Monthly Archives: May 2010

Links of interest: Suicide

ma-xiangquianSurveillance for Violent Deaths — National Violent Death Reporting System, 16 States, 2007 (CDC)

The latest official statistics on US violent deaths, including suicides, from the CDC. The report covers the year 2007, with information from 16 states. You might think the latest statistics would be more recent, but the CDC does an extensive amount of analysis. The report contains 39 tables that compare such things as the manner of death, the mechanism of injury, precipitating events, and whether more than one person was involved. Here’s a summary of the suicide analysis by age group and ethnicity (emphasis added):

Overall, the crude suicide rate was 11.6 per 100,000 population. The rate for males was more than three times that for females (18.4 and 5.0 per 100,000 population, respectively). Non-Hispanic whites accounted for the largest number of suicide deaths, and AI/ANs [American Indian/Alaskan Native] and non-Hispanic whites had the highest rates of suicide (18.2 and 14.0 per 100,000 population, respectively). The highest rates of suicide by age group occurred among persons aged 45–54 years, 75–84 years, and 35–44 years (17.6, 16.4, and 16.3 per 100,000 population, respectively). Children aged 10–14 years had the lowest rates of suicide among all age groups (0.8 per 100,000 population). Rates of suicide among adolescents aged 15–19 years (6.9 per 100,000 population) were approximately half of those for persons aged ≥30 years.

Suicide Rate Highest in Middle Age (MedPage Today)

A summary of highlights from the CDC report, including this observation:

Alcohol was a factor in about one-third of all suicides, and alcohol and drug abuse ranked second behind depression and other mood disorders as the most frequent risk factors for suicidal behaviors, the report authors wrote.

As Thomas Joiner writes in Myths about Suicide, the role of alcohol in suicidal behavior is complex. He cites an interesting study in which there was a high correlation between a mother’s consumption of alcohol and the suicide of an adolescent child. “[A]lcohol use is a signal of a deeper substrate of chronic risk – a risk that is passed on from parents to children. … [N]ot a lot of women [drink excessively]; for her to do so means that she has a severe underlying condition, and that severity is getting signaled to you [the child] either genetically or through family environment.”

Electronics Maker Promises Review After Suicides (The New York Times)

A report on employee suicides at Chinese company Foxconn, a major supplier of electronics for Apple, Dell, and HP. Run with “military-style” efficiency, employees work 12-hour shifts under constant camera surveillance. They live in cramped dormitories, with as many as 10 to a room. The dormitories house 330,000 to 400,000 people. In its defense, the company boasted that it provided recreational facilities, but the employees are too exhausted to use them. As of May 28, there had been 13 suicide attempts this year, ten of them successful and three with serious injuries. Employees jump from the upper floors of their dormitories. Foxconn is erecting netting.

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Does astrology make predictions about climate change?

Polar Bear on Melting Iceberg in the Svalbard IslandsThe South Dakota state legislature recently passed a resolution urging public schools to teach global warming as merely one of many scientific theories, definitely not a proven fact. The resolution cited a number of significant, interrelated dynamics affecting “world weather,” including “climatological, meteorological, astrological, thermological, cosmological, and ecological” factors.

It’s a good thing they pointed out that at least some of these dynamics are speculative, since there’s not much evidence lately that astrology affects the weather.

Same goes for thermology, which admittedly sounds like it would have to do with heat. There’s a lot we can learn about temperature distribution from infrared images of the earth, but the term thermology is reserved for the medical diagnostic technique that analyzes infrared images of the human body.

Meanwhile, polar bears will suddenly starve to death

Meanwhile, BBC Earth News reports that polar bears will experience a dramatic “tipping point” due to climate change and suffer a sudden decline in population.

Based on what is known of polar bear physiology, behaviour and ecology, [research] predicts pregnancy rates will fall and fewer bears will survive fasting during longer ice-free seasons. …

Southern populations of polar bears fast in summer, forced ashore as the sea ice melts. As these ice-free seasons lengthen, fewer bears are expected to have enough fat and protein stores to survive the fast.

“…as the climate warms, we may not see any substantial effect on polar bear reproduction and survival for a while, up until some threshold is passed, at which point reproduction and survival will decline dramatically and very rapidly.”

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Compression only CPR: Be the Beat

CPRWhen someone is having a heart attack, bystanders (outside of a hospital) are encouraged to administer life-saving cardio-pulmonary resuscitation (CPR). The traditional form of CPR involves a ratio of 30 chest compressions per minute alternating with two mouth-to-mouth rescue breaths. When I learned CPR, students were provided with a sealed, sterile cloth for covering the victim’s mouth. This was to remain in your wallet in anticipation of an emergency.

When the American Heart Association (AHA) studied the effectiveness of bystander CPR (as opposed to CPR from medical professionals), they learned a number of things. It turns out only 15% of bystanders are willing to perform the mouth-to-mouth part — the rescue breath. That may explain why only 25% of heart attack victims receive bystander CPR before emergency services arrive.

