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Published: Fri, 26 May 2017 00:00:00 -0400

Last Build Date: Fri, 26 May 2017 01:25:13 -0400

 



Coroner Says Everyone Should Avoid Energy Drinks, Which Kill at Random

Mon, 22 May 2017 10:00:00 -0400

Last week a South Carolina coroner blamed a teenager's sudden death on caffeine-induced arrhythmia, prompting yet another burst of alarmist warnings about the dangers posed by energy drinks. As usual, the stories either glossed over or misrepresented the amount of caffeine these products contain compared to other, less controversial beverages. Davis Cripe, a student at Spring Hill High School in Chapin, collapsed during art class on the afternoon of April 26 and was rushed to Palmetto Health Baptist Parkridge Hospital, where he was pronounced dead about an hour later. Cripe's friends reported that he had drunk a McDonald's latte, a large Mountain Dew, and an unspecified energy drink over the course of two hours. Richland County Coroner Gary Watts attributed Cripe's death to a "caffeine-induced cardiac event causing a probable arrhythmia." Watts, who announced his findings at a news conference that also featured Cripe's grieving father, conceded that his conclusion was debatable. "I realize this is a controversial scenario," he said. "There are are obviously people that don't think this can happen—that you can have this arrhythmia caused by caffeine." One reason to doubt Watts' determination is that Cripe does not seem to have consumed a very large dose of caffeine. According to the website Caffeine Informer, a McDonald's latte contains 142 milligrams of caffeine, a large (20-ounce) bottle of Mountain Dew has 90, and the most popular energy drinks contain 10 milligrams per fluid ounce, or 160 milligrams in a 16-ounce can. That's a total of less than 400 milligrams, which is the daily limit recommended by the Food and Drug Administration (FDA) for adults. A lethal dose of caffeine is estimated to be somewhere between 5 and 10 grams—i.e., between 5,000 and 10,000 milligrams—for an adult. Cripe was 16 and weighed about 200 pounds. Watts acknowledged that Cripe did not consume very much caffeine. "This is not a caffeine overdose," he told Reuters. "We're not saying that it was the total amount of caffeine in the system. It was just the way that it was ingested over that short period of time, and the chugging of the energy drink at the end was what the issue was with the cardiac arrhythmia." Millions of teenagers chug energy drinks, of course, but very few of them die afterward. So assuming Watts is right, Cripe must have been especially sensitive to caffeine. Yet Watts said Cripe seemed perfectly healthy and there was no evidence of previously undetected cardiovascular disease. The coroner suggested that energy drinks kill at random. "This is what's dangerous about this," he said. "You can have five people line up and all of them do the exact same thing with him that day, drink more, and it may not have any type of effect on them at all. It's not something that just because you drink one drink or three drinks [it] is necessarily going to have this effect." The implication that energy drinks kill something like one out of six teenagers who consume them obviously has no basis in reality. Yet for some reason Watts wants people to think that energy drink consumers face Russian roulette odds. "Our purpose here today is to let people know, especially our young kids in school, that these drinks can be dangerous," he said. "Be very careful with how you use them, and how many you drink on a daily basis." But since Watts is saying even one can might be lethal, complete abstinence would seem to be the only prudent course. That does appear to be Watts' message. "These drinks can be very dangerous," he said. "I'm telling my friends and family, 'Don't drink them.'" Yet he also claimed that "the purpose here today is not to slam Mountain Dew, not to slam cafe lattes, or energy drinks." It is hard to see how Watts is not slamming energy drinks when he describes them as so dangerous that no one should consume them. Although Watts emphasized that Cripe did not die from a caffeine overdose, news outlets bent over backward to exaggerate the amount of the stimulant he ingested. Relying on Caffeine Informer's numbers, BBC News reported that [...]



