In this blog post, I will be summarizing a court case regarding public health and its complications and addressing some public health legal issues.
The specific court case in the article regarded whether or not a woman called Miss Mary Kink, who had gotten anesthetic leprosy, should be sent to the city pesthouse. Miss Kink got affected by this contagious disease while working on missionary efforts in Brazil but she had developed anesthetic kind of leprosy, which is not dangerous to the community. Furthermore, she is an elderly woman who has lived and been part of the community of Aiken for a long time and has not spread this disease to anyone else. The city board of health stated that Miss Kink be placed in the city pesthouse or she move out of the city. Miss Kink and her doctor complained and stated their reasons for complaint to the city court judge, Judge Aldrich. Miss Kink is a woman of culture and comfort, so moving her to the city pesthouse would make living very difficult for her. Also, the city pesthouse was usually a place to keep African Americans who had developed smallpox. Furthermore, the city pesthouse was located very close to a city waste dumping site where waste was incinerated and the foul odors were present in the pesthouse. After reviewing and prolonging the case for months, the court ruled that Miss Kink could stay in the city and does not have to be sent to the city pesthouse or move out of the city.
The difference between quarantine and isolation is quite clear. A person is sent to isolation when he or she is known to become ill from a contagious disease. The person is isolated from the general population and can make no contact with other people to prevent people from catching the contagious disease. A person is quarantined when he or she is only known to be exposed to a contagious disease. It is unknown whether the person has actually developed the contagious disease. The person is told to remain in specific locations (such as his or her house) to prevent the person from spreading the disease to others. In most cases, state and local public health authorities decide whether or not a person should be quarantined. Their power comes from the US Constitution. According to the article, the principles of constitutional law governing health regulations provides the legislation of the rights of the individual vs. the rights of the community. In specific cases, it is up to the courts to interpret this law and decide how to balance these rights. Personally, I believe that it is more appropriate to err on the side of protecting the rights of the community because the ultimate goal is to protect as many people as possible. However, there has to be an empirical statistical analysis of each option and decide whether quarantining the individual will actually provide better prevention to those who are not yet affected by the disease.
-YP
Friday, October 29, 2010
Saturday, October 23, 2010
Global Health Problems and Concerns
In this blog post, I will be summarizing the article "The Challenge of Global Health" by Laurie Garrett. Then, I will be discussing some of my thoughts and opinions on the article.
This article basically addresses the issues regarding global health and the effectiveness of the measures taken to deal with them. Nowadays, a lot of money from various organizations (WHO, NGOs, private donors) have generously been donating money to deal with the health problems in developing countries. However, due to the lack of organization and that most of the money is directed towards specific diseases rather than public health in general, it is likely that we will not reach our global health expectations. One major reason is that most of the proposed public health projects are created by wealthy nations, experimented on under a limited scope, and don't allow the developing communities being served say what they need. The author then starts giving a history of global health and the role that organizations play. The author claims that the surge in funding and donations to global health is a direct result of the HIV/AIDS pandemic. It all started towards the turn of the 21st century and has since involved numerous nations. Nations opt to take part in contributing to global health for various reasons such as moral duty, public diplomacy, and self-protection against the disease itself. Finally, the author talks about why global health problems are still a high priority despite the increasing amount of funds provided. Problems include the money not being used efficiently and effectively, lack of coordination amongst public health organizations, ignorance of the true needs of developing communities, and others.
In my opinion, the biggest reason why the surge in public health funds is still not enough to counter the issue of global health problems is that the money is not being utilized and distributed effectively. There are many reasons for this. Developing countries receiving the aid such as areas in Sub-Saharan Africa do not have the public health infrastructure (hospitals, clinics) to distribute these resources. Also, money leaks out to transportation costs, random employees, the black market, and other underground business since corruption is prevalent in these areas. Furthermore, the lack of a stable government in these countries means that there are flaws in the coordination of distributing the resources.
