In defiance of dire predictions, children haven’t been sent to workhouses and women haven’t been chained to utensils after the GOP gained strength in the House and the Senate. And Vivek Murthy, the unabashed Obamaphile, was finally confirmed Surgeon General.
To be honest, I always thought the controversy surrounding Murthy’s nomination because of his stance on gun control was rather daft. Stopping doctors from pontificating over guns, such as the Docs versus Glocks legislation, is like banning me from trying to convert Pope Francis to Hinduism. The legislation is a parody not just for its own sake but because what it seeks to prevent is parody as well.
Murthy’s first challenge is to raise the position of the Surgeon General from that tokenism of a career UN bureaucrat to something vaguely useful. Which means Murthy must resist the call of banality, the banality of ideology and the ideology of making all of mankind’s imperfections public health problems.
Continue reading “Advice to Vivek Murthy: Be Nonpartisan, Use Common Sense and Move Americans”
Filed Under: THCB
Tagged: Gun Control, Project Locomotion, public health, Surgeon General, Vivek Murthy
Dec 18, 2014
Why are they so afraid of public health types who want to do something about the carnage caused by guns in America?
Vik Khanna is the latest man with a gun to write squealing in terror before the kale crunching, fitbit wearing hordes of public health types who he is somehow sure are out to disarm him and, even more hilariously, have any chance of doing so.
Vik, buddy, no one and especially the roughly 28 folks in public health not completely distracted by their lack of funding and inability to secure tenure is capable of doing anything that will pry your gun from your warm-blooded grip. There is no political movement to take away anyone’s guns. The NRA is the mightiest lobbying outfit in these United States and the best Mike Bloomberg or Bill Gates are going to be able to do is to get the anti-gun lobby a few more op-eds and soundbites.
Vik stop being afraid of your critics. You hold all the bullets er … cards. Time to think harder. Do public health folks have anything to offer that might reduce the mayhem while letting you hunt deer or shoot partridge or blast targets or whatever it is you and your son like to do with your guns?
Well yes in fact there are some things from the minds of the unarmed weenies of public health worth your consideration and that of your open-carry pals.
Continue reading “What Is It With Gun Rights Proponents?”
Filed Under: OP-ED, THCB
Tagged: Gun Control, NRA, public health
Sep 16, 2014
I am a public health professional, educated at the vaunted Johns Hopkins University Bloomberg School of Hygiene and Public Health. I like guns, and I believe the Second Amendment clearly secures the rights of individuals to own firearms.
You read that correctly. I am a public health professional.
And I like guns.
This make me a heretic in American public health, where embracing firearms and the rights of gun owners is a gross violation of orthodoxy.
As a society, our focus on guns and not gun users derives from the shock of mass killings, such as those in Newtown, CT, Aurora, CO, Virginia Tech, and Norway, which has some of the strictest gun control laws on the planet. Mass killings, however tragic, get distorted by saturation media hysterics and 24-hour political grandstanding. What gun opponents refuse to discuss is the precipitous fall in violent crime and deaths by firearms over the past 20 years, and how it coincides with an equally dramatic increase of guns in circulation in the US.
While that isn’t cause and effect, the association is certainly curious.
In 2013, the Institute of Medicine, at the behest of the Centers for Disease Control, produced a report on firearms violence that has been ignored by the mainstream media. The upshot: defensive use of firearms occurs much more frequently than is recognized, “can be an important crime deterrent,” and unauthorized possession (read: by someone other than the lawful owner) of a firearm is a crucial driver of firearms violence.
That report went away for political reasons. Translation. Nobody wanted to talk about it because it raised more questions than it answered.
Continue reading “Why Public Health Needs a New Gun Doctrine”
Filed Under: OP-ED, THCB
Tagged: Gun Control, Institute of Medicine, Newton, public health, Vik Khanna, Virginia Tech, Wellness
Sep 11, 2014
Lately, stories about outbreaks seem to be spreading faster than the diseases themselves. An outbreak of measles in Ohio is just part of an 18-year high of U.S. cases. Meanwhile, polio continues to circulate in Pakistan, Afghanistan, and Nigeria, while spreading to other countries, like Cameroon, Equatorial Guinea, and Syria, leading the World Health Organization to declare a “Public Health Emergency of International Concern” last month.
