Data from OECD, 2007, Health at a Glance 2007; OECD Indicators
For Further discussion see this post on the Incidental Economist, particularly the comment section.
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The Buck Continues Here
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Showing posts with label health. Show all posts
Showing posts with label health. Show all posts
Thursday, February 24, 2011
Is the US an extreme outlier in Healthcare per Capita?
Data from OECD, 2007, Health at a Glance 2007; OECD Indicators
For Further discussion see this post on the Incidental Economist, particularly the comment section.
Thursday, October 29, 2009
Childbirth and Evolution
From Half the Sky:
"One reason women die in childbirth has to do with anatomy, arising from two basic evolutionary trade-offs. The first is that once our ancient ancestors began to walk upright, too large a pelvis made upright walking and running inefficient and exhausting. A narrow pelvis permits fast running. That however makes childbirth exceedingly difficult. So the evolutionary adaptation is that women generally have medium-sized pelvises that permit moderately swift locomotion and allow them to survive childbirth - most of the time.
The other trade-off is head size. Beginning with our Cro-Magnon ancestors, human skull size expanded to accommodate more complex brains. Larger brains offer an evolutionary advantage once a child is born, but they increase the chance that a large-headed fetus will never emerge alive from the mother."
"One reason women die in childbirth has to do with anatomy, arising from two basic evolutionary trade-offs. The first is that once our ancient ancestors began to walk upright, too large a pelvis made upright walking and running inefficient and exhausting. A narrow pelvis permits fast running. That however makes childbirth exceedingly difficult. So the evolutionary adaptation is that women generally have medium-sized pelvises that permit moderately swift locomotion and allow them to survive childbirth - most of the time.
The other trade-off is head size. Beginning with our Cro-Magnon ancestors, human skull size expanded to accommodate more complex brains. Larger brains offer an evolutionary advantage once a child is born, but they increase the chance that a large-headed fetus will never emerge alive from the mother."
Wednesday, October 7, 2009
Improving Self Reported BMI
Many epidemiological studies measure adiposity (obesity) through the surrogate BMI via self reported measures of height and weight. As I have mentioned before, there are many problems with this. But how can we improve on this while maintaining our level of accuracy and not using a direct measure requiring a more intensive doctor visit?
Two ideas to use along with BMI:
1. Waist size - pant size for men, dress size for women
2. Bench press - probably more reasonable for men. Could use max (weight you can bench press once), or weight you can bench press ten times.
Wednesday, February 25, 2009
How Reliable is Health Advice?
Via the Health Blog:
Just 11% of more than 2,700 established heart recommendations are backed by high-quality testing, says a study in the current issue of JAMA.
The American College of Cardiology and American Heart Association jointly issue guidelines to doctors, WSJ explains. The ones thought to have the highest level of evidence are based on multiple randomized clinical trials. Those considered weakest are backed by expert opinion or case studies.
According to the JAMA paper there are three type of sources:
1. Sources based on multiple randomized clinical trials (high quality testing)
2. Sources based on a single randomized clinical trial or observational study (moderate)
3. Sources based on case studies, expert opinion - etc (poor)
As an epidemiologist, I will probably spend most of my time dealing with observational studies in the moderate category. While not "high quality", these are still important since many randomized control trials can not be conducted because of ethical, feasibility, and financial reasons. For example, we can't ethically conduct a randomized control trial on whether smoking causes lung cancer - since there is substantial evidence that we would inflecting harm in our control arm.
However, randomized clinical trials (RCTs) should be used whenever possible because they are removing many biases and confounding from the relationship of interest. A classic case of the benefit of RCTs is Hormone Replacement Theory (HRT) in women. The Nurses Health Study and others found a protective effect on mortality for HRT in several of their observational studies. Their evidence looked so convincing that hundreds of thousands of women went on the therapy. That was until randomized clinical trial results found that it can increase breast cancer and disease risk.
Getting back to the JAMA article, it's pretty scary when you think about. Heart Disease is America's biggest killer, and quite possibly the most widely studied disease. What this says is that there is a lot of work to do in the health field and that there will be a lot of reversals, ala HRT, of doctor opinion in future recommendations.
On a positive to note, I'm happy to say that we're headed in the right direction with this $1.1 billion dollar allocation to compartive effectiveness research in the stimulus package. Maybe Billy Beane had Mr. Obama's ear?
Monday, February 23, 2009
Measuring Fat by MRI
A striking image that won a National Geographic Picture of Year award. The images are full body MRI shots of two women: 5'6" 250 lbs on the left, 5'5" 120 lbs on the right.Looks like there is a lot of alteration in most areas of the body except for brain and maybe the ankle area. I wonder if pictures like these could be used for the fight against obesity?
