Avoidable Death

Science is supposed to tell us what causes ill health so that we can do something about it. At least that’s one version of what science is supposed to do. Armed with health science, public health institutions can focus on the causes of illness and work to eliminate them. It’s called prevention. Continue reading

Compliant Patients

The White House Office of Science and Technology Policy has created something called the Social and Behavioral Science Team. It is intended to draw upon these fields in order to make government policies more effective and efficient. Continue reading

Transpoosion and GMOs

You have an organ that is essential for your health. The cells of that organ have none of your DNA. I’m speaking, of course, about your gut microbiome—the ecosystem of over 500 species of bacteria that live in your large intestine. Continue reading

Health and Justice

Computer scientists at Notre Dame have come up with a technology for delivering personalized medical care. What’s noteworthy is that until now, the promise of personalized medical care has been synonymous with genetic testing. Not so with these researchers who are applying Big Data to medical practice. Continue reading

The Biology of EMF

A group of ninth graders in Denmark conducted an interesting experiment in plant development—with implications for human health. Like all good science, the experiment began with an observation. The five young women who conducted the experiment observed that when they slept with their cellphones on, they had difficulty concentrating the next day. Continue reading

Whistleblowers in Health Science

Researchers at Baylor University in Texas found that when people are too generous, they are punished for their generosity. People are also punished if they’re too stingy. The trouble is nonconformity and what one of the researchers called “the power of norms.”

This made me think of Tom Jefferson, an English epidemiologist who works in Rome on infectious disease. He was asked by the drug company Roche to evaluate the research on its Tamiflu product in the build-up to a swine flu epidemic that never materialized. An honest scientist, Jefferson asked Roche for all of the clinical trial data. When Jefferson refused to sign a confidentiality agreement, Roche denied him access to the proprietary data.

So Jefferson went ahead with data that was the publically available and found that there was no evidence that Tamiflu improved the outcome for flu patients. This launched him on a path that questioned quite a bit about the seasonal hysteria and very big business of flu vaccination. Because of these important discoveries, he was an outcast within the infectious disease research community. That is, he was punished for his failure to conform.

To judge by a big article in the New York Times about Dr. Jefferson’s colleague and collaborator Peter Doshi, the punishment hasn’t stopped either of them. The topic of the article is not just the critique of vaccination but the ability of researchers to get hold of all the clinical data held by drug companies like Roche, companies that have denied access on the grounds that the data is proprietary and would put them at a commercial disadvantage. While drug companies haven’t yet lost, more and more of them are releasing previously sequestered data to researchers—which also means to the public.

Although I’m sure that they don’t think they’re whistleblowers, I think Dr. Jefferson and Dr. Doshi qualify. They reveal the misconduct and dishonesty of drug companies and public agencies when these organizations tell us that, for example, Tamiflu is very effective or that 36,000 people die each year from the flu and that if only they had been vaccinated those who died would have survived.

For this they are punished. Not with life in prison or self-exile to foreign soil, yet they’re still punished for revealing misconduct and dishonesty.

As admirable as the work of these medical whistleblowers might be, it leaves us at the mercy of “the power of norms.” Tom Jefferson and Peter Doshi are nonconformists of a fairly mild kind: they’re working diligently to make the drug companies and the CDC and the FDA honest.

But that leaves us stuck in the world of drugs. There are alternatives. As alternatives to drugs, there are herbs and homeopathic remedies. From the standpoint of the dominant system of health care, these are very, even wildly nonconformist. And we see that plainly in how they are punished. No self-respecting or career-respecting researcher would propose—let along get funding for—a research project that honestly compared the efficacy of pharmaceutical, herbal, and homeopathic treatments.

Yet even this is quite limiting, in my opinion. It traps us in a universe of alternative forms of magic. What pill makes you larger. What pill makes you small.

Research on how viruses make us sick show that not only influenza but other viruses such as West Nile and Dengue highjack aspects of the hosts immune system, specifically several varieties of interferon. Interferon is an element in the innate immune system, which is our general-purpose first line of defense against invading organisms. So when the innate immune system is weak, the body is more vulnerable to viral attack.

The dominant mode of health care against viruses is vaccination, which exposes the body to the virus in a dose that will provoke an immune response. Unfortunately, this is a response of the adaptive immune system—in other words, it creates antibodies.

