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Public Health

All articles with the "Public Health" tag.

Published: Wed, 21 Mar 2018 00:00:00 -0400

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Free Yourself From the Soft Tyranny of Nutrition Studies

Wed, 07 Mar 2018 15:30:00 -0500

"Fish oil or omega-3 supplements won't help people with heart disease," writes nutritionist Alice Callahan in Lifehacker. Her source is a recent JAMA Cardiology meta-study that looked at 10 trials with a total of 77, 917 participants and found that "supplementation with marine-derived omega-3 fatty acids for a mean of 4.4 years had no significant association with reductions in fatal or nonfatal coronary heart disease or any major vascular events." American consumers were told to supplement with omega-3 (and to eat more fish) based on studies of Inuit people in Greenland who eat a lot of omega-3-rich animals and have exceptionally healthy hearts. You should read Callahan's piece at Lifehacker for the full story (turns out, Inuit genes may be different than yours and mine), then check out the JAMA Cardiology paper if you want more. The post you're reading right now, however, is about nutrition studies and why you shouldn't think about them too much. Nutrition studies are confusing and mostly useless for regular people. I do not say that just because a leading nutrition researcher has been exposed for manipulating data for years and years. I say it because most nutrition studies test the validity of small claims that just don't matter in the larger scheme of living a life you love, and because the problems that ail us at the population level cannot be fixed with a bandolier of colloidal silver bullets. There is no "supplement" that can cure heart disease, or melt away obesity, or reverse the effects of inhaling a carcinogen all day, every day, for decades. Take curcumin. For years and years, people have sworn by the yellowing agent in turmeric as an exceptionally potent natural remedy for almost everything. But as Derek Lowe noted last year, "no curcumin trial has ever reported any convincing positive results." Turmeric is a great ingredient. Put it on everything if you like—but because it tastes good, not because it'll change your genetic predisposition to disease or undo the decades you spent treating yourself like garbage. And if you live up north or are worried about bone health, there's no harm in taking the daily recommended amount of vitamin D in supplement form. Just don't expect it to cure your cancer. Our desire for incontestable and universally true claims about nutrition reflects our fear of death and our inability to navigate the Age of Abundance, which I posit began in 1863 with the publication of William Banting's Letter on Corpulence, Addressed to the Public, and extends through today, when you can choose from 13 different types of Cheerios. A wealth of options and of competing health claims, coupled with our ability to consume media everywhere, all the time, seems to have given many of us the impression that living a good life requires reviewing all of that information, deciding whether to believe it, and integrating new products into our lives on a revolving basis. Never mind that most of us aren't capable of critically reviewing the studies that produce these claims (nor are most journalists), or, that many such products are forgettable fads. Remember the pomegranate craze? How about the insanity over echinacea in the late 1990s and early 2000s? We'll probably be talking about coconut oil the same way a few years from now. There is a simpler method for stocking your medicine cabinet and your fridge, and that is to opt out of the micro-efficacy debate entirely. Enjoy things you like in moderation, eat more things you generally resisted as a child (broccoli; I'm talking about broccoli), and don't throw money at the next big thing. Even if it is mildly carcinogenic, bacon alone probably will not kill you, any more than curcumin alone will allow you to live forever, even if is revealed to be mildly anti-inflammatory. For most Americans, there are bigger and more important questions to tackle: Am I getting enough sleep? How can I eat more perishable (read: fresh) foods? Should I be drinking less alcohol? What's a good way to quit smoking cigarettes? How do I work regular exercise into my schedule? If you'r[...]