Sunday, February 15, 2009
1979 vs. 2009
The New York Times and CBS has some nice new data out on a range of controversial issues. In this PDF, they compare the data to records they have from the late 1970s.
Here are a few I found notable:
HEALTH INSURANCE: PRIVATE ENTERPRISE VS. GOVERNMENT?
Here are a few I found notable:
HEALTH INSURANCE: PRIVATE ENTERPRISE VS. GOVERNMENT?
Hat tip to this daily kos diary1979
Private Enterprise: 48%
Government - All Problems: 28%
Government - Emergencies: 12%
Don't know: 12%2009
Private Enterprise: 32% (-16%)
Government - All Problems: 49% (+21%)
Government - Emergencies: 10% (-2%)
Don't know: 9% (-3%)HOMOSEXUAL RELATIONS BETWEEN ADULTS
1979
Wrong: 62%
Not Wrong: 25%2009
Wrong: 41% (-21%)
Not Wrong: 54% (+29%)SHOULD MARIJUANA USE BE LEGALIZED?
1979
Yes: 27%
No: 69%2009
WHO MAKES BETTER CARS?
Yes: 41% (+14%)
No: 52% (-17%)
1979
U.S. Automakers - 46%
Foreign Automakers - 26%
2009
U.S. Automakers - 29% (-17%)
Foreign Automakers - 55% (+29%)
Tuesday, January 27, 2009
Teenage Sex Stats
From the Latest Well Article from Tara Parker-Pope:
Today, fewer than half of all high school students have had sex: 47.8 percent as of 2007, according to the National Youth Risk Behavior Survey, down from 54.1 percent in 1991.
A less recent report suggests that teenagers are also waiting longer to have sex than they did in the past. A 2002 report from the Department of Health and Human Services found that 30 percent of 15- to 17-year-old girls had experienced sex, down from 38 percent in 1995. During the same period, the percentage of sexually experienced boys in that age group dropped to 31 percent from 43 percent.
About 16 percent of teenagers say they have had oral sex but haven't yet had intercourse.
"I give presentations nationwide where I'm showing people that the virginity rate in college is higher than you think and the number of partners is lower than you think and hooking up more often than not does not mean intercourse," Dr. Bogle said. "But so many people think we're morally in trouble, in a downward spiral and teens are out of control. It's very difficult to convince people otherwise."
I wonder how these sex rates compare to the 1960s and 70s. Have rates significantly increased or are parents just hypocrites? While the given oral sex statistic is interesting, I wonder how many sexually active teens engage in oral sex. It sounds like the article is assuming that basically all of the sexually active teens engage in both.
Today, fewer than half of all high school students have had sex: 47.8 percent as of 2007, according to the National Youth Risk Behavior Survey, down from 54.1 percent in 1991.
A less recent report suggests that teenagers are also waiting longer to have sex than they did in the past. A 2002 report from the Department of Health and Human Services found that 30 percent of 15- to 17-year-old girls had experienced sex, down from 38 percent in 1995. During the same period, the percentage of sexually experienced boys in that age group dropped to 31 percent from 43 percent.
About 16 percent of teenagers say they have had oral sex but haven't yet had intercourse.
"I give presentations nationwide where I'm showing people that the virginity rate in college is higher than you think and the number of partners is lower than you think and hooking up more often than not does not mean intercourse," Dr. Bogle said. "But so many people think we're morally in trouble, in a downward spiral and teens are out of control. It's very difficult to convince people otherwise."
I wonder how these sex rates compare to the 1960s and 70s. Have rates significantly increased or are parents just hypocrites? While the given oral sex statistic is interesting, I wonder how many sexually active teens engage in oral sex. It sounds like the article is assuming that basically all of the sexually active teens engage in both.
Friday, January 23, 2009
Stat of the Week: Hospitials as Hotels
According to a paper from the National Bureau of Economic Research
"We also find that a one-standard-deviation increase in amenities raises a hospital's demand by 38.4% on average, whereas demand is substantially less responsive to clinical quality as measured by pneumonia mortality."
-It's interesting they used pneumonia mortality as a measure of clinical quality. I can only read the abstract, but I would assume that they adjusted for confounders and such like a good epidemiologist would do.
"We also find that a one-standard-deviation increase in amenities raises a hospital's demand by 38.4% on average, whereas demand is substantially less responsive to clinical quality as measured by pneumonia mortality."