Harm Reduction an Alternative to Incoherent Opioid Addiction Policies

Wed, 19 Apr 2017 00:05:00 -0400

You can't pick up a newspaper, turn on the TV or radio, or access any online news source without encountering headlines screaming "opioid epidemic." There is the alarming rise in the number of chronic pain patients who have become addicted to opioids. And the explosion, in recent years, of opioid prescriptions by health care providers now under government pressure to curtail their prescribing. This pressure has driven many opioid addicts to the illicit drug market to avoid the pains of withdrawal. There, according to the Centers for Disease Control and Prevention (CDC), they often find opioid heroin cheaper and sometimes more readily available despite a 50-year "War on Drugs." Thus they become heroin addicts. Media hysteria begets calls to action. Politicians and the administrative state devise new laws to control this "evil plague." As a surgeon who regularly prescribes painkillers for patients suffering from postoperative pain or painful conditions, I see a painful cognitive dissonance. Begin with US policy towards heroin. Originally developed in the 1870s, diacetyl-morphine was marketed under the brand name Heroin, by the Bayer pharmaceutical company. Despite pleas by the Surgeon General and the American Medical Association to keep it legal, Heroin was banned in the US in 1924 because political leaders believed it the drug corrupted an individual's moral character. Meanwhile, dilaudid, 3 to 4 times more potent than morphine, is legal and is routinely administered for pain both as an oral and an injectable agent. Fentanyl, or Duragesic, is legal, too, although it is more than 50 times the potency of morphine. There is even greater cognitive dissonance with methadone, the powerful opioid approved for use in the US in 1947 and commonly used in this country to treat addiction to heroin and other opioids. Chronic users of opioids develop a tolerance, requiring ever-increasing doses to achieve the desired effect. A low, oral dose of methadone binds with enough of a person's opioid receptors to prevent withdrawal symptoms yet not produce the euphoric effects. The idea behind "methadone maintenance" programs is to transfer the addiction from heroin or another opioid. Because they do not experience the euphoria and "escape" of their chosen opioid, methadone addicts can resume a normal, productive—even conventional—life. Some can be tapered off from methadone and "detoxified." But many remain on methadone, sometimes for their entire lives. To put things in proper perspective, chronic alcohol use is much more dangerous. Chronic use can cause cirrhosis of the liver, cardiomyopathy (heart failure from damaged heart muscle), encephalopathy and dementia, chronic pancreatic inflammation, and has been linked to cancer of the stomach and the esophagus. In addition, one can overdose on alcohol as well—which may cause a person to stop breathing, become hypoxic, and die. And here's where the cognitive dissonance comes in: it is perfectly acceptable and permissible—even public policy—to allow people to be chronically addicted to the opioid methadone. The side-effects of prolonged use are considered serious yet tolerable. But it is unacceptable and counter to public policy for a person to be chronically addicted to any other opioid, even if that person self-doses to prevent withdrawal while avoiding the "high" in order to lead a peaceful and productive life. The concept of "harm reduction" as an approach to substance abuse has gained increased acceptance by health care practitioners as well public health and government authorities. Harm reduction approaches chemical dependency in a non-judgmental and realistic way, leaving drug prohibition in place. The strategy seeks to ameliorate the most destructive effects of prohibition on the individual drug user and addict. The health care practitioner focuses on minimizing the addict's self-inflicted harm. Clean needle-exchange programs to prevent the spread HIV and hepatitis are a part of harm reduction. Methadone maintenance is in its way a form of harm reduct[...]



Deregulation of Local Foods Is a Winning Idea That's Spreading

Sat, 18 Feb 2017 08:00:00 -0500

Newly proposed legislation in Montana and California could loosen restrictions on millions of small food entrepreneurs in those states. In Montana, the Local Food Choice Act would "allow for the sale and consumption of homemade food and food products and... encourage the expansion of agricultural sales by ranches, farms, and home-based producers" in the state. The law would exempt those who make and sell such foods directly to consumers from mandatory licensing, permitting, packaging, labeling, inspection, and other requirements. The law doesn't exempt those who don't sell food directly to consumers—as in the case of those who sell to restaurants or grocers—or to those who sell food across state lines. "Eating what we choose should never be a crime," said State Rep. Greg Hertz (R), as he introduced the bill last month. Indeed, Hertz's bill would effectively legalize in Montana what is now a crime there and in almost every state: the act of selling something as basic as homemade cheese dip or pickles to your neighbor. Hertz's Local Food Choice Act is fashioned after Wyoming's groundbreaking Food Freedom Act, first-in-the-nation legislation passed two years ago that deregulated many direct-to-consumer food sales within the state. As I detailed here, Colorado passed a similar law last year. Other states have also considered similar measures. In California, a bill introduced this week by Assemblyman Eduardo Garcia (D), the Homemade Food Operations Act, "would allow home cooks to sell hot, prepared foods directly to customers." The California bill isn't as ambitious as those adopted in Wyoming and Colorado or that proposed in Montana—it still contains requirements for sanitation, training, and permitting—but it's a giant leap in the right direction. "Many of my constituents have expressed their concerns and frustrations trying to work in compliance with the existing, overly complicated cottage food laws," said Assemblyman Garcia in a statement announcing the bill, referencing the state's overly restrictive cottage food laws. Not surprisingly, all this talk of deregulating local food sales has some people nervous. State and local health officials in Montana, for example, have spoken out against the state bill, claiming it could lead to a rise in cases of foodborne illness. "Every state that looks at setting their local food economy free inevitably finds food police lining up with statistics on how freedom of choice is a danger," said Wyoming State Rep. Lindholm (R), who sponsored the Food Freedom Act in his state, in an email to me this week. "These individuals, bureaucrats, and industry associations all espouse their merits as to being defenders of ignorant consumers that cannot be trusted to make their own decisions as to what is best for their family." I asked Lindholm if there's been any uptick in foodborne illnesses in Wyoming since the law's passage. "Wyoming has seen the exact opposite that these do gooders predict," Lindholm tells me. "Wyoming[']s local food options have exploded and we still have had 0 foodborne illness outbreaks due to this Act passing into law." I've chuckled while hearing more than one overly cautious eater tell me they'd never eat food that was prepared in an uninspected home kitchen. Everyone should be free to avoid such food if they want, of course. But keep in mind that your own home kitchen isn't inspected. Your parents' kitchen and your grandparents' kitchen weren't inspected, either. Your friends' and relatives' kitchens aren't inspected. The baked goods you took to school to sell to other kids as part of a bake sale (or that you send with your own kids to school today) haven't earned any government seal of approval. Avoiding all foods save for those prepared in an inspected kitchen means dining out at every meal or not eating at all. If one or both of these are your choice, then so be it. But Montana and California have moved to allow others to exercise their own choices. And I hope they succeed.[...]



