DISPATCH 6/27/08: Lying Brains, Silent Strokes, Unsafe Sex, and Rotavirus Vaccines
ACSH: A group of Rota(Teq)-rooters
We were thrilled to hear that RotaTeq, a rotavirus vaccine approved in 2006, is dramatically reducing the incidence of the gastrointestinal virus in the United States. Rotavirus is the leading cause of severe vomiting and diarrhea in infants and young children around the world, killing at least 500,000 each year. Dr. Elizabeth Whelan says, "This vaccine has really changed the course of the disease in the U.S.," where it delayed the onset of the rotavirus season by three months and reduced its severity by half. "Imagine the benefits that will flow to children when it becomes available worldwide," adds Dr. Gilbert Ross.
The recent progress with RotaTeq calls to mind the lost potential of the vaccine RotaShield, which was approved in 1998 but was pulled off the shelves six months later over concerns of adverse effects on recipients' small intestines. The fears proved to be unwarranted, as the few children who experienced complications were older than the recommended age group for the vaccine and probably would have developed the condition anyway.
"It took from 1999 to 2006 to get a new vaccine approved, during which time three to five million children died from rotavirus around the world," says Dr. Ross. ACSH's Jeff Stier believes, "We should hold those responsible for the unnecessary withdrawal of RotaShield accountable for these deaths and remember this example the next time Public Citizen's Sidney Wolfe issues a press release attacking some drug."
The new vaccine will only live up to its full potential if it is efficiently and cost-effectively distributed around the world as soon as possible. With the news that global vaccine sales are soaring, we hope that developing countries make widespread vaccination a public health priority.
Too many children still die of the flu
Eighty-three children died of influenza in the U.S. during the last flu season, a number we find tragically high. "We're in denial about the impact of influenza in this country," Dr. Whelan believes. "Just think of how many parents lost a child."
Approximately 36,000 people in the U.S. die each year of influenza, but the 2007-2008 flu season was more severe than recent years, due in part to a vaccine that did not match up well with the circulating flu viruses. "Even if all the children who died got flu shots, we can't say it was the right strain," says Dr. Ruth Kava. Dr. Whelan believes distribution of the vaccine might have been an issue; more than enough doses are manufactured each year, but still, she says, "you go to the doctor and she or he doesn't have it."
Repetition transforms lies into "truth"
Neuroscientists Sam Wang and Sandra Aamodt published a fascinating op-ed in today's New York Times about why so many of us hold false beliefs. When you first learn a fact, they write, it is stored in the hippocampus, but as you recall the fact over and over again the information is transferred to the cerebral cortex and separated from the context in which you learned it, causing "source amnesia." As you forget the source of a fact, you also forget if that source was credible or not.
"The more often you read or hear something, the more likely you are to believe it is true," says Stier -- a phenomenon we have certainly observed in unfounded health scares that catch on in the news and have far-reaching effects. "When you keep hearing this misinformation over and over again, it is hard to keep your facts straight, says Dr. Whelan. Dr. Ross jokes, "Even I now believe that phthalates are toxins!"
Unsafe sex in the city
We were shocked at the number of New Yorkers who practice unsafe sex. According to a study released by the city health department, only 60% of people who had multiple sexual partners used a condom the last time they had sex, and 39% of women ages 18-44 did not use any form of contraception -- despite the fact that 83% of them were not planning a pregnancy. "These numbers are astounding in 2008," says Dr. Ross.
Silent strokes affect a surprising number of adults
Ten percent of middle-aged adults showed signs of a "silent stroke" in routine brain scans. "The strokes were asymptomatic but when you have them over time they can set you up for dementia," explains Dr. Whelan. "Silent strokes" are usually caused by a clot that interrupts the flow of blood to the brain. Doctors found that participants in the study who had atrial fibrillation or high blood pressure were more likely to have suffered this kind of stroke.
Combined vaccines reduce number of jabs
We were happy to hear that U.S. immunization officials are encouraging the use of vaccines that protect against multiple infections at once, decreasing the number of shots children must receive. "People are so perturbed over the number of shots," says Dr. Kava, with many parents buying into the health scare slogan "Too many, too soon." While we doubt the new development will quell all the scares over vaccines, we do hope it encourages more parents to have their children completely vaccinated. Kids will appreciate having fewer shots too!