-It's interesting they used pneumonia mortality as a measure of clinical quality. I can only read the abstract, but I would assume that they adjusted for confounders and such like a good epidemiologist would do.
Media Attention and Risk Perception
From a Freaknomics interview of author Ben Sherwood:
Can a positive outcome to a crash like USAir 1549 change often unrealistic public perceptions of the fatality of plane crashes?
I doubt it. It’s incredibly safe to fly — your chances of dying on your next domestic flight are just one in 60 million — but many Americans are still petrified of air travel.
It’s no surprise: Plane crashes monopolize media coverage. Indeed, one MIT study found that airplane crash coverage on the front page of The New York Times was 60 times greater than reporting on HIV/AIDS per 1,000 deaths; 1,500 times greater than reporting on auto hazards; and 6,000 times greater than cancer.
-----------------------------------------------------------------------------------------------
Now, the key to this passage is they only looked at the front page. Still, it's very interesting and telling on why our perceived risks rarely match the actual risks.
Monday, January 12, 2009
Our (Potential) Future Surgeon General and Marijuana Legalization
Before I begin, I implore to you watch this Daily Show clip on Dr. Gupta. Aasif Mandvi does a great job. I hadn't laughed that hard in awhile. (start at minute 2 for the good stuff)
Anyway, Dr. Gupta recently wrote an article for Time Magazine entitled "Why I would vote No on Pot". I'm pretty disappointed in this article by our (potential) future surgeon general. He brings to light both sides of the issue, but I don't think he argues his case very well.
So what did he bring up in the article (which leaves out other valid arguments for both sides):
positives of legalizing pot
- can help really sick people - those going through chemo, and those suffering from Alzheimer's
- 15 million people all ready use it, so wouldn't have to enforce law on them
- cut illegal drug trafficking and make communities safer
negatives of legalizing pot
- addiction
- affect short term memory
- impair cognitive ability
- lead to long term depression or anxiety
- can impair driving - cause accidents
First off I am disappointed by the lack of statistics. From this article I have no idea how severely pot affects short term memory, leads to long term depression, etc. A reasonable question would be, how do these negatives compare to alcohol? It seems that alcohol shares all of these negative consequences and is potentially worse in some cases. He also suggests outcomes that are rather subjective like depression, cognitive ability, etc. It is not nearly as clear cut as tobacco's relationship to lung cancer and other disease. I don't doubt his medical claims, but he should at least link to scientific/epidemiological studies supporting it.
So how authoritarian is Sanjay Gupta? Yes, it would be better medically if we banned alcohol and soda - but is it the right move for the country? There are reasonable reasons to keep marijuana illegal, but Dr. Gupta needs to bring a little more substance to his argument. Granted this was just a short article for Time Magazine, but adding links similar to Frank Rich's style at the New York Times would be refreshing.
One of my major reasons for reluctance of Gupta for Surgeon General is his lack of public health training or experience. If this is the way he would describe a public health epidemic in the future as surgeon general, consider me unimpressed.
Looking further at the Marijuana issue as a whole:
Gallup polling has explored the legalization of Marijuana question for years, and while support is still on Dr. Gupta's side the margin is eroding.
When asked if medical marijuana should be legalized, support jumps into the 70 percent range. Dr. Gupta points out that 11 states have all ready decriminalized marijuana for medical use. I honestly believe that polling (on legalization of both medical and recreational) would change if people were more informed on this subject.
For example, there is a very valid economic argument that would play well in today's economic situation.
Jeffery Miron an economist from Harvard conservatively estimates that the US could receive 14 billion dollars a year from the legalization of marijuana. "...the government would save $7.7 billion a year if it didn't have to spend money policing and prosecuting marijuana activity. Then, if the feds taxed marijuana at a rate comparable to cigarettes and booze, another $6.2 billion would come rolling in."
It will be interesting to see if any "change" is made on this issue with the Obama administration, considering it's the "#1 Idea" proposed on their site change.org.
Anyway, Dr. Gupta recently wrote an article for Time Magazine entitled "Why I would vote No on Pot". I'm pretty disappointed in this article by our (potential) future surgeon general. He brings to light both sides of the issue, but I don't think he argues his case very well.