Study Confirms Health Advantages of Vaping

Wed, 15 Feb 2017 00:01:00 -0500

The first surgeon general's report on e-cigarettes, published in December, describes them as "an emerging public health threat." A "tip sheet for parents" that accompanied the report recommends evasion in response to the question, "Aren't e-cigarettes safer than conventional cigarettes?" Curious teenagers (and adults) will have to look for an answer elsewhere, such as a study reported last week in the Annals of Internal Medicine. It confirmed that e-cigarettes are much less dangerous than the traditional, combustible sort, a fact that may come as a surprise to Americans who get their health information from government officials. The researchers, led by Lion Shahab, a health psychologist at a University College London, tested the saliva and urine of 181 volunteers representing five groups: current smokers, current smokers who also use e-cigarettes, current smokers who also use nicotine replacement therapy (NRT) products such as gum or patches, former smokers who have switched to e-cigarettes, and former smokers who have switched to NRT. Shahab et al. found all five groups were receiving similar amounts of nicotine, but the switchers showed "substantially reduced levels of measured carcinogens and toxins." The differences between vapers and smokers were dramatic, ranging from 57 percent reductions in three volatile organic compounds (ethylene oxide, acrylonitrile, and vinyl chloride) to 97 percent reductions in acrylonitrile (another VOC) and in a tobacco-specific nitrosamine, a potent carcinogen. The levels for vapers were at least as low as those for NRT users and in some cases lower, which is striking because NRT is widely accepted as a safe alternative to cigarettes. This study, which involved long-term e-cigarette users, reinforces the results of a 2016 study finding large reductions in toxins and carcinogens among smokers who switched to vaping during a two-week experiment. Shahab et al.'s findings also jibe with chemical analyses of e-cigarette liquids and the aerosol they produce, work that led Public Health England to endorse an estimate that vaping is something like 95 percent safer than smoking. The huge difference in risk between vaping and smoking is hardly surprising, since the former involves inhaling an aerosol that typically consists of propylene glycol, glycerin, water, flavoring, and nicotine, while the latter involves inhaling tobacco smoke, which contains thousands of chemicals, hundreds of which are toxic or carcinogenic. Yet misconceptions about the hazards of vaping are widespread, thanks to public health officials and anti-tobacco activists who seem intent on obscuring the truth. In a recent survey of American adults by Vanderbilt Law School professor W. Kip Viscusi, 48 percent of respondents erroneously said e-cigarettes are either just as hazardous as the conventional kind or even more hazardous. Thirty-eight percent said e-cigarettes are less hazardous, but only 14 percent correctly said they are much less hazardous. It's no wonder the public is confused, when the surgeon general, the Food and Drug Administration, and the U.S. Centers for Disease Control and Prevention portray e-cigarettes as a menace to public health instead of an opportunity to reduce smoking-related disease. All three inaccurately describe e-cigarettes as "tobacco products," falsely implying that the risks posed by vaping are similar to the risks posed by smoking. Writing in the Philadelphia Inquirer a few weeks after Surgeon General Vivek Murthy's report came out, a local physician took her cue from him, dodging a straightforward question about the relative hazards of vaping and smoking with an irrelevant litany of speculative warnings. Such efforts to scare people away from e-cigarettes are positively pernicious and potentially lethal to the extent that they deter smokers from making a switch that could save their lives. For Donald Trump, who was elected on promises of disruption and deregulation, an obvious target is the FDA's onerous new e-c[...]



Trump Brings Back Ban on Funds for Groups That Promote Abortion, While Congress Reconsiders Global Anti-Prostitution Pledge

Mon, 23 Jan 2017 15:00:00 -0500

On his first Monday in office, Donald Trump signed executive orders instituting a hiring freeze for all federal government positions outside the military and reinstating a ban on international aid going to nonprofits that provide abortions or promote information on them, regardless of what other services they offer. The contentious abortion rule represents a back and forth that's been taking place under Republican and Democratic administrations since the 1980s. Known as the "Mexico City Policy," it was instituted under President Ronald Reagan, reversed by Bill Clinton, restored by George W. Bush, and again reversed by Barack Obama. Not to be confused with the 1973 Helms Amendment, which bans groups from using U.S. government funds directly for abortion services abroad, the Mexico City Policy targets broader conduct, requiring that "as a condition of their receipt of federal funds," groups must agree to "neither perform nor actively promote abortion as a method of family planning in other nations." A diverse group of more than 100 public health, women's issues, and civil liberties organizations have already issued a statement opposing the return of the Mexico City Policy, which they refer to as "the global gag rule." "The global gag rule ... interferes with the doctor-patient relationship by restricting medical information healthcare providers may offer, limits free speech by prohibiting local citizens from participating in public policy debates, and impedes women's access to family planning by cutting off funding for many of the most experienced health care providers who chose to prioritize quality reproductive-health services and counseling over funding that restricts care and censors information," it says. Groups endorsing the statement include the American Civil Liberties Union, the American Congress of Obstetricians and Gynecologists, Amnesty International USA, the National Organization for Women, the Alliance to End Slavery & Trafficking, the Unitarian Universalist Women's Federation, the International Medical Corps, New York University's Global Justice Clinic,and Human Rights Campaign. The Mexico City Policy is one of several federal aid conditions that have been contingent on controversial social issues. Since 2003, the U.S. has banned groups that get grants to fight HIV/AIDs and/or human trafficking from supporting the decriminalization of prostitution. Referred to as the anti-prostitution pledge, the policy was proposed for anti-HIV groups as part of Bush's "Emergency Plan for AIDs Relief," passed by Congress in May 2003 as the "United States Leadership against HIV/AIDS, Tuberculosis, and Malaria Act." It stipulated that no grant money could be used "to promote or advocate the legalization or practice of prostitution or sex trafficking" nor to "provide assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking." The anti-prostitution pledge was also part of the bipartisan 2003 reauthorization of the Trafficking Victims Protection Act (TVPA), which stated that no federal money "may be used to promote, support, or advocate the legalization or practice of prostitution" and no funds "may be used to implement any program" by an organization that "has not stated in either a grant application, a grant agreement, or both, that it does not promote, support, or advocate the legalization or practice of prostitution." Many public-health and human-rights groups opposed these policies on the grounds that decriminalizing prostitution is often supported as a means to stop the spread of sexually-transmitted infections and sex trafficking by force, fraud, or coercion. The pledge was initially applied only to foreign nonprofits, but in 2005 the Bush administration began applying it to U.S. groups, too. In 2013, the U.S. Supreme Court ruled that the part of the pledge requiring anti-HIV/AIDs groups to explicitly denounce prostitution was unconstitutional as it vi[...]