What I just said is that the dominant approach—the norm—to viral infection is all wrong. Innate immunity should be the focus of attention. To that extent, herbal and homeopathic remedies are likely superior. But that’s not the path I want to follow.

If supporting innate immunity protects against viral infection, what supports innate immunity? Not vaccination. Vaccination uses adaptive immunity. Not a drug.

What supports innate immunity is social justice.

A recent study in the open access journal PLoS One found that social injustice and inequity in income, education, and race (all manifestations of the “power of norms”) weaken a child’s innate immune system and increased the incidence of infectious disease not just for the child but for the adult into which the child grew.

Let me say this more strongly. Social injustice and inequity cause the flu and other viral infections.

So if the CDC is serious about preventing viral epidemics, it should make sure that our children are well-fed, well-educated, well-housed, and free from discrimination.

It’s Not Like Diabetes…

I was listening to a radio interview with a psychotherapist who is critical of the so-called Bible of Psychiatry: the Diagnostic and Statistical Manual of Mental Disorders or DSM. One of his criticisms is that psychiatry as a practice tries to make the diagnoses in the DSM like medical diagnoses, which have their basis in biology. He said something like “Depression isn’t like diabetes, where there’s a biological disorder that can be treated with insulin.” Continue reading

Ibuprofen Kills

New research suggests that ibuprofen and similar over-the-counter pain medications do as much damage as prescription painkillers such as the now infamous Vioxx. With or without a prescription, these non-steroidal anti-inflammatory drugs have long been suspect for suppressing the body’s natural response to inflammatory assaults from injury and disease processes. Continue reading

Who Will Save You

I have a Medicare card. It kicks in next month. I can say goodbye to extortionate insurance company premiums and micromanagement of my medical care. Good riddance.

Yet a study published 30 years ago by the RAND Corporation says that my health won’t improve. So if better health insurance won’t save me, who or what will?

Conservative columnist Ross Douthat wrote in the New York Times last week under the title What Health Insurance Doesn’t Do that recent increases in Medicaid implemented under Obamacare won’t accomplish anything other than waste a lot of money. What launched this and the reference to the 30-year old RAND study is research published in the New England Journal of Medicine that reports that people in Oregon who went on Medicaid experienced no improvement in standard health measures.

Where commentators take this is captured by the title of an article in Slate that covered the Oregon research: Bad News for Obamacare: A new study suggests universal health care makes people happier but not healthier.

How odd. I thought being happy was healthy. Evidently not. What counts for health, it turns out, is things such as serum cholesterol and glycated hemoglobin.

What this illustrates is a structural blindness in both the science and the media. The obvious conclusion to the 30-year old RAND study and the more recent Oregon study is that the medical system doesn’t know how to measure actual health and that the medical system fails to effectively treat people’s medical conditions.

Another outcome that both studies identified is that the more people have to pay for health care, the less they use it—a real shock there. Conservatives think this is really great because for them it means that we could save a pile of money by only providing catastrophic insurance because doing so would have no effect on people’s medical conditions.

This is nonsense, of course. Not because spending more and using the medical system more will make things better but because health is about having a good life, which includes things such happiness and social justice. How can you say it doesn’t? Yet the conventional understanding is that health care is the same as medical care.

Let me say it again: health is not the absence of disease as measured by a blood test and health care is not a course of medical procedures. To be simple but direct, health is happiness, it is having a good life.

Looking back to the early RAND study, almost all medical measures failed to improve as medical care became more financially accessible—almost, but not all. What improved were a collection conditions that are unmistakably associated with stress, especially chronic stress. In other words, as access to medical care got easier, life got better as measured by indicators of chronic stress.

As I’m sure you know, obesity among children is a big worry. The President’s wife has taken on the issue, cheerleading for lifestyle changes and so forth. Yet a study presented at the Pediatric Academic Societies meeting this last weekend as part of its forum on the social determinants of childhood obesity says that neighborhood characteristics have a powerful effect on childhood obesity rates. The neighborhood characteristics that had the greatest effect were the distance to parks and stores and the safety of the neighborhood.

And as I’m sure you also know, obesity among children is associated with poverty, both because of the poverty itself and the characteristics of the neighborhoods where the children live. As a matter of fact, the Pediatric Academic Societies meeting includes a forum on the health effects of childhood poverty. As a class, children suffer greater rates of poverty than any other class. Because of that poverty they are more likely to have a wide variety of both medical conditions and health impairments.