According to the article, the two markers for public health success in developing countries are increased maternal survival and increased overall life expectancy. Maternal survival is a key indicator of public health success because in order for a pregnant woman to survive, the environment, personnel, and equipment involved in the delivery needs to be as best as possible to ensure a high success rate. Therefore, if the country has these resources and personnel available, it means that the country has a good overall health care system. Overall life expectancy is an indicator of public health success because the average person in a country lives, the better the quality of health in that country. It means that the water is cleaner leading to less contamination, the mosquito population is low leading to low rates of malaria, and immunizations are available for prevalent infectious diseases.
The author indicates that some public health measures have caused more harm than good. For example, many of the hospitals and clinics in developing countries reuse syringes for vaccinations, inadequately sterilize surgical instruments, and lack testing for blood-bank systems, all of which could increase the spread of HIV to the patients that are vaccinated (for preventable diseases) and the general population. Another example of how public health measures may have caused more harm than good is the concern about influenza spreading across the world. Public health measures dealing with this issue include donating money and inventing methods to prevent the spread of influenza. However, the developing nations lack hospital personnel, public health experts, and research scientists to perform the preventive methods. Also, coordination requires the presence of public health infrastructure, which these countries also lack.
This article basically addresses the issues regarding global health and the effectiveness of the measures taken to deal with them. Nowadays, a lot of money from various organizations (WHO, NGOs, private donors) have generously been donating money to deal with the health problems in developing countries. However, due to the lack of organization and that most of the money is directed towards specific diseases rather than public health in general, it is likely that we will not reach our global health expectations. One major reason is that most of the proposed public health projects are created by wealthy nations, experimented on under a limited scope, and don't allow the developing communities being served say what they need. The author then starts giving a history of global health and the role that organizations play. The author claims that the surge in funding and donations to global health is a direct result of the HIV/AIDS pandemic. It all started towards the turn of the 21st century and has since involved numerous nations. Nations opt to take part in contributing to global health for various reasons such as moral duty, public diplomacy, and self-protection against the disease itself. Finally, the author talks about why global health problems are still a high priority despite the increasing amount of funds provided. Problems include the money not being used efficiently and effectively, lack of coordination amongst public health organizations, ignorance of the true needs of developing communities, and others.
In my opinion, the biggest reason why the surge in public health funds is still not enough to counter the issue of global health problems is that the money is not being utilized and distributed effectively. There are many reasons for this. Developing countries receiving the aid such as areas in Sub-Saharan Africa do not have the public health infrastructure (hospitals, clinics) to distribute these resources. Also, money leaks out to transportation costs, random employees, the black market, and other underground business since corruption is prevalent in these areas. Furthermore, the lack of a stable government in these countries means that there are flaws in the coordination of distributing the resources.
According to the article, the two markers for public health success in developing countries are increased maternal survival and increased overall life expectancy. Maternal survival is a key indicator of public health success because in order for a pregnant woman to survive, the environment, personnel, and equipment involved in the delivery needs to be as best as possible to ensure a high success rate. Therefore, if the country has these resources and personnel available, it means that the country has a good overall health care system. Overall life expectancy is an indicator of public health success because the average person in a country lives, the better the quality of health in that country. It means that the water is cleaner leading to less contamination, the mosquito population is low leading to low rates of malaria, and immunizations are available for prevalent infectious diseases.
The author indicates that some public health measures have caused more harm than good. For example, many of the hospitals and clinics in developing countries reuse syringes for vaccinations, inadequately sterilize surgical instruments, and lack testing for blood-bank systems, all of which could increase the spread of HIV to the patients that are vaccinated (for preventable diseases) and the general population. Another example of how public health measures may have caused more harm than good is the concern about influenza spreading across the world. Public health measures dealing with this issue include donating money and inventing methods to prevent the spread of influenza. However, the developing nations lack hospital personnel, public health experts, and research scientists to perform the preventive methods. Also, coordination requires the presence of public health infrastructure, which these countries also lack.