So what did he bring up in the article (which leaves out other valid arguments for both sides):
positives of legalizing pot
- can help really sick people - those going through chemo, and those suffering from Alzheimer's
- 15 million people all ready use it, so wouldn't have to enforce law on them
- cut illegal drug trafficking and make communities safer
negatives of legalizing pot
- addiction
- affect short term memory
- impair cognitive ability
- lead to long term depression or anxiety
- can impair driving - cause accidents
First off I am disappointed by the lack of statistics. From this article I have no idea how severely pot affects short term memory, leads to long term depression, etc. A reasonable question would be, how do these negatives compare to alcohol? It seems that alcohol shares all of these negative consequences and is potentially worse in some cases. He also suggests outcomes that are rather subjective like depression, cognitive ability, etc. It is not nearly as clear cut as tobacco's relationship to lung cancer and other disease. I don't doubt his medical claims, but he should at least link to scientific/epidemiological studies supporting it.
So how authoritarian is Sanjay Gupta? Yes, it would be better medically if we banned alcohol and soda - but is it the right move for the country? There are reasonable reasons to keep marijuana illegal, but Dr. Gupta needs to bring a little more substance to his argument. Granted this was just a short article for Time Magazine, but adding links similar to Frank Rich's style at the New York Times would be refreshing.
One of my major reasons for reluctance of Gupta for Surgeon General is his lack of public health training or experience. If this is the way he would describe a public health epidemic in the future as surgeon general, consider me unimpressed.
Looking further at the Marijuana issue as a whole:
Gallup polling has explored the legalization of Marijuana question for years, and while support is still on Dr. Gupta's side the margin is eroding.
When asked if medical marijuana should be legalized, support jumps into the 70 percent range. Dr. Gupta points out that 11 states have all ready decriminalized marijuana for medical use. I honestly believe that polling (on legalization of both medical and recreational) would change if people were more informed on this subject.
For example, there is a very valid economic argument that would play well in today's economic situation.
Jeffery Miron an economist from Harvard conservatively estimates that the US could receive 14 billion dollars a year from the legalization of marijuana. "...the government would save $7.7 billion a year if it didn't have to spend money policing and prosecuting marijuana activity. Then, if the feds taxed marijuana at a rate comparable to cigarettes and booze, another $6.2 billion would come rolling in."
It will be interesting to see if any "change" is made on this issue with the Obama administration, considering it's the "#1 Idea" proposed on their site change.org.
Saturday, December 27, 2008
How Do Men Die in the Prime of their Lives?
My friends and I are reaching a milestone soon - a quarter century lived. Our own deaths are probably very far from our minds, and for good reason: about 2 percent of male deaths come from the 25-34 category. So while small, it is not insignificant and worth looking at.
According to the CDC in 2004 - the following are the top ten causes of death for males in the United States between the ages of 25-34.
1. Unintentional Injury - 34.8%
2. Suicide - 14.6%
3. Homicide - 13.3%
4. Heart Disease - 7.6%
5. Cancer - 6.2%
6. HIV Disease - 3.2%
7. Diabetes - 1.2 %
8. Stroke - 1.0%
9. Birth Defects - 0.8%
10. Chronic Liver Disease - 0.8%
According to the CDC in 2004 - the following are the top ten causes of death for males in the United States between the ages of 25-34.
1. Unintentional Injury - 34.8%
2. Suicide - 14.6%
3. Homicide - 13.3%
4. Heart Disease - 7.6%
5. Cancer - 6.2%
6. HIV Disease - 3.2%
7. Diabetes - 1.2 %
8. Stroke - 1.0%
9. Birth Defects - 0.8%
10. Chronic Liver Disease - 0.8%
Unsurprisingly, most of the deaths are not related to traditional disease: accidents (probably mostly automobile), suicide, and murder. This possibly suggests the need for better mental health counseling, which is an area I know very little about - including it's effectiveness and differences between nations.
What surprised me the most in these numbers is the rate of heart disease. Every year a couple of thousand in this young age group are dying of heart disease. I'm interested to know who these people are. Do they have some genetic defect that makes them especially vulnerable? Do they smoke a lot? Are they morbidly obese?
I'll break down the cancer rates in a later post, but younger males should look for cancer in the testis, the blood cancers (lymphoma), and skin cancer (melanoma).
| Causes of Death | Number of Deaths | Rate per 100,000 |
| 25-44 years All causes | 148,904 | 177.8 |
| 1 Accidents and adverse effects | 26,554 | 31.7 |
| . . . Motor vehicle accidents | 14,528 | 17.3 |
| . . . All other accidents and adverse effects | 12,026 | 14.4 |
| 2 Human immunodeficiency virus infection | 22,795 | 27.2 |
| 3 Malignant neoplasms, including neoplasms of lymphatic and hematopoietic tissues | 22,147 | 26.4 |
| 4 Diseases of heart | 16,261 | 19.4 |
| 5 Suicide | 12,536 | 15 |
| 6 Homicide and legal intervention | 9,261 | 11.1 |
| 7 Chronic liver disease and cirrhosis | 4,230 | 5.1 |
| 8 Cerebrovascular diseases | 3,418 | 4.1 |
| 9 Diabetes mellitus | 2,520 | 3 |
| 10 Pneumonia and influenza | 1,972 | 2.4 |
| . . . All other causes (Residual) | 27,210 | 32.5 |
You can notice the homicide and suicide rates are down, while Cancer and HIV increase. However this data is a bit older (1996), so the HIV mortality rate has gone down in recent years.