The 2010s Have Been a Banner Decade for Unintended Consequences

Tue, 06 Mar 2018 11:35:00 -0500

The 2010s are proving to be a banner decade for unintended consequences in America's war on drugs. By now, readers are likely familiar with the policies that bolstered the markets for heroin and then illicit fentanyl: Law enforcement cracked down on doctors who prescribed large amount of painkillers, pharmacists were required to report opioid prescriptions to government databases, and regulators asked the pharmaceutical industry to make pills harder to manipulate. Unable to access snortable or injectable pills, users turned to the black market. As a result, prescription overdose deaths have declined in many states, but fentanyl- and heroin-related overdose deaths have skyrocketed. The New York Times reports that two other substances are also having a moment. "Overshadowed by the Opioid Crisis: A Comeback by Cocaine," reads a Times headline from Monday morning. "Meth, the Forgotten Killer, Is Back. And It's Everywhere," the Grey Lady declared in February. Neither drug really went away—only Quaaludes have ever done that—but they are cheaper and more plentiful than they have been in years, thanks to supply reduction policies enacted by the United States and its allies. The Times tells us, for example, that a study by RAND found that cocaine consumption fell 50 percent between 2006 and 2010. But in the past few years, the cocaine supply from Colombia has climbed to a record high in part because of a peace settlement that includes payments to farmers who stop growing coca. To be in a position to qualify for those payments in the future, many farmers started growing it. As a result...cocaine prices have fallen, leading to an increase in cocaine use in the United States and some European countries. The Economist says farmers in Colombia knew for years before the peace settlement was completed that the government would eventually pay them to stop growing coca, which is a very good reason to not grow anything else until the checks start coming in. Stateside, cocaine is cheap and, in many places, contaminated. Last week, Harm Reduction Ohio reported that cocaine samples across the state tested positive for illicit fentanyl and its analogs, meaning cocaine users with no opioid preference (or tolerance) are playing Russian roulette every time they put schnozz to mirror. People who intentionally mix heroin and cocaine, meanwhile, are increasingly likely to shoot those two plus fentanyl. The result is more dead cocaine users. Back in December, the pseudonymous blogger Jubal Harshaw emailed me with some data from the Centers for Disease Control showing that cocaine overdose deaths involving fentanyl had increased from 23 percent of cocaine deaths in 2015 to 40 percent in 2016. In Maryland, the number of opioid-cocaine deaths has increased dramatically: A large number of overdose deaths have always involved more than one drug. Classically deadly combinations include opioids plus alcohol and opioids plus benzodiazepines. Mainstream reporting seldom covers the crisis with that much nuance, but now's as good a time as any to split hairs, per a recent Vice dispatch: One CDC report found that nearly half of such ODs nationwide involved consumption of drug cocktails, and in New York City, the local health department has repeatedly reported that upwards of 90 percent of overdoses involved the interaction of multiple drugs. In Ohio, meanwhile, a study in 2015 found that the cause of death for 73 percent of overdose victims was linked to more than one drug—and nearly a quarter had four or more drugs listed. As for meth: The Times wants you to know that it's still around and still very bad. This sequence of paragraphs is particularly illuminating: Here in Oregon, meth-related deaths vastly outnumber those from heroin. At the United States border, agents are seizing 10 to 20 times the amounts they did a decade ago. Methamphetamine, experts say, has never been purer, cheaper or more lethal. Oregon took a hard line against meth in 2006, when it began requiring a doctor's prescription to buy the nasal decongest[...]

Is Keto the Cure for Type II Diabetes?

Wed, 28 Feb 2018 14:40:00 -0500

Type II diabetes is one of America's most ubiquitous—and expensive—chronic diseases. Patients often require a suite of pharmaceutical products to manage high blood glucose levels, and the complications that arise over the long term, ranging from loss of vision and limbs to kidney failure and coronary artery disease, strain the resources of patients, their families, and the health care system. The financial strain on insurance companies, employers, and Medicaid and Medicare is even more enormous. A 2013 study in the American Journal of Preventive Medicine put the lifetime direct medical costs for type II diabetes treatment at $124,000 for patients diagnosed in middle age. With nearly 30 million Americans affected by the disease, the American Diabetes Association estimates the national cost of direct diabetes care to be roughly $176 billion per year. But unlike type I diabetes, which is an autoimmune disorder that destroys insulin-producing cells in the pancreas, type II diabetes is a lifestyle disease, and thus reversible. Over time, people with type-II diabetes can be made more receptive to their own insulin, which in turn allows their bodies to effectively clear glucose from the blood without insulin medication. The trick for the vast majority of type II patients is as simple as losing weight. ("The relationship between obesity and diabetes is of such interdependence that the term 'diabesity' has been coined," two diabetes researchers wrote in 2005.) But that "trick" is actually pretty hard. Permanent weight loss without bariatric surgery is practically impossible at the population level. A 2014 study by Kaiser Permanente that looked at incidents of non-surgical diabetes remission in 122,781 patients found that it basically doesn't happen. The most commonly cited number among obesity researchers, meanwhile, is five percent—only five percent of people who lose weight without surgery will succeed in keeping it off over the long term. Now Virta Health, a Silicon Valley startup, has developed a lifestyle modification system that can reverse the markers of type II diabetes. In a study published this month, Virta researchers found that over the course of a year, they were able to achieve remission of symptoms and a cessation of several pharmaceutical products in nearly two hundred patients using a "novel metabolic and continuous remote care model." Virta uses a combination of the ketogenic diet—which involves moderate fat and protein intake combined with very low carbohydrate intake—and frequent remote contact with a physician and a health coach to help patients change their lifestyle and lower their body weight, their blood glucose, and their HbA1c (a biomarker for diabetes). In its February study, 94 percent of patients in the intervention arm of the trial were able either to cease using insulin or to radically lower their insulin dose, and all of the patients in the intervention arm were able to stop using a class of antidiabetic drugs called sulfonylureas, which increase the amount of insulin released by the pancreas. The control group meanwhile, increased its insulin use over the course of that same year. At $370 a month, Virta's model isn't cheap, but it's cheaper over the course of a year than the suite of drug therapies many type II patients require. And if Virta's model is scalable, the long-term savings on dialysis, hospital stays, and management of diabetic foot ulcers could be massive. Already, the company has partnered with Purdue University and Nielsen to offer the Virta system as a covered health benefit to employees with type II diabetes. The company's stated goal is to reverse diabetes in 100 million people by 2025. I recently spoke to James McCarter, Virta's head of research, about the company's treatment model and the broader landscape of type II diabetes care. McCarter received his A.B. in biology from Princeton, and he got his M.D. and a PhD in genetics from Washington University in St. Louis, where he's an adjunct professor at the medical s[...]

Banning Porn Is a Bad Idea. Half a Century of Science Shows It.

