Public vs Individual Health

The difference between public and individual health that often stands in the way of disease eradication and incidence decrease is simple: public health aims to do what is best for the greater good, the population as a whole; individuals aim to do what is best for them and their survival.

These two things often do not coincide. Some vaccination programs, such as smallpox, can lead to a large number of illnesses or death, but eradicates the disease in the long-run. This is good for the population, but not for the individuals who face the risk of side effects when getting the injection. There are efforts to eradicate yellow fever and polio in Africa, but villagers will not take the vaccine for fear of what it might do to their children. This is a prime example of individual health decisions not coinciding with public health goals. The increase in Measles and the reappearance of Whooping Cough in the United States has also occurred because individual health decisions to not vaccinate children do no coincide with the public health effort to keep the diseases at bay. In this scenario, no one is wrong. We each do what we believe to be best for us and ours, and the public health system continues to do what it believes is best for the population.

So how do we solve this problem?
Individuals need to keep in mind the potential effect their decision has on the public health structure and be sure they are bypassing the recommendations to avoid serious consequences only. I won't go into my recommendations of what to avoid here, but the major childhood vaccines should be sought out for healthy children, any worried parents can ask to be sure a doctor is available if side effects occur - DPT (diphtheria, pertussis/whooping cough, tetanus), MMR (measles mumps rubella), and polio. There are no longer mercury-based preservatives in pediatric vaccines. The only one containing a preservative, though it is prior to purification and so considered preservative-free at the end, is the influenza vaccine. So any questions about serious side effects have been addressed. Again, this is an individual decision and information regarding side effects is available from your pediatrician. Ask questions that pertain specifically to your child's health if you are worried. Ask them how often they see severe side effects, that will give you an indication of the actual occurrence and not just statistics printed on paper. (Vaccines are just one example of what is covered by the health system.)

The public health system needs to keep in mind that they are the amalgamation of millions of individual health decisions and structure their guidelines to be, and recommend treatments that are, beneficial to the individual if they follow them. Yes, their goal is for the health of the population, but the population is made up of individuals, if their health increases their collective health increases. Noone wants medicine that has a 20% chance of killing them just because it will ensure 40% of the population is healthy in 20 years (just a made up example).

It is time that the public health and the individual health once again join hands to solve the current health problems, before it's too late.

Alcohol Consumption Study is Questionable

A look at alcohol consumption collected from 8,600 heart patients over a 50-year period, as published in this month’s issue of the American Journal of Medicine, finds that alcohol consumption was down in recent years. Though, disorders associated with heavy drinking, such as cirrhosis of the liver or alcohol-related cardiomyopathy, was consistent across the age groups, as was the incidence of alcohol dependence. Some say that this represents a healthier trend in American drinking.

One problem with the study though is that it looked at a very specific population that is now in one particular age group. So it really says nothing about today’s adults under 50 years of age. To say that the long-term alcohol consumption is decreasing is a bit of a leap off of limited data.

Recommended read: The Big Fix

I would like to recommend the book "The Big Fix: How the Pharmaceutical Industry Rips Off American Consumers" by Katharine Greider. The first few chapters have my head spinning. Loopholes, litigation, false patents, and stays against generics have increased the cost of medicine and limited patient options. Written about 5 years ago, the book provides some recent history and helps fill in the knowledge gaps about the pharmaceutical companies holding the lives of millions in their pocketbooks.

A Congressional Response

I was surprised to log into my email this morning and find I had been written to by a congressman. It was actually in response to a petition I had signed asking for my local representative to support Barney Frank's Personal Use of Marijuana Act H.R. 5843. This is actually a bill that will allow those who use medical marijuana to no longer be persecuted for being sick. Unfortunately, the congressman that responded is the one from Northern Indiana, where I am from originally, but not my current district in New Hampshire - a big difference in ideals! But I wanted to dissect the form response to point out where they are wrong.

I am strongly opposed to efforts to legalize marijuana. Marijuana is addictive, it adversely affects the immune system, and leads to the use of other drugs, such as cocaine.

There is no evidence that marijuana is addictive. If it's being used to treat the pain associated with terminal cancer, then the person is not going to be around very long anyway. What are they scared of? The brain has receptors for cannabis because the body produces its own naturally occurring cannabis. They're called endocannabinoids, and they are involved in pain, memory, and anxiety. I want to quote a research article on cannabinoid addiction from 2002. "The use of cannabis sativa preparations as recreational drugs can be traced back to the earliest civilizations. However, animal models of cannabinoid addiction allowing the exploration of neural correlates of cannabinoid abuse have been developed only recently." Why is there NOW such a problem when the plant has been used for so long without interference. Could it be that the illegality has pushed it into overuse and misuse? Marijuana only leads to other drugs by socially connecting users with those who sell those other drugs. How? Because it's illegal. If it weren't, the patients would never come into contact with such dealers. Plus, there's a psychological line that's crossed. Also, how come just NOW they are looking into the neural mechanisms yet have been screaming for 35 years how addictive and bad it is. Someone didn't do their homework!

