Category: Health Policy

FDA Crackdown on Misleading Dietary Supplements

The United States is in the midst of a scientific wave. We are lucky to live during a time where new and effective medicines have changed the way we can prevent and treat chronic disease. However,  we have begun to see that fraudulent claims and products accompany this innovation. Amongst these deceptive products, dietary supplements are amongst the guiltiest parties.

The dietary supplement industry is extremely prosperous, with a market size of nearly $112 billion. Although some dietary supplements are effective, there are many which provide no benefit or can even cause harm to a consumer. Many false products make sweeping claims which have absolutely no backing evidence – such as dietary supplements which advertise that they can prevent Alzheimer’s Disease. Dietary supplements do not have to be reviewed by the Food and Drug Administration (FDA) before hitting the market. They can only be taken down afterwards if they have shown to cause adverse health outcomes or if the product is fake/misleading.

Just this week, the Food and Drug Administration (FDA) has released a statement regarding just this. This press announcement calls for a new, massive regulation of dietary supplements. The FDA is addressing this issue because they believe ineffective dietary supplements can cause a great deal of harm when people take them as alternatives to approved treatments. This new statement provides a hopeful potential of establishing a more honest and less misleading supplement market.

 

https://www.jillcarnahan.com/2018/02/17/fake-supplement-issue-no-one-talking-beware-amazon/

https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm631046.htm

https://www.fda.gov/Food/DietarySupplements/UsingDietarySupplements/ucm109760.htm

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm631065.htm

 

 

Designer Babies: Questions of Ethics

Imagine a world with no disease. No one gets cancer, birth defects are a thing of the past, and STDs like HIV have been eliminated. At the end of 2018, Chinese scientist He Jiankui announced that we were one step closer to this reality. He had successfully created genetically altered babies, who were, he claimed, resistant to HIV. This announcement threw the scientific community into an uproar. It reignited a decades old debate over the role of eugenics amid our increasing ability to alter—and select—the human genome to create the “perfect” human. Some countries banned all gene-editing in response, pending review. The ethical implications of gene-editing are complex, and we can no longer delay discussing them. These are some of the questions that you should be asking:
 
1) Does creating “designer babies” increase disadvantages or discrimination within a society? In other words, if we can create the “perfect” human, how are the less than perfect humans affected?
 
2) When should we allow gene-editing in humans? Gene editing that removes a devastating disease may be acceptable. What about gene editing that determines eye-color or intelligence? Where do we draw the line?
3)What are the population-level implications of gene-editing human embryos?
4) What are the potential benefits of gene-editing in humans? Beyond addressing illness, could gene-editing also be used to change personality traits?
 
5) Who gets to decide whether gene-editing is permissible? What gives them the authority to do so? Who else deserves a say?
 
6) What are the appropriate legal measures in favor or against gene editing in humans?
 
Check out these links for more in-depth discussion of these issues:
https://www.bbc.com/news/world-asia-46943593
https://www.huffingtonpost.ca/dr-caitlin-dunne/designer-babies-and-human-gene-editing_a_23637685/
https://www.independent.co.uk/news/health/designer-babies-gene-editing-genetics-genome-nuffield-ethics-disease-a8449971.html
https://jme.bmj.com/content/30/6/e5
https://www.nih.gov/about-nih/who-we-are/nih-director/statements/statement-claim-first-gene-edited-babies-chinese-researcher

Drug Overdose & Suicide Rates Climb in the US While Life Expectancy Falls

Despite being leaders in medical innovation, the United States is often criticized for healthcare problems that don’t exist in other developed nations. Lately, increasing rates of suicide and drug overdose have taken a toll on our population’s life expectancy. Recent government reports from the CDC have shown a decrease in life expectancy from 2016 to 2017.

 

In 2017, approximately 70,000 yearly deaths were attributed to drug overdosing, which is almost 7,000 more than the year before. In addition to this, suicide rates had increased by nearly 4% from the previous year. Both of these statistics are alarming and disturbing. For while we are constantly advancing science and medicine to create novel disease treatments and cures, we often are ignoring preventable public health crises.

