Filed under: Uncategorized | Tags: epidemiology and community health, polypill
in The Jouranal of Epidemiology and Community Health, Drs. Holmes and Bhala (2013; 67:897-902 doi:10.1136/jech-2013-202690) lay out a cogent and interesting argument for the allocation of a polypill to the general adult population – one that includes low doses of drugs against cardiovascular diseases, hypertension, and potentially Alzheimer’s, diabetes, and certain forms of cancer (were appropriate and effective drugs for prevention made available). Though I appreciated many of the arguments, for example, that a polypill would reduce risk of diseases in all people uniformly, addressing genetic and environmental causes of diseases, that a polypill has similarities to vaccine programs and certainly to food supplementation programs, which rely on herd immunity or are used to benefit only a small proportion of the population, I found myself wondering about critical societal factors which are important determinants of the chronic diseases which would be addressed by a polypill.
Vaccination programs or micronutrient supplementation is employed because there is no other way for the government or society to intervene on the causes of these diseases. Indeed, efforts to reduce infectious diseases like cholera or influenza begin with environmental changes – cleaning the water supply or quarantining individuals – in conjunction with vaccination.
While governmental efforts to reduce chronic diseases have been established (Eat Smart, Move More for obesity, or dietary guidelines for sodium reduction for hypertension), there has not been the large-scale shift towards physical infrastructure, food system, or health system change needed to significantly reduce the burden of these diseases in the population. Until the government efforts to lower the risk of these diseases reaches businesses and their own strategies, rather than relying on recommendations to individuals, it does not seem that we have done enough to warrant a polypill as the most viable strategy.
Filed under: Uncategorized | Tags: gene environment, health wars, nature vs nurture, richard horton
Reblogged from my tumblr…
We do a lot of studies in nutrition epidemiology about gene environment interactions, the general hypothesis that some individuals have a genetic predisposition towards a certain health outcome, but that certain behaviors may enhance or diminish the effects of this genetic disposition (and thus, are good targets for public health policy).
I’ve been reading Health Wars by Richard Horton, which is full of beautiful gems and new thoughts about health issues that I had taken for granted as fixed and known. He includes a discussion of our approach to genetic research, and he mentions an interesting book by scientist Matthew Ridley called Nature via Nurture, saying
“he argues that…it is nurture that is less amenable to change than nature….it is our environment that governs which genes are switched on and when, and so ‘genes are at the mercy of our behavior’. They exist simply to extract information from our surroundings.”
In a world that love quick fixes and easy answers, we want to believe that we are not in control of our destiny, that we are fighting an impossible fight, and we allay our fears by convincing ourselves that a doctor or science will be able to provide a quick fix. Thus far, genetic answers to complex diseases have not come. Obviously, it would be great to find genetic explanations for diseases, but we also seem to find it easier to address issues of biology than to address issues related to environment, social structure, nutrition, infrastructure.
The biologic and social sciences are both needed, but competitive quests to find social solutions to health issues are not popularized and publicized on the scale of the excitement surrounding the Human Genome Project. Sometimes I wonder if our social environment may actually be more complex than our genome.
Surveys of opinions, of the prevalence of disease, of habits or of environmental exposures may be informative, but they are not science in the same way that causal studies about how nature operates are science.
Ken Rothman, JE Gallacher, and EE Hatch in “Why representativeness should be avoided” Int J Epidemiology (2013) 42(4): 1012-1014
I read some articles in the last few days that compared grass-fed beef to feed-lot raised cows. The articles, such as this one in Slate a few days ago state that grass-fed beef supporters say the E. Coli doesn’t actually grow in the stomachs of grass-fed beef. I was under the impression, and perhaps I was mistaken, that the connection between E. Coli and grass-fed beef was that the bacteria was much less likely to be found in grass-fed beef because the cows are given more space and are in generally cleaner conditions than those in feed lots, and because their feed is more closely regulated than feed lot beef. Just to get the clear picture out there… E. Coli CAN grow and live in any cow’s stomach! HThere’s always going to be some bacteria. It’s part of life. The problem is that in feed lot cattle, the living conditions are facilitating E. Coli growth by generally mistreating the cows. E. Coli will happen, but steps should still be taken to prevent their growth (and by more ways than inoculating them). There is an expectation for us to eat germ-free food…it’s never going to happen. The problem is when these germs are in foods they definitely should not be in (i.e., cookie dough…) or when we are exacerbating the problem by the way we actually raise farm animals in this country.
Just like you don’t eat an organic apple for it’s “higher nutrient content,” but rather for the environmental methods by which it’s produced, grass-fed cattle is there to alleviate many worries about feed-lot cattle, not just E. Coli and other food safety issues.
Long story short (can you tell I can get worked up about this??), eating grass-fed beef does not give 100% certainty that you won’t get sick from E. Coli. But your odds probably are a lot higher, and you can at least know that you’re doing better on many other fronts (keeping your Omega-6 to Omega-3 ratios down, letting the cows eat what they want and are meant to eat, have beef that is free from antibiotics, cows that are eating VEGETARIAN!! (as they should be….), not supporting a very large corn industry, happy farms, happy people, this list goes on…). So eat your grass-fed burger with a little less trepidation than your feedlot burger tonight.
I promise, the last post about sprouts in a while. Wheat sprouts were successful!! And so delicious!! Once again, a light saute and some salt make a delicious accompaniment for any meal!
Lastly, I leave you with a good link to a last weekend’s Living on Earth. It featured Will Allen, who founded Growing Power, an urban farm and education center in Milwaukee. He’s a pretty cool dude, and so is this program, which dealt with our food system past, present and future.