Harm Reduction

There has been a lot of ink spilled, and bytes spent this week discussing the FDA’s approval of aducanumab, brand-name Aduhelm, for the treatment of Alzheimer’s Disease. I have mixed feelings; there are advantages to a Phase 4 study, but how do you say no to hope?
The New York Times reported that the US Environmental Protection Agency (EPA) will reconsider reducing the National Ambient Air Quality Standard (NAAQS) from its current 12 μg/m3 as an annual average. What’s new, and what’s a tired retread? 
The battles we have witnessed firsthand, or on video, over mask-wearing seem to be all about public health, or personal freedoms, or being isolated. But, of course, those are the obvious reasons. So, how 'bout we look at what psychologists are saying: not about the fighting, but the vehemence of the argument?
Over the years, I’ve generated tens of thousands of cubic feet of radioactive waste, managing the radioactive waste program at a large Midwestern university, and as the Radiation Safety Officer at a mid-sized university in the Northeast. None of this was glowing – in any color – and none of it looked much different from any of the other laboratory, medical, or remediation waste produced in so many places around the world every year. 
“Maximum containment laboratories, commonly referred to as biosafety level 4 (BSL4) labs, are designed and built to work safely and securely with the most dangerous bacteria and viruses that can cause serious diseases and for which no treatment or vaccines exist.” 
Organized medicine, and by that, I mean healthcare with all its players, institutions, and systems, is continuing to undergo seismic shifts. Those related to COVID-19, like video visits or increasing acknowledgment of socioeconomic determinants of our health, get the headlines. But the changes to the business of medicine are rapidly increasing, will affect us far sooner, and I am afraid, for far longer. What are we sacrificing on the altar of efficiency and access?
Smoking cigarettes is stupid, involving financial and, more importantly, significant health costs. While there are several “drivers” to the smoking habit, including sociability and status (especially during those rebellious teen years), could we agree that nicotine is, by far and away, the most significant component of chemical dependency?
Phase III trials put the efficacy of the two earliest COVID-19 vaccines in the mid-’90s, certainly more than we had hoped. The word on the media “street” has been that vaccinations result in fewer hospitalizations and no deaths. The CDC is now reporting on “breakthrough infections” since the beginning of the year. 
Despite increasing evidence that vaping is safer than smoking, uncertainty surrounds the long-term effects of electronic cigarette use. Many in the tobacco control field have used the lack of data to speculate about these unknown risks. Here's a better way to deal with the uncertainty.
There seems to be a reproducibility “crisis” in the sciences, where the results obtained by one group of researchers cannot be reproduced by another, putting the validity of the original work in doubt. What is the fate of those papers? Do they languish in some academic backwater hell lining birdcages?
According to at least one source [1], it takes an average of 17 years for a proven intervention to be fully implemented. By that metric, we would have no treatments for COVID-19 besides those identified anecdotally. How did the boots on the ground of our healthcare systems actually respond?
When it rains, when a low-pressure system passes by, and when water soaks the soil, it's not a great day to sample for radon. Those conditions force radon out of pore spaces and into basements.