Friday, February 26, 2010

The damage of the anti-vaccination movement -

The damage of the anti-vaccination movement -

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Salt reduction - does it make sense as a public health policy?

Here is an interesting NY Times piece about salt intake. It starts with a quiz: If companies are forced to use less salt, what would be the effect?

A) More than 44,000 deaths would be prevented annually (as estimated recently in The New England Journal of Medicine).

B) About 150,000 deaths per year would be prevented annually (as estimated by the New York City Department of Health and Mental Hygiene).

C) Hundreds of millions of people would be subjected to an experiment with unpredictable and possibly adverse effects (as argued recently in The Journal of the American Medical Association).

D) Not much one way or the other.

E) Americans would get even fatter than they are today.

According to this article, there is no right answer, because the evidence is so conflicting.

So what should we do about salt intake? See this post from a couple weeks ago for the answer.

And PS: Here is a "Room for Debate" article from the NY Times seeking answers from several prominent food folks. Interesting.

Wednesday, February 24, 2010

Health Insurance isn't really like other insurance

The idea that health insurance is different from all other types of insurance came up in a casual conversation and it got me thinking -- health insurance is something that you know you will use at some point. Prescription drugs, eye glasses, dental check ups, etc - everyone will access the health care system at some point for some thing. Health insurance also differs from other types of insurance because other types are generally focused on a negative occurrence. Fire, flood, car, homeowners, life insurance -- all associated with slightly unlikely, negative events. All of these insurance types are priced according to the risk the insurance company takes in relation to your probability of having that event. Life insurance at age 25 is much cheaper than at age 55 due to this reason.

Health insurance is a little different however, as it is insuring you for events that are highly likely to occur numerous times throughout the year. The scale and cost of being insured for these events follows the same model as the other insurance types but is used for routine access to the benefits of insurance rather than exceptional access.

So this really gets into a larger discussion of health care reform. There is an article on that gets into assessment of risk, ignoring pre-existing conditions, employer based health insurance and more. "Ignoring pre-existing conditions might sound compassionate, but it is the equivalent to declaring that a fire-insurance company must charge the same amount for a modern house with smoke detectors and interior fireproofing as a century-old, wooden-frame former stable, complete with some hay left over, and a basement full of painting supplies. Taking the analogy further, the same premium must be charged for a well-protected, unscathed house as for one that is already on fire. The business of insurance is about determining risk and charging accordingly. It's why insurance companies exist. If we eliminate that, medical insurers are just form-processing companies for the government. Worse, we lose a valuable economic input: that of accurate risk assessment and pricing, without which sensible management of medical expenses is impossible."

For the full article on please visist:

And keep in mind the original purpose of health insurance when you ponder health care/insurance reform. What is the purpose and what is the best way for accomplishing that purpose?

Friday, February 19, 2010

Did the WHO manipulate the H1N1 pandemic??

I've come across several articles lately that indicate (ok, downright say) that the World Health Organization (WHO) misled the public regarding facts about the H1N1 influenza pandemic. (Is this like the "link" between vaccines and autism?)

Apparently there are charges that "the agency deliberately fomented swine flu hysteria." An epidemiologist at the WHO himself said that there was a giant mis-allocation of funds that favored the pharmaceutical companies who made the H1N1 influenza vaccines. The author of the article says that the WHO was covering itself for the millions (billions) of dollars spent on preparing for a pandemic of H1N1 or H5N1 that never materialized (until now). The Parliamentary Assembly of the Council of Europe (PACE) delcared that this "false pandemic" is "one of the greatest medicine scandals of the century." Whoa!!! Really? Preparing for something we didn't know the severity of was a scandal? A hoax? Really?

Luckily, ("unquestionably") H1N1 has been much milder than seasonal influenza and than previously expected. But there was no way to know whether it would increase in intensity or not (clearly, it did not). Look, there will be varying opinions as to whether this could have been predicted or not. But, in the end, isn't it better that we were overprepared than underprepared? Imagine how scathing the media would have been if public health were to have not been ready for widespread morbidity and mortality? What then? Exactly. That's what I'm saying.

Yes, there were resources lost on preparations for this pandemic. But that's what public health does - it prepares for things that may or may not happen, and then when those things don't happen, the public never knows about it. That is preparedness at its best. You don't know how good your water system is until your neighboring city's system falls to pieces, and then you realize how well you're protected against everyday things.

This. Is. Public. Health. article
Atlantic Free Press article
Council of Europe article

Friday, February 5, 2010

How the CDC counts H1N1 cases

Thought you (you one person reading this, you) might be interested in this Wall Street Journal blog post about how CDC counts H1N1 cases.

The accompanying print article discusses how H1N1 information is based on flawed data. Carl Bialik writes that CDC relies on "the nation's patchy surveillance system" for its data - Well, Carl, if the U.S. were to fully fund states to perform adequate surveillance, maybe we'd be able to provide better data for you! (Are you listening, Congress?)

Wednesday, February 3, 2010

Salt intake: the new public health hot topic shaking onto the scene

A recent New England Journal of Medicine article discusses reducing salt intake and its benefit to society. A national effort to reduce salt intake by 3 g (1200 mg of sodium) per day could reduce the incidence of coronary heart disease by 60,000-120,000, stroke by 32,000-66,000, and heart attacks by 54,000-99,000. Wow! The number of deaths annually due to these diseases could decrease by up to 90,000. Wow! And... for those number-crunchers, this could save the country $10-24 billion annually. Yes, annually.

And: "Even if the intervention reduced salt intake by just 1 g per day, the benefits would still be substantial and would warrant implementation." Now that's saying something.

The authors say there are 2 approaches to reducing salt intake:
  1. The individual approach involves individual consumers to reduce their daily intake through voluntary dietary decisions. However, the authors say, this method has been attempted and does not work.
  2. The public health approach involves getting manufacturers to reduce the amount of salt in processed foods.
New York City has started an initiative to get restaurants to reduce the amount of salt in food served to New Yorkers - a 25% reduction over 5 years has been proposed. The Institute of Medicine (IOM) is about to release a report about salt intake. And the FDA is considering
changing the designation of salt to a category that would give consumers more information. [All from this New York Times article.]

One editorial article from the New York Times mentions that most salt in people's diets comes from processed foods, not from adding salt individually. So the processed foods are what we should be targeting - restaurants and food manufacturers. Let the battle begin!

This post comes in honor of World Salt Awareness Week, according to CDC. (There's a week/month for everything, eh?) Check out this fact sheet about salt and salt intake.

And check out this previous post by Lisa for more about reducing sodium levels.

Tuesday, February 2, 2010

Important news about vaccines

Everyone has heard the rumor that vaccines lead to autism. Well, here is breaking news: The Lancet, the journal that published Dr. Andrew Wakefield's 1998 groundbreaking study linking autism to vaccines, has formally retracted the article. This is hugely important news in the public health and vaccine world. According to this breaking CNN article, the author was found to be acting unethically in conducting his research.