Marijuana also causes cancer, including cancer of the lungs, mouth, throat, lips, and tongue; respiratory diseases and mental disorders, such as schizophrenia and other psychoses, depression, panic attacks, hallucinations, paranoia, hostility, depersonalization, flashbacks, decreased cognitive performance, disconnected thought, delusions and impaired memory. Since marijuana impairs coordination and judgment, it is a major cause of accidents. Babies born to women who smoke marijuana during pregnancy have an increased incidence of leukemia, low birth weight, and other abnormalities.

Replace "marijuana" with "tobacco" and it's true. Yet the tobacco companies have a large lobby in Congress. Money = power I guess. Also, the schizophrenia research was biased government funded research from decades ago. Marijuana actually relieves anxiety, depression, and psychoses in those suffering from them when talking to the patient. From the researcher's point of view the jury is still out according to the most recent research. So why make such conclusive statements other than to scare me? A link has been found that shows that cannabis use predicts psychoses, but does not cause them. They are independent events, though whether they are self-medicating is still open for debate. A person would have to be vulnerable to the development of schizophrenia before cannabis would cause it.

Despite these effects, legalization advocates often promote medical use as a legitimate reason for the legalization of marijuana. This argument, however, is simply a red herring for the legalization of marijuana for recreational use. Studies have continually rejected the notion that marijuana is suitable for medical use because it adversely impacts concentration and memory, the lungs, motor coordination and the immune system. Even though some states have passed measures to legalize marijuana for medical use following multimillion dollar campaigns financed entirely by special interests, such legalization generally has overwhelming opposition.

What special interests? There are no marijuana companies! There are grassroots campaigns by patients, doctors, educated individuals, and others who believe that scientific and medical evidence should be taken into consideration. And how dare he tell me about medical issues...he even addressed me as Dr. Prater and my letter included information about the medical aspects. I KNOW the research. Representative Souder obviously does not. Tobacco and alcohol are legal while their brother is not...I continuously wonder why. If the states have passed the measures then obviously some people somewhere are for it and the will of the people is what is supposed to guide this country.

While some argue that marijuana may help to relieve some of the pain associated with some chronic illnesses, there is only one ingredient, THC, in the drug that has any reported medical use. Furthermore, there are safer and more effective medications that are preferred by physicians. Scientists at the National Institute of Health have declared that there is no evidence to suggest that smoking marijuana is superior to any currently available therapy for glaucoma, weight loss associated with AIDS, nausea and vomiting associated with cancer chemotherapy, or muscle spasticity associated with multiple sclerosis or intractable pain. In addition, the American Cancer Society, the American Glaucoma Society, and the American Medical Association, and the National Multiple Sclerosis Society all oppose using marijuana for medical purposes.

THC alone does NOT have the same effect as the full plant. It does not even have to be smoked, or used in large quantities - a tea or brownie is suitable for many patients. This is true of many medicines. In the context of its natural environment it is effective, extracted, isolated, and purified it is not. Something is lost in the processing. There are still ongoing studies to determine if this is true in multiple sclerosis that are funded by the NIH nonetheless! There are also ongoing clinical trials for HIV pain, general analgesic effects, and whether cannabis treatment will interact with the painkillers given for cancer. Painkillers which are opiates - highly addictive and commonly abused pills derived from opium and a brother to heroin. Yet those are legal!

Some argue that by decriminalizing marijuana, we would be actually taking the profit out of production and sales. However, I believe that legalizing this drug would lessen the stigma of the dangers of its use. We also would most certainly attract new first time "experimenters
who otherwise might not have even had thoughts about trying marijuana. The side effects of this drug, which include those mentioned above, are reasons enough for keeping marijuana illegal. In addition, those who currently make outrageous profits from marijuana will merely move to possibly even more dangerous drugs.

New pharmaceuticals are introduced all the time that have harsh side effects - yet they go to market and kill people before a lightbulb goes off. Why pick on marijuana? It's only been illegal since 1970, yet they act like it's the worst killer ever.

The war against drugs has been, and continues to be, a very difficult one. Statistics show that drug use is up an alarming amount-especially among teenagers-and Fort Wayne and Northeast Indiana are not immune to this increasing trend. As you may know, I have worked hard to fight against this trend. In addition, I have worked to bring a Drug Enforcement Agency (DEA) office to downtown Fort Wayne to help with both local and national drug enforcement efforts. I will continue to fight to keep marijuana illegal and combat the abuse of other drugs.