 

These statistics contribute to the evidence that drug overdose is a mishandled and somewhat neglected epidemics in the United States. Other sources suggest that mental health has been on the decline in the United States for years. Taken as a whole, these findings highlight the need for more attention to these preventable morbidities and mortalities.

 

https://www.cnn.com/2018/11/29/health/life-expectancy-2017-cdc/index.html

https://www.cdc.gov/nchs/

https://www.realclearhealth.com/articles/2018/05/17/cdc_neglect_is_killing_americans_110787.html

https://www.scientificamerican.com/article/is-mental-health-declining-in-the-u-s/

 

Vaping on the Rise

In 1965, the National Health Interview Survey (NHIS) began tracking cigarette smoking in the United States. Although it is still a widespread and serious problem in the US, the rates of traditional cigarette smoking have steadily declined. Now, in 2018, our nation is faced with a new tobacco use: vaping.

A new statement by the Food and Drug Administration (FDA) states that adolescents are vaping at a dangerous level. From 2017 to 2018, the FDA found an 80% increase in the number of high schoolers vaping, and a 50% increase in middle schoolers. In total, the FDA and the Centers for Disease Control found that one out of five high schoolers have vaped in the last month.

Many people worry that the spike in adolescent vaping is a result of youth-targeted branding by e-cigarette companies. In particular, many people have pointed fingers at the e-cigarette brand “Juul”. In the recent past, Juul’s advertising campaigns contained images full of young faces, bright colors, and several fruit-flavored vaping options. Now, due to a series of initiatives from the FDA, Juul has recalled many of these campaigns and suspended sales of untraditional flavors.

Evidence does suggest that e-cigarettes should be safer than traditional tobacco cigarettes. However, these products are still new to the market and health-associated risks have not been fully evaluated.  In addition, when adolescents vape they are still being exposed to nicotine. This is a dangerous and addictive substance which can be harmful to a developing brain.

 

 

https://www.cdc.gov/media/releases/2018/p0118-smoking-rates-declining.html

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm625884.htm

https://www.cnn.com/2018/11/15/health/fda-vaping-ecigarette-regulation/index.html

https://www.nytimes.com/2018/11/13/health/juul-ecigarettes-vaping-teenagers.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110871/

https://e-cigarettes.surgeongeneral.gov/knowtherisks.html

 

 

 

Health and the midterm elections

Today is election day. Across the country there are numerous elections which are weighing in on important health issues. There are several important health topics in the ballots, including: abortion rights, Medicaid expansion, marijuana usage, grocery taxes, and laws related to drug use and possession charges. Due to the political leanings of the current national administration, abortion rights are particularly vulnerable during this time.

Alabama, West Virginia, and Oregon are voting on legislation which will seriously affect access to abortion. On Alabama’s ballot, a newly proposed Amendment 2 is trying to change the wording which defines a fetus’ rights on the state Constitution. The amendment is aiming to grant a fetus the same rights and protections as a baby who has been born. If passed, this issue could have serious implications on further legislation which may eventually outlaw abortion in the state. In addition, this ballot measure doesn’t include the right to an abortion in the case of rape, incest, or if the mother’s life is at-risk.

West Virginia and Oregon are voting on measures which attempt to withhold state funding for abortion cases in respect to state employees and Medicaid recipients. However, in contrast to Alabama’s measure, these states do grant the right to victims of rape, incest, or when the mother’s life is in danger.

It is important to consider how our votes can act as determinants for health issues like these and many others. Voting at a state level can have a much larger impact on both national and local issues – especially pertaining to public health and medicine. Go out and vote today!