DISPATCH 6/26/08: Fried Food, Older Women, Deformed Genitals, Strokes, and 9/11
Jeff Stier argues against "the exploitation of 9/11"
ACSH's Jeff Stier has an op-ed in today's New York Post about the questions surrounding the lawsuit filed by 10,000 Ground Zero workers who claim to have medical problems caused by dust exposure after 9/11. The first detailed examination of their medical records, however, revealed that many of them have never been sick with any illness potentially caused by the dust created by the collapse of the World Trade Center. "Allowing special interests to grab money on the basis of junk science does nothing to protect heroes. All New Yorkers should be incensed at this exploitation of 9/11," Stier writes.
"Just think of the precedent this sets," says ACSH's Dr. Elizabeth Whelan. "Billions of dollars in costs must be borne by the citizens of New York because their city was attacked." ACSH believes it is especially important to stay focused on sound science in situations as complex and emotional as the aftermath of 9/11.
The Bronx wants you to get an HIV test
The New York City Department of Health announced its plan to encourage every adult living in the Bronx to be tested for HIV in the next three years. While Manhattan still has the highest rate of HIV infection and AIDS cases in New York City, the Bronx has the highest death rate from the disease -- with many patients first learning they are HIV positive when they are diagnosed with AIDS.
"Unfortunately, the people who are most at risk in these cases are not the ones that are coming to the attention of doctors," says ACSH's Dr. Gilbert Ross. The new initiative aims to make an HIV test a routine (though not mandatory) part of any visit to the emergency room. Dr. Whelan worries the initiative might be misleading, since, she says, "It communicates the message that everyone is at risk for HIV when everyone is not." However, Dr. Ross says, "I don't see a real downside except for the expense."
Gardasil not yet approved for use in older women
We were surprised to read that the FDA did not approve the use of Gardasil, Merck's HPV vaccine, for use in women ages twenty-seven to forty-five. "That really puzzles me," says Dr. Whelan. "The vaccines protects against four strains of HPV, and even if you are a sexually active woman in this older age bracket, the likelihood of you being infected with all of them is low." HPV, or human papillomavirus, is most often sexually transmitted and can cause genital warts and cervical cancer. Gardasil has already been approved for use in women ages nine to twenty-six.
Stier believes the FDA's tests of the vaccine probably found the same amount of risk and lower efficacy in the older group of women, since they were more likely to have already been exposed to some form of the virus. "Of course there's higher efficacy in younger women, but where's the increased risk for older women?" he asks. Dr. Ross points out that doctors could still use the vaccine off label; however, insurance problems might make it prohibitively expensive for some women.
Democrats ban fried foods from convention
ACSH staffers found the decision to ban fried foods from August's Democratic convention ridiculous. "This is politically correct to the point of denying people choices," says Dr. Whelan. "Are you actually a better person if you don't eat fried food?" The ban is part of Denver's effort to host "the most sustainable political convention in modern American history." "I wouldn't want to go to a convention if I couldn't have French fries," jokes ACSH's Dr. Ruth Kava.
Men, be afraid! "Phthalates threaten masculinity," says clueless alarmist
We were amused by an essay by Joshua Zaffos that argues phthalates and other "dangerous" chemicals cause lower sperm counts and deformed penises. Noticing that Zaffos also claims exposure to chemicals is "skewing our odds against cancers," Dr. Ross points out "he is completely oblivious to the statistics, which all say that cancer rates are declining." If Zaffos is so concerned about being, as he writes, "half the man [his] father was," phthalates should be the least of his worries.
"Antioxidants" in coffee and tea said to prevent strokes
A new study from Sweden concludes that male smokers who drank eight cups of coffee or two cups of tea daily had a lower risk of stroke. "Coffee is always in the news one way or another," Dr. Whelan observes.
While the researchers argued that the antioxidant properties of the beverages might have contributed to a lower risk of stroke, Dr. Ross points out, "There's never been a documented benefit of anything from antioxidants." Meanwhile, coffee and tea continue to have regular seats at the ACSH breakfast table.