Forced rescue breathing has some disadvantages

Another statistic that turned up was that certified CPR practitioners took an average of 16 seconds to deliver those two breaths. That’s a long time when the brain and the heart are desperately in need of more oxygen.

Chest compressions, which manually force the heart to pump, can save lives because most people typically have eight to 10 minutes worth of oxygen in their bloodstream. The idea is to keep that oxygenated blood circulating fast enough so the brain stays alive and isn’t damaged.

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The esteem of the medical profession: Then and now

pharmacy-in-ancient-babyloniaEach issue of The Journal of the American Medical Association includes an excerpt from an issue of exactly 100 years ago. (JAMA has been published continuously since 1883.) The May 7, 1910 issue of JAMA included remarks on how much physicians were paid and, by implication, how they were regarded in 2250 B.C.

Ability to pay and malpractice

According to the famous Babylonian Code of Hammurabi (“an eye for an eye”), a physician’s fee varied with the social status of the patient. There were three classes in ancient Babylonian society. The upper class included wealthy landowners, affluent traders, officials, and priests. Freemen were farmers, clerks, and craftsmen. And then there were slaves.

If an upper class citizen was severely wounded and a physician (using his “bronze lancet”) saved his life, the physician received 10 shekels of silver. If the patient was a freeman, the fee was five shekels. For a slave, the physician was paid only two shekels.

JAMA of 1910 benevolently describes this as “regulating fees according to the patient’s ability to pay.” One might also wonder, however, if there were any differences in the alacrity and quality of care.

Ancient penalties for malpractice also varied by social class. If a physician caused the death of a “man” (presumably either upper class or freeman) or destroyed his eye, the physician’s fingers were cut off. (See, malpractice policy could be worse.) For the death of a freeman’s slave, the physician was required to pay the monetary value of the slave. If it was just the loss of an eye, the penalty was half the slave’s price.

The esteem and remuneration of physicians

The JAMA article continues with an attempt to estimate the income of physicians relative to other members of Babylonian society. Laborers at the time of Hammurabi earned eight shekels of silver a year. Admittedly, the standard of living for laborers may have been low. Earning one and a quarter times the annual wages of a workman for a single operation, however, seems “fairly satisfactory,” in the restrained wording of 1910.

This seems to indicate, the article concludes, that “four thousand years ago the medical profession was highly esteemed and rewarded.” If the editors of JAMA could have seen 100 years into the future, I wonder what they’d say about the esteem and remuneration of physicians today.

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How Big Pharma plans to stay big

Prescription drugsThe days of exponential growth for the pharmaceutical industry are past. Sales growth has been leveling off since the 1990s. Companies simulate growth by buying smaller companies and firing employees.

What will Big Pharma look like as it moves into the future? FierceBiotech provides a summary of a forecast offered by industry expert, Steven Burrill. The three-pronged strategy: Globalization, more biotech acquisitions, and generics.

Globalization

Now that growth in the US, Europe, and Japan has leveled off, companies are targeting “emerging” markets, such as Brazil, Russia, China, and India. This is not good news for US and European consumers. Burrill urged companies to concentrate on drugs that treat the most common diseases in emerging countries – drugs that may be of little importance to the health care needs of highly developed nations.

Acquisitions

Pharma is often referred to these days as biopharma, due to the rampant acquisition of so many biotech companies. We can expect acquisitions to continue.

More drugs from biotechs – valuable as they may be – contribute to escalating costs. Drug prices increased 9.1% last year, the biggest increase in 10 years.

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Suicide in Japan (part 2): The Internet and media coverage

tojinbo

Continued from Suicide in Japan (part 1): The recession.

The Internet plays a role in Japanese suicides, especially among the young. There’s easy access both to tips on committing suicide and to individuals willing to join in a suicide pact.

A few years ago, there was an epidemic of joint suicides using carbon monoxide from charcoal briquettes. This was followed in popularity by hydrogen sulfide, a chemical produced by combining readily available detergents. The poisonous gas is highly dangerous to anyone who comes to the rescue.

In April [2008], 80 people were injured and another 120 had to be evacuated after a 14-year-old girl killed herself with hydrogen sulfide in southern Japan’s Kochi prefecture. She’d left a note on the door of her family’s apartment that said, “Gas being emitted. Don’t open,” according to the Kyodo news service.

There was a story in Tokyo Vice of a polite and considerate young man who electrocuted himself and left a sign on his naked back, warning people not to touch him. “Do not touch me, please. Imminent danger of electrocution.” Nearby was a suicide manual that recommended the method and provided instructions.

Is media coverage educational or inflamatory?