The Role of Globalization
As recent threats of H5N1, H1N1, and MERS attest, the increasingly global nature of infectious diseases presents serious risks. Foreign tourists, Americans returning home from international travel, immigrants, and refugees can all expose countries to disease.
With modern transportation shuttling people and products to nearly any part of the world in a matter of hours, the volume of these comings and goings is unprecedented. In 2008, approximately 360 million travelers entered the United States, which also takes in about 50,000 refugees annually.
It should be unsurprising, then, that the Ohio measles outbreak started when unvaccinated Amish missionaries visited the Philippines, then returned home. Infected persons spread the disease to others within their largely unvaccinated communities. The last naturally occurring U.S. outbreak of polio occurred in similar fashion: An outbreak in the Netherlands spread to Canada in 1978, then to the United States the following year, all among unvaccinated Amish populations across four states.
Compared to the United States, nations experiencing social unrest and political conflict face even more serious obstacles to preventing infectious disease.
Strife can interrupt routine vaccination campaigns, as is largely happening with polio. For example, the largest numbers of polio cases last year were in Somalia and Pakistan. Refugees and other displaced populations without health care access can create fertile settings for disease spread, especially if they’re not protected by vaccination. Health workers involved in vaccination campaigns can become targets of violence. And in some areas—Nigeria, for example—religious leaders haveconvinced their followers that the polio vaccine is a biological weaponpromulgated by the West.
For the most part, the United States doesn’t face these barriers. In America, vaccination is more of a choice. Unfortunately, some Americans are putting themselves, their families, and their communities at risk by choosing not to get vaccinated. If those who opt out of vaccination travel to areas where diseases are more common or come in contact with individuals arriving from such areas, they’ll be at risk of becoming ill from otherwise preventable diseases. Continue reading “An Outbreak of Outbreaks”
Filed Under: Uncategorized
Tagged: Anti-vaxxers, CDC, H5N1, Measles, MERS, Outbreak, Polio, public health, risk
Jun 11, 2014
Last year, about 43 million people around the globe were injured from the hospital care that was intended to help them; as a result, many died and millions suffered long-term disability. These seem like dramatic numbers – could they possibly be true?
If anything, they are almost surely an underestimate. These findings come from a paper we published last year funded and done in collaboration with the World Health Organization. We focused on a select group of “adverse events” and used conservative assumptions to model not only how often they occur, but also with what consequence to patients around the world.
Our WHO-funded study doesn’t stand alone; others have estimated that harm from unsafe medical care is far greater than previously thought. A paper published last year in the Journal of Patient Safety estimated that medical errors might be the third leading cause of deaths among Americans, after heart disease and cancer.
While I find that number hard to believe, what is undoubtedly true is this: adverse events – injuries that happen due to medical care – are a major cause of morbidity and mortality, and these problems are global. In every country where people have looked (U.S., Canada, Australia, England, nations of the Middle East, Latin America, etc.), the story is the same.
Patient safety is a big problem – a major source of suffering, disability, and death for the world’s population.The problem of inadequate health care, the global nature of this challenging problem, and the common set of causes that underlie it, motivated us to put together PH555X.
It’s a HarvardX online MOOC (Massive Open Online Course) with a simple focus: health care quality and safety with a global perspective.
Continue reading “Harvard MOOC: Patient Safety and Quality with Ashish Jha”
Filed Under: THCB
Tagged: Ashish Jha, EduX, Global Health, Medical Education, MOOC, Patient Safety, PH55X, public health, Quality
May 15, 2014
Antibiotic resistance — bacteria outsmarting the drugs designed to kill them — is already here, threatening to return us to the time when simple infections were often fatal. How long before we have no effective antibiotics left?
It’s painfully easy for me to imagine life in a post-antibiotic era. I trained as an internist and infectious disease physician before there was effective treatment for HIV, and I later cared for patients with tuberculosis resistant to virtually all antibiotics.
We improvised, hoped, and, all too often, were only able to help patients die more comfortably.
To quote Dr. Margaret Chan, Director General of the World Health Organization: “A post-antibiotic era means, in effect, an end to modern medicine as we know it.”
