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Category: Public Health

A War on Science is a War on Us

By KIM BELLARD

We’re in the midst of a major U.S. election, as well as hearings on a Supreme Court vacancy, so people are thinking about litmus tests and single issue voters – the most typical of which is whether someone is “pro-life” or “pro-choice.”  Well, I’m a single issue person too; my litmus test is whether someone believes in evolution. 

I’m pro-science, and these are scary times.

Within the last week there have been editorials in Scientific American, The New England Journal of Medicine, and Nature – all respected, normally nonpartisan, scientific publications – taking the current Administration to task for its coronavirus response.   Each, in its own way, accuses the Administration of letting politics, not science, drive its response. 

SA urges voters to “think about voting to protect science instead of destroying it.”  They cite, among other examples, Columbia Law School’s Silencing Science Tracker, which “tracks government attempts to restrict or prohibit scientific research, education or discussion, or the publication or use of scientific information, since the November 2016 election.”  Their count is over 450 by now, across a broad range of topics in numerous federal agencies on a variety of topics.   

The SA authors declare:

Science, built on facts and evidence-based analysis, is fundamental to a safe and fair America. Upholding science is not a Democratic or Republican issue.

Similarly, NEJM fears:

Our current leaders have undercut trust in science and in government,4 causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.

Jeff Tollefson, in Nature, warns:

As he seeks re-election on 3 November, Trump’s actions in the face of COVID-19 are just one example of the damage he has inflicted on science and its institutions over the past four years, with repercussions for lives and livelihoods. 

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Now Is Not the Time to Forget About the AIDS Epidemic

By SOMA SEN

I keep hearing the voices of colleagues and friends that have been part of the AIDS epidemic compare it to the current COVID-19 pandemic. In fact Dr. Kathy Creticos, Director of Infectious Disease at Howard Brown Health spoke about the politicization of both the pandemics. 

“Here we are in 2020 with this disease that kills people, that we don’t have any treatments for, that we really don’t understand the full manifestation and presentation biology of the virus,” Creticos said In the final segment of an interview with Contagion during International AIDS Society (IAS) AIDS 2020 Virtual Sessions. “We’re really dealing in the same situation as in the HIV epidemic.” 

Her words make me reflect on the levity with which the Raegan administration treated the AIDS epidemic and it’s parallel to the Trump administration’s treatment of the current pandemic. However, she makes an important distinction between the two when she says, “I think a lot of it has to do with the fact that COVID affects everybody, but HIV was certainly perceived as not affecting everybody.”

As an Asian American researcher with more than 15 years of experience in this area, whenever, I bring up the issue of the scourge of HIV/AIDS in our community, the common response both from inside and outside the community is “It’s not a problem in this community.” 

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Too Many Small Steps, Not Enough Leaps

By KIM BELLARD

I was driving home the other day, noticed all the above-ground telephone/power lines, and thought to myself: this is not the 21st century I thought I’d be living in.  

When I was growing up, the 21st century was the distant future, the stuff of science fiction.  We’d have flying cars, personal robots, interstellar travel, artificial food, and, of course, tricorders.  There’d be computers, although not PCs.  Still, we’d have been baffled by smartphones, GPS, or the Internet.  We’d have been even more flummoxed by women in the workforce or #BlackLivesMatter.  

We’re living in the future, but we’re also hanging on to the past, and that applies especially to healthcare.  We all poke fun at the persistence of the fax, but I’d also point out that currently our best advice for dealing with the COVID-19 pandemic is pretty much what it was for the 1918 Spanish Flu pandemic: masks and distancing (and we’re facing similar resistance).  One would have hoped the 21st century would have found us better equipped.

So I was heartened to read an op-ed in The Washington Post by ReginaDugan, PhD.  Dr. Dugan calls for a “Health Age,” akin to how Sputnik set off the Space Age.  The pandemic, she says, “is the kind of event that alters the course of history so much that we measure time by it: before the pandemic — and after.”  

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Can Community Be a Medicine?