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Suicide in Japan (part 1): The recession

aokigahara-forest-japanWhen the Great Recession was in its infancy, late in 2008, there was speculation on the impact of the economic downturn on health. Many stories featured the studies of economist Christopher Ruhm, who claimed health improves during economic hard times. What his statistics actually showed was that fewer people died, perhaps due to fewer automobile accidents. That’s not quite the same as improved health.

Though I never found Ruhm’s reasoning very convincing, there was one statistic that made sense. Of the ten causes of death Ruhm had tracked, the only one that didn’t fall with economic hardship was suicide.

Number of Japanese suicides exceeds 30,000 for 12th straight year

Statistics for suicide in the US are not yet available for 2009, but they’ve just been released for Japan, a country where suicide is a significant social problem. As Japanese sociologist Kayoko Ueno writes: “Suicide rates are increasing at such high speed in Japan that it has made scholars wonder if the proper name for the phenomenon is suicide or social murder.”

Here are the 2009 numbers for Japan. For comparison, the number of suicides in the US per 100,000 people was 11.6 in 2007.

• For people in their 20s, the number is 24.1, an all-time high (“Young people are having difficulties in finding the meaning of life,” according to a representative of a suicide prevention organization).

• For those in their 30s, the number is 26.2.

• For those in their 40s to 60s, the number is over 30.

These numbers are for both men and women. The statistics for men only are much higher.

Prior to 1998, the number of annual suicides had ranged between 15,000 and 25,000. Suicides peaked in 2003 at 34,427, but the number has remained over 30,000 for the past 12 years. The total for 2009 is 32,845.

Is it the economy or is it something about Japanese society?

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Justice triumphs for whistle-blowing Texas nurse

The wheels of justice may turn slowly, but for Anne Mitchell, the Texas nurse who was prosecuted for complaining about the unethical conduct of a doctor, justice is proceeding. The doctor in question, Rolando Arafiles, is about to be formally disciplined. (For background on this story, see Whistle blowing: Nurse Anne Mitchell vs. Dr. Arafiles.)

Although Ms. Mitchell was found not guilty of committing a felony in February, a civil suit is still pending against Mitchell and a second nurse, Vickilyn Galle. In April, Winkler County Memorial Hospital in Kermit Texas was fined for firing the two nurses.

Related posts:
Whistle blowing: Nurse Anne Mitchell vs. Dr. Arafiles
Where were the melamine whistle blowers?

Resources:
Dr. Arafiles to be Formally Disciplined June 10th: After Putting RNs through Hell, Law Med Blog, May 18, 2010

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The Economist reviews Kaiser Permanente health care

Kaiser Permanente West Los AngelesThe “newspaper” The Economist originates in London, but it has a wide circulation, with almost half of its subscribers in the US. A recent issue contained a lengthy opinion of the health care provider Kaiser Permanente (KP).

Europeans tend to regard American health care with distain. French President Nicolas Sarkozy commented, after the passage of US health care reform, “Welcome to the club of states who don’t turn their back on the sick and the poor.” The Economist argues not only that KP is the best of a few “nuggets of good practice” in the US, but that Europeans could learn a few things from KP’s example.

Economically viable, quality care: Why don’t we have more of this?

The first item of praise is an economic one:

For the most part, the American health system is dominated by cream-skimming health insurers and the myriad “fee for service” providers they do business with, which drive up costs by charging high prices for piece work. KP’s business model integrates fixed-price health insurance with treatment at its own hospitals and clinics. This has led to big efficiency gains, making KP one of the cheapest health-care providers in most of the regional markets in which it competes.

The article goes on to praise the quality of care (“KP’s medical results are as good as its financial ones”), its comprehensive computerization of medical records, its investment in long-term care (wellness classes, preventive dentistry), and fixed salaries for doctors: “[U]nlike America’s many self-employed physicians, [KP doctors] have every incentive to share information with other specialists and no financial motive to order unnecessary procedures.”

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Novartis gender discrimination verdict: Guilty as charged

Sexual harassmentThe Novartis gender discrimination trial has concluded, and damages have been awarded to the plaintiffs. Novartis must pay $3.4 million in compensatory damages and $250 million in punitive damages.

Highlights of the trial’s testimony included the behavior of one manager, Brian Aiello, who asked female sales reps to sit on his lap while he showed them pornography. Novartis took years to respond to complaints about this manager and testified, in its defense, that “every company has a few jerks.”

One of the lawyers for the plaintiffs made this comment on the verdict:

This jury learned that Novartis is not somewhere you would want your wife, your mother, your sister or your daughter to work. Novartis expected its female employees to do more than just go out and market its drugs — Novartis has a corporate culture that expects female representatives to be available and amenable to sexual advances from the doctors they call on. Time and time again, Novartis looked the other way when female representatives complained about inappropriate doctors. And then, to add insult to injury, Novartis paid those same women less, wouldn’t promote them into management, and punished them if they got pregnant. Novartis refused to treat its female employees as the competent and hard-working professionals that they were and are.