DISPATCH 6/25/08: Turf, Exposures, 9-11 Dust, Parasites, Diabetes, and Fat
Artificial turf scare takes to the field
The latest health scare to hit the newsstands concerns low levels of lead found in artificial turf. "High exposure to lead obviously causes very serious health problems, but you can't argue for banning a product just because you can measure it at trace levels," argues ACSH's Dr. Elizabeth Whelan.
Companies manufacturing and selling artificial turf are faced with legal action in California, even though, as ACSH's Dr. Gilbert Ross points out, "No child has ever been found -- nor is one ever likely to be found -- to have an elevated lead level because of artificial turf, as usual with these scares."
Mark Schapiro: Exposing the public to health scares
We were disappointed to see how much press the new book Exposed is receiving. Author Mark Schapiro, of the Center for Investigative Reporting, promotes health scares concerning everything from cosmetics to plastics, with phrases like "We're all walking around in this soup of chemicals."
"We are a soup of chemicals," ACSH's Dr. Ruth Kava points out, while Dr. Ross finds several instances where Schapiro states "facts" that are known to be myths -- such as the idea that chemicals cause infertility in young women and lower sperm counts in young men.
"I guess if you repeat it often enough, it becomes a fact," says Dr. Whelan. "I can't believe the rhetoric these people use."
Dust from Ground Zero may not be as harmful as lawyers claim
The first detailed review of the medical records of the Ground Zero workers suing New York City for failing to provide proper breathing equipment during rescue and clean-up operations revealed that many of the workers might not be as sick as they previously claimed. Workers filed the lawsuit on the basis that exposure to the dust created by the collapse of the World Trade Center caused respiratory illness, gastrointestinal sickness, and even more serious health problems like cancer.
Thirty percent of the workers actually reported symptoms no more serious than a runny nose or cough, however, and no deaths have been connected to health problems caused by working at Ground Zero. "In order to prove causation, you need a control group," explains Dr. Whelan, so it is difficult to prove the dust actually caused even these minor sicknesses. "With 10,000 people suing, the liability for the city will be enormous," she worries.
Dr. Ross adds, "If undeserving claimants recover many millions in awards, the desperately needed funding for city public health programs such as anti-smoking efforts and vaccines will be markedly impaired."
Parasites still infect millions in the U.S.
We were shocked to read that diseases caused by worms and other parasites continue to affect millions of Americans, particularly in poor and often largely minority areas in the Mississippi Delta, the American South, cities, and the U.S.-Mexico borderlands. The diseases include ascariasis (roundworms) and many other parasitic infections that impact child development, intellectual development, hearing, and sometimes even heart disease. The diseases are also prevalent in certain immigrant populations and disadvantaged areas of Appalachia. "I thought I was reading about the Third World," says Dr. Whelan.
Diabetes on the rise
A new report states that 24 million Americans now have diabetes, up to 8% of the total population. "It is a ridiculously high percentage," says Dr. Ross, also noting that 25% of Americans over sixty now have the disease.
With the current obesity problem, we can't say we're surprised, but Dr. Kava does wonder, "How much of the increased prevalence is due to increased attention and diagnosis?"
Britain finally takes a risk
Americans aren't the only ones struggling with expanding waistlines, and England has just made a surprising decision in its effort to cope with obesity. The National Institute for Health and Clinical Excellence has just approved Sanofi-Aventis's weight loss drug Acomplia (chemical name rimonabant) for use in Britain -- deviating from the U.S.'s decision not to approve the drug, after it was linked to rare cases of suicidal thoughts.
We are pleasantly surprised that a country that so regularly makes public health decisions based on the precautionary principle did not adhere to it in this case. "They are so risk-averse over there," says Dr. Whelan. "The decision to approve Acomplia speaks volumes about the importance of dealing with obesity in new and creative ways." Now that the U.S. has an example to follow, we hope it considers taking another look at Acomplia -- especially since the drug also helps patients quit smoking.