Why aren’t income and neighborhood safety health measures like blood pressure and glycated hemoglobin?

According to the studies I mentioned, single payer insurance would be no better than private insurance restricted to catastrophic coverage: the medical outcomes (mistakenly called health outcomes) are the same. I say that’s a demonstration of the ineffectiveness of current medical care, in which more is not better. I also say it’s a demonstration of our failure to accurately understand and attend to what makes us sick and what makes us healthy.

If insurance won’t save us, who or what will? Isn’t it obvious? We will.

Nano-silver Poisoning

The CDC reports that 1 in 38 children have measureable levels of lead. That’s almost 3%. Lead, as I’m sure you know, poisons nerve tissue. It also poisons the kidneys, heart and blood vessels, and reproductive organs. There is essentially no safe dose.

The shocking thing is that this is good news. When the CDC started tracking lead poisoning in children 30 years ago, the figure was 8 in 10 children with measurable levels: 80%. Elimination of lead in gasoline and paint is credited with that dramatic change. Currently, attention is focused on substandard housing with vestiges of lead-based paint.

This sunny portrait, if it can be called that, makes it look like we’re dealing with what’s left from our past. Oh, but wait: batteries used in cars and in photovoltaic energy systems use lead. So we’re still adding lead to the environment because eventually the lead has to be mined, processed, and disposed of one way or another. More importantly, the children of the people who work in the factories that produce those products have higher levels of lead in their blood than other children. On top of that, abandoned lead plants and disposal sites provide continuing exposures to those who live nearby.

To close this thought on lead exposure, substandard housing where lead-based paint thrives, working in lead factories, and proximity to abandoned lead plants are associated with low income. In other words, yet another health impairment imposed by income inequity.

There is no technical reason why this health problem can’t be solved. And yet it is not.

Take another example of a toxin that’s allegedly been eliminated from our environment: asbestos. The US imports over 1,000 metric tons of asbestos each year. How can the EPA allow this? Because the chlorine industry needs asbestos for its production process.

This isn’t a case of corruption. The EPA has the authority to make exceptions to environmental laws when the cost of preventing the use of a toxic substance has too great an effect on commercial enterprises. This is the case with the chlorine industry. For EPA, keeping the wheels of commerce in motion can outweigh the health risk from a known toxin.

Now consider an emerging toxin: nano-silver. For over a decade, concerns have been raised about nano-particles released into the environment. Nano-silver is now added to exercise clothing in order to eliminate body odor: you exercise, you sweat, God forbid you smell.

The small silver particles kill bacteria that cause smelly body parts. Little is known about the health effects on people or the environment, yet EPA gave nano-silver a so-called conditional registration so that it can be used in a growing number of products.

Is there reason for concern? Yes. Nano-silver washes out of clothes and is widely dispersed throughout the environment. Since it’s designed to kill odor-causing bacteria, a reasonable person might conclude that it also kills microorganisms in the soil, organisms necessary for the health of the soil and the plants (including, food) that grow there. A reasonable person might even conclude that these microbe killers affect our own microbiome, both on our skin and in our gut and impair, for example, our immune response.

Isn’t EPA supposed to protect us from this kind of potentially harmful exposure? Yes, they are. But they, like all other government agencies, are supposed to maintain social order.

There might be some kind of corruption at EPA, but that’s not the source of the problem we face. Maintaining the social order means maintaining the very relations of production that the ruling class works so hard to sustain and develop in its interest. EPA and virtually all other regulatory agencies exist to make sure the capitalist mode of production works smoothly.

When EPA hears that income inequality leads to lead poisoning, it is powerless to act because it hasn’t the authority to do anything about it—and besides, that’s not its job. If it hears that chlorine manufacturers need asbestos, EPA’s duty is to maintain the orderly production of that necessary industrial ingredient. If a clothing manufacturer wants to prevent body odor, EPA must let it until there’s proof (and not just reasonable concern) that there’s a problem,

What’s called for isn’t better information or smarter shopping. What’s called for is seizing the means of production and turning it toward the satisfaction of human not commercial needs.

But the lesson for me in all this is not just that our health is at risk because of the way we produce things. The lesson is that the mode of production and its social relations are the actual cause of illness.

I’m not speaking metaphorically. We are conditioned to think of agents such as bacteria or chemicals or traumatic events as the cause of illness. In my view, the cause of an illness is the social relations that permit or even encourage exposure to individual agents and so cannot be separated from them.