By ARAS TOKER

Analysis on peer accountability focused community building efforts in making lifestyle changes through digital therapeutic programs

Before we jump ahead to the medicine piece, what the heck does a community even mean? In the past, communities were more likely associated with a group of people living in the same physical location such as a neighborhood, school, or a town. I remember my neighborhood soccer community very well, for instance. Instead of being born into or trying to fit in, community is something we choose for ourselves and express our identities through. With the advancement of accessing the high-speed internet globally, today’s community has no physical or geographical boundaries.

Community builder Fabian Pfortmüller brilliantly explains the difference between communities and other groups. He asserts that unlike project teams or companies who are optimizing for external purposes (collective goals); communities optimize for internal purposes (the relationship and the shared identity). His definition of a community deeply resonated with me and the communities that I had the opportunity to build.

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Pfortmüller’s definition of community
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Everyone has a role to play: Reducing your child’s risk of developing food allergies

By RUCHI GUPTA, MD, MPH

The average American elementary school class includes two students living with one or multiple food allergies. That’s nearly six million children in the United States alone. And these numbers are climbing. There was a staggering 377 percent increase in medical claims with diagnoses of anaphylactic food reactions between 2007 and 2016, two-thirds of these were children.

As parents, we want the absolute best for our children. For many years, guidance around food introduction was unclear. Parents were told that babies, and especially those considered at risk for food allergies, should avoid some allergy-causing foods such as peanuts until they were three years old.

But thanks to ongoing research from our nation’s top allergists and immunologists, we are beginning to learn more and more about food allergies, including what new and expecting parents can do to reduce the risk of their children developing food allergies. In fact, studies now show that introducing a variety of foods early is the best course of action and has been shown to reduce the occurrence of certain food allergies like peanuts for many children.

For instance, the partially FARE-funded Learning Early About Peanut Allergy (LEAP) study showed a remarkable 80 percent reduction in peanut food allergies in high-risk infants who were exposed to peanut foods at a young age. Shortly after LEAP, there was the Enquiring About Tolerance, or EAT, study. This project, led by top medical researchers at Kings College London, found significant reductions in allergies to both peanut and egg after introducing small amounts of the foods into infants’ diets. The LEAP-on study soon followed, and had the same children from the original LEAP study remove peanut from their diets for 12-months. The results showed that they maintained their tolerance to peanut, indicating early introduction to babies can result in long-lasting protection from peanut allergy.

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We Are in Store for the Greatest Change to Our Health Care System Since the Affordable Care Act. Here’s Why.

By LOGAN CHO

The COVID-19 pandemic has been harsher and lasted longer than many of us would have predicted. While our media has been inundated with updates on death tolls and economic depression, there has been little conversation of healthcare beyond the era of COVID-19. The first question that we ask when we hear of deaths: was it COVID? We have grown to expect the primary cause of death to be of coronavirus. But the impact of COVID-19 will extend beyond the individual, effecting fundamental and long-lasting change to our healthcare system.

By this point, it is clear that the public health ramifications are reaching well beyond the physical impacts of the virus. Social isolation, economic depression, soaring unemployment, and mandated closures all contribute to the adversity that we have had to face – notwithstanding the explosive, ever-present sociopolitical climate of a pandemic that is killing Black Americans at a rate almost three times that of whites. This hardship will likely last for months more.

A recent Kaiser Family Foundation publication found that half of the public have skipped or postponed medical care due to the pandemic, with one-fourth reporting worse health as a result. Many of these people do not plan to receive the care they need within the next three months. The public is simultaneously reporting declines in mental health. Furthermore, over 30% say they have had difficulty paying for household expenses, like food, rent, and medications. The figures are disproportionately damning among Black and Hispanic populations.

Taken together, the inaccessibility of medical care, deteriorating mental health, increasing poverty, worsening access to nutrition, and host of other challenges present a dark, impending storm. Cancer, diabetes, and other chronic diseases will all be rearing their untreated heads post-pandemic. Communities and policymakers must therefore act quickly and decisively to heal not only a sick population, but a fraying social fabric.

