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 heard this great piece on NPR this morning about the land usage required to get the same amount of energy out of some renewable sources compared to traditional power plants. The numbers were staggering. It takes 72 more times the square acres for wind and (here’s the big one) 300+ times for ethanol production for every square acre of traditional power plant.
I’m currently reading The Omnivore’s Dillema, and Michael Pollen spends a lot of time discussing the monoculture of corn in the mid-west and it’s negative impact on the ecology of those areas, the farmer’s economic situation, oil usage to grow the corn at such high yields, pesticide application, and the fact that other crops are not being grown. I feel like adding government pressure to grow this heavily subsidized crop for fuel will exacerbate these problems. Plus I find of scary to have our food system so intimately tied to our energy generation. This piece struck me because the legislation to increase ethanol production is having a great effect on what is grown in this country, and how it is grown. Corn for ethanol production can be Genetically modified, sprayed heavily with pesticides, and most consumer’s won’t know or care. But all the while it will be having an effect, and we shouldn’t be ignoring it.
One great thing about the story on NPR was that the big solutions presented to our energy problem was greater efficiency (i.e., low energy consumption appliances/higher miles per gallon cars) and curbing consumption. Hopefully more people will jump on that bandwagon.
Filed under: Uncategorized
Nothing too crazy…but just wanted to mention that Starbucks stopped using Silk Soymilk because of they are no longer organic. Hopefully consumers will notice and make similar changes to their soymilk consumption.