We’d have to rethink our approach to many advances in medical treatment such as joint replacements, organ transplants and cancer therapy, as well as improvements in treating chronic diseases such as diabetes, asthma, rheumatoid arthritis and other immunological disorders.
Treatments for these can increase the risk of infections, and we may no longer be able to assume that we will have effective antibiotics for these infections.
Last September, CDC published our first report on the current antibiotic resistance threat to the United States.
The report conservatively estimates that each year, at least 2 million Americans become infected with bacteria resistant to antibiotics, and at least 23,000 die. Another 14,000 Americans die each year with the complications of C. difficile, a bacterial infection most often made possible by use of antibiotics. WHO has just issued their report on the global impact of this health threat.
It’s a big problem, and one that’s getting worse. But it’s not too late. We can delay, and even in some cases reverse the spread of antibiotic resistance.
Continue reading “The End of Antibiotics. Can We Come Back from the Brink?”
Filed Under: OP-ED, THCB
Tagged: Antibiotic resistance, C. difficile, CDC, CRE, federal budget, FutureMed, MRSA, National Healthcare Safety Network (NHSN), post-antibiotic era, public health, Tom Frieden
May 5, 2014
Ever since 1969, when the IRS established the “community benefit” standard for hospital tax exemption, nonprofit hospitals have been able to achieve federal tax exemption without any precise accountability for the benefits they provided.
The ACA’s passage, however, ushered in significant changes to federal tax-exemption standards for hospitals.
The new § 501(r) of the Internal Revenue Code requires hospitals to take numerous measures, including establishing written financial assistance policies, limiting the amount charged to patients eligible for financial assistance, and limiting their use of “extraordinary collection actions” against patients.
These requirements responded to concerns about how some purportedly “charitable” hospitals treated uninsured patients and, more generally, hospitals’ lack of transparency regarding indigent care.
They stop well short, however, of requiring hospitals to provide any particular quantum of free care to patients unable to pay.
Section 501(r) also incorporates a different tack, requiring that at least once every three years, a hospital conduct a “community health needs assessment” (CHNA) and adopt an “implementation strategy” to respond to the needs identified by the assessment.
The needs assessment requirement is novel as a matter of federal tax policy, but is similar to mandates previously existing in a number of states.
As announced in the statute and fleshed out in Proposed Regulations issued by the IRS in April 2013, the CHNA requirement entails a series of steps.
In identifying and prioritizing community health needs, a hospital must take into account “input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health.”
Once the assessment is completed, the hospital must make a report on it “widely available to the public” and adopt an “implementation strategy” to meet the community health needs it identified.
Continue reading “Health Reform and the Mission of Nonprofit Hospitals”
Filed Under: Uncategorized
Tagged: community health, community health benefit, community health needs assessment (CHNA), hospital tax exemption, Mary Crossley, nonprofit hospitals, public health
Apr 28, 2014
I know it seems like the obvious choice, but I would not run a randomized clinical trial.
I have recently lamented the pernicious influence, within my domain of public health practice, of hyperbolic headlines proclaiming “this,” followed unfailingly by equally and oppositely hyperbolic headlines reactively proclaiming “that.”
But we are obligated to acknowledge that there are, generally, research studies underlying the headlines, however extreme the pop culture distortions of the actual findings. So to some extent, the problem originates before ever the headlines are a gleam in an editor’s eye, with our expectant anticipation of the next clinical trial, and the next, and the next.
By all means, bring on the clinical trials! They serve us well. They advance the human condition. I run a clinical research lab — my career is devoted to just such trials.
But still, I wouldn’t conduct one if my foot caught fire.
Of course, there is a very good case for running such a study, as many vitally important questions about the right response to a foot on fire are at present unanswered. What, for instance, would be the ideal volume of water? Should it be hard water, or soft? Fluoridated, or not? A controlled trial is very tempting to address each of these.
The vessel is even more vexing. What would be the best kind of bucket? What size should it be? What color should the bucket be, what composition, and what’s the ideal kind of handle? I think the variations here are the basis for an entire research career.
Perhaps the notion of running randomized, double-blind, controlled intervention trials to determine the right response to a foot on fire seems silly to you. But if so, you must be suggesting that science does not preclude sense.