Look up your registration status, local polling place, and sample ballot here:

https://vt.ncsbe.gov/RegLkup/

 

 

https://www.cnn.com/2018/11/05/health/health-ballot-initiatives/index.html

https://ballotpedia.org/Alabama_Amendment_2,_State_Abortion_Policy_Amendment_(2018)

 

Soot Happens

A new study released from the Queen Mary University of London has shown for the first time that air pollution exposure can affect a pregnant woman’s placenta. The placenta is a vital organ which develops during a woman’s pregnancy. It is responsible for providing nutrients and oxygen to a developing baby. In addition, it also serves as an immune system barrier for the baby, which is vulnerable during pregnancy. Any injuries inflicted on the placenta can have serious health effects on the unborn child.

The Queen Mary study examined placenta cells of five women who were exposed to air pollution. Within the samples, researchers found evidence of the presence of soot. Soot is a common air pollutant classified as particulate matter. This type of pollution is made of large damaging particles, and can often be found coming from power plants, manufacturing sites, and motor vehicles. Soot exposure is dangerous, and it is the cause of thousands of premature deaths annually. The findings of this study are novel and alarming – it demonstrates that inhaled particulate matter can travel from the lungs to the placenta.

Placental immune cells are necessary to keep an unborn baby healthy. If the placental immune system is compromised, so is that of the growing baby. It is still unclear what this study’s findings mean for fetal-placental health in the long term. However, researchers on this study are particularly concerned about how soot exposure may disrupt this system.

One thing is clear – this news is disturbing. The study demonstrated that air pollution damage does not stop at the lungs. The conversation about air pollution is not always an environmental one; many pollutants like soot affect human health dramatically. Going forward, it is important to consider how these findings should influence policy. Regulating air pollution is a necessary step to take in order to protect the health of people worldwide.

 

 

https://www.momscleanairforce.org/soot-facts/

https://www.qmul.ac.uk/media/news/2018/smd/first-evidence-that-soot-from-polluted-air-may-be-reaching-placenta.html

https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/placenta/art-20044425

https://www.nichd.nih.gov/research/supported/HPP/default

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025805/

 

 

New things to know about your cup of joe

The general public loves to scrutinize the coffee drinking habit. Multitudes are drinking it (in relatively large amounts) – so what does that mean for us? In recent years, research and public opinion has begun to favor the pros of drinking coffee. Some studies have even shown that there are significant health benefits which may be associated your daily cup of joe.

Despite this trend, news has recently surfaced which may upset these well-received findings. When coffee beans are roasted at a high temperature, they produce a chemical called acrylamide. It has been shown that higher doses of acrylamide can be harmful, and has been linked to cancer. This chemical cannot be separated from a coffee product; if someone drinks coffee, they are likely exposed to the chemical.

This evidence appears grim, but don’t dismay coffee drinkers. There are a few silver-linings to this story. The formal research on acrylamide is still inconclusive, as exposure has not been directly linked to any specific cancer. Along with this, the amount of acrylamide in coffee appears to be minute. Due to this, California has recently pushed back against labeling coffee as a cancer-causing substance. Acrylamide intake can also be avoided by considering the amount and type of coffee consumed. Drinking a little less coffee means a little less exposure. Additionally, opting for dark-roasted beans tends to minimize exposure to chemical.

https://www.bmj.com/content/359/bmj.j5024

http://time.com/5222563/what-is-acrylamide/

https://www.healthline.com/nutrition/acrylamide-in-coffee#section3

https://www.usnews.com/news/healthcare-of-tomorrow/articles/2018-09-04/cancer-schmancer-in-california-coffee-is-king

 

 

 

 

Dirty Lungs: the Affordable “Clean” Energy rule

The U.S. Environmental Protection Agency recently proposed the Affordable Clean Energy (ACE) rule. In spite of the word “clean”, the plan will likely lead to an increase in coal emissions across the United States. ACE will grant states the individual responsibility of policing their own air pollution. Without federal regulation, this may lead to a net increase in green house gas emissions. The policy also aims to cut other protocols which limit emissions from coal plants.
 