Friday, October 15, 2010
Whooping Cough is on the rise again!
In this blog post, I will be summarizing the Washington Post article, "Whooping cough makes a comeback." Then I will be talking about herd immunity and vaccinations in public health.
This article basically states that whooping cough, considered a disease of the past, is starting to rise again starting in California. If the right preventive measures are not taken, this disease could spread nationally and with an infection rate greater than smallpox, has potential to be a very serious public health issue. Whooping cough is also a cyclical disease, meaning that it has its highs and lows in terms of infection rates. It is a very dangerous disease because of its high infection rate and various characteristics that differ from most other diseases. The bacteria that causes whooping cough, Bordetella pertussis, initially only causes minor symptoms in its host and once it is detected, the disease is usually too late to treat. The article gives an example of a woman's child who died because he was detected with this disease too late.
Herd immunity is a theory that states that if a portion of the population is vaccinated against a particular disease, this will provide protection for the unvaccinated portion of the population from that disease. The logic behind this is that if a large portion of the population is vaccinated and since infectious diseases are passed from person to person, this chain of infection is going to be less significant. Normally, those who do not receive vaccinations will experience some sort of negative side effect upon vaccination. Therefore, the public health importance here is that if most of the population who can be vaccinated are vaccinated, the rest of the population who, for whatever reason, cannot take the vaccination will be protected because it is harder for the infectious disease to get to them since the majority of the population will be immune to the disease.
This article basically states that whooping cough, considered a disease of the past, is starting to rise again starting in California. If the right preventive measures are not taken, this disease could spread nationally and with an infection rate greater than smallpox, has potential to be a very serious public health issue. Whooping cough is also a cyclical disease, meaning that it has its highs and lows in terms of infection rates. It is a very dangerous disease because of its high infection rate and various characteristics that differ from most other diseases. The bacteria that causes whooping cough, Bordetella pertussis, initially only causes minor symptoms in its host and once it is detected, the disease is usually too late to treat. The article gives an example of a woman's child who died because he was detected with this disease too late.
Herd immunity is a theory that states that if a portion of the population is vaccinated against a particular disease, this will provide protection for the unvaccinated portion of the population from that disease. The logic behind this is that if a large portion of the population is vaccinated and since infectious diseases are passed from person to person, this chain of infection is going to be less significant. Normally, those who do not receive vaccinations will experience some sort of negative side effect upon vaccination. Therefore, the public health importance here is that if most of the population who can be vaccinated are vaccinated, the rest of the population who, for whatever reason, cannot take the vaccination will be protected because it is harder for the infectious disease to get to them since the majority of the population will be immune to the disease.
The revival of whooping cough especially in California is due to numerous reasons. First, it is legal and easy for parents in California to refuse vaccinations for their children. Vaccination laws differ among different states and California is lenient in terms of an individual choosing whether or not to get vaccinated. The reason they opt to not be vaccinated is that there was a rumor that vaccinations cause autism, brain damage, and other negative side effects. Parents also believe in herd immunity, thinking that if their children's peers all get vaccinated, their children will be protected against the disease as well. Also, these days, physicians give children acellular vaccines instead of whole-cell vaccines because acellular vaccines are considered safer. However, they are not as effective in curing whooping cough than whole-cell vaccines are. Also, the Pertussis bacteria (the bacteria that causes whooping cough) has evolved and mutated and is more resistant to vaccines nowadays. Therefore, the vaccines used earlier up to the mid 1990s are not as effective as the newly developed vaccines. Furthermore, this bacteria is very good at hiding and is hard to detect even with advanced biological tools used by researchers. The whooping cough vaccination, unlike other vaccinations, does not 100% prevent someone from getting the disease, so one can get infected even after being vaccinated.