That’s rather radical thinking in some quarters.
Continue reading “What I Would Do If My Foot Caught Fire”
Filed Under: THCB
Tagged: academic research, Clinical Trials, David Katz, Evidence Based Medicine, public health, Wellness
Apr 16, 2014
Fred Shaw went to St. Martin and all he got was a painful virus called chikungunya.
On an island stop during his Caribbean cruise vacation, Mr. Shaw was infected with the mosquito-borne virus that causes a severe fever and an arthritis-like condition in people, similar to dengue fever. After infection, the virus still may cause long periods of fatigue and incapacitating joint pain.
Writing on Facebook, Mr. Shaw said, “The fever, leg rash and swelling were bad enough, but then followed by months of headache, joint pain and malaise, I finally have gotten over it (I think).”
Chikungunya virus was first described during an outbreak in Tanzania in 1952 and was subsequently discovered in other parts of Africa and Asia. The name ‘chikungunya’ is derived from a local phrase that means ‘that which bends up’ and describes the stooped appearance of sufferers with joint pain.
In late 2013, chikungunya was found for the first time in modern history on islands in the Caribbean. Based on our research and the evidence we have observed, it is likely that the virus is on its way to the U.S.
Vector-borne viruses—which are transmitted to people by an animal or insect—threaten half the world’s population and are responsible for millions of human infections annually. Various mosquitoes and ticks transmit a subgroup of these viruses that are called arboviruses.
There are over 100 known arboviruses that infect humans and can cause neuroinvasive diseases like encephalitis, febrile illnesses and hemorrhagic fevers. Except for yellow fever, tick-born encephalitis and Japanese encephalitis, there are no commercially available vaccines for most arboviral disease.
As the world becomes flatter and the globe opens to new opportunities for international trade and travel, viruses that used to be confined to “over there” are increasingly coming “over here,” and they are arriving sooner rather than later.
Continue reading “Are We Prepared For The Next Viral Disease Threat?”
Filed Under: THCB
Tagged: chikingunya, FutureMed, Global Virus Network, public health, Robert Gallo, Scott Weaver, Sharon Hrynkow, vector-borne diseases
Apr 6, 2014
In their best-selling 2013 book Big Data: A Revolution That Will Transform How We Live, Work and Think, authors Viktor Mayer-Schönberger and Kenneth Cukier selected Google Flu Trends (GFT) as the lede of chapter one.
They explained how Google’s algorithm mined five years of web logs, containing hundreds of billions of searches, and created a predictive model utilizing 45 search terms that “proved to be a more useful and timely indicator [of flu] than government statistics with their natural reporting lags.”
Unfortunately, no. The first sign of trouble emerged in 2009, shortly after GFT launched, when it completely missed the swine flu pandemic. Last year, Nature reported that Flu Trends overestimated by 50% the peak Christmas season flu of 2012. Last week came the most damning evaluation yet.
In Science, a team of Harvard-affiliated researchers published their findings that GFT has over-estimated the prevalence of flu for 100 out of the last 108 weeks; it’s been wrong since August 2011.
The Science article further points out that a simplistic forecasting model—a model as basic as one that predicts the temperature by looking at recent-past temperatures—would have forecasted flu better than GFT.
In short, you wouldn’t have needed big data at all to do better than Google Flu Trends. Ouch.
In fact, GFT’s poor track record is hardly a secret to big data and GFT followers like me, and it points to a little bit of a big problem in the big data business that many of us have been discussing: Data validity is being consistently overstated.
As the Harvard researchers warn: “The core challenge is that most big data that have received popular attention are not the output of instruments designed to produce valid and reliable data amenable for scientific analysis.”
The amount of data still tends to dominate discussion of big data’s value. But more data in itself does not lead to better analysis, as amply demonstrated with Flu Trends. Large datasets don’t guarantee valid datasets. That’s a bad assumption, but one that’s used all the time to justify the use of and results from big data projects.
Continue reading “Google Flu Trends Shows Good Data > Big Data”
Filed Under: Tech
Tagged: Big Data, flu, Google Flu Trends, Kaiser Fung, OCCAM framework, public health, statistics
Mar 26, 2014