Tue, 20 Feb 2018 09:50:00 -0500

Is porn fueling a "public health crisis?" That's the breathless and baseless worry spreading from Utah's legislature to other statehouses (most recently, Florida and Kansas) and the pages of papers like The New York Times. These latest legislative freakouts are part of a rich history of government ignoring science and common sense in an emotional crusade against pornography, be it in the form of photos or cable movies or internet clips. I talked with Fox News correspondent Ellison Barber about the issue last night on Fox News @ Night: I was on @foxnewsnight last night talking to @ellisonbarber about porn being a "public health crisis." Check it out: — Elizabeth Nolan Brown (@ENBrown) February 20, 2018 I also wrote last week for Buzzfeed about how would-be porn prohibitionists such as Times columnist Ross Douthat are part of a long, dumb, and dishonorable tradition—one that always tries to claim that this time it's different—that whatever new medium exists for producing or distributing porn is uniquely dangerous to the youth and degrading to good women. For decades now, this supposed difference has been chalked up to the proliferation of online pornography. Though the 1970s and '80s panic over porn had begun to simmer down by the early '90s, the advent of the internet fueled its slow burn back into a full-scale boogeyman. A 1997 op-ed from Cox News Services fretted over "cybersmut" being easily accessible to teens on their home computers. "For the first time, collectors of deviant material" have a "free place to trade and barter," cautioned one activist. And the new wave of amateur porn was "especially dangerous for children." Just as earlier fears that novels, nudie mags, and Skinemax would ruin our youth have proved unfounded, there's no evidence that internet porn has been destroying millennials—some of whom now have two decades of post-high-school (and first-porn-viewing) data to offer. Read the whole thing here. Two presidential study commissions have found no reason to panic about porn. "Exposure to pornography during adolescence had little effect on persons who later became rapists and child molesters," reported the Associated Press, 48 years ago, on the first commission's findings. "One's family background and his current attitudes...seem much more likely to determine his sexual behavior" than access to porn, reported researchers Harold S. Kant and Michael J. Goldstein in a Psychology Today piece about their work. In fact, "normal adults...reported more experience with pornography as teenagers than any deviant group we studied and, as adults, they continue to see more erotica than sex offenders do." The AP explained that "sexual deviates generally came from homes where pornography was restricted and sex was never discussed," and "most deviates had been severely punished as teenagers by their parents when caught with pornographic material." The federal commission recommended against a porn ban. But the Nixon administration disavowed the report, and the Senate voted on a resolution condemning it as "unscientific." Neither offered any substantive critique of the scientists' work or any reasons to think the research was deficient; it simply didn't fit with their political aims and was thus reflexively rejected as fake news. A Reagan-era commission also found few links between porn consumption and social harm, concluding that watching pornography is "predominantly harmless"; it too was ignored by officials who found its conclusions inconvenient. Again and again, the power of scientific study seems no match for the power of political propaganda. But as Reason's Peter Suderman wrote last week, "prohibition never works, and internet smut is no exception." A new paper from psychologist David Ley tackles "the pseudoscience" behind porn health crisis legislation. "There are people who are experiencing challenges integrating pornography into their life," writes Ley. "Unfortunately, the label of porn addictio[...]

San Francisco to Open Safe Drug Injection Sites by Summer

Tue, 06 Feb 2018 15:50:00 -0500

(image) San Francisco may end up being the first city in the United States to open injection sites where drug addicts can shoot up safely.

Several other major cities are considering proposals. Seattle has been planning injection sites but has had to fight off a ballot initiative to try to stop them. San Francisco is now moving forward with plans to open two sites by July.

Barbara Garcia, director of the city's Department of Public Health, told the San Francisco Chronicle that facilities' operators would be selected from the small group of nonprofits that already operate needle exchange programs in San Francisco. The facilities will be funded from private sources, though Garcia declined to say where specifically the money will come from.

The private operations should ease some heartburn among people who don't like the drug war but aren't fond of the notion of using public dollars to subsidize drug use.

The reason the sites will be privately funded, Garcia explained, is to avoid any potential liability for the City of San Francisco, since the sites will be operating in defiance of state and federal law. San Francisco is already in the Department of Justice's crosshairs because of its status as a sanctuary city for illegal immigrants.

San Francisco has an estimated 22,000 intravenous drug users, and they often shoot up in public. City officials think 85 percent of those drug users would use an injection facility if they could. They also think this could potentially save the city $3.5 million in medical costs, given that it will be overseen by professionals and will hopefully reduce the need to call emergency responders.

Some lawmakers and prosecutors complain that allowing for drug injection facilities "normalizes" heroin use. But that ship has long sailed. Studies have shown that in practice, safe injection sites reduce overdoses and help marginalized users find access to health care, and that they do not lead to more drug use, drug trafficking, or crime. Other Western countries have opened such facilities; as overdose deaths climb, it's time America tried this option too.