DISPATCH 6/24/08: Industry, Rice, Vitamin D, Mosquitoes, and Age
Industry contributes to a majority of drug development
We weren't surprised by the findings of a new report concluding that a large part of drug development takes place in the private sector. Released by the Manhattan Institute today, the report counters the belief that government research is behind most medical advancements while drug companies only sell products that have already been developed.
In reality, as the New York Sun reports, the two systems are complementary, since industry research often leads to improvements and applications of government-funded basic science. "The report acknowledges that the government is important for basic research," says ACSH's Jeff Stier. "But industry plays an important role in applying that in ways that save lives."
Chinese food helps the heart
Red yeast rice, which is commonly used in China as a food preservative, a spice, and an ingredient in rice wine, has been found to reduce the risk of repeat heart attacks. "It makes sense because the active ingredient is lovastatin," which can lower cholesterol levels, says ACSH's Dr. Ruth Kava. The study's authors caution that the red yeast rice they gave to patients is different than what is available over the counter in the U.S. "There is no regulation when it is sold as a dietary supplement," warns Dr. Kava.
When taking an unregulated supplement, "who knows what dose you're getting?" Stier asks. He recommends keeping an eye out for labels that do not claim to cure or prevent a disease but rather use awkward language such as "promotes healthy heart function." He suggests people should "see that as a red flag that means the supplement hasn't been tested."
Summer brings mosquitoes, which can bring West Nile
Mosquitoes won't just disrupt your picnic; they might ruin your whole summer. The pests are vectors of diseases like West Nile virus, which emerged in the U.S. nine years ago and has since infected 1.5 million people -- including one of the leading experts on the disease. The most common symptoms include headache, fever, and extreme fatigue, although the infection can also cause encephalitis, a potentially fatal inflammation of the brain and spinal cord.
According to the New York City Health Department, infected mosquitoes have been found on Staten Island much earlier than usual this year. Non-residential areas are currently being treated with larvicide to control the mosquito population, but more action might be necessary. "Spraying affected areas with pesticide can be an important public health intervention," says Stier. Public health officials are also monitoring mosquitoes in flooded areas of the Midwest for the disease.
The best way to protect yourself is to use an insect repellent, make sure all windows have screens, and eliminate all standing water from your property. Prevention is particularly important in the case of West Nile because, as Dr. Kava points out, "It’s a virus, so antibiotics won't help."
Vitamin D deficiency linked to death
A new study shows that people with low levels of vitamin D have a greater risk of dying from heart disease and other causes. "People are really pushing this, but there are some who say it's too soon to draw definitive conclusions," says Dr. Kava. Vitamin D has anti-inflammatory effects that may protect against heart disease and a host of other problems; however, Dr. Kava cautions, "The blood test we use to measure levels of vitamin D might not be the most accurate, so the studies are still a little bit up in the air."
The body produces vitamin D when it is exposed to the sun, but sunscreen -- which is important for protecting against skin cancer -- can inhibit its formation. "Some people burn very easily and can't use enough sunscreen," says Dr. Kava. People concerned about their vitamin D levels might consider boosting it through diet and supplements rather than excessive time in the sun.
Recommendations for growing old and staying healthy
As we've been reporting, people are living longer than ever before, so it is important to take steps to stay healthy into old age. Jane E. Brody's column in the New York Times recommends regular exercise to prevent the frailty that causes some elderly people to lose mobility and independence. While thirty minutes of aerobic activity five times a week has been the standard minimum recommendation for some time, Dr. Kava says, "Aerobic exercise is not enough." She agrees with Brody's emphasis on strength training and flexibility exercises to maintain balance and keep joints healthy.
Another article explores how seemingly minor neurological problems can help doctors predict strokes in elderly people. "They studied the integrity of the nervous system and found that subtle changes could be signs the person was at risk for a stroke," explains Dr. Kava. The study should encourage doctors to look out for changes such as reduced reflexes or unstable posture -- and recommend patients experiencing them follow up with neurological tests that may reveal larger problems, like atrophy and tumors.