Sunday, December 14, 2008
Women Concentrate on the Wrong Organ (too)
Fear is an interesting concept that I hope to explore more in the future.
In a 2005 study by Women's Health Research, over 1000 women were asked - which disease they feared the most. I was rather surprised they found the fear of Breast Cancer more than doubled Heart Disease. While Breast Cancer caused approximately 3% of the US deaths in 2005, over 22 percent have the most fear for the disease. On the other hand, heart disease accounts for 28.6 percent of diseases and only 9.7 percent consider their top fear!! I know the US society has placed a higher emphasis of breasts over heart, but I can't say I expected this.
So what are the possible explanations for this?
High Incidence?
-While the mortality of breast cancer is low, there is a significant amount of women living and bravely battling the disease. On the other hand, the same can be said about heart disease.
Feeling of Control
-While risk factors such as diet, obesity, and hormones have been established, the cause for breast cancer can still be considered quite a mystery. So most women likely believe that she could develop BC and don't have the power to control it. The risk factors for heart disease - (diet, physical activity, smoking) are a bit more established, so women's feeling of control may be stronger for CHD.
Public Exposure
-Another explanation is that breast cancer has had stronger activists, fundraisers, and lobbyists that push the disease into the mainstream. The general wisdom may be that since Breast Cancer is getting the same or more ad time than Heart Disease - women's risk of death are great for BC.
*Edit*
Age of Disease
Women may believe that they are more likely to get Breast Cancer at a younger age than Heart Disease. According to SEER the median age of dianosis is 61, while the median age of death is 69. For heart disease the average age of a first heart attack is around 70 years old (though the disease can be caught at a much earlier stage).
Women still believe it's a male disease
The stereotypical person with heart disease (at least in my mind) is an overweight, red faced guy in a suit. Women only comprise of about 25 percent of heart studies, and things like this need to change.
Conclusion:
Heart disease kills about 8 times the women than Breast Cancer. The medical community needs to do a better job about expressing this risk. Maybe when people go to their primary doc, they should be asked this "what disease do you fear the most" question. Then the education can begin. Another idea is instead of counseling by doctor, people should have a "medical counclier" who discuss peoples risk of disease and what they can do for prevention. According to the Women's Heart fact sheet only 2 percent of the NIH budget is spent on prevention, and that is just flat out wrong .
2005 data from:
CDC
Women's Health Research
Women's Heart Fact Sheet
In a 2005 study by Women's Health Research, over 1000 women were asked - which disease they feared the most. I was rather surprised they found the fear of Breast Cancer more than doubled Heart Disease. While Breast Cancer caused approximately 3% of the US deaths in 2005, over 22 percent have the most fear for the disease. On the other hand, heart disease accounts for 28.6 percent of diseases and only 9.7 percent consider their top fear!! I know the US society has placed a higher emphasis of breasts over heart, but I can't say I expected this.
| Fear Rank | Disease | Women's Most Feared Diseases | Cause of Death in Women | Difference | |||||||||||||||||||||||||||||||||
| 1 | Cancer (unspecified) | 24.00% | 21.60% | 2.40% | |||||||||||||||||||||||||||||||||
| 2 | Breast Cancer | 22.10% | 3.24% | 18.86% | |||||||||||||||||||||||||||||||||
| 3 | Heart Disease | 9.70% | 28.60% | -18.90% | |||||||||||||||||||||||||||||||||
| 4 | HIV/AIDS | 9.30% | 2% | 7.30% | |||||||||||||||||||||||||||||||||
| 5 | Alzheimer’s Disease | 4.60% | 3.40% | 1.20% | |||||||||||||||||||||||||||||||||
| 6 | Ovarian Cancer | 2.70% | 1.30% | 1.40% | |||||||||||||||||||||||||||||||||
| 7 | Lung Cancer | 2.40% | 5.62% | -3.22% | |||||||||||||||||||||||||||||||||
| 8 | Diabetes | 2.40% | 3.10% | -0.70% | |||||||||||||||||||||||||||||||||
| 9 | Colon Cancer | 1.60% | 1.94% | -0.34% | |||||||||||||||||||||||||||||||||
| 10 | Stroke | 1.20% | 8.00% | -6.80% |
So what are the possible explanations for this?
