I'm in Washington, D.C., attending the annual meeting of the Global Health Council. I'm giving a talk at the media luncheon tomorrow. (Update: here's a link to my talk on covering global health news.)
Will post more items from the conference on my other blog, www.globalhealthreport.com (The link was broken earlier but now it's fixed.)
Paying attention to poor people's health is not just a worthy humanitarian goal, it could also save your own life or that of someone you love. Judith Graham has a chilling story in the Chicago Tribune about how a drug-resistant skin rash is spreading rapidly through the poorest parts of Chicago. Caused by the methicillin-resistant staph aureus (MRSA) bacteria, the rash is potentially fatal--particularly if it spreads into the lungs.
The focus of Graham's piece is on the Cook County Jail, but she could have easily included the larger problems in Cook County's public hospitals and clinics. Although this deadly bacterium seems to be targeting poor neighborhoods, MRSA is increasingly being found in a lot of other wealthier folk, as I reported in an article for TIME last year.
Sure hope Graham isn't one of the journalists being cut at the Trib.
I'm pleased to report that yours truly, Christine Gorman, has just been named one of three Nieman Foundation Fellows for Global Health Reporting at Harvard University for the class of 2007-2008. The other two global health journalists are Ran An (China) from China Newsweek and Andrew Quinn (United Kingdom) from Reuters.
We'll be joining 27 other Nieman Fellows who will be exploring such wide-ranging topics as increasing friction between Muslim and Christian societies, racial implications of urban sprawl and the impact of government regulations on alternative energy technologies.
In addition to exploring basic healthcare infrastructure in developing countries, I plan to use my Nieman year to figure out ways of expanding coverage of global health news beyond traditional media outlets.
Here's the press release with more information about all 30 Nieman Foundation Fellows for 2007-2008.
Photo: C.P. Storm/Creative Commons
Men who take too many vitamins may (or may not) increase their risk of developing an aggressive form of prostate cancer, according to preliminary evidence published in the Journal of the National Cancer Institute.
Of the dozen or so articles I've read about the study, the best is by Liz Szabo in USA Today.
Right up front, Szabo lets you know that even if the suggested link turns out to be true, the consequences are relatively small. She talks about a "possible link" between heavy use of multi-vitamins and prostate cancer. Then she makes this important point:
If doctors followed 10,000 men for 10 years, there would be about 30 extra cases of advanced prostate cancer and seven or eight extra cases of fatal prostate cancer associated with heavy supplement use, says lead author Michael Leitzmann of the NCI.
This is a variation of the "number needed to treat" figure that should be included with almost any medical story about a proposed new intervention but often isn't. The number need to treat, or NNT, tells you how many people have to follow a particular medical regimen in order to save one person's life or prevent further problems down the line.
For example, you can expect that giving antibiotics to 16 people who have been bitten by a dog will prevent one case of infection. Great for the one person who avoided infection and only a mild nuisance for the 15 others--although you'll never know who was who. (Mike Lemonick had a nice article on the NNT in TIME Magazine in February.)
In the case of vitamins and prostate, Szabo uses it to show that even if the link is true--it's not a huge deal, as these things go.The "award" for worst headline of the week goes to The Register in the U.K. for its recent article titled "Oral sex could be more dangerous than cigars." This craven attempt to titillate readers deliberately mis-characterized the results of a recent study about oral cancer in the New England Journal of Medicine.
Making matters worse, Lewis Page, the author of the Register piece, goes on to say that "The study appeared to suggest that throat-cancer risks from booze and cigs were insignificant compared to those from getting too frisky."
Did you even bother to read the study, Lewis? The NEJM study authors were trying to show that a virus--one of many strains of human papilloma virus or HPV to be exact--may play a role in triggering cancers of the mouth and tongue.
Table 4 clearly shows that study participants who were NOT infected with HPV but who smoked more than a pack a day for 20 years or four packs a day for five years (both amounts are considered equivalent to 20 pack-years) increased their risk of oral cancer nearly THREE-fold.
And those who were not infected with HPV but who had more than 20 pack-years under their belt AND who drank at least 15 alcoholic drinks per week increased their risk nearly NINE-fold.
The reason the NEJM researchers included a question about oral sex in their study was to give an indication of one mechanism by which HPV might be spread from one person to another. They also looked at number of vaginal sex partners--which increased the risk as well. But the focus is still on the virus, not the means of transmission. (By the way, regular condom users showed no increased risk of oral cancer.)
The NEJM researchers also found that study participants who did not brush their teeth every day increased their risk of oral cancer by five times. No HPV connection there. But "Brushing Your Teeth May Prevent Oral Cancer" isn't the sexiest headline in the world--is it?
It's important to note that the NEJM study was not definitive. It was a preliminary study that looked at only 100 people with oral cancer and compared them to 200 people who didn't have oral cancer to see what the differences might be.
Bottom line: the intriguing suggestion that HPV may (or may not) help trigger oral cancer still needs to be proven. Unfortunately, headlines like the one found in the Register serve only the puerile interests of their writers and do not help the general consumer at all.
Source: G. D'Souza, et al. "Case–Control Study of Human Papillomavirus and Oropharyngeal Cancer." New England Journal of Medicine; Volume 356:1944-1956 (May 10, 2007), available in full for free.
We all believe we are more immune to the effects of advertising than we really are. That's one of the reasons why ads for cigarettes work so well. Never mind the ads in magazines or the so-called product placement of cigarettes in movies. A study in the Archives of Pediatrics and Adolescent Medicine showed that even the display ads found in stores increase the chances that younger teenagers who can't legally buy cigarettes will try smoking.