If an elderly person's mental and physical decline results in dementia, doctors warn against overprescribing antipsychotic drugs. "Some people who have Alzheimer's or other types of dementia have behavioral problems that make them difficult to 'manage'," says Dr. Kava. Nursing homes often turn to antipsychotic drugs in hopes of controlling patients' behavior, but the drugs sometimes simply exacerbate the problem. Doctors recommend prescribing antipsychotics to treat dementia only as a last resort and at a very low dose for a short time.
DISPATCH 6/23/08: Death, Fat, HPV, and Continuing Dihydrogen Monoxide Dangers
The CDC focuses on the big picture: declining death
An encouraging graph from the Centers for Disease Control shows that age-adjusted death rates for several leading causes of death have been steadily declining since 2001. "People are living longer, but we never hear about this in the news," say ACSH's Dr. Gilbert Ross. We hope good news like this puts the media's focus on health scares in perspective.
Restaurants cut back on trans fats while beefing up menu boards
An informative article in the New York Times covers the lead-up to the trans fat ban in New York City, which goes into effect July 1. "It points out that the substitutes for trans fats are laden with saturated fat," says Dr. Ross. The city created a Trans Fat Help Center and will require bakeries to fill out "spec sheets" detailing the ingredients in every dish. "It's going to be like the size of War and Peace," said Stuart Zaro, president of Zaro's New York Bakery.
New York City now also mandates that chain restaurants post the calorie counts of every dish on their menu boards. We were impressed by Steve Chapman's argument against the new law in a Chicago Tribune op-ed, with which ACSH's Dr. Ruth Kava assisted. "The belief that more facts will generate wiser decisions is appealing but, at least in the realm of food, yet to be proved," he points out.
"These new ways of dealing with obesity are based on premises that have no foundation," says ACSH's Dr. Elizabeth Whelan.
Keeping the weight off with hormone therapy
ACSH staffers were intrigued by a study suggesting that increasing a person's leptin levels after they have lost weight through dieting can help them keep it off. "When the hormone leptin was first discovered they thought it would be the cure for obesity. But lots of people have plenty of leptin, they're just resistant to it," says Dr. Kava.
The body often produces less appetite-suppressing leptin after a diet than before, possibly as an evolutionary adaptation toward protecting its energy stores. The new research suggests that restoring people's leptin to pre-diet levels can help those who have lost weight continue to resist overeating. "This new use is for weight maintenance, not for helping people lose weight, which could be very interesting," says Dr. Kava.
Bariatric surgery may reduce risk of some cancers
The benefits of losing weight and keeping it off are apparent in the fact that people who lose a significant amount of excess weight through surgery lower their risk of some cancers by up to 80%. "Obesity is linked to some forms of cancer, so we shouldn't be surprised to hear that," comments Dr. Kava. Morbidly obese patients who lost weight after undergoing procedures such as gastric band surgery had a much lower risk of developing breast, colon, and pancreatic cancer than patients who did not have surgery.
Continuing support for the HPV vaccine
We were happy to see an argument for widespread use of the HPV vaccine make the Wall Street Journal opinion section again. The Journal's James Taranto criticized Michelle Obama's decision to advise doctors not to recruit black teenage girls for experimental testing of Gardasil at a Chicago hospital because of "the specter of the Tuskegee-syphilis experiment," in which hundreds of black men went untreated for syphilis so doctors could study the disease. Regardless of varying opinions on Mrs. Obama's decision, ACSH staffers were unanimous in applauding the Journal's promotion of Gardasil, which a few critics have hastily accused of encouraging the young to have sex. "The conservative editorial page supported the use of the vaccine, which is the good news I got out of it," says Dr. Whelan.
Iowa encounters the dangers of dihydrogen monoxide
Iowa and other Midwestern states continue to experience flooding this week. Cities like Cedar Rapids have been virtually destroyed, and basic services in many areas are gone. Public health officials from the University of Iowa warn of the dangers of skin infections, tetanus, water-borne illnesses, and mold, as well as potentially widespread depression. As clean-up efforts begin, we hope those affected take precautions and stay healthy.
Elizabeth Wade is a research intern at the American Council on Science and Health (ACSH.org, HealthFactsAndFears.com). Receive ACSH Morning Dispatch in your e-mail in-box each weekday by donating to ACSH and then requesting subscription.