E-Cigarettes Can Be Lifesavers

Wed, 24 Jan 2018 00:01:00 -0500

This week the National Academies of Sciences, Engineering, and Medicine (NASEM) weighed in on the question of whether e-cigarettes are a public health menace or a public health boon. The answer is yes, according to a NASEM report published on Tuesday. The report, which was sponsored by the Food and Drug Administration (FDA), concludes that "e-cigarettes cannot be simply categorized as either beneficial or harmful to health." While that is true in principle, the report gives too much weight to scenarios in which these products could be harmful, even while confirming that they dramatically reduce exposure to toxins and carcinogens for smokers who switch to them. NASEM's advice is important because it will guide the FDA as the agency decides how to regulate the vaping industry, which last year got a four-year reprieve from rules that threatened to drive the vast majority of companies out of business. The demands that the FDA ultimately imposes on manufacturers of vaping equipment and liquids will affect the options available to consumers and their knowledge of them, which in turn will determine the extent to which they take advantage of products that could save their lives. The NASEM report, which is the work of a committee chaired by University of Washington toxicologist David Eaton, acknowledges the harm-reducing potential of e-cigarettes. "E-cigarette aerosol contains fewer numbers and lower levels of most toxicants than smoke from combustible tobacco cigarettes does," Eaton et al. say. "Laboratory tests of e-cigarette ingredients, in vitro toxicological tests, and short-term human studies suggest that e-cigarettes are likely to be far less harmful than combustible tobacco cigarettes." When people who otherwise would be smoking use e-cigarettes instead, that represents an unambiguous gain from a public health perspective, which seeks to minimize disease and preventable death. "If e-cigarette use by adult smokers leads to long-term abstinence from combustible tobacco cigarettes," the report says, "the benefit to public health could be considerable." But Eaton and his colleagues worry that e-cigarettes also could increase tobacco-related morbidity and mortality if they encourage teenagers to smoke. Depending on how big that effect is, they say, it might even outweigh the benefit from smoking cessation among adults. That concern seems wildly implausible in light of current trends. Cigarette smoking by teenagers has continued to fall despite a surge in experimentation with vaping, and last year it reached the lowest level ever recorded by the Monitoring the Future Study, which began surveying high school students in 1975. Two other factors make it unlikely that significant numbers of teenagers become smokers after getting hooked on nicotine in e-cigarettes. The vast majority of nonsmoking teenagers who vape do so only occasionally, and most of them use nicotine-free e-liquids. Against these facts, the NASEM report cites studies that find teenagers who try vaping are more likely than those who don't to subsequently try smoking. According to Eaton et al., these studies amount to "substantial evidence that e-cigarette use increases risk of ever using combustible tobacco cigarettes among youth and young adults." As the report acknowledges, however, these observational studies do not distinguish between correlation and causation. They may simply show that teenagers who are inclined to try vaping are also inclined to try smoking. Such research cannot tell us how many of these teenagers become regular smokers or whether they would have experimented with tobacco even if e-cigarettes did not exist. Under the collectivist calculus prescribed by the Family Smoking Prevention and Tobacco Control Act, Eaton et al. note, it is not enough to show that e-cigarettes are much less hazardous than the conventional kind and therefore offer a big benefit to smokers who might want to switch. The FDA also must be [...]

The Feds Are Willing to Let More Medical Workers Treat Opioid Addicts. Now the States Need to Step Up and Allow It.

Tue, 23 Jan 2018 15:30:00 -0500

The Drug Enforcement Administration (DEA) announced today that it will begin granting waivers making it easier for nurse practitioners and physician assistants to administer a drug designed to wean people off prescription painkillers and heroin without inducing withdrawal. Under the new rule, they'll be able to give patients the drug—buprenorphine—in outpatient settings without requiring that care providers register as narcotics treatment programs. If the state where they practice allows it, nurse practitioners will also be allowed to administer the drug without a physician on the premises. The Food and Drug Administration approved buprenorphine in 2002. That same year, the Department of Health and Human Services created a waiver program that would allow physicians to administer the drug in a primary care setting. The waiver system was designed to provide an alternative to the regulatory obstacles physicians must navigate to set up a treatment center. Establishing a federally approved treatment program requires you to submit an application to both the DEA and the Food and Drug Administration, plus a state regulatory agency. Applicants must then be interviewed and have their facilities inspected by all three agencies. The waiver provision—which also involves a fair amount of paperwork—was intended to expand treatment access to Americans in rural areas. But nurse practitioners and physician assistants weren't allowed to apply for the waivers. In 2016, the Comprehensive Addiction and Recovery Act changed the waiver eligibility language from "qualifying physician" to "qualifying practitioner." The DEA's notice states that the definition of "qualifying practitioner" will include physicians, physician assistants, and nurse practitioners until October 2021, at which point the language will have to be reauthorized. Under the new regulations, any nurse practitioner or physicians assistant who is licensed to administer a schedule III drug can now apply for a waiver. (Schedule III drugs have moderate potential for abuse and can be mildly habit forming.) They will be required to undergo 24 hours of training, and they will need a physician's authorization if their state requires them to work under a doctor's supervision. All physician assistants require such supervision, but 22* states and the District of Columbia allow nurse practitioners "full practice" status, meaning they can prescribe drugs independently of a medical doctor. Unfortunately, many of the states hit hardest by opioids do not allow nurse practitioners this independence. Pennsylvania, New Hampshire, Kentucky, West Virginia, and Ohio had the highest overdose death rates in 2016. Of those five, only New Hampshire allows nurse practitioners to prescribe independently. That blunts the impact of today's announcement. According to the DEA, "rural providers of buprenorphine report a demand far beyond their capacity and say they lack the resources to adequately support themselves and patients in treatment." A 2017 report from the National Rural Health Association revealed that only 39 percent of rural counties have a waivered physician. Meanwhile, a 2016 survey found that 36 percent of waivered physicians who are not treating the maximum number of patients allowed by Health and Human Services say it's because they lack the time to treat additional patients. A 2015 research review by the Kaiser Family Foundation found that nurse practitioners "can manage 80–90% of care provided by primary care physicians" and that primary care outcomes between nurse practitioners and physicians are roughly identical. The DEA took a step in the right direction today. Now states need to make it easier for non-physicians to keep their patients alive. *Correction: This post erroneously stated that nurse practitioners have full practice authority in 21 states; they currently have full practice authority in 22 states.[...]

