There’s a reason this present U.S government works in secrecy, so these “obscure” (I am sorry, but nothing that directly affects human health can be called obscure) rule changes will not hit the public eye before it’s too late. Apparently, the FDA can now only consider resistance to food borne diseases in considering an application. That’s like saying that a hospital will only treat victims of food borne diseases, so if you catch the cold, we won’t treat you! This is the Food and Drug Adminstration (all food and all drugs), not the food borne disease protection council.

This drug is absolutely unnecessary for the following reasons:

  1. The disease it treats (respiratory distress in cows) is brought about by insane levels of animal overcrowding
  2. There are currently a dozen antibiotics for this particular problem, none of which are considered susceptible to resistance
  3. The FDA has previous history with similar public health threats with fluoroquinolones
  4. This drug is considered a last resort drug for antibiotic resistant strains of diseases in cancer patients – So strains resistant to this drug will evolve shortly after the antibiotic is overexposed . This is a death sentence for a lot of very vulnerable people.
  5. A similar drug used in Europe for the last 10 years has resulted in an increase in resistant strains of bacteria.

This is what you get when you vote for an ideology that hates government. You get a government that hates itself and is busy pawning parts of itself off to its cronies.

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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Feds punt on Bisphenol A

Byoliveridley

By studiously ignoring all the subtle hormone disruption effects of bisphenol A and concentrating on easily observable neurological effects, the CERHR essentially does the industry’s bidding.

Some risk linked to plastic chemical – Los Angeles Times

A federal panel of scientists concluded Wednesday that an estrogen-like compound in plastic could be posing some risk to the brain development of babies and children.

Bisphenol A, or BPA, is found in low levels in virtually every human body. A component of polycarbonate plastic, it can leach from baby bottles and other hard plastic beverage containers, food can linings and other consumer products.

Culminating months of scientific debate, the decision by the 12 advisors of the Center for the Evaluation of Risks to Human Reproduction — part of the National Institutes of Health — is the first official, government action related to the chemical. Their recommendation will be reviewed for a federal report that could lead to regulations restricting one of the most used chemicals.

The scientists ranked their concerns about BPA, concluding they had “some concern” about neurological and behavioral effects in fetuses, infants and children, but “minimal” or “negligible” concern about reproductive effects. The findings put the panel roughly in the middle — between the chemical industry, which has long said there is no evidence of danger to humans, and the environmental activists and scientists who say it is probably harming people.

For a detailed look at how bisphenol research has been corrupted by industry sponsored “focused counter research” – where the goal is to show no effects and the experiment is tiled to ensure this goal, read this excellent article in the The Public Library of Science Biology Open Source Journal. Note, because it is Open Access, you can actually read it without selling a kidney! Some highlights…

The moment we published something on bisphenol A, the chemical industry went out and hired a number of corporate laboratories to replicate our research. What was stunning about what they did,” vom Saal says with a mix of outrage and bemused disbelief, “was they hired people who had no idea how to do the work. Each of the members of these groups came to me and said, ‘We don’t know how to do this, will you teach us?’”

More…

The HCRA report, commissioned before Schwartz’s tenure, concluded that “the weight of the evidence for low-dose effects is very weak” [15]. Industry groups hailed the report as a comprehensive review by independent experts and quickly disseminated its findings. Yet the “comprehensive” report reviewed just 19 of 47 studies available in April 2002, and when it was published more than two years later, three panelists asked not to be listed as authors.

What the hell, just read the whole article, especially the bit about the Harvard Center for Risk Analysis and its well documented industry shillness.

The key to understanding bisphenol research is to realize that it is a hormone disruptor that works at low doses. At high doses, normal toxicological testing doses that is, it floods the hormone receptors and slows down the receptor pathways. So, the usual technique of testing in rats and mice at high doses and extrapolating will not work.

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India drastically reduces AIDs incidence

Byoliveridley

India’s efforts at combating AIDs through the use of superior statistics and survey techniques (yes, we are geeky like that only!) pays off as the number of AIDs cases is slashed from 5.7 million to close to 3 million.

Study: Fewer Indians with HIV seen – Yahoo News

The number of Indians infected with HIV is far smaller than previously believed, according to new data that appears to vindicate critics who said earlier U.N. assessments of the country’s epidemic were vastly overestimated.

Experts say the still-unreleased survey is likely to show that India’s number of HIV cases, which last year was said to be the highest in the world at 5.7 million, is actually well below that mark.

“The actual number we’ve come up with in aggregate is likely to be lower, and perhaps substantially lower,” said Ashok Alexander, director of the Avahan, the Indian program of the Bill & Melinda Gates Foundation, which helped fund the study.

Now, if we can only make the other 3 million cases go away. Unfortunately, math is not going to get us there. But this is good news, I guess, for the 2.7 million people who we thought had AIDs, but actually did not. Were these poor people clued in?

The real reason this is good news is that if money was budgeted to take care of 5.7 million cases, then it will go a little further now! Happy Friday, takes away from all the other crap going on in my world that I am too jaded and cynical to blog about.

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Diacetyl hits the big time

Byoliveridley

It’s well known that occupational exposure to various pollutants including pesticides, manufacturing raw materials, and in this case, flavoring agents, is a serious problem affecting millions of factory and farm workers all over the world.

Which is why it is interesting when one case of a man contracting an illness possibly linked to at-home diacetyl exposure makes much more splashy news than the well documented cases of many workers dying of such exposure at work. It is unfortunate, but people working at factories and in farms are somehow expected to handle higher levels of exposure and risk. The assumption is that they are protected by agencies such as OSHA, and that they will provided with protective wear, etc. But, when the agencies drop the ball on protecting workers, it takes an “escape” of the incident into the ambient realm for the news agencies to pick it up as a headline.

I guess the good thing now is that this diacetyl issue is blown open, and should result in reform, because alternatives are available.

Doctor Links a Man’s Illness to a Microwave Popcorn Habit – New York Times

A fondness for microwave buttered popcorn may have led a 53-year-old Colorado man to develop a serious lung condition that until now has been found only in people working in popcorn plants.

Lung specialists and even a top industry official say the case, the first of its kind, raises serious concerns about the safety of microwave butter-flavored popcorn.

“We’ve all been working on the workplace safety side of this, but the potential for consumer exposure is very concerning,” said John B. Hallagan, general counsel for the Flavor and Extract Manufacturers Association of the United States, a trade association of companies that make butter flavorings for popcorn producers. “Are there other cases out there? There could be.”

A spokeswoman for the Food and Drug Administration said that the agency was considering the case as part of a review of the safety of diacetyl, which adds the buttery taste to many microwave popcorns, including Orville Redenbacher and Act II.

Meanwhile, ConAgra, the biggest manufacturer of popcorn, announces plans to drop diacetyl at some undetermined “later date”. Weird, their website’s currently down!