What We Don't Know About Marijuana's Risks and Benefits

Fri, 13 Jan 2017 10:00:00 -0500

The last time the National Academy of Sciences issued a report on marijuana, three states allowed medical use of the drug. Eighteen years later, there are 28 states that recognize marijuana as a medicine, and eight of them also allow recreational use. But as a new NAS report published yesterday shows, there are still big gaps in our knowledge of marijuana's risks and benefits. The 1999 report, commissioned by a drug czar who insisted there was no evidence that marijuana is medically useful, refuted that claim but highlighted the paucity of relevant research. "The accumulated data indicate a potential therapeutic value for cannabinoid drugs, particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation," it concluded. The new report, which takes into account studies conducted during the last two decades, is less tentative but still finds the evidence for most medical applications inconclusive. "We found conclusive or substantial evidence...for benefit from cannabis or cannabinoids for chronic pain, chemotherapy-induced nausea and vomiting, and patient-reported symptoms of spasticity associated with multiple sclerosis," the authors say. "For these conditions the effects of cannabinoids are modest; for all other conditions evaluated there is inadequate information to assess their effects." The report notes that investigation of marijuana's medical utility has been constrained by legal and bureaucratic barriers, including continued federal prohibition and the Drug Enforcement Administration's refusal to license more than one producer of cannabis for research. "There are specific regulatory barriers, including the classification of cannabis as a Schedule I substance, that impede the advancement of cannabis and cannabinoid research," the authors say. "It is often difficult for researchers to gain access to the quantity, quality, and type of cannabis product necessary to address specific research questions." Last August the DEA once again refused to reclassify marijuana but agreed to start accepting applications from additional marijuana producers. As state-legal marijuana products proliferate across the country, federal prohibition prevents scientists from investigating their properties: Cannabis concentrate sales doubled in Colorado from 2015 to 2016, reaching $60.5 million in the first quarter of 2016, and yet current federal law prevents chemists from examining the composition of those products as it may relate to safety, neuroscientists from testing the effects of those products on the brain or physiology in animal models, and clinical scientists from conducting research on how these products may help or harm patients. And while between 498,170 and 721,599 units of medical and recreational cannabis edibles were sold per month in Colorado in 2015, federal law also prohibits scientists from testing those products for contaminants, understanding the effects of these products in animal models, or investigating the effects in patient populations. Regarding the potential dangers of these products, the report is mostly reassuring, finding little or no evidence that marijuana impairs the immune system or increases the risk of heart attacks, lung cancer, or chronic obstructive pulmonary disease (contrary to the claims of anti-pot activists). Regular pot smoking seems to worsen bronchitis symptoms, and marijuana consumption by pregnant women is associated with lower birth weight, although there is little evidence of a link to pregnancy complications or postnatal health problems. Marijuana use is associated with schizophrenia, suicide, poor academic performance, and abuse of other drugs, but the causal relationships remain murky. The report says "there is limited evidence of a statistical association between sustained abstinence from cannabis use and impairments in the cognitive domains of learning, memory, and attention"—i.e., effects that persist long [...]