Good Samaritans in Southern California Cited for Feeding the Homeless

Tue, 16 Jan 2018 11:45:00 -0500

Police in the City of El Cajon (near San Diego) spent part of the Martin Luther King holiday weekend citing people for feeding the homeless. Now those people are fighting back. On Sunday, police cited about a dozen people—including one 14-year-old girl—with misdemeanor charges for feeding homeless people in a public park. El Cajon passed this law as an "emergency" in October, claiming it was needed due to a rise in Hepatitis A in Southern California last year, an outbreak that has hit the homeless especially hard. Hepatitis A can be spread quite a few ways among those who live unsanitary lives (as the homeless typically do), but it seems unlikely that it's a result of non-homeless people giving homeless people food. El Cajon's City Council is abusing a health scare to make it harder for the public to provide assistance to homeless people because they want them off the streets and into managed shelters and churches. This "solution" then criminalizes voluntary charitable interactions between citizens for not fitting into the model of how the city wants people to behave. High school teacher Matthew Schneck shared his citation on Twitter: Today I got arrested for feeding the homeless in Wells Park in El Cajon. The City of El Cajon has made it illegal to share food with homeless people. "...One has a moral responsibility to disobey unjust laws" —Martin Luther King Jr. — Matthew Schneck (@matthew_schneck) January 15, 2018 Listen to El Cajon City Council member Bob McClellan complain about people finding their own ways of helping the homeless and not complying with the city's master plan (via the San Diego Union Tribune): Councilman Bob McClellan said the city has published a list of churches where people can get food and where activists can help serve food, in an effort to contain food sharing to closed and sanitary environments. "They don't have to feed them in the park where it could cause a problem according to the health authorities," McClellan said. "If they want to help the homeless, look at the list of places. All they have to do is read the list." The group responsible for the event on Sunday knew full well what was going to happen. The group—named Break the Ban—is defying the ordinance on purpose. They and their lawyers are now going to use the citations to challenge the constitutionality of the law itself. This was their fourth event feeding the homeless in defiance of the law. They're planning another event for January 27. The American Civil Liberties Union (ACLU) describes the ban as "unconstitutional and unnecessarily cruel." They're claiming the sharing ban violates freedom of speech. It may seem strange to say that giving food is a form of speech, but the ACLU argues that the city is picking and choosing who can express charitable attitudes toward the homeless and the circumstances of how they may do so: "By prohibiting food sharing only when done for 'charitable purposes,' El Cajon is regulating food sharing because of its expressive content, punishing only those who share food to express their religious or political beliefs in ministry or charity but not those who share food for other purposes," said David Loy, ACLU SDIC's legal director. "If charitable appeals for funds are within the protection of the First Amendment, the same is true for charitable giving, whether of money or food." El Cajon is hardly alone here. Atlanta has targeted good Samaritans for feeding the homeless in public spaces, as have such cities as Orlando, Tampa, Houston, and Philadelphia, among others. Watch ReasonTV's video from 2012 about Philadelphia's attempt to stop people from feeding the homeless: src="" allowfullscreen="allowfullscreen" width="560" height="340" frameborder="0">[...]

Adolescent Smoking Rates Reach Historic Lows, Despite Vaping's Popularity

Thu, 14 Dec 2017 14:30:00 -0500

Survey data released today show that cigarette consumption by teenagers has reached "historic lows," nothwithstanding warnings that the rising popularity of vaping would make smoking cool again. In an interview with The New York Times, Thomas Glynn, former cancer science director at the American Cancer Society, called the dramatic decline in adolescent smoking since the late 1990s "an astounding accomplishment in public health." But he added that "I think we have to have alarms out" about adolescent vaping, which may yet lead to a surge in smoking. Don't give up fear!

The share of high school seniors reporting past-month cigarette use in the Monitoring the Future Study has fallen from 36.5 percent in 1997 to 9.7 percent this year—a 73 percent drop. The declines among younger students have been even more dramatic: from 30.4 percent in 1996 to 5 percent this year among 10th-graders (an 84 percent drop) and from 21 percent in 1996 to 1.9 percent this year among eighth-graders (a 91 percent drop). These downward trends have continued even as adolescent experimentation with e-cigarettes has become increasingly common.

(image) The survey puts past-month vaping this year at 16.6 percent among 12th-graders, 13.1 percent among 10th-graders, and 6.6 percent among eighth-graders. Those rates are up significantly since last year but about the same as in 2015 and lower than they were in 2014, when the survey first asked about vaping. Earlier data from the CDC's National Youth Tobacco Survey indicate that past-month e-cigarette use by teenagers tripled between 2011 and 2013.