A human resources department from hell

The trial included testimony from a highly successful Novartis sales rep who was on the verge of breaking into management. Three men were involved in what appeared to be an arranged rape: The sales rep’s boss, his best friend (a top prescribing doctor), and a buddy of the friend (the rapist). DailyFinance summarizes the sales rep’s testimony:

The rape allegedly occurred after a Novartis golfing event that Salame [the sales rep] had hosted for two doctors. Following the game, Salame’s car keys were missing — she suspects her boss’s friend took them from her purse — and when his buddy offered her a ride, instead of taking her home, he took her to a remote location and attacked her. Although her supervisor was initially supportive, Salame said, that later changed. Within a few weeks, she was being interviewed by a human resources executive and her supervisor in a hotel lobby.

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What musical instruments convey about social class

chamber-musicHere’s an interesting observation on the associations between musical instruments and social class. It’s from Paul Fussell’s Class: A Guide Through the American Status System (emphasis and paragraph breaks added).

There seems no place where hierarchical status-orderings aren’t discoverable. Take musical instruments. In a symphony orchestra the customary ranking of sections recognizes the difficulty and degree of subtlety of various kinds of instruments: strings are on the top, woodwinds just below, then brass, and, at the bottom, percussion. On the difficulty scale, the accordion is near the bottom, violin near the top.

Another way of assigning something like “social class” to instruments is to consider the prestige of the group in which the instrument is customarily played. As the composer Edward T. Cone says, “If you play a violin, you can play in a string quartet or symphony orchestra, but not in a jazz band and certainly not in a marching band. Among woodwinds, therefore, flute, and oboe, which are primarily symphonic instruments, are ‘better’ than the clarinet, which can be symphonic, jazz, or band. Among brasses, the French horn ranks highest because it hasn’t customarily been used in jazz. Among percussionists, tympani is high for the same reason.” And (except for the bassoon) the lower the notes an instrument is designed to produce, in general the lower its class, bass instruments being generally easier to play. Thus a sousaphone is lower than a trumpet, a bass viol lower than a viola, etc.

If you hear “my boy’s taking lessons on the trombone,” your smile will be a little harder to control than if you hear “My boy’s taking lessons on the flute.” On the other hand, to hear “My boy’s taking lessons on the viola da gamba” is to receive a powerful signal of class. the kind attaching to antiquarianism and museum, gallery, or “educational” work.

Guitars (except when played in “classical” – that is, archaic – style) are low by nature, and that is why they were so often employed as tools of intentional class degradation by young people in the 1960s and ‘70s. The guitar was the perfect instrument for the purpose of signaling these young people’s flight from the upper-middle and middle classes, associated as it is with Gypsies, cowhands, and other personnel without inherited or often even earned money and without fixed residence.

Not sure I agree with that. Guitars were used in the sixties because they allowed the musician to sing (something you certainly can’t do with a wind instrument), and guitar playing in the sixties was often about group singing.

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A generation obsessed with material wealth

ill-fares-the-landFrom Tony Judt’s Ill Fares the Land:

As recently as the 1970s, the idea that the point of life was to get rich and that governments existed to facilitate this would have been ridiculed: not only by capitalism’s traditional critics but also by many of its staunchest defenders. Relative indifference to wealth for its own sake was widespread in the postwar decades. In a survey of English schoolboys taken in 1949, it was discovered that the more intelligent the boy the more likely he was to choose an interesting career at a reasonable wage over a job that would merely pay well. Today’s schoolchildren and college students can imagine little else but the search for a lucrative job.

How should we begin to make amends for raising a generation obsessed with the pursuit of material wealth and indifferent to so much else?

The survey of English schoolboys is cited in T.H. Marshall’s Citizenship and Social Class.

No one talks about this anymore

At the end of the introduction to his book, Judt quotes a comment he received on his New York Review of Books essay “What Is Living and What Is Dead in Social Democracy?”, which contained the theme of Ill Fares the Land:

“What is most striking,” she wrote, “about what you say is not so much the substance but the form: you speak of being angry at our political quiescence; you write of the need to dissent from our economically-driven way of thinking, the urgency of a return to an ethically informed public conversation. No one talks like this any more.” Hence this book.

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Links of interest: Sleep

Data Underload #18 – Sleep Schedule (Flowing Data)Two babies asleep

A picture worth a thousand words. Diagram of the hours of the day showing when we’re asleep and awake throughout the lifespan.

Sleeping (or Not) by the Wrong Clock (The New York Times)

When your sleep schedule is out of sync with the rest of the world, there’s hope from the science of chronotherapeutics. It can reset your internal circadian clock.

In American psychiatry, chronotherapeutics is a new kid on the block, viewed by some as a counter-intuitive departure from conventional medication. By contrast, in Europe, where it is already well established, it is seen as compatible with medication and a means for expediting improvement with fewer residual symptoms.