Public Health policymakers should educate the general population about whooping cough and inform them of its various unique characteristics. Therefore, people will be more cautious and parents will be more willing to let their children get vaccinated. Policymakers should provide evidence that states that there are no negative side effects in getting vaccinated for this disease. Also, parents should be informed that herd immunity will only work up to a certain point (herd immunity threshold). That is, a certain level of the community needs to be vaccinated in order for herd immunity to operate. Therefore, all children who don't experience negative side effects should be vaccinated. Also, biomedical researchers should continue doing ongoing research on this disease and not just reject it as a "disease of the past." This bacteria has shown that it can mutate and evolve various mechanisms to continue to infect even those who are vaccinated. Also, researchers should be informed that this bacteria is very hard to detect even with the most advanced scientific tools so they should perform numerous trials and scrutinize their results carefully.
Friday, October 8, 2010
Non-smokers is not an independent group!
In this blog post, I will be discussing the effect that smoking husbands have on the development of lung cancer for their non-smoking wives. I will be summarizing a study done in Japan regarding this subject.
This study was a Cohort study that interviewed and followed 122,261 men and 142,857 women age 40 years and above. The population was separated into non-smoking wives of smoking husbands and non-smoking wives of non-smoking husbands. The objective of this study was to determine whether wives of smokers have an increased risk of lung cancer development. The results showed that 346 women deaths occurred during the 14 year follow up period. 174 of these women were non-smoking women who were married to smoking husbands. The results yielded a two tailed p-value of 0.00097, which means that the null hypothesis is rejected in favor of the alternative hypothesis since the results are statistically significant because it was not the result of chance. In this case, the null hypothesis was that non-smoking women of smoking husbands and non-smoking women of non-smoking husbands have the same chance of developing lung cancer. Since the p-value, 2*0.00097 < alpha (0.05 most of the time), we will accept the alternative hypothesis, which, in this case, was that non-smoking women of smoking husbands have a greater chance of developing lung cancer than non-smoking women of non-smoking husbands. The study also concluded that husbands' smoking and alcohol drinking habits have no effect of their non-smoking wives' risk of developing other types of major cancers other than lung cancer. Also, the effect of passive smoking was compared with the effect of direct smoking, yielding a relative risk of developing lung cancer by passive smoking of 1.8 compared to a relative risk of 3.8 for direct smokers. Therefore, the study showed a dose-response relationship between passive smoking and the risk of developing lung cancer.
The advantage of this study is that it allowed the examination of multiple outcomes of non-smoking wives of smoking husbands. For instance, the study showed a relation between husbands' smoking habits and deaths from emphysema and asthma in their wives. Also, the study found that the risk of developing other types of cancer, such as stomach and cervical cancer, in non-smoking wives did not increase with smoking husbands. In my opinion, second hand smoking is an environmental health issue because when the primary smoker exhales the smoke, this smoke is inhaled by people who are standing within the vicinity of the primary smoker. Therefore, these people will inhale these bad chemicals and toxics, including carcinogens, and increase their chances of developing lung cancer, since the above study has showed a dose-response relationship between passive smoking and lung cancer. Since these toxic chemicals exhaled by the primary smoker permeates the environment and affects all of those around the primary smoker, a smoke-free environment is needed to protect people from second hand smoking. Therefore, second hand smoking is an environmental problem because toxic chemicals are released into the air. Although association does not always imply causation, I believe that the results of this study support second hand smoking as a cause of lung cancer. The results from the study concluded a dose-response relationship between second hand smoking and the development of lung cancer. Although most dose-response relationships have a safe amount of dose one can take before experiencing an adverse response, cancer does not have this safe threshold. Therefore, the chance of developing cancer is linearly proportional to amount of dose taken by the subject. Thus, the more dose of carcinogen taken, the greater the chance you might develop cancer. So in this case, the more toxics inhaled by a second hand smoker, the greater the chance that person will develop lung cancer.