FDA Says Explaining the Main Advantages of E-Cigarettes Would Confuse Consumers

Wed, 11 Jan 2017 09:15:00 -0500

In a "clarification" published this week in the Federal Register, the Food and Drug Administration indicates that e-cigarettes cannot legally be sold as tools to quit smoking unless their manufacturers go through the prohibitively expensive process of getting them approved as new pharmaceutical products. The FDA also says e-cigarettes cannot legally be sold as a less hazardous alternative to the conventional kind unless their manufacturers go through the prohibitively expensive process of getting them approved as "modified risk tobacco products." The upshot is that e-cigarette companies are forbidden to be honest about the main benefits offered by their products, a form of censorship that is bound to retard the shift from smoking to vaping, thereby endangering lives that could have been saved by switching to a much less dangerous nicotine habit. The FDA's new rule is supposed to clarify when "a product made or derived from tobacco that is intended for human consumption will be subject to regulation as a drug, device, or a combination product." That can happen in two ways, one of which is "if the product is intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease." The FDA regulates nicotine products such as gum and patches as medical products, based on the dubious premise that nicotine addiction is a disease, the treatment for which is nicotine in a different form. The label on Nicorette gum, for instance, identifies it as a "stop smoking aid" that "reduces withdrawal symptoms, including nicotine craving, associated with quitting smoking." As far as the FDA is concerned, selling e-cigarettes as a competing form of nicotine replacement for smokers trying to quit (which is what they are) puts them in the same regulatory category as Nicorette: Claims related to smoking cessation have long been recognized as evidence of intended use conferring drug or device jurisdiction. Smoking cessation claims have also long been associated with intended uses of curing or treating nicotine addiction and its symptoms....Against this backdrop, smoking cessation claims on any product generally create a strong suggestion of intended therapeutic benefit to the user that generally will be difficult to overcome absent clear context indicating that the product is not intended for use to cure or treat nicotine addiction or its symptoms, or for another therapeutic purpose. The FDA does not explicitly rule out any reference or allusion to smoking cessation in the marketing of e-cigarettes. The agency even allows that "evidence may be developed showing that, in some situations, 'smoking cessation' is understood in context as referring to ending the use of traditional cigarettes and switching to a non-combustible product made or derived from tobacco." It's a mystery why new evidence would be required to prove that point, since that surely is the way that millions of people who have used e-cigarettes to quit smoking understand the concept. In any case, the FDA promises to "closely scrutinize 'smoking cessation' claims," creating a strong presumption that will encourage manufacturers to steer clear of the subject. The FDA says "the rule's treatment of smoking cessation claims as generally suggestive of a therapeutic purpose means that products marketed with such claims would generally be regulated as medical products." It adds that disclaimers of therapeutic intent generally will not be sufficient to keep e-cigarettes out of that category. Boston University public health professor Michael Siegel, an advocate of vaping as a harm-reducing alternative to smoking, questions the FDA's legal reasoning, arguing that smoking (unlike nicotine addiction), is a "health-related behavior," not a disease. Hence "a claim that e-cigarettes are intended to help someone quit smoking is not necessarily a claim that the product is intende[...]



Trump Selects Anti-Vaccination Kook Robert Kennedy Jr. to Head Vaccination Safety Commission - Update: Not So Fast?

Tue, 10 Jan 2017 18:04:00 -0500

Sadly, the selection of Robert Kennedy Jr. by Donald Trump to head some kind of vaccination commission should not be a suprise. After all, Trump evidently met with prominent anti-vax leaders back in August; one whom described Trump as being "extremely educated on our issues." (In contrast, I have explained that Trump is an "idiotarian" with regard to vaccine safety science.) Kennedy is similarly "educated." During a promotional tour for the anti-vaccination "documentary" Trace Amounts in 2015, Robert Kennedy Jr. once declared, ""They get the shot, that night they have a fever of a hundred and three, they go to sleep, and three months later their brain is gone," Kennedy said. "This is a holocaust, what this is doing to our country." We can all look forward to the scientific conclusions reached by fellow Kennedy commission panelists Jenny McCarthy and Jim Carrey. After his meeting with Trump today, Kennedy reportedly said, "President-elect Trump has some doubts about the current vaccine policies and he has questions about it. Kennedy added, "He says his opinion doesn't matter ... but the science does matter, and we ought to be reading the science and we ought to be debating the science." Yes, the science does matter, and perhaps once Kennedy is exposed to it, he might change his mind about the enormous benefits of vaccination versus the minor risks. Vaccination has been critical in preventing the all-too-natural holocaust of death by contagious diseases that has afflicted humanity throughout the ages. For example, infectious diseases were the leading cause of death in the United States up until 1920. A 2007 Journal of the American Medical Association review article reported that "a greater than 92% decline in cases and a 99% or greater decline in deaths due to diseases prevented by vaccines recommended before 1980 were shown for diphtheria, mumps, pertussis, and tetanus." New vaccines developed and deployed after 1980 continued this trend toward lower disease and death rates from contagious diseases. The JAMA review noted, "Declines were 80% or greater for cases and deaths of most vaccine-preventable diseases targeted since 1980 including hepatitis A, acute hepatitis B, Hib, and varicella. Declines in cases and deaths of invasive S pneumoniae were 34% and 25%, respectively." The Tycho Project at the University of Pittsburgh estimates that vaccination has prevented as many 103 million cases of infectious diseases since 1924 in the United States. That's the kind of science that Kennedy and his commission will need to look at. Finally, the notion that vaccinations somehow cause autism has been thoroughly debunked many times. I will be following the Kennedy vaccine commission's deliberations with considerable interest. We do live in interesting times. *Apparently Kennedy has since apologized for likening vaccination to the murder of six million Jews by the Nazis. UPDATE: The New York Times is reporting that Kennedy may have read too much into his chat with Trump. A tweet from the Times' White House correspondet Maggie Haberman reports this statement from Trump: "The President-elect enjoyed his discussion with Robert Kennedy, Jr. on a range of issues and appreciates his thoughts and ideas. The President-elect is exploring the possibility of forming a committee on Autism, which affects so many families; however no decisions have been made at this time. The President-elect looks forward to continuing the discussion about all aspects of Autism with many groups and individuals." We do live in interesting times, don't we?[...]



Is Sugar an Addictive Poison?