Sleeping for less than six hours may cause early death, study finds (The Guardian)

[T]hose who generally slept for less than six hours a night were 12% more likely to experience a premature death over a period of 25 years than those who consistently got six to eight hours’ sleep. … [T]hose who consistently sleep more than nine hours a night can be more likely to die early. Oversleeping itself is not seen as a risk but as a potential indicator of underlying ailments. “Whilst short sleep may represent a cause of ill health, long sleep is believed to represent more an indicator of ill health.”

Modern society has seen a gradual reduction in the average amount of sleep people take, and this pattern is more common amongst full-time workers, suggesting that it may be due to societal pressures for longer working hours and more shift-work.

Lifespan linked to sleep (NHS Behind the Headlines)

Don’t believe any health news until you’ve read an analysis by the National Health Service. Commenting on the “less than six hours may cause early death” reports:

This is interesting and informative research. However, it should not be taken to mean that people who do not follow the ‘standard’ pattern for sleep are more likely to die early. Though a causal relationship is possible, the underlying reasons for poor sleep patterns and their possible relation to physiological changes in the body also need consideration. The BBC quotes Professor Horne from the Loughborough Sleep Research Centre: “Sleep is just a litmus paper to physical and mental health. Sleep is affected by many diseases and conditions, including depression.”

In addition, different people need different amounts of sleep, and this can be influenced by age, lifestyle, diet and environment. For example, newborn babies can sleep for 16 hours a day, while school-age children need an average of 10 hours sleep. Most healthy adults sleep for an average of seven to nine hours a night. As you get older, it is normal to need less sleep. Most people over 70 need less than six hours sleep a night, and they tend to be light sleepers.

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Genetic testing: Walgreens says it will, and then it won’t

Walgreens genetic test kitOn Monday, news broke that Walgreens was about to announce a genetic test kit, available in stores starting on Friday. The kits would allow consumers to test for such things as how you respond to statins or blood-thinners; whether you carry genes for Tay-Sachs disease or cystic fibrosis; whether you have an increased risk for coronary artery disease, Alzheimer’s, MS, colon, lung or prostate cancer; and your chances of becoming obese, developing psoriasis, or going blind. There are three separate tests, individually priced, so you don’t have to confront the bad news all at once.

On Tuesday, when the announcement became official, commentators speculated on how the FDA would react. A spokesman for Pathway Genomics, the developer of the test partnering with Walgreens, said: “FDA clearance is not necessary to sell the … Kit in retail.” He also confirmed that the product had not been submitted for FDA approval.

Meanwhile, FDA officials, contacted for their comments, were saying that any test that “could lead to a consumer making a decision on whether they are going to terminate a pregnancy — we consider that a very important decision to be made on a test that has not been looked at by the FDA.”

The FDA requires products that make health claims to be reviewed. Walgreens/Pathway argued that the test provides consumers with “information about their personal genetic makeup and traits,” hoping that would be sufficient to avoid the FDA’s purview.

On Wednesday the FDA made public a letter to Pathway “suggesting” that the kit did need regulatory approval. The FDA was on top of this all along. The letter was actually written on Monday.

Late Wednesday, Walgreens announced it would postpone sales of the kit.

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Links of interest: Organic food

Organic vegetable gardenOrganic Foods Slideshow: To Buy or Not to Buy Organic (WebMD)

A slide show with advice on when to buy organic and when it’s OK to use conventionally grown fruits and vegetables. Peaches, apples, peppers, strawberries, pears, grapes, broccoli, and more..

Organic: What it means on different products (Los Angeles Times)

Is the extra dollar worth it? Organic and conventional food may have similar nutritional value, but then there’s the environment to consider. “What we do to our environment, we are also doing to ourselves.” A good discussion of pesticides, dairy and meat, cosmetics and personal care products, processed food, cotton and coffee. Very informative.

Benefits of organic food questioned yet again (GMO Pundit)

Evidence from human studies suggests that children who consume organic fruits and vegetables and adults who consume organic cereal may significantly reduce their pesticide exposure compared with groups consuming conventional diets, although the levels of pesticide exposures in both groups is within accepted safety standards. There is no evidence of any other benefits of consuming organic food based on human dietary studies. Finally, although rates of bacterial contamination did not differ significantly between organic and conventionally grown meats, eggs, and milk, the antibiotic resistance of bacteria cultured from conventional meats, eggs, and milk was significantly greater than for organic products.

Is Organic Food Marketing Hype? (Newsweek)

Six experts disagree. “In eight countries which have looked at this issue, in every case they have concluded there is no health benefit of eating organic food compared with conventional food.” On the other hand: “Organic animals eat a diet free of excrement … [and] organic is free of antibiotics.”

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The new Chinese middle class and syphilis

Chinese middle classIn his recent book on the financial crisis, John Lanchester mentions China’s unprecedented economic growth, which has created a “hugely expanding, highly consuming new middle class.”