High Incidence?
-While the mortality of breast cancer is low, there is a significant amount of women living and bravely battling the disease. On the other hand, the same can be said about heart disease.
Feeling of Control
-While risk factors such as diet, obesity, and hormones have been established, the cause for breast cancer can still be considered quite a mystery. So most women likely believe that she could develop BC and don't have the power to control it. The risk factors for heart disease - (diet, physical activity, smoking) are a bit more established, so women's feeling of control may be stronger for CHD.
Public Exposure
-Another explanation is that breast cancer has had stronger activists, fundraisers, and lobbyists that push the disease into the mainstream. The general wisdom may be that since Breast Cancer is getting the same or more ad time than Heart Disease - women's risk of death are great for BC.
*Edit*
Age of Disease
Women may believe that they are more likely to get Breast Cancer at a younger age than Heart Disease. According to SEER the median age of dianosis is 61, while the median age of death is 69. For heart disease the average age of a first heart attack is around 70 years old (though the disease can be caught at a much earlier stage).
Women still believe it's a male disease
The stereotypical person with heart disease (at least in my mind) is an overweight, red faced guy in a suit. Women only comprise of about 25 percent of heart studies, and things like this need to change.
Conclusion:
Heart disease kills about 8 times the women than Breast Cancer. The medical community needs to do a better job about expressing this risk. Maybe when people go to their primary doc, they should be asked this "what disease do you fear the most" question. Then the education can begin. Another idea is instead of counseling by doctor, people should have a "medical counclier" who discuss peoples risk of disease and what they can do for prevention. According to the Women's Heart fact sheet only 2 percent of the NIH budget is spent on prevention, and that is just flat out wrong .
2005 data from:
CDC
Women's Health Research
Women's Heart Fact Sheet
Wednesday, December 10, 2008
Vaccines, Autism, and the Stupid Media
From the Economist:
"In the UK, the MMR vaccine was the subject of controversy after publication of a 1998 paper by Andrew Wakefield et al. reporting a study of twelve children who had autism spectrum disorders and bowel symptoms, in many cases with onset observed soon after administration of MMR vaccine.[23] During a 1998 press conference, Wakefield suggested that giving children the vaccines in three separate doses would be safer than a single injection. This suggestion was not supported by the paper, and several subsequent peer-reviewed studies have failed to show any association between the vaccine and autism.[24] Administering the vaccines in three separate doses does not reduce the chance of adverse effects, and it increases the opportunity for infection by the two diseases not immunized against first.[24][25] Health experts have criticized media reporting of the MMR-autism controversy for triggering a decline in vaccination rates.[26]
In 2004, after an investigation by The Sunday Times,[27] the interpretation section of the study, which identified a general association in time between the vaccine and autism, was formally retracted by ten of Wakefield's twelve coauthors.[28] The Centers for Disease Control,[29] the Institute of Medicine of the National Academy of Sciences,[30] the UK National Health Service[31] and the Cochrane Library review[9] have all concluded that there is no evidence of a link between the MMR vaccine and autism.
In 2007 Wakefield became the subject of a General Medical Council disciplinary hearing over allegations that his research had received funding related to litigation against MMR-vaccine manufacturers, and had concealed this fact from the editors of The Lancet.[32] It was later revealed that Wakefield received £435,643 [about $780,000] plus expenses for consulting work related to the lawsuit. This funding came from the UK legal aid fund, a fund intended to provide legal services to the poor.[27]"
Why the sudden spike in Measles when we have a vaccine?
"The rise, says the HPA, is due to a fall in vaccination rates. In 1998 91% of two-year-olds were immunised, but by 2004 that had fallen to 80%, far below the 90% rate needed to keep the disease under control....Happily, the dip in vaccination seems to have been temporary. Immunisation rates today are 85% and rising"
Why the drop in Vaccination rate?
Thank you Dr. Wakefield....
