Archive for the ‘Health’ Category

“Payback Time” cancer campaign mis-step

September 12, 2014

Here’s the video and some background.

It’s a two minute animation currently showing on British TV, in support of an upcoming Channel 4 cancer research fundraising evening, which will be held on 17th October 2014.

The cause is impeccable and I’d urge people to support it. Furthermore, the animation is well made and quite striking. If it gets circulated widely and discussed and some of this buzz translates into increased donations to cancer research, I’m sure the makers will fairly say “job done”.

But…

[spoiler follows]

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Peak health?

April 11, 2013

Something I’ve often wondered about before, and now a paper’s been published that touches on it (in terms of cardiovascular health, at least).

What happens next, in terms of life expectancy, in the developed world? First of all there was sanitation and better housing to reduce the disease burden from infectious diseases. And immunisation, of course. Then economic development and societal changes drive gains from the third stage of the demographic transition (ie better maternal and childhood nutrition reaps more healthy years of life decades later in the lifecourse). And we start to identify some of the big risk factors for disease, and belatedly, deal with them in a meaningful society-wide way (eg smoking bans).

Some of the benefit from these changes is yet to filter through to the life expectancy figures of course, but the era of big improvements is probably drawing to a close. Meanwhile, an overweight younger generation is coming through which is steadily accumulating a hefty burden of future cardiovascular risk.

So how are we going to sustain those improvements in life expectancy in the future?

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Media Chaos and measles outbreaks

April 7, 2013

After the MMR scare comes the inevitable measles scare: there’s now a big outbreak in Swansea, Wales.

BBC report

What Wakefield et al sowed is now being reaped. No reports yet of deaths or serious disability, but unfortunately the odds of getting through the outbreak without them are poor.

Why Swansea? It has been suggested that an anti-MMR campaign spearheaded by the local rag in the 1990s may, in part, be responsible for lower MMR uptake in the region and loss of herd immunity.

Now, I heard/read about this somewhere in the media in the last couple of days, so it’s not as if there’s a big conspiracy to keep it quiet. But in other circumstances,  if the actions of a named individual, organisation (eg hospital), or even another professional group (eg doctors) could be deemed even part-responsible for an outbreak of potentially serious harm to a large group of people, I’d expect to hear a lot more about it in the news. But maybe the fact that the media aren’t saying much about their own failings shouldn’t be a big surprise.

Anyway, here’s a pretty good account of it on “the home of UK regional journalism and jobs”.

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The Death of Theory: Kaggle, randomised control trials, and optimisation without understanding

January 7, 2013

Another effort to draw together some semi-coherent thoughts prompted by a couple of recent-ish items in the media.

Item 1:

“Down with experts”, a New Scientist opinion/interview piece from last month. It looks like Slate has the same interview subscription-free. (more…)

The best GP surgery website ever

November 13, 2012

For future reference:
http://www.ehealthservice.co.uk/bolton/singh/

In case recent exposure on the doctors.net.uk forum leads to Powers-That-Be taking it down here’s an older, though apparently identical, version:
Archived version

London’s volcanic winter, and finding causal truth

August 27, 2012

…unendurable cold, that … bound up the face of the earth, sorely afflicted the poor, suspended all cultivation, and killed the young of the cattle. 

Owing to the scarcity of wheat, a very large number of poor people died; and dead bodies were found in all directions, swollen and livid, lying by fives and sixe’s in pigsties, on dunghills, and in the muddy streets…

These quotes come from a thirteenth century Benedictine diarist, Matthew Paris, recounting conditions in southern England in 1258. (more…)

More linked reviews: Horizon ‘The Truth about Fat’ and ‘The Energy Glut’ by Ian Roberts

March 23, 2012

The Horizon programme, screened a couple of nights ago, promised to reveal the ‘surprising truth’ about what causes obesity, and ‘how to fight the fat epidemic’. Recently I read a book by  an epidemiology professor called Ian Roberts, “The Energy Glut”, which tackles similar questions, so I was interested to see whether the answers would match.

The short answer is: they don’t.

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In Memoriam: Barbara Starfield

June 17, 2011

Some sad news that escaped my attention until today. Barbara Starfield died on 10th June.

While hardly a household name, she has been a vastly important figure in my professional life— well before I’d even heard of her. For over fifty years she conducted and collated research that largely established the effectiveness of primary care-oriented health systems over and above the effectiveness of specialty-based ones (France, with its secondary care-oriented system but good health outcomes, seems to be the main exception to the rule).

Here’s how:

1. Primary care increases access to health services for relatively deprived population groups.

2. The contribution of primary care to the quality of clinical care.

3. The impact of primary care on prevention.

4. The impact of primary care on the early management of health problems.

5. The accumulated contribution of primary care characteristics to more appropriate care.

6. The role of primary care in reducing unnecessary or inappropriate specialty care.

(Contribution of primary care to health systems and health, Starfield et al. Milbank Quarterly 2005.)

In other words, the World Health Organisation’s 1978 Alma Ata declaration was on the right track.

It’s an unsexy subject for non-public health research interested people, but it would be better for all if her work got wider recognition outside of the population health community. It’s a shame this recognition, when it comes, will have to be posthumous.

Ash cloud and swine flu anniversaries: lessons on the polarisation of risk

May 1, 2011

It’s roughly the second anniversary of the kicking off of the 2009 H1N1 influenza pandemic, and the first anniversary of the European ash cloud airspace closures.

There are some interesting parallels between these two events. Both were unexpected to some degree—in the case of the impact of the Eyjafjallajokull eruption, spectacularly so.
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Multiple Sclerosis: blaming the sunshine

March 31, 2011

Multiple sclerosis (MS) is an unpleasant neurological disease, displaying an unpredictable range of symptoms which manifest themselves with equally unpredictable severity and rapidity. It is an autoimmune condition affecting the nerves: during relapses, an over-enthusiastic immune system attacks and damages the protective coating of nerve cells in the brain and spinal cord. People are often diagnosed in their most productive years— their 20s, 30s and 40s— when they must learn to deal with an uncertain prognosis, often ending with debilitating loss of mobility, speech, and memory at an unforeseeable point in the future.

For many years, the cause of the disease remained a mystery. Then, in 1960, Donald Acheson proposed a link between sun exposure in early life and a later diagnosis of MS. This hypothesis was founded on a growing body of evidence suggesting a north-south gradient of diminishing disease risk, based on research in several different northern hemisphere nations. Early studies demonstrated this relationship in World War 1 veterans living in several US states, and across populations in different regions of Norway. In the next few years similar associations were found in the southern hemisphere, but this time going in a reverse direction— with a higher risk of disease in the south versus the north— and it was discovered that immigrants tended to bring the risk of their original country with them when they moved, suggesting exposure in early life was an important factor. It seemed like Acheson was on to something.
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