The consequences of this legislation concern many health professionals. The EPA’s own impact analyses has shown what health effects can be expected by 2030. Changes in air quality could lead to as many as 1,400 new premature deaths per year. Along with this, increases in asthma, cardiovascular disease, and respiratory problems are expected. The same report projected 15,000 new upper-respiratory cases yearly. These grim side effects are due to the expected increase in fine particulate matter in the air. Particulate matter is a type of air pollution which comes from burning fuels like coal and oil.
 
When creating new legislation, the EPA must consider studies on effects of air pollution on human health. With this in mind, a new policy by the EPA worries scientists and health professionals. It states that the EPA will not consider research unless all original data is made public for scientists and industry. Although transparency is good in theory, this new policy would exclude a large number of studies which use human health data. Much of this research relies on confidential patient health information. Data like this often remains private to protect patients’s rights. Excluding this research may lead to misinformation and underestimates of premature death. This new provision would interfere with ethical creation of air pollution policy.

Resources:

Current Climate of HIV Disparity in NC: Part 2

Impact of Disparity

Research has shown that the prevalence of HIV diagnoses and the rates of new HIV infections are highest in the southern US, including North Carolina.7 In the state of North Carolina:

  • Male-to-male sexual contact represents the mode of transmission for almost 70% of men living with HIV8
  • Almost 6% of transmissions for men living with HIV were the result of dual exposure through injection drug use and male-to-male sexual contact8
  • Almost three-fourths of total HIV transmission in the state are the result of male-to male sexual contact8
  • Among new diagnoses, these numbers only seem to be increasing, closer to 84%8
  • Black men in the state of North Carolina are also 6 times more likely to be living with HIV than white males8
  • The Durham-Chapel Hill, Winston-Salem, Greensboro-High Points metropolitan areas were also identified within the top 25 metropolitan areas for prevalence of HIV diagnoses and rates of new infections7

Causes of Disparity

Pre-exposure prophylaxis offers many opportunities to prevent the spread of HIV; however, stigma surrounded the drug itself may be preventing many gay and bisexual men from seeking out the drug and many medical providers from prescribing the drug to their gay and bisexual patients. This could partially be a result of general stigma about asking patients sexual health questions or questions about sexuality. Simply prescribing PrEP to all gay and bisexual men would result in overuse. Hence, discussions about sexual risk behaviors is important for assessing an individual’s need for the drug. However, medical provider stigma might represent a larger barrier to accessing PrEP, especially for black men who have sex with men. Further, the population of medical providers has been less of a focus for current public health interventions to increase the use of PrEP.

 

References

  1. Duran, D. Truvada Whores? Huffinton Post. 2012. https://www.huffingtonpost.com/david-duran/truvada-whores_b_2113588.html
  2. Addison, V. Larry Kramer, Truvada Whores and the Angry Divide Between Two Generations. HIVEqual. n.d. http://www.hivequal.org/homepage/larry-kramer-truvada-whores-and-the-angry-divide-between-two-generations
  3. Logo. Revisiting “Truvada Whore” Three Years Later. NewNowNext. 2016. http://www.newnownext.com/revisiting-truvada-whore-three-years-later/02/2016/
  4. Emory University Rollins School of Public Health. North Carolina. AIDSVu. n.d. https://aidsvu.org/state/north-carolina/
  5. Calabrese SK, Underhill K. How Stigma Surrounding the Use of HIV Preexposure Prophylaxis Undermines Prevention and Pleasure: A Call to Destigmatize “Truvada Whores”. American journal of public health. 2015;105(10):1960-1964.
  6. Calabrese SK, Earnshaw VA, Underhill K, Hansen NB, Dovidio JF. The Impact of Patient Race on Clinical Decisions Related to Prescribing HIV Pre-Exposure Prophylaxis (PrEP): Assumptions About Sexual Risk Compensation and Implications for Access. AIDS and behavior. 2014;18(2):226-240.
  7. Rosenberg ES, Grey JA, Sanchez TH, Sullivan PS. Rates of Prevalent HIV Infection, Prevalent Diagnoses, and New Diagnoses Among Men Who Have Sex With Men in US States, Metropolitan Statistical Areas, and Counties, 2012-2013. JMIR Public Health Surveill. 2016;2(1):e22.
  8. Britz JJ. To Know or not to Know: A Moral Reflection on Information Poverty. Journal of Information Science. 2004;30(3):192-204.