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A Conversation with John Ioannidis

By SAURABH JHA, MD

The COVID-19 pandemic has been a testing time for the already testy academic discourse. Decisions have had to be made with partial information. Information has come in drizzles, showers and downpours. The velocity with which new information has arrived has outstripped our ability to make sense of it. On top of that, the science has been politicized in a polarized country with a polarizing president at its helm.

As the country awoke to an unprecedented economic lockdown in the middle of March, John Ioannidis, professor of epidemiology at Stanford University and one of the most cited physician scientists who practically invented “metaresearch”, questioned the lockdown and wondered if we might cause more harm than good in trying to control coronavirus. What would normally pass for skepticism in the midst of uncertainty of a novel virus became tinder in the social media outrage fire.

Ioannidis was likened to the discredited anti-vax doctor, Andrew Wakefield. His colleagues in epidemiology could barely contain their disgust, which ranged from visceral disappointment – the sort one feels when their gifted child has lost their way in college, to deep anger. He was accused of misunderstanding risk, misunderstanding statistics, and cherry picking data to prove his point.

The pushback was partly a testament to the stature of Ioannidis, whose skepticism could have weakened the resoluteness with which people complied with the lockdown. Some academics defended him, or rather defended the need for a contrarian voice like his. The conservative media lauded him.

In this pandemic, where we have learnt as much about ourselves as we have about the virus, understanding the pushback to Ioannidis is critical to understanding how academic discourse shapes public’s perception of public policy.

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And We Thought Pandemics Were Bad

By KIM BELLARD

Those of us of a certain age, or anyone who loves classic movies, remember the famous scene in “The Graduate” when Benjamin Braddock is given what is intended as a helpful clue about the future.  “Plastics,” one of his father’s friends says.  “There’s a great future in plastics.”

Well, we’re living in that future, and it’s not all that rosy.  Plastics have, indeed, become an integral part of our world, giving billions of us products that we could never otherwise have or afford.  But our future is going to increasingly be driven by an unintended consequence of the plastics revolution: microplastics. 

And that’s not good.

Microplastics are what happens to plastic after it has gone through the wringer, so to speak.  Plastic doesn’t typically decompose, at least not in any time frame we’re capable of grasping, but it does get broken down into finer and finer particles, until they reach microscopic levels (thus “microplastics”).  We’ve known for some time that plastics were filling our landfills, getting caught in our trees and bushes, washing up on our shorelines, even collecting in huge “garbage patches” in the ocean.  But it wasn’t until more recently that we’ve found that plastics’ reach is much, much broader than we realized, or could see.

The ocean full of microplastics, and fish are as well. They’re in our drinking water. Indeed, “There’s no nook or cranny on the surface of the earth that won’t have microplastics,” Professor Janice Brahney told The New York Times.  

Dr. Brahney was coauthor on a recent study that found microplastics were pervasive even in supposedly pristine parts of the Western U.S.  They estimated that 1,000 tons of “plastic rain” falls every year onto protected areas there; 98% of soil samples they took had microplastics.  Dr. Brahney pointed out that, because the particles are both airborne and fine, “we’re breathing it, too.”  

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How Traditional Health Records Bolster Structural Racism

By ADRIAN GROPPER, MD

As the U.S. reckons with centuries of structural racism, an important step toward making health care more equitable will require transferring control of health records to patients and patient groups.

The Black Lives Matter movement calls upon us to review racism in all aspects of social policy, from law enforcement to health. Statistics show that Black Americans are at higher risk of dying from COVID-19. The reasons for these disparities are not entirely clear. Every obstacle to data collection makes it that much harder to find a rational solution, thereby increasing the death toll.

In the case of medical research and health records, we need reform that strips control away from hospital chains and corporations. As long as hospital chains and corporations control health records, these entities may put up barriers to hide unethical behavior or injustice. Transferring power and control into the hands of patients and patient groups would enable outside auditing of health practices; a necessary step to uncover whether these databases are fostering structural racism and other kinds of harm. This is the only way to enable transparency, audits, accountability, and ultimately justice.

A recent review in STAT indicates that Black Americans suffer three to six times as much morbidity due to COVID-19. These ratios are staggering, and the search for explanations has not yielded satisfying answers.

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