This study was a Cohort study that interviewed and followed 122,261 men and 142,857 women age 40 years and above. The population was separated into non-smoking wives of smoking husbands and non-smoking wives of non-smoking husbands. The objective of this study was to determine whether wives of smokers have an increased risk of lung cancer development. The results showed that 346 women deaths occurred during the 14 year follow up period. 174 of these women were non-smoking women who were married to smoking husbands. The results yielded a two tailed p-value of 0.00097, which means that the null hypothesis is rejected in favor of the alternative hypothesis since the results are statistically significant because it was not the result of chance. In this case, the null hypothesis was that non-smoking women of smoking husbands and non-smoking women of non-smoking husbands have the same chance of developing lung cancer. Since the p-value, 2*0.00097 < alpha (0.05 most of the time), we will accept the alternative hypothesis, which, in this case, was that non-smoking women of smoking husbands have a greater chance of developing lung cancer than non-smoking women of non-smoking husbands. The study also concluded that husbands' smoking and alcohol drinking habits have no effect of their non-smoking wives' risk of developing other types of major cancers other than lung cancer. Also, the effect of passive smoking was compared with the effect of direct smoking, yielding a relative risk of developing lung cancer by passive smoking of 1.8 compared to a relative risk of 3.8 for direct smokers. Therefore, the study showed a dose-response relationship between passive smoking and the risk of developing lung cancer.
The advantage of this study is that it allowed the examination of multiple outcomes of non-smoking wives of smoking husbands. For instance, the study showed a relation between husbands' smoking habits and deaths from emphysema and asthma in their wives. Also, the study found that the risk of developing other types of cancer, such as stomach and cervical cancer, in non-smoking wives did not increase with smoking husbands. In my opinion, second hand smoking is an environmental health issue because when the primary smoker exhales the smoke, this smoke is inhaled by people who are standing within the vicinity of the primary smoker. Therefore, these people will inhale these bad chemicals and toxics, including carcinogens, and increase their chances of developing lung cancer, since the above study has showed a dose-response relationship between passive smoking and lung cancer. Since these toxic chemicals exhaled by the primary smoker permeates the environment and affects all of those around the primary smoker, a smoke-free environment is needed to protect people from second hand smoking. Therefore, second hand smoking is an environmental problem because toxic chemicals are released into the air. Although association does not always imply causation, I believe that the results of this study support second hand smoking as a cause of lung cancer. The results from the study concluded a dose-response relationship between second hand smoking and the development of lung cancer. Although most dose-response relationships have a safe amount of dose one can take before experiencing an adverse response, cancer does not have this safe threshold. Therefore, the chance of developing cancer is linearly proportional to amount of dose taken by the subject. Thus, the more dose of carcinogen taken, the greater the chance you might develop cancer. So in this case, the more toxics inhaled by a second hand smoker, the greater the chance that person will develop lung cancer.
Friday, October 1, 2010
Noncommunicable Diseases - Worlds Coming Together
In this blog post, I will be summarizing the article, "Global Noncommunicable Diseases - Where Worlds Meet" by NEJM. Then, I will be discussing my thoughts and opinions on this matter.
This article basically shows the increasing importance of preventive care for noncommunicable diseases. Noncommunicable diseases, such as heart disease, cancer, and diabetes, are becoming increasingly prevalent. According to the article, six of the top ten risk factors of all deaths are associated with noncommunicable diseases. Non-communicable diseases, unlike most communicable diseases, affect countries of all income levels. The reason for this is that as developing countries become more developed, they are becoming more urbanized. This results in demographic and lifestyle shifts that introduce bad habits such as eating excessively, which increases the chance of heart disease. This is quite a paradox because globalization is key to economic development and the improvement of health, but it also causes a higher incidence of noncommunicable diseases. There are multiple causes for noncommunicable diseases and these diseases can have lifelong impacts. In addition, monetary incentives for industries and interest groups hinder policy makers' effectiveness in dealing with the control of the risk factors behind noncommunicable diseases. This problem can be dealt with by a combined proactive intervention plan from all areas of society nationally and globally. It is surprising that there is a great overlap between the leading risk factors for death in both the richest and poorest countries. For example, the causes of high blood pressure, such as smoking and obesity, are usually applied to rich countries. It is hard to imagine citizens of poor countries having enough money to buy tobacco when there are definitely more pressing concerns. However, this may be likely the case because since most poor countries do not have a stable agricultural infrastructure or meat industry, they rely on foods rich in fats and oils, which are usually cheaper than agricultural goods or fresh produce. Therefore, the accumulation of these oils and fats into the blood vessels ultimately results in high blood pressure.