One reason that teenagers who vape have not gotten hooked on nicotine and graduated to combustible cigarettes is that most of them are not consuming nicotine. In the Monitoring the Future Study, 58 percent of 12th-graders who reported vaping in the previous month said their e-liquid contained "just flavoring." Even those who vape nicotine rarely do it often enough to develop a habit. The Monitoring the Future Study does not report numbers for daily vaping. But in the National Youth Tobacco Survey, less than 1 percent of middle school students and less than 3 percent of high school students report vaping on 20 or more days in the previous month.

Another possible reason why adolescent vaping and smoking rates have been moving in opposite directions, of course, is that teenagers who otherwise would be smoking are vaping instead. Since the hazards of vaping pale beside the hazards of smoking, such substitution also should count as an "accomplishment in public health."

Goat Yoga Gets Baaaaaa-nned

Fri, 01 Dec 2017 16:12:00 -0500

Good, old-fashioned goats and the ancient Hindu practice of yoga are two things that don't seem to go together.

(image) And yet, last year, a small farm in Corvallis, Oregon started offering classes that combined the two. Goat yoga is exactly what it sounds like: the practice of yoga in the presence of goats.

Soon these classes had a 900-person waiting list for an hour of ritual calisthenics with a bunch of horned ruminants. Within a year, the unlikely trend had spread across the nation.

"We would go through the different asanas and the different flows," explains Amanda Bowen, a goat-yoga instructor with GoatToBeZen in Maryland, "and the goats will come around and interact with people as we're doing the class."

And then the unstoppable force of goat yoga locked horns with the immovable object of the Washington, D.C. Department of Health. When Congressional Cemetery Director Paul Williams applied for a livestock permit in the District of Columbia, he was greeted by four lawyers "ready to throw every curve ball they possibly could at me to prevent goat yoga."

But goat springs eternal. Since Manchester, CT. reversed its ban late last summer, the only place in the country where risk-averse municipal bureaucracies are undermining this fitness-to-farm trend threat is the nation's capital.

Produced, shot, narrated, and edited by Todd Krainin.

J.S. Bach, BWV 536 Prelude and Fugue in A Major, performed by James Kibbie
J.S. Bach, BWV 546 Prelude and Fugue in C Minor, performed by James Kibbie
Front Porch Sitter, by Audionautix

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Public Health Nannies Want to Stop You From Boozing. Why? Because Cancer

Thu, 09 Nov 2017 15:45:00 -0500

The great thing about modern epidemiology is that you can find multiple studies to justify just about any public health policy you happen to favor. If you have a bias, there is plenty of confirming evidence from which to cherry pick. Now come the doyens of the American Society of Clinical Oncology (ASCO) with their statement on alcohol and cancer. ASCO cites research estimating "3.5 percent of all cancer deaths are attributable to drinking alcohol" in the United States. That would mean some 21,000 of the 596,000 Americans who died of cancer in 2016 were killed by cancers associated with alcohol consumption. In comparison, smoking tobacco is estimated to cause 32 percent of all cancer deaths (about 120,000 deaths). Drinking booze is specifically associated with oropharyngeal and larynx cancer, esophageal cancer, hepatocellular carcinoma, breast cancer, and colon cancer. The group treats consuming alcohol as a pure public health problem to which the only solutions are various forms of prohibition. They recommend regulating alcohol outlet density; increasing alcohol taxes and prices; maintaining limits on days and hours of sale; enhancing enforcement of laws prohibiting sales to minors; restricting youth exposure to advertising of alcoholic beverages; and resisting further privatization of retail alcohol sales in communities with current government control. ASCO tells only part of the story about the health effects of drinking beer, wine, and spirits. There appear to be plenty of studies that find hard drinking increases an individual's risk of cancer. But the devil is in the cherry picking. Lots of research finds light to moderate drinking involves a trade-off between a slightly higher risk of cancer and significantly lower risk of cardiovascular disease. Of course, the folks at ASCO are aware of this issue. In an attempt to deal with it, the ASCO statement cites a line of research that argues that "the benefit of alcohol consumption on cardiovascular health likely has been overstated." For example, one 2005 study referenced by ASCO warned that due to confounding effects, "nonrandomized studies about the health effects of moderate drinking should be interpreted with caution." As far as I can tell, the ASCO statement itself cites meta-analyses of mostly nonrandomized studies in support of its claims that drinking alcohol causes cancer. Gander, meet sauce. Claims for the cardiovascular benefits of moderate alcohol consumption remain somewhat controversial. That being said, a huge new meta-analysis in the Journal of the American College of Cardiology (JACC) probing the relationship of alcohol consumption to all-cause, cardiovascular, and cancer-related mortality in U.S. adults finds significant health benefits from light to moderate drinking. To some extent there is a trade-off between reduced cardiovascular risks and higher cancer risks. The JACC researchers subdivided drinkers into six groups: lifetime abstainers, lifetime infrequent drinkers, former drinkers, and light drinkers (fewer than 3 drinks per week), moderate drinkers (more than 3 and less than 14 drinks per week for men and less than 7 for women), or heavy drinkers (more than 14 per week for men and more than7 for women). Binge drinking was defined as five or more drinks on one or more days per week. ASCO asserted that "even modest use of alcohol may increase cancer risk." However, Medscape reports of the JACC study that "light and moderate alcohol intake predicted reduced all-cause, cardiovascular, and cancer mortalities in both men and women." That's right, light to moderate drinkers not only had lower risks of dying from any cause or from cardiovascular diseases, but also lower risks of dying from cancer. On the other hand, the JACC researchers found "the highest levels of alcohol intake wer[...]