In Indiana the drug of choice is actually Meth. Which is really really bad. But the so-called war on drugs has locked up millions of noncombative marijuana users and spent billions of dollars in attempts to control the cash crop. Let's focus on the major offenders, shall we? And let the sick have a little peace.

I hate the tone of 'well I know better than you, trust me', when our representatives are supposed to listen to what we want and execute those plans. If he had said 'a majority of my constituents feel differently'. Ok, that's how government works. But to lecture me!? I'm insulted. Also, this idea that medical use is just a smokescreen. No, sorry, some of us really do want patients to be allowed access. The bill I support explicitly names patients, it can even be a conditional clause, make marijuana a prescription drug! Go for it! I would be ecstatic! Recreational use is off my radar, what I'm concerned about is the patients. If a few hippies or underclassmen are now able to get access because of the bill I don't think that will hurt much. Everyone smoked in the 60s and 70s and the world didn't end. They just wouldn't have to travel to Amsterdam anymore. By the way, they have had decreased crime and heroin use since decriminalizing.

Oh, and I was provided no links to the supposed research supporting the other side...nice huh?

New FDA Advisory Panel Regulations

The FDA has issued new guidelines for participation in their advisory panels, which establish treatment and therapy guidelines, including which medications and devices to use. And I, for one, am very excited about them. 1) Any researcher or physician with more than $50,000 worth of reported financial interests in pharmaceutical or medical device companies are barred from the panels 2) Briefing materials will be publicly released no later than 48 hours prior to the meetings of advisory committees 3) Votes will now be simultaneous so one does not affect another 4) Website redesign for easier public access to materials.

The third world in the U.S. - it's real

Rural regions of Virginia have a lot in common with other regions of the United States - distance between neighbors, questionable economy from plant shut downs or company withdrawals (think GM and Flint, Michigan; the gold rush ghost towns of the West; and the New England papermill towns), and a lack of health insurance. But the region also has a lot in common with Guyana and East Africa - thousands of people show up to get treated at a free medical and dental expedition. So many, in fact, that hundreds are turned away.

What does this say about the country in which these individuals live? It says that healthcare is not a priority, people really don't matter, and the state of things is worse than we think. Recent figures released by the CDC showed that 15% of all Americans are uninsured. That means that in a room of 100 people, 15 have no way to care for their teeth, eyes, diabetes, high blood pressure, pregnancies, infections, migraines, cancer, flu, whooping cough (it's coming back!), or anything else they may contract, present with, or suffer from. And how many more only have basic coverage without dental, eye, or both?

These numbers, sadly, include the government programs. They are not covering everyone, which they are supposed to do. Changes are needed to prevent many areas of the U.S. from becoming the third world.

Scientist Solidarity

I post this as a statement of solidarity with researchers and those who pursue knowledge by acceptable and justifiable means. Violence against science and those who contribute to its advancement is a sign of ignorance and intolerance, something that would have occurred in the dark ages, not the 21st century. This weekend, a UCSC researcher, whose name appeared in an anti-animal research pamphlet last week, woke up to his home being firebombed and had to escape with his family, including two young children. This is unacceptable behavior in a civilized society. The crime is being treated as domestic terrorism, which is a federal offense, and as attempted homicide. Animal models are extremely important to the advancement of our understanding and medicine. Education is needed to limit the number of people who do not realize this. I feel for the animals, I really do. I used to work with mice, and it's difficult work. But to know that it may lead down the road to a better quality of life, and that everything is done to minimize their discomfort, makes it a little easier. Scientists are not animal abusers, and they're definitely several rungs higher on the moral ladder than people who firebomb other people's homes.

The UK is surpassing US research

A third British research team has received the government ok, and funding, to pursue research into hybrid embryos, one that will be half pig and half human but not contain any animal DNA. From The Scientist:

The team plans to use a new technique that, if it works, could provide a well of human embryonic stem cells without the use of human embryos. They will fuse human adult skin cells into empty pig eggs, resulting in embryos with mostly human DNA and some pig mitochondrial DNA. Then, stem cells taken from the embryos will be chemically treated to destroy the pig DNA, which could impair cell function when interacting with human mitochondrial DNA.

The team plans to use skin cells from patients with mutations for heart disease, and hopes to grow the resulting stem cells into human heart cells. The stem cells will not be used to treat humans but to research genetic mutations.

Meanwhile, New Jersey is not getting the state stem cell institute it has been building. After voters chose to not borrow state money to fund the research that would be conducted there, the state has halted construction on the $150 million facility. And though California and Massachusetts are still progressing with stem cell research, an egg shortage is making the future questionable.

Without federal funding and a viable way to obtain materials (i.e. eggs), the United States will be reading about research rather than conducting it.