An example of a chronic disease is Epilepsy, a brain disorder that causes clusters of nerve cells to signal sudden motions. Primary prevention avoids the development of a disease by eliminating the risk factors associated with the disease. In this case, primary prevention deals with genetic screening and prenatal diagnosis in the pregnant mother for the genes that cause Epilepsy. Secondary prevention deals with preventing a disease from occurring among those who are at risk. In the case of Epilepsy, secondary prevention includes wearing seat belts, bicycle helmets, or anything that prevents head injury. Tertiary prevention is preventing a disease from worsening for those who already have the disease. In this case, various medications would be used for those who have epilepsy. The effectiveness of these prevention strategies would be more effective in more developed countries because there are more vehicles (more opportunity for head injury) and money for medications in developed countries whereas developing countries may not have as many risk factors or enough money for tertiary prevention. Also, in more developed countries, motor safety and bike riding policies may be easier to implement with an organized government rather than a government yet fully established, as in the case with most developing countries.
This article basically shows the increasing importance of preventive care for noncommunicable diseases. Noncommunicable diseases, such as heart disease, cancer, and diabetes, are becoming increasingly prevalent. According to the article, six of the top ten risk factors of all deaths are associated with noncommunicable diseases. Non-communicable diseases, unlike most communicable diseases, affect countries of all income levels. The reason for this is that as developing countries become more developed, they are becoming more urbanized. This results in demographic and lifestyle shifts that introduce bad habits such as eating excessively, which increases the chance of heart disease. This is quite a paradox because globalization is key to economic development and the improvement of health, but it also causes a higher incidence of noncommunicable diseases. There are multiple causes for noncommunicable diseases and these diseases can have lifelong impacts. In addition, monetary incentives for industries and interest groups hinder policy makers' effectiveness in dealing with the control of the risk factors behind noncommunicable diseases. This problem can be dealt with by a combined proactive intervention plan from all areas of society nationally and globally. It is surprising that there is a great overlap between the leading risk factors for death in both the richest and poorest countries. For example, the causes of high blood pressure, such as smoking and obesity, are usually applied to rich countries. It is hard to imagine citizens of poor countries having enough money to buy tobacco when there are definitely more pressing concerns. However, this may be likely the case because since most poor countries do not have a stable agricultural infrastructure or meat industry, they rely on foods rich in fats and oils, which are usually cheaper than agricultural goods or fresh produce. Therefore, the accumulation of these oils and fats into the blood vessels ultimately results in high blood pressure.
An example of a chronic disease is Epilepsy, a brain disorder that causes clusters of nerve cells to signal sudden motions. Primary prevention avoids the development of a disease by eliminating the risk factors associated with the disease. In this case, primary prevention deals with genetic screening and prenatal diagnosis in the pregnant mother for the genes that cause Epilepsy. Secondary prevention deals with preventing a disease from occurring among those who are at risk. In the case of Epilepsy, secondary prevention includes wearing seat belts, bicycle helmets, or anything that prevents head injury. Tertiary prevention is preventing a disease from worsening for those who already have the disease. In this case, various medications would be used for those who have epilepsy. The effectiveness of these prevention strategies would be more effective in more developed countries because there are more vehicles (more opportunity for head injury) and money for medications in developed countries whereas developing countries may not have as many risk factors or enough money for tertiary prevention. Also, in more developed countries, motor safety and bike riding policies may be easier to implement with an organized government rather than a government yet fully established, as in the case with most developing countries.
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