Treating Drug Overdoses As Homicides May Be Deadly

Tue, 07 Nov 2017 17:30:00 -0500

Because prompt medical attention is crucial in saving people from potentially fatal opioid overdoses, 40 states and the District Columbia have enacted "911 Good Samaritan" laws that shield bystanders from some drug-related charges when they call for help. But as a new report from the Drug Policy Alliance (DPA) notes, a countervailing legal trend undermines efforts to keep drug users alive by encouraging homicide prosecutions when they die. "The most common reason people cite for not calling 911 in the event of an overdose is fear of police involvement," says the report, which was written by DPA senior staff attorney Lindsay LaSalle. "The only behavior that is deterred by drug-induced homicide prosecutions is the seeking of life-saving medical assistance." Treating fatal overdoses as homicides therefore makes them more likely. DPA found that 20 states have laws that specifically address drug-induced homicide, while others "charge the offense of drug delivery resulting in death under various felony-murder, depraved heart, or involuntary or voluntary manslaughter laws." Possible sentences range from two years to life, which is the minimum penalty in six states. Under federal law, drug distribution resulting in death or serious injury is punishable by 20 years to life in prison. These laws have been on the books since the 1980s, but prosecutions seem to have risen sharply in recent years, judging from mentions in news stories, which by DPA's count more than tripled between 2011 and 2016, from 363 to 1,178. Prosecutions were reported in all but four states and were especially common in the Midwest. The highest counts during this period were in Wisconsin (882), Ohio (577), Illinois (486), and Minnesota (433). The surge in prosecutions looks like a reaction to the dramatic increase in heroin-related deaths since 2010, a trend fostered by the crackdown on prescription narcotics and the increasingly common use of fentanyl, a highly potent synthetic opioid, as a heroin adulterant or substitute. Although politicians may claim that drug-induced homicide prosecutions are aimed at high-level dealers, the targets are usually people close to the decedent. Their role in "distributing" the drug may be limited to buying it for someone else or sharing a stash. When money changes hands, the dealers are often selling just enough to finance their own habits. "The vast majority of charges," LaSalle writes, "are sought against those in the best positions to seek medical assistance for overdose victims—family, friends, acquaintances, and people who sell small amounts of drugs, often to support their own drug dependence." LaSalle cites several studies to support that conclusion. A 2002 analysis of 32 drug-induced homicide prosecutions, published in the New Jersey Law Journal, found that "25 involved prosecution of friends of the decedent who did not sell drugs in any significant manner." According to a 2017 report by a Wisconsin TV station that looked at the 100 most recent prosecutions for drug-induced homicide in that state, "nearly 90% of those charged were friends or relatives of the person who died, or the lowest people in the drug supply chain." When the Chicago Tribune examined drug-induced homicide cases filed between 2011 and 2014, it found "the defendant was typically the last person who was with the person who overdosed." These trends make sense when you consider the practical challenges of tying a defendant to a batch of drugs that figured in someone's fatal overdose. The last link in the supply chain or a fellow drug user is an easier target than someone who never met the decedent. But prosecuting those closest to people who die from overdoses (or, more typically, from combinations of drugs) is perverse as a strategy for minimizing fatal[...]

Brickbat: The Tick

Fri, 15 Sep 2017 04:00:00 -0400

(image) Members of Japan's Miyazaki prefectural government say that in retrospect it was a bad idea to bring a deadly tick with them to a press conference to warn about the dangers of a tick-borne disease. The tick got away, and even with help from the reporters at the press conference, officials were unable to find it.