"In the UK, the MMR vaccine was the subject of controversy after publication of a 1998 paper by Andrew Wakefield et al. reporting a study of twelve children who had autism spectrum disorders and bowel symptoms, in many cases with onset observed soon after administration of MMR vaccine.[23] During a 1998 press conference, Wakefield suggested that giving children the vaccines in three separate doses would be safer than a single injection. This suggestion was not supported by the paper, and several subsequent peer-reviewed studies have failed to show any association between the vaccine and autism.[24] Administering the vaccines in three separate doses does not reduce the chance of adverse effects, and it increases the opportunity for infection by the two diseases not immunized against first.[24][25] Health experts have criticized media reporting of the MMR-autism controversy for triggering a decline in vaccination rates.[26]
In 2004, after an investigation by The Sunday Times,[27] the interpretation section of the study, which identified a general association in time between the vaccine and autism, was formally retracted by ten of Wakefield's twelve coauthors.[28] The Centers for Disease Control,[29] the Institute of Medicine of the National Academy of Sciences,[30] the UK National Health Service[31] and the Cochrane Library review[9] have all concluded that there is no evidence of a link between the MMR vaccine and autism.
In 2007 Wakefield became the subject of a General Medical Council disciplinary hearing over allegations that his research had received funding related to litigation against MMR-vaccine manufacturers, and had concealed this fact from the editors of The Lancet.[32] It was later revealed that Wakefield received £435,643 [about $780,000] plus expenses for consulting work related to the lawsuit. This funding came from the UK legal aid fund, a fund intended to provide legal services to the poor.[27]"
It's sad what the scientifically illiterate media has done to this issue. I'm also disappointed in the political leaders like Tony Blair who would not reveal if his child was vaccinated or not. You don't mess with diseases like Measles when there is no scientific or epidemiological backup on the subject. Some random doctor speculating does not count...
Saturday, November 29, 2008
Stat of the Week: Health Care Costs
According to 2005 Paul Krugman article at the New York Times:
The following is per capita spending on Health Care
It's amazing how high our health care spending is. Hard to believe that our government spending on health care (medicare, medicaid, etc) is more than Canada and France's govt spending! My thoughts are that the biggest faults are the administrative costs that come with our insurance system. However I'm starting to believe that United States does not evaluate health decisions correctly, for instance over-emphasizing screening that does not extend or improve lives. More on this later, but as you can see in the following graph...yeah it's a problem.
The following is per capita spending on Health Care
United States: $5,267 on health care/ $2,364 is government spending.
Canada: $2,931 on health care / $2,048 is government spending.
France: $2,736 on health care / $2,080 is government spending.
It's amazing how high our health care spending is. Hard to believe that our government spending on health care (medicare, medicaid, etc) is more than Canada and France's govt spending! My thoughts are that the biggest faults are the administrative costs that come with our insurance system. However I'm starting to believe that United States does not evaluate health decisions correctly, for instance over-emphasizing screening that does not extend or improve lives. More on this later, but as you can see in the following graph...yeah it's a problem.
Wednesday, November 26, 2008
US Trend in Tobacco Use and Lung Cancer Mortality
A question was proposed in the comments of the previous entry - how has smoking rate changed after the GIs had been given cigarettes in their rations during World War 2 (early 1940s).
The following graphic displays this trend well. It also shows the lag in time of tobacco use to lung cancer mortality. It's nice to see both the cigarrette consumption and lung cancer mortality decreasing, but sadly this is not true in developing asian and african countries where ciagrette use is becoming very common.
The following graphic displays this trend well. It also shows the lag in time of tobacco use to lung cancer mortality. It's nice to see both the cigarrette consumption and lung cancer mortality decreasing, but sadly this is not true in developing asian and african countries where ciagrette use is becoming very common.
Source: ACS 2008 Cancer Statistics Presentation
The graphic below displays the amount of different cancer deaths that can be attributed to smoking. Lung cancer greatly outranks the rest of the cancers, with an attribute rate of 80-90 percent. However only 20 percent or so of smokers end up with lung cancer, due to other risk factors such as genetics, amount smoked, etc.
Source: ACS Cancer Facts and Figures
Tuesday, November 25, 2008
Top Cancers in the United States
Here are the most popular figures in general cancer epidemiology - a flavor of things to come for this blog. Please share ideas on what to show in the future.
Notice how deadly Lung, Pancreas , and Leukemia - comparing their incidence and mortality rates. It's interesting how little you hear about Pancreas, Ovary, etc - it's probably because the 5 years survival is so low that there is much less pressure to lobby for these diseases. Overall Men have a 1 in 2 chance of developing cancer in their lifetime, while Women have a 1 in 3 chance.
Male death rates over time - notice how lung how over-trumped them all due to tobacco use. The disappearance of stomach cancer is still a bit mysterious.