China’s [middle class] went from 174 million to 806 million, arguably the greatest economic achievement anywhere on Earth, ever. Chinese personal income grew by 6.6 percent a year from 1978 to 2004, four times as fast as the world average. Thirty million Chinese children are taking piano lessons. … Hundreds of millions of people are measurably richer and have new expectations to match.

The combination of more wealth and Chinese regard for socially correct behavior has resulted in an increase in sexually-transmitted diseases. As a recent issue of The New England Journal of Medicine points out (emphasis added):

After China’s economy became increasingly market-based in the 1980s, the growing numbers of Chinese businessmen with money and young women without money translated into expanded demand and supply for the country’s commercial sex industry. Meanwhile, Chinese social structures influence the effectiveness of syphilis-control programs in two important but countervailing ways: although newly established advocacy organizations for marginalized groups provide a foundation for expanding such programs, the social stigma associated with high-risk behaviors is a powerful deterrent to widespread syphilis-screening efforts.

Social “deviants” don’t show up for testing

The social stigma is associated with behaviors that have the greatest risk of contracting syphilis: selling or buying sex and men having sex with men. To get tested for syphilis might suggest that one’s behavior had been less than socially acceptable.

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Antibiotic resistance genes in soil microbes

Forest soil microbesWe’ve known for years that antibiotic resistant bacteria (ARB) are increasingly a problem in hospital settings. As the recently published (and excellent) book Superbug describes, ARB are also increasingly common in the community – in sports teams, prisons, and on pig farms, for example.

A recent study finds that antibiotic resistance is on the increase in the very ground we walk on. Microbes in soil samples collected in the Netherlands over a sixty year period were analyzed to see if antibiotic resistance genes (ARG) had become more abundant. Resistance was tested for four classes of antibiotics, including tetracyclines and penicillins.

The study reports: “Results show that ARG from all classes of antibiotics tested have significantly increased since 1940, but especially within the tetracyclines, with some individual ARG being >15 times more abundant now than in the 1970s.” Also: “Seventy-eight percent of detected resistance genes, associated with four classes of antibiotics, showed increasing levels since 1940.”

Gene transfer can happen in the food and water supply

The authors of the study expressed concern for the public health implications of their findings. The concern stems from the ability of bacteria to transfer their genes to other bacteria in their surroundings, not just to their own offspring. Humans pass their genes vertically, from parent to child. But single-celled microbes can pass genetic material to another living microbe. It’s called horizontal (or lateral) gene transfer. In fact, this may be the most common form of gene transfer in single-celled microbes.

So we’re not talking about picking up disease-causing bacteria while walking in the woods, the way athletes contract MRSA from towels in the locker room. The significance of an increase in ARG in soil microbes is the ability to transfer resistance genes to bacteria that make us sick.

As lead researcher David Graham explains: “The genes themselves do not get passed directly to humans per se. The genes get passed from exposed bacteria to bacteria … [that] might ultimately end up in humans, some of which might be pathogenic. An example is on food or in water that has been exposed to resistance bacteria.”

Like food that’s grown in soil. Or water that comes in contact with the earth.

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Is it OK to eat and drink during labor?

Woman in laborSometimes childbirth – the hours spent in labor – can last a long time. You can get thirsty. Or hungry. Is it OK to eat and drink during labor? If not, why not?

In any childbirth scenario there’s always the possibility that surgery – and general anesthesia — will be necessary. Under anesthesia there’s a risk of “aspiration” – inhaling something into the lungs other than air. That’s why US medical societies have said no, you shouldn’t eat or drink during labor.

It turns out there’s very little data on the dangers of aspiration. This has led other groups to advocate a more liberal policy, arguing that the psychological and physical benefits of food and drink outweigh the risks. Joan Tranmer, PhD, RN, coauthor of a review of the evidence, commented:

For low-risk women in labor, they should be offered the choice to eat and drink. … Now, most women in active labor are not going to want to eat, but some may find comfort in some toast or tea.

It’s a comfort thing

Before the mid-1940s, medical wisdom advocated food and fluids for the mother-to-be, since she needed to maintain all the stamina she could muster for the upcoming effort of delivery. This changed in 1946 when Dr. Curtis Mendelson first described aspiration of stomach contents during general anesthesia. This was a rare event during scheduled surgeries, since patients had been told not to eat beforehand. But going into labor is much less predictable, and problems arose more frequently with obstetric anesthesia. Offering toast was no longer an option.

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Are married people happier? Are parents?

Happy Family Hugging Each OtherResearch tells us that married people are happier than the unmarried, that is, they’re happier than those who are single, separated, divorced, widowed, or simply living together. This doesn’t necessarily mean there’s a cause and effect relationship going on here: Get married, be happy. It could be that happy people are more inclined to marry in the first place and that we enjoy staying married to a happy spouse.