Fixating on Adolescent Vaping Could Be Deadly for Adult Smokers

Thu, 07 Sep 2017 14:50:00 -0400

The first surgeon general's report on e-cigarettes, published last December, could have highlighted the enormous harm-reducing potential of products that simulate smoking but do not contain tobacco or burn anything. Instead Surgeon General Vivek Murthy sounded the alarm about adolescent vaping, which he called "a major public health concern." A critique of Murthy's report, published online yesterday by Harm Reduction Journal, shows how dangerously misguided his concerns were. "The majority of e-cigarette use among US youth is infrequent and experimental, and minimal among never-smoking youth," note Italian internist and tobacco researcher Riccardo Polosa and his co-authors. "Additionally, the majority of the very small proportion of US youth who do use an e-cigarette frequently are actually using e-cigarettes that do not contain nicotine." Polosa et al. also point out that "the increasing prevalence of e-cigarette use between 2010 and 2015 has coincided with the sharpest declines in the smoking rate among US youth and young adults on record." Murthy, who was removed from his post in April but has not been permanently replaced yet, focused on the share of teenagers who report using an e-cigarette in the previous month, which rose "an astounding 900 percent" (from 1.5 percent to 16 percent) between 2011 and 2015, as measured by the National Youth Tobacco Survey (NYTS). Digging more deeply into the survey data, Polosa et al. show that relatively few teenagers vape frequently and almost all of those who do are current or former smokers. In the 2015 NYTS, for example, just 0.6 percent of middle school students and 2.5 percent of high school students reported vaping on 20 or more days in the previous month. According to the 2014 Monitoring the Future Study (MTF), less than 1 percent of teenagers who vape that often are never-smokers. The MTF data also indicate that most adolescents who vape use nicotine-free e-liquids, which makes Murthy's fear that they will get hooked on the drug and later graduate to smoking seem even more fanciful. On the face of it, nothing like that seems to be happening. As Polosa and his colleagues point out, "the increasing rate of ever-use of e-cigarettes among US youth has coincided with the sharpest declines in youth smoking rates in many decades." That is true for young adults as well as teenagers. The coincidence of these opposing trends does not necessarily mean that e-cigarettes have hastened the decline in smoking. But it is a plausible possibility that should not be overlooked by public health officials who want to reduce smoking-related morbidity and mortality, since e-cigarettes are far less hazardous than the conventional kind. Even in the rare instances where teenagers who have never tried tobacco take up vaping, they are far better off in terms of health risks if they otherwise would be smoking. As Polosa et al. note, "e-cigarettes may have the potential to reduce the likelihood of smoking initiation among youth who may be especially at risk for initiating smoking in the absence of e-cigarettes." The studies that Murthy cited as evidence that vaping leads to smoking show only that teenagers who try the former are more likely to try the latter. "There was no evidence that adolescents were regular e-cigarette users at baseline," Polosa et al. note, "and no evidence that they were smoking cigarettes regularly at follow-up." Even if some teenagers go through a vaping phase before becoming regular smokers, that does not necessarily mean the experience of vaping makes them more inclined to smoke. An attraction to both forms of nicotine consumption could be a function of personality and circumstance. If e-cigarettes are a gateway to the real thin[...]

FDA Lies About Vaping While the CDC Inches Toward the Truth

Thu, 31 Aug 2017 14:15:00 -0400

Between 2011 and 2016, according to survey data from the U.S. Centers for Disease Control and Prevention, cigarette smoking by teenagers fell by half, cigar smoking fell by a third, pipe smoking fell by two-thirds, and smokeless tobacco use fell by a quarter. Yet according to the Food and Drug Administration, there were "no significant declines in overall high school tobacco use" during that period. How is that possible? Let me answer that riddle by posing another one. If you call an e-cigarette a tobacco product, and the incidence of past-month vaping among high school students more than sextupled from 2011 to 2016, how does that affect the trend in overall tobacco use? The answer is that it does not affect the trend in overall tobacco use at all, because calling an e-cigarette a tobacco product does not make it a tobacco product. Yet that is what FDA does, partly for regulatory reasons. E-cigarette fluid often contains nicotine derived from tobacco, which supposedly transforms a tobacco-free product into a tobacco product, giving the FDA authority to regulate it. The FDA maintains that pretense even when reporting what is happening in the real world. The result, as Boston University public health professor Michael Siegel notes on his tobacco policy blog, is an alternative reality where dramatic declines in adolescent tobacco consumption never happened. The CDC plays the same game, falsely claiming "current use of any tobacco product did not change significantly" among high school students from 2011 to 2016. This blatant misrepresentation magnifies a problem (underage tobacco use) that the FDA and the CDC are charged with addressing, making their work seem more urgent and more worthy of funding. It also conflates e-cigarettes, a noncombustible, tobacco-free alternative to conventional cigarettes, with products that are far more dangerous, obscuring the enormous harm-reducing potential of this innovation. By lumping e-cigarettes in with tobacco products, the FDA and CDC may hope to scare kids away from them. But the message to current smokers—that they might as well keep puffing away, since all these nicotine sources are essentially the same—is potentially deadly. A new CDC webpage about e-cigarettes gives some ground on that score, conceding that "e-cigarettes have the potential to benefit adult smokers who are not pregnant if used as a complete substitute for regular cigarettes and other smoked tobacco products." But by insisting that e-cigarettes be a "complete substitute," the CDC dismisses the health benefits of smoking less, even if the number of cigarettes per day does not fall to zero. "Dual use is not an effective way to safeguard your health," the CDC says. "Because smoking even a few cigarettes a day can be dangerous, quitting smoking completely is very important to protect your health." This slippery formulation deliberately obscures the fact that smoking a few cigarettes a day is less dangerous than smoking a pack or two a day. If e-cigarettes help smokers make that change, they are reducing tobacco-related harm. The CDC's discussion of how the health hazards of vaping compare to those of smoking is similarly misleading. "Are e-cigarettes less harmful than regular cigarettes?" it asks. "Yes—but that doesn't mean e-cigarettes are safe. E-cigarette aerosol generally contains fewer toxic chemicals than the deadly mix of 7,000 chemicals in smoke from regular cigarettes. However, e-cigarette aerosol is not harmless. It can contain harmful and potentially harmful substances, including nicotine, heavy metals like lead, volatile organic compounds, and cancer-causing agents." Sadly, it counts as an improvement that the CDC is willing t[...]