Fri, 06 Jan 2017 13:30:00 -0500

The Case Against Sugar, by Gary Taubes, Knopf, 368 pp., 26.95. Less than 1 percent of Americans—1.6 million people—were diagnosed with Type 2 diabetes in 1958. As of 2014, that figure had risen to 9.3 percent, or 29.1 million. If current trends continue, the figure could rise to more than 33 percent by 2050. Something has clearly gone wrong with American health. The rising rate of diabetes is associated with the rising prevalence of obesity. Since the early 1960s, the percent of Americans who are obese—that is, whose body mass index is greater than 30—has increased from 13 percent to 35.7 percent today. (Nearly 70 percent of Americans are overweight, meaning their BMIs are over 25.) Roughly put, the prevailing theory is that rising fatness causes rising diabetes. But what if both are caused by something else? That is the intriguing and ultimately persuasive argument that Gary Taubes, author Why We Get Fat (2011) and cofounder of the Nutrition Science Initiative, makes in his new book, The Case Against Sugar. For Taubes, sugar—be it sucrose or high-fructose corn syrup—is "the principal cause of the chronic diseases that are most likely to kill us, or at least accelerate our demise," explains Taubes at the outset. "If this were a criminal case, The Case Against Sugar would be the argument for the prosecution." In making his case, Taubes explores the "claim that sugar is uniquely toxic—perhaps having prematurely killed more people than cigarettes or 'all wars combined,' as [diabetes epidemiologist] Kelly West put it." Taubes surveys the admittedly sparse research on sugar's psychoactive effects. For example, researchers have found that eating sugar stimulates the release of dopamine, a neurotransmitter that is also released when consuming nicotine, cocaine, heroin, or alcohol. Researchers are still debating the question of whether or not sugar is, in some sense, addictive. In the course of his exploration, Taubes devastatingly shows that most nutrition "science" is bunk. Various nutritionists have sought to blame our chronic ills on such elements of our diets as fats, cholesterol, meat, gluten and so forth. Few have focused their attention on sugar. His discussion of how nutritionists started and promoted the now-debunked notion that eating fats is a significant cause of heart disease is particularly enlightening and dismaying. Nowadays the debate over the role of fats in cardiovascular disease consists mostly of skirmishes over which fats might marginally increase risk. Interestingly, Taubes finds that a good bit of the research on fats was funded by the sugar industry. It is not just a coincidence that the low-fat food craze took off when the U.S. Department of Agriculture issued its first dietary guidelines in 1980 advising Americans to eat less fat. The added sugar that made the newly low-fat versions of prepared foods more palatable contributed to the rise in sweetener consumption. The USDA guidelines did advise Americans cut back on eating sugar, but they also stated that, "contrary to widespread opinion, too much sugar in your diet does not seem to cause diabetes." By the way, Taubes agrees since both sucrose and high-fructose corn syrup are essentially half glucose and half fructose there is no important metabolic differences between them. Taubes reviews the global history of sugar consumption. The average American today eats as much sugar in two weeks as our ancestors 200 years ago consumed in a year. The U.S. Department of Agriculture estimates that per-person annual consumption of caloric sweeteners peaked at 153.1 pounds in 1999 and fell to only 131.1 pounds in 2014. A 2014 analysis of data from 165 countries found that "gross per capita consumption of sugar correlates with diabetes prevalence." So how does eating lots of sugar cause disease? Reviewing the scientific literature, Taub[...]



Adolescent Smoking Falls Again, Confounding E-Cigarette Alarmists

Wed, 14 Dec 2016 08:45:00 -0500

New survey results deal yet another blow to the hypothesis that vaping leads to smoking, showing that conventional cigarettes are less popular than ever among teenagers despite the recent surge in adolescent experimentation with e-cigarettes. In the Monitoring the Future Study, the percentages of eighth-, 10th-, and 12th-graders who reported smoking cigarettes during the previous month fell again this year, continuing a downward trend that began in the late 1990s. This survey began asking about e-cigarette use in 2014, and the share of teenagers who report vaping in the previous month has been falling since then. Among eighth-graders, past-month use fell from 8.7 percent in 2014 to 8 percent last year and 6.2 percent this year. Among 10th-graders, the rate was 16.2 percent in 2014, 14.2 percent this year, and 11 percent this year. Among 12th-graders, it fell from 17.1 percent in 2014 to 16.3 percent last year and 12.5 percent this year. According to the National Youth Tobacco Survey, past-month vaping among high school students rose dramatically between 2011 and 2015—"an astounding 900 percent," as Surgeon General Vivek Murthy recently put it. The latter survey also shows a continuing decline in adolescent smoking, which last year hit a record low. Somehow that trend has not put a damper on warnings from alarmists like Murthy that e-cigarettes might be a gateway to the real thing. Even Richard Miech, a Monitoring the Future researcher who recently pointed out that most adolescent vapers do not vape nicotine, seems unable to shake this unsupported fear. "Vaping may lead to friendship networks that encourage vapers to smoke," he says in a press release. "Also, vapers may come to believe the dangers of smoking are exaggerated if they do not experience any immediate health consequences from vaping." Maybe, but so far there is very little evidence that anything like that is happening. "Whether adolescent vaping has peaked or only paused is something we will be able to determine in the coming years," Miech says. "In the past, we have seen new drugs follow a pattern in which use increases at a fast pace during a honeymoon period and then reverses course and declines as knowledge of the substance's drawbacks became known." If vaping by teenagers is waning, maybe the panic about it, which for too long has overshadowed the tremendous harm-reducing potential of e-cigarettes for people who otherwise would be smoking, will finally abate. "At this point," writes Boston University public health professor Michael Siegel, "it is clear that whatever the risks of youth vaping may be, one of them is not the risk of progressing to smoking. If this hypothesis were true, we would simply not be seeing the historic declines in youth smoking that are occurring. Quite clearly, smoking continues to be de-normalized, not re-normalized as anti-tobacco groups and many health agencies have claimed. It appears that a culture of vaping is largely replacing a culture of smoking. If anything, it appears that the advent of e-cigarettes has accelerated the de-normalization of smoking by largely replacing it....Vaping appears not to be making smoking more cool, as claimed by the Surgeon General, the CDC, and anti-tobacco groups, but to be making smoking less cool. It also appears that there has been a plateau and now a decline in the rising fad of youth vaping, which should help ease the concerns of anti-tobacco groups that an entire generation of kids is going to be addicted to nicotine." Note: This post, which originally said Monitoring the Future first asked about e-cigarette use in 2015, has been corrected and updated with survey numbers from 2014, which were omitted from this year's MTF report.[...]