While studies (PDF) find that marriage increases a sense of “well-being” (another term for happiness), that state of mind may be only temporary. After a few years, bride and groom seem to return to the level of happiness they enjoyed before the big day.

As Derek Bok points out in The Politics of Happiness, conflicting answers to questions about marriage and happiness may result from observing two different groups: Those who become happier with the years and those whose marriages go sour. When you combine the two, the results may very well cancel each other out.

The end of a marriage. The health benefits of marriage.

So we don’t have a definitive answer to the question “Are married people happier?” What is certain, however, is that the end of a marriage – whether through separation, divorce, or death – is followed by a sharp decline in happiness. On a scale of 100, the average drop in happiness following divorce is 5 points and, following separation, the drop is 8 points. Why the greater unhappiness with separation? Perhaps, as Bok suggests, those who divorce were unhappier with their marriage to begin with, so they now feel some relief. Or perhaps the separated are still adjusting to the change, whereas the divorced have had more time to adapt.

We do know that married people live longer. One study (PDF), for example, found that the impact of marriage on how long we live was much greater than the impact of how much we earn. The longevity benefit for men can be quantified as equivalent to a lifetime of not smoking. The longevity benefits for married women are only half as much as for men. Hmmm.

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Scientists confront political attacks on climate change

three-polar-bears-climate-changeThere’s a wonderful letter (PDF) in Science signed by 255 members of the National Academy of Sciences. It’s titled “Climate Change and the Integrity of Science,” and it’s not simply about climate change. It argues that politically motivated attacks on climate change threaten the very integrity of science.

As the lead signer points out, since it’s unusual to get 255 scientists to agree on anything, the endorsement of this statement by so many scientists is important and significant.

Here are some excerpts that address political issues and the attacks on scientific integrity:

We are deeply disturbed by the recent escalation of political assaults on scientists in general and on climate scientists in particular. All citizens should understand some basic scientific facts. There is always some uncertainty associated with scientific conclusions; science never absolutely proves anything. When someone says that society should wait until scientists are absolutely certain before taking any action, it is the same as saying society should never take action. For a problem as potentially catastrophic as climate change, taking no action poses a dangerous risk for our planet. …

Many recent assaults on climate science and, more disturbingly, on climate scientists by climate change deniers, are typically driven by special interests or dogma, not by an honest effort to provide an alternative theory that credibly satisfies the evidence. …

We also call for an end to McCarthy- like threats of criminal prosecution against our colleagues based on innuendo and guilt by association, the harassment of scientists by politicians seeking distractions to avoid taking action, and the outright lies being spread about them. Society has two choices: we can ignore the science and hide our heads in the sand and hope we are lucky, or we can act in the public interest to reduce the threat of global climate change quickly and substantively.

It’s about time someone other than a columnist said this. I certainly hope this statement receives the wide publicity it deserves.

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Do children really need chocolate baby formula?

Should parents use chocolate milk to bribe toddlers to eat their vegetables? Mead Johnson’s chocolate-flavored “Toddler Formula” has received a decidedly mixed reaction from blogging moms, ranging from outrage to gratitude.

Here’s a comment from nutritionist Marion Nestle:

But really, aren’t you worried that your baby might be suffering from a chocolate deficit problem? Don’t you love the idea of year-old infants drinking sugar-sweetened chocolate milk? And laced with “omega-3s for brain development, 25 nutrients for healthy growth, and prebiotics to support the immune system”? What’s next, genetically modifying moms to produce chocolate breast milk?

Obesity begins before the age of two

Almost one thirDrinking from a baby bottled of children in the US over the age of two are already overweight or obese. For low-income children the statistics are even worse. Michelle Obama is promoting her admirable Let’s Move Campaign. It advocates better product labeling, improved nutrition in school lunches, more opportunities for children to be physically active, and better access to high-quality food in all neighborhoods. Unfortunately that won’t be enough.

Studies show that attempts to modify behavior and nutrition, whether at school or in the home, have very limited success in preventing weight gain in children. The New England Journal of Medicine reports (emphasis added):

At as early as 3 years of age, obese children have elevated levels of inflammatory markers that have been linked to heart disease that is manifested later in life. To be a truly comprehensive and successful program … the Let’s Move Campaign must stimulate prevention efforts targeting the youngest Americans – those under 2 years of age and pre-schoolers. Indeed, prevention must start as early as possible, since school-age children already have an unacceptably high prevalence of obesity and associated medical conditions.

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Do houseflies spread antibiotic resistance?

HouseflyThere was a one-day Congressional hearing last week on antibiotic resistance and industrial agriculture. Members of congress were looking for evidence that would link agricultural use of antibiotics to human illness. One Republican specifically asked for research done in the US, implying European studies would not be good enough. Medical experts from the CDC and NIH were evidently unable to cite an American study.

It’s almost impossible to connect the bacteria in a specific individual with an animal that received an antibiotic. But there’s certainly a case to made for the use of antibiotics in agriculture and the spread of antibiotic resistance. And that’s based on research done right here in the US.