Current Climate of HIV Disparity in NC: Part 1

For many people, the term AIDS is no longer representative of the state of HIV; with current treatment options, no individual’s manifestation of HIV should reach the level of AIDS. However, more work needs to be done to prevent the spread of HIV, specifically with a goal of protecting men in the gay community. In the US, men who have sex with men continue to carry the burden of prevalence of individuals living with HIV and rates of new diagnoses. This issue is exacerbated in the South and among black men who have sex with men. Pre-exposure prophylaxis for HIV (PrEP) represents an opportunity to drastically reduce the number of new HIV diagnoses; however, individuals must be able to gain access to this preventative treatment.

Evidence of Disparity

On November 12, 2012, more than five years ago, David Duran wrote an article for the Huffington Post, titled “Truvada Whores?” Duran argued that pre-exposure prophylaxis for HIV (PrEP) allows gay men (and other men who have sex with men) to engage in unsafe sex while taking a pill, rather than encouraging them to partake in safer-sex practices, by which I assume he means the use of a barrier method like a condom.1 In the past five years, little has changed in the way that people think about stigma and PrEP. Even within gay publications and HIV-centered advocacy groups, people continue to write about the “Truvada Whore.”2,3 The use of this term is strongly connected to stigma related to the use of PrEP, which is pervasive even within the medical community4,5 Stigma is exasperated when coupled with the implicit racial bias of providers that causes them to assume that black men who have sex with men engage in riskier sex6 As a result, there is stigma from within the gay community that assumes men who take PrEP are riskier or more likely to have HIV, from outside of the gay community that assumes they’re sluts or whores, and also specifically from the medical community, which assumes that prescribing PrEP will increase risk behaviors, leading to more HIV infections.

 

References

Works Cited

  1. Duran, D. Truvada Whores? Huffinton Post. 2012. https://www.huffingtonpost.com/david-duran/truvada-whores_b_2113588.html
  2. Addison, V. Larry Kramer, Truvada Whores and the Angry Divide Between Two Generations. HIVEqual. n.d. http://www.hivequal.org/homepage/larry-kramer-truvada-whores-and-the-angry-divide-between-two-generations
  3. Logo. Revisiting “Truvada Whore” Three Years Later. NewNowNext. 2016. http://www.newnownext.com/revisiting-truvada-whore-three-years-later/02/2016/
  4. Emory University Rollins School of Public Health. North Carolina. AIDSVu. n.d. https://aidsvu.org/state/north-carolina/
  5. Calabrese SK, Underhill K. How Stigma Surrounding the Use of HIV Preexposure Prophylaxis Undermines Prevention and Pleasure: A Call to Destigmatize “Truvada Whores”. American journal of public health. 2015;105(10):1960-1964.
  6. Calabrese SK, Earnshaw VA, Underhill K, Hansen NB, Dovidio JF. The Impact of Patient Race on Clinical Decisions Related to Prescribing HIV Pre-Exposure Prophylaxis (PrEP): Assumptions About Sexual Risk Compensation and Implications for Access. AIDS and behavior. 2014;18(2):226-240.
  7. Rosenberg ES, Grey JA, Sanchez TH, Sullivan PS. Rates of Prevalent HIV Infection, Prevalent Diagnoses, and New Diagnoses Among Men Who Have Sex With Men in US States, Metropolitan Statistical Areas, and Counties, 2012-2013. JMIR Public Health Surveill. 2016;2(1):e22.
  8. Britz JJ. To Know or not to Know: A Moral Reflection on Information Poverty. Journal of Information Science. 2004;30(3):192-204.