Lung cancer has recently become the number 1 killer for females, due to a later development of tobacco use. Breast and colon cancer, which diet is a major risk factor, are well ahead of the rest of the cancers
Notice how deadly Lung, Pancreas , and Leukemia - comparing their incidence and mortality rates. It's interesting how little you hear about Pancreas, Ovary, etc - it's probably because the 5 years survival is so low that there is much less pressure to lobby for these diseases. Overall Men have a 1 in 2 chance of developing cancer in their lifetime, while Women have a 1 in 3 chance.
The jump in prostate cancer in the early 90s is due the PSA screening coming into the mainstream. PSA screening is still controversial today - it has not been proven to extend/save lives as of yet. With prostate cancer's five year survival rate of 99 percent, epidemiologists are asking: should we put putting men through this?
Male death rates over time - notice how lung how over-trumped them all due to tobacco use. The disappearance of stomach cancer is still a bit mysterious.
Lung cancer has recently become the number 1 killer for females, due to a later development of tobacco use. Breast and colon cancer, which diet is a major risk factor, are well ahead of the rest of the cancers
Friday, November 14, 2008
Stat of the Week: Tobacco Deaths
"But if global adult smoking prevalence declines to 20% by 2020, at least 100 million fewer people currently alive will be killed prematurely by tobacco."
How to prevent 100 million deaths from tobacco
Thomas R Frieden, Michael R Bloomberg
How to prevent 100 million deaths from tobacco
Thomas R Frieden, Michael R Bloomberg
Thursday, October 30, 2008
Stat of the Week: Life Expectancies in Baltimore
It's crazy how great the dispairites are between two locations within a few miles of each other. Infant mortality and violence are probably the biggest contributors to this difference.
Wednesday, October 29, 2008
Abortion
Like the author of this article I believe abortion should be considered a public health problem.
The hypothesis is based on this research paper in the journal international family planning perspectives which comes to this conclusion:
Abortion rates are no lower overall in areas where abortion is generally restricted by law (and where many abortions are performed under unsafe conditions) than in areas where abortion is legally permitted.
The evidence is there to make the correct public health decision - but instead of promoting sex education and other social measures, the United States wastes their time with whole roe vs. wade (life/choice) argument. I feel both sides of the aisle are looking at this problem in the wrong way - we can have life and choice, but we're too blind to see it.
I can't say I'm a huge fan of that research paper and there are probably some flaws in it. However the issue is - why aren't we talking about roe v. wade instead of just saving lives?
Other people are a lot more passionate about this issue than I am, so maybe someone can enlighten me.
The hypothesis is based on this research paper in the journal international family planning perspectives which comes to this conclusion:
Abortion rates are no lower overall in areas where abortion is generally restricted by law (and where many abortions are performed under unsafe conditions) than in areas where abortion is legally permitted.
The evidence is there to make the correct public health decision - but instead of promoting sex education and other social measures, the United States wastes their time with whole roe vs. wade (life/choice) argument. I feel both sides of the aisle are looking at this problem in the wrong way - we can have life and choice, but we're too blind to see it.
I can't say I'm a huge fan of that research paper and there are probably some flaws in it. However the issue is - why aren't we talking about roe v. wade instead of just saving lives?
Other people are a lot more passionate about this issue than I am, so maybe someone can enlighten me.
Thursday, October 23, 2008
Evolution and Science in America
Via 2006 National Geographic article:
(blue = believes in evolution, red doesn't)
Selected Quotes:
(blue = believes in evolution, red doesn't)
Selected Quotes:
-"In the U.S., only 14 percent of adults thought that evolution was "definitely true," while about a third firmly rejected the idea. "
-"The researchers cite a 2005 study finding that 78 percent of adults agreed that plants and animals had evolved from other organisms. In the same study, 62 percent also believed that God created humans without any evolutionary development."
-"Fewer than half of American adults can provide a minimal definition of DNA, the authors add. "
-"Fewer than half of American adults can provide a minimal definition of DNA, the authors add. "
My thoughts:
-We need to teach and emphasize genetics much earlier in school (elementary). You can make better inferences about a wide range of topics - history, science, even English when you understand genetics.
-Since a majority of Americans are now required to go to college - all students, particularly liberal arts majors should be required to take some type of biology/genetics class. We need to avoid the hubris of humanities (NYT).
-Get more scientists in public office. According to the above NYT article, there were 218 lawyers, 12 doctors, and 3 biologists in congress in 2005. When 90 percent of our representatives probably have a weak science background, we're probably going to fall behind. See the recent examples of stem cells, climate change, research funding, and bioethics.
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