Brickbat: You Dirty Rat

Fri, 09 Dec 2016 04:00:00 -0500

(image) The federal Environmental Protection Agency has sent letters to several states and cities ordering them to stop using dry ice to kill urban rats. The dry ice is stuffed into rat burrows, and as it outgasses it suffocates the rats. The EPA says it has not approved dry ice as a pest control measure.




Surgeon General Launches E-Cigarette Scare Campaign That Will Harm Public Health

Thu, 08 Dec 2016 11:15:00 -0500

A new report from Surgeon General Vivek Murthy repackages familiar alarmism about e-cigarettes, which it depicts as a grave threat to the youth of America using the same deceptive techniques favored by U.S. Centers for Disease Control and Prevention (CDC). "To protect our nation's young people from being harmed by these products," Murthy recommends policies, such as higher taxes, vaping bans, limits on advertising, and possibly flavor restrictions, that will undermine public health by making e-cigarettes less appealing to people who currently get their nicotine from conventional cigarettes, a much more dangerous source. Murthy declares that e-cigarette use by teenagers "is now a major public health concern," noting that it rose "an astounding 900 percent" from 2011 to 2015. "These products are now the most commonly used form of tobacco among youth in the United States, surpassing conventional tobacco products, including cigarettes, cigars, chewing tobacco and hookahs," says Murthy, who worries that e-cigarettes "could be an avenue by which kids are addicted to nicotine" and eventually start smoking. The numbers cited by Murthy come from the CDC's National Youth Tobacco Survey, which found that the share of high school students who reported using e-cigarettes in the previous month rose from 1.5 percent in 2011 to 16 percent in 2015—an increase of 967 percent. But according to data from the Monitoring the Future Study, another government-sponsored survey of teenagers, nonsmoking adolescents almost never vape often enough to get hooked on nicotine. In the 2014 survey, just 0.7 percent of never-smoking 12th-graders reported vaping on 20 or more days in the previous month. Furthermore, adolescent vapers typically use nicotine-free e-fluid, so the share of nonsmoking teenagers who are even theoretically at risk of nicotine addiction via vaping is even smaller—something like 0.3 percent. In addition to highlighting big numbers with little public health significance, Murthy copies the CDC's habit of calling e-cigarettes "tobacco products," which they aren't. That description falsely implies that the risks posed by vaping are similar to the risks posed by smoking, when they are in fact dramatically lower. Although Murthy concedes the difference in risk, his office deliberately obscures it. "Aren't e-cigarettes safer than conventional cigarettes?" asks a "tip sheet for parents" posted today. The recommended answer is absurdly evasive: "Because your brain is still developing, scientific studies show that it isn't safe for you to use any tobacco product that contains nicotine, including e-cigarettes. Whether you get nicotine from an e-cigarette or a cigarette, it's still risky. Some e-cigarette batteries have even exploded and hurt people." Uh, thanks, Mom, but how about answering the question? This is propaganda masquerading as science, which has already warped public perceptions of the hazards posed by e-cigarettes. In a recent survey of American adults by Vanderbilt Law School professor W. Kip Viscusi, 48 percent of respondents incorrectly said e-cigarettes are either just as hazardous as the conventional kind or even more hazardous. Thirty-eight percent said e-cigarettes are less hazardous, but only 14 percent correctly said they are much less hazardous. Since Americans already tend to think e-cigarettes are much more dangerous than they actually are, Murthy's recommendation that public health agencies and medical professionals get out the word about the hazards of vaping is rather alarming, especially if his office's educational efforts are meant to be a model. Such efforts to scare people away from e-cigarettes are positively pernicious and potentially lethal to the extent that they deter smokers from making a switch that could[...]



Brickbat: Getting Drilled

Tue, 06 Dec 2016 04:00:00 -0500

(image) The good news is that the Tomah, Wisconsin, Veterans Affairs Medical Center is offering free screenings for hepatitis and HIV to 592 veterans. The bad news is that they are doing this because a VA dentist did not properly clean equipment between patients.