A poultry house and its 30,000 flies

Chicken houses are very attractive to flies. A Danish study estimated that, over a six-week period, as many as 30,000 flies may enter a poultry house. The Johns Hopkins Bloomberg School of Public Health (Baltimore, MD) just released a study on antibiotic resistant bacteria found in houseflies who make their home on industrialized chicken farms.

The study collected houseflies and poultry litter from chicken farms in an area of Maryland, Delaware and Virginia. Poultry litter is the absorbent material on the floor of a chicken farm. By the time it’s been used, it consists primarily of chicken manure, which is rich in bacteria.

When scientists compared the antibiotic resistant bacteria found in both flies and litter, they found striking similarities. The bacteria from both sources had very similar resistance characteristics and very similar resistance genes. “Resistance characteristics” refers to exactly which antibiotics can no longer destroy the bacteria. Characteristics of the mechanism of resistance can now be identified on the genes themselves.

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Are you distracting a driver?

Are you ever just a little bit nervous when someone calls you while they’re driving? Maybe you should be. Distracted driving takes two.

These public service ads are from Bangalore, India. Without the text (“Don’t talk while he drives”), they simply seem shocking. But they certainly accomplish their intent of getting your attention and making a point.

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Babies are individuals: Don’t fret the milestones

Nice post on Slate about how developmental milestones can be meaningless and create needless worry.

A little less than a century ago, Arnold Gesell, a developmental scientist at Yale, proposed that motor skills were related to the maturing of the brain. This led to the pronouncement that all infants would pass through the same steps of development – sitting, walking, talking – in the same order and at the same time.

Babies are remarkably adaptable

It turns out that the theory was just plain wrong. Not only were the developmental milestones inaccurate, but so was the fundamental assumption that muscular activity is strictly a function of how the brain matures.

Human beings have a remarkable ability to adapt to their environment. That’s what has allowed humans to thrive in climates from the tropics to the Arctic. Babies develop in response to the culture and environment in which they’re raised.

One study found that mothers of different cultural backgrounds, living in the same city at the same time, could accurately predict the development of motor skills in their infants, even though the milestones for each group differed by several months.

A total of 124 mothers from three cultural groups living in the same British city were asked to give the ages at which they expected their one-month-old infants to achieve three motor milestones. Jamaican mothers expected their infants to sit and walk much earlier than their English and Indian counterparts. The Indian mothers gave later estimates for crawling than those of the other two groups. The actual ages at which the abilities were attained closely reflected the cultural differences in expectations between the Jamaican and English mothers. Jamaican mothers were particularly accurate in predicting sitting age.

Here’s a trailer from the movie Babies, which follows four babies from four different cultures from birth to their first steps.

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Jack Abramoff and healthcare lobbying

Alex Gibney is probably best known as the director of Enron: The Smartest Guys in the Room. He also produced the documentary Money-Driven Medicine, based on Maggie Mahar’s book of the same name.

Gibney’s latest work is Casino Jack and the United States of Money, a documentary about the lobbyist Jack Abramoff. The video excerpt below, which deals with healthcare lobbying by the pharmaceutical and insurance industries, was not included in the final edit of the film.

Casino Jack opens in theaters May 7. You can reserve the DVD now at Netflix for future viewing.

The book Casino Jack and the United States of Money: Superlobbyist Jack Abramoff and the Buying of Washington, by journalist Peter H. Stone, was released on May 4.

Related posts:
Big Pharma lobbies against health reform: Big time
A health insurance executive changes sides
Importing drugs from Canada: Will lobbyists win or lose this round?
The Sicko files
Doctors in the trenches speak out – Part One
Doctors in the trenches speak out – Part two
Doctors in the trenches speak out – Part three
Why are US health care costs so high?

Sources:

Andrew O’Hehir, Exclusive Alex Gibney clip: Jack Abramoff and healthcare, Salon, April 30, 2010

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Links of interest: Funerals, cremations, wakes

[A]s a society, Americans are no longer sure what to do with our dead. … Today … our death rituals have become downsized, inwardly directed, static and, as a result, spiritually and culturally impoverished. … At upbeat, open-mike “celebrations of life,” former coaches, neighbors and relatives amuse us with stories and naïvely declare that the dead, who are usually nowhere to be seen and have nowhere to go, will nevertheless live always in our memories. Funerals, which once made confident public pilgrimage through town to the graveyard, now tread lightly across the tiny tableau of our psyches.

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The financial crisis: Blame it on the collapse of Communism

Why did the global economy collapse so suddenly, seemingly without warning? Economic experts and political analysts continue to offer explanations, but sometimes an outsider’s viewpoint can be especially illuminating. John Lanchester is a British novelist (The Debt to Pleasure) who stumbled on his insights into the financial collapse while researching a novel. The result is… Read more

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