Other promotional gimmicks, like free makeovers, are also, not surprisingly, pretty effective at getting young people to experiment with smoking.
Indeed as Jocelyn Noveck points out in an Associated Press article on the launch of a new Camel brand of cigarettes aimed at women, "80 percent of new smokers are under the age of 18, and one-third of teenagers now smoking will eventually die from it. "
Source: SJ Slater et al, "The Impact of Retail Cigarette Marketing Practices on Youth Smoking Uptake." Archives of Pediatrics and Adolescent Medicine (Vol. 161 No. 5, May 2007), available in full for free
And now we learn that farmed fish may have been fed melamine-contaminated meal. This is quickly shaping up to be the worst food scandal since the the "mad cow disease" debacle of 1996.
We keep learning a lot more than we wanted to know about how domesticated animals are fed.
Ten years ago, the general public discovered that cows were fed cows' brains as a matter of course. Now we're learning all about fillers like wheat gluten--or possibly wheat flour, according to the latest reports--that are added to animal feed.
At least in the melamine scandal, so far, no people seem to have died.
I still plan to cook some farmed salmon this weekend for dinner.
Andy Ness from the University of Bristol in England has pointed me to some more real-world examples of vigorous, as opposed to mild or moderate, exercise: hiking, rowing, dancing, bicycling 10 to 16 mph.
You can find more examples of vigorous exercise at the Healthful Life website, published by the University of Medicine and Dentistry of New Jersey.
Ness recently co-authored a scientific paper that showed that children who are vigorously active are less likely to be overweight or obese. That prompted many of you to wonder, "What is vigorous exercise?" Or "How can I tell if my child is engaged in vigorous play?
The easy rule of thumb for measuring vigorous exercise, as I wrote in April, is the singing/talking test.
If you can sing while exercising, that's mild exercise. If you can carry on a conversation but cannot sing, that's moderate and if you can only speak a sentence or so at a time, that's vigorous exercise.
With the arrest by the Chinese government of a local businessman for allegedly contaminating pet food ingredients with the industrial chemical melamine, the current food safety scandal has taken another turn--from the assumption of accidental contamination to growing evidence of deliberate behavior, from contamination of pet food to possible contamination of human food.
Ever notice how a particular story--like the melamine scandal or the death of Anna Nicole Smith--will keep showing up in the news? Journalists call this a story with legs.
In this case, the melamine scandal continues to resonate because it taps a growing fear of food that has become a hallmark of our globalized age. There was a time when food couldn't travel far without spoiling. Now fresh fruit from South America can fill the plates of North America out of season and for little cost.
Eating fruit is, of course, a very good thing. I wouldn't want to have to depend on all my food coming from local farmers and ranchers.
And yet, we're growing increasingly concerned about the long distances our food has to travel before it gets on our plates. What do we really know about the food we eat? Is shipping all this food long distances contributing to global warming?
In a sense, the many pets that have died from melamine contamination have served as the canary in the coal mine--an early warning system of something that has gone wrong.
How old a woman is when she takes supplemental hormones may determine whether it helps to protect her against developing dementia later in life, according to a new analysis of data from the Women's Health Initiative that was presented at the American Academy of Neurology annual meeting in Boston.
Readers of this blog will immediately note the "Mighty May" and will mentally rewrite the news as "hormones, depending on when they are taken, may or may not help prevent dementia."
Here's why this research is considered preliminary and not definitive.
The researchers looked at the original Women's Health Initiative (WHI), which conclusively showed a few years ago that years and years of hormone replacement therapy (either estrogen alone or estrogen plus progestin) actually increased the risk of dementia in women 65 and older.
The new analysis was designed to answer the question whether timing matters when starting hormone therapy. But instead of conducting a randomized, controlled clinical trial--which would give a definitive answer but would be costly and unlikely to get many participants because of what has already been shown about long-term hormone therapy--the researchers, led by Victor Henderson of Stanford University in California, looked at the questionnaires the women filled out.
Based on the women's responses, Henderson and his colleagues created a new set of data points that showed which women started hormone therapy early--before menopause or after menopause.
On the basis of those answers, the researchers determined that early hormone therapy was protective, while later therapy--started after age 65--was not.
But the conclusion rests on what the women reported about themselves so it's subject to recall bias.
Also, women who turned to hormone therapy throughout the 1980s and 1990s are known to be healthier overall than those who didn't. In other words they started off healthy, wanted to stay that way and had access to doctors. So even if they accurately remembered whether or not they took hormones, that could simply be a measure of how healthy they were in the first place.
The bottom line: if you're having severe menopausal symptoms and want relief, you may want to consider hormone therapy--but only for one or two years. Taking hormones in the hopes of staving off Alzheimer's or heart disease in the future is still more likely to hurt you than to help you.
On the other hand, if you're worried about dementia, there's compelling evidence that your best bet is to get plenty of exercise and avoid getting hit in the head.
Sources:
1. The Women's Health Initiative
2. Shumaker SA, et al. "Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women's Health Initiative Memory Study: a randomized controlled trial," JAMA. 2003 May 28;289(20):2651-62
3. Shumaker SA, et al. "Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women: Women's Health Initiative Memory Study," JAMA. 2004 Jun 23;291(24):2947-58
4. Larson, EB, et al."Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older." Ann Intern Med. 2006 Jan 17;144(2):73-81
5. Guskiewicz KM, et al. "Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery. 2005 Oct;57(4):719-26