FDA Salt Guidance Could Kill More People Than It Saves

Fri, 02 Dec 2016 11:10:00 -0500

The Food and Drug Administration issued proposed guidance in June to the food industry aiming to reduce the amount of sodium in many prepared foods. In its draft guidance, the agency stated: Average sodium intake in the U.S. is approximately 3,400 mg/day. The draft short-term (two-year) and long-term (10-year) voluntary targets for industry are intended to help the American public gradually reduce sodium intake to 2,300 milligrams (mg) per day, a level recommended by leading experts and the overwhelming body of scientific evidence. The targets are also intended to complement many existing efforts by food manufacturers, restaurants, and food service operations to reduce sodium in foods. The FDA further asserted: CDC has compiled a number of key studies, which continue to support the benefits of sodium reduction in lowering blood pressure. In some of these studies, researchers have estimated lowering U.S. sodium intake by about 40 percent over the next decade could save 500,000 lives and nearly $100 billion in healthcare costs. So, the science of salt is settled, right? Actually, no. The FDA asked for public comments on its draft guidelines and it evidently received sufficient pushback that it extended the deadline for comments until December 2, 2016. As I reported earlier more and more studies are calling into question that idea that reducing salt consumption at the population level will actually result in net health benefits. For example, the New England Journal of Medicine published a study in August 2014 finding that people who consume less 1,500 milligrams of sodium (about 3/4ths of a teaspoon of salt) are more likely to die than people who eat between 3,000 to 6,000 milligrams of sodium per day (1.5 and 3 teaspoons of salt). The free-market think tank, the Competitive Enterprise Institute has submitted comments that show that the FDA's confident claim that reducing salt consumption by Americans will save lives is at best, a hope, and at worst, tragically wrong. The CEI comments to the FDA nicely summarizes the relevant scientific studies. Here is the nub of the issue: Reduced sodium consumption affects different individuals in different ways. Only an estimated 17 to 25 percent of the population is "salt sensitive"—they experience higher blood pressure with increased dietary sodium—while 75 percent are considered salt resistant and will experience no change in blood pressure with altered dietary sodium. However, an estimated 11 to 16 percent of the population are inverse salt sensitive, which means reduced dietary sodium can increase their blood pressure. With this heterogeneity in response to salt, trying to force a population-wide reduction in sodium availability in order to reduce incidences of hypertension would be ineffective at best and counterproductive at worst. Among other evidence, CEI cites a 2014 metanalysis in the American Journal of Hypertension of more than two dozen sodium studies which concluded that risk of death appeared to be lowest among individuals consuming between 2,565mg and 4,796 mg of sodium a day with higher rates of death in the upper and lower range. The FDA itself notes that average daily consumption - 3,400 mg - is right in the middle of that range. CEI correctly argues: For a minority of the population, reducing dietary sodium can be an effective means of lowering cardiovascular and hypertension risk. But identifying for whom sodium restriction may be beneficial and by how much is something that individuals and their doctors must determine. For the general population, sodium reduction is, by no means, a silver bullet to reducing hypertension and has the potential to increase risks for a large portion of the population. Treat [...]



Surgeon General's Report Mistakenly Treats All Drug Use As a Problem

Fri, 18 Nov 2016 08:35:00 -0500

You might think Surgeon General Vivek Murthy, who acknowledges marijuana's medical utility, has relatively enlightened views on drug policy. But a report he released yesterday reveals that Murthy is utterly conventional in his attitude toward drinking and other kinds of recreational drug use, which he views as a problem to be minimized by the government. Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health claims "addiction is a chronic brain disease" caused by exposure to psychoactive substances, even while acknowledging that the vast majority of people who consume those substances do not become addicted to them. The report describes even low-risk, harmless, and beneficial drug use as "misuse," giving the government broad license to meddle with personal choices through policies aimed at making drugs more expensive and less accessible. Murthy argues that driving down total consumption, rather than focusing on problematic use, is the most effective way to reduce the harm caused by alcohol and other drugs. As he sees it, every drinker and drug user, no matter how careful, controlled, or responsible, is a legitimate target of government intervention. Murthy's report eschews the term substance abuse, explaining that the phrase "is increasingly avoided by professionals because it can be shaming." Instead the report talks about "substance misuse," which "is now the preferred term." But substance misuse is just as judgmental, vague, and arbitrary as substance abuse. In fact, Murthy cannot quite decide what it means. On page 5 of the introduction, he says misuse occurs when people use drugs "in a manner that causes harm to the user or those around them." But elsewhere (including the very next page), the report uses a much broader definition. "Although misuse is not a diagnostic term," Murthy says, "it generally suggests use in a manner that could cause harm to the user or those around them." Could cause harm? That definition is wide enough to cover all drug use. Murthy does seem to think drug use is problematic even when it causes no problems. As an example of drug misuse, Murthy repeatedly cites a 2015 survey in which 25 percent of the respondents, representing 66.7 million Americans, reported that they had engaged in "binge drinking" during the previous month. "By definition," Murthy says, "those episodes have the potential for producing harm to the user and/or to those around them, through increases in motor vehicle crashes, violence, and alcohol poisonings." But the government's definition of a binge—five or more drinks "on an occasion" for a man, four or more for a woman—encompasses patterns of consumption that do not harm anything except the sensibilities of public health officials. If a man at a dinner party drinks a cocktail before the meal, a few glasses of wine during it, and a little bourbon afterward, he is drinking too much, according to Murthy, even if he takes a cab home. By that standard, at least 44 percent of past-month drinkers are misusing alcohol. Murthy also counts all consumption of federally proscribed drugs as misuse, no matter the context or consequences. As far as he is concerned, all 36 million Americans who consumed cannabis last year misused it, even if they lived in states where the drug is legal for medical or recreational purposes (which is now most states). Unauthorized use of prescription drugs also counts as misuse, whether or not harm results. "In 2015," Murthy says, "12.5 million individuals misused a pain reliever in the past year—setting the stage for a potential overdose." That makes the risk sound much bigger than it is. According to the CDC, there were 18,893 deaths invo[...]