Assignment 3: Vaccine Wars

The Frontline Special on "Vaccine Wars" had to do with the great benefits of vaccination to public health, explaining why the acquisition of vaccines is a social responsibility that should be enforced by institutions rather than just a parental choice. In order to support this argument the concept of "herd immunity" is introduced to explain how the vaccination of a significant portion of the population provides protection to unprotected individuals, especially those who cannot receive the vaccine due to the vulnerability of their inmune system because of their age or the presence of another illness.

As I was watching the video I could not help to think about the mumps outbreak that happened in my little cousin's school a couple of years ago. Around 15 kids contracted the disease, including my little cousin, and he developed the symptoms about a week later when he was already in summer vacation in North Carolina. Since he contracted the disease in his school in Venezuela, it took a while for the doctors in North Carolina to diagnose it (since the disease is not as common in the United States as it is in Venezuela).

After the doctors in North Carolina finally found out that he had mumps, my cousin was quarantined, in order to stop a further spread of the disease. He and most of the kids who got the disease in his school in Venezuela were vaccinated, which protected them from the possibility of the development of a much more serious condition. The idea of "herd immunity" made me think about them contracting the disease from a kid who didn't get the mumps shot, which proves how this facilitates the spread of a disease, even outside a country's boundaries. This is why I consider that requiring immunizations is an important policy for public health, which is why awareness on this matter should be raised so that parents can understand that this is an issue that goes beyond a parenting choice.

Another of the things that impressed me the most about the documentary is the power that internet and media have over society. The "free flow" of information can be overwhelming, especially if it is alarmist; and I understand how not being able to tell what is true and what is not can be scary, which is probably why people in today's world have grown to be very skeptical or, on the other extreme, very easily mislead into false information. This is why flawed research, like the one that linked autism with the MMR shot, has caused so much controversy on why children should not receive the recommended immunizations.

The strong support that has grown for this public misconception has also been supported by the little information we have on autism, which is why I think that further studies on these conditions (and any other ones that can possibly be related as "side effects") should be encouraged in order to have stronger evidence to convince people that their fears for vaccination are not real. People must also be educated to recognize the legitimacy of primary sources, like well known medical journals and institutions that have reliable data, like the CDC. But the most effective policy to increase vaccination rates would be to limit the reasons for exemptions in immunization only to medical conditions, and to start public health campaigns in local communities that offer immunizations for free.

However, this would be a very difficult policy to implement due to philosophical or religious reasons for which parents don't want their children to receive the required shots, but I believe that if the institutions  commence with strong actions to raise awareness of the importance of vaccination for public health and the availability of immunizations and information on them, some advancement can be made in order to reduce the number of those who oppose mandatory immunization.

Assignment 2: Second-hand Smoking and Lung Cancer

A study conducted in women in Japan proved that non-smoking wives of heavy smokers have a higher risk of lung cancer. About 92,000 non-smoking wives aged 40 and above were followed up for 14 years (1966-1979), and results showed that the risk was greater in agricultural families when the husbands were 40-59 years old. The husbands' smoking habits did not affect their wives' risks dying of other types of cancer; and their was just a small increase in the risks of the wives dying of heart diseases or developing ephysema and asthma. How much did the husbands smoke, their drinking habits and the environment in which the family was set were variables considered in the study. The results were published in The British Medical Journal on January 1981.

The study is an example of a cohort study, since it was done with a large number of subjects and over an extended period of time. It dealt with some confounding variables (i.e rural vs. urban environments, age groups, drinking habits of the husbands) and it also considered the dose-response relationship between exposure and risk of disease. 

In my opinion, asserting that second hand smoking is a "cause of lung cancer" rather than a "factor of risk" is a very strong accusation, especially because of unavoidable bias in the control group that might have lead to associating variables by chance.

In this particular case, bias might not been a problem in reporting, because the population was interviewed and followed by establishing a record linkage system between the risk-factor records and a residence list obtained by special yearly census, with death certificates. However, I do see bias as a big problem regarding the controlled variables in the group of non-smoker women. The variables were set upon what their husbands were doing, but what about what the women were doing? Were they drinking? Were they doing exercise? What were their diets like? Did other people who they were around continuously smoked? All of these confounding variables are not mentioned in the study, and that makes me question the certainty of the results because of a bias selection of control groups.

Also, I find incredible how passive smoking is associated with a disease as complex as cancer and not with the obvious asthma that comes with breathing contaminated air. The weak association between the exposure and disease and the lack of a biological explanation that addresses this association also takes away from this study credibility and reliability.

When we are analyzing a study of such a complex nature and large dimension it is important to recognize the limits of epidemiological research. For the most part, this epidemiologic study no matter how well designed it was to avoid error, it cannot prove cause and effect because of its susceptibility to many sources of error. As it was proven in this study, confounding factors may influence results, suggesting an association that cannot be entirely proved; and bias might have also played its part in the selection of control cases. Asserting the wrong conclusions could have enormous consequences, so one must always be skeptical on reading on these studies and very careful and perfectionist when conducting one.

Hans Rosling’s 200 Countries, 200 Years, 4 Minutes - The Joy of Stats

Hans Rosling presents his data very dynamically. It reminded me of what Ms. Dana Sleicher said on Tuesday about Public Health being ever expanding and in continuous movement. It also shows what we have been talking this past week about how the improvements in Public Health in the beginning of the 20th century have changed life so broadly.

Assignment 1: My Impressions of my first week in Intro to Public Health

So far, I have only had two classes in Introduction to Public Heatlth. Dr. Miriam Alexander has given the two lectures, the first one focusing on the question of "What is Public Health?" and the second one on an introduction to Epidemiology and the Analytical Methods of Public Health.

Dr. Alexander explained that public health deals with several factors: population, health policy, environmental health, economics, social behavior and medicine. I honestly found this lecture very interesting because she gave us real life examples dealing with this factors, and through this examples she was able to explain how improvements in Public Health have enormously contributed to declines in the mortality rate and disappearance of several contagious diseases. The one that stuck to me the most was sanitation, because it is something that nowadays we take for granted, without realizing how much harder and less healthy our lives would be without it.

The lecture on Epidemiology was a lot more technical, but it helped me understand how statistics are so important for the study of Public Health. My favorite part was learning about how studies in epidemiology started when a man named John Snow traced the incidence of cholera in London back to the water pumps in which people were getting their water. We also learned the difference between "incidence" and "prevalence" (in epidemiological terms) and the basic math in some association methods used to trace causality or correlation. It made me realize the importance of the organization and presentation of data for  Public Health studies.

Can we trust supermarkets and labels? How do we know that the food we are eating is safe?

This is a review I wrote on Robert Kenner’s Food, Inc. as an assignment for my Fall 2011class "Public Health in Film and Media".

Don’t let the name fool you. Unlike Supersize Me, Food, Inc. is not another documentary that criticizes America’s unhealthy fast food chains. Food, Inc.deals with what Americans are buying in their supermarkets, cooking in their homes and serving to their families. It tackles the problem of the American food culture from its very root: Where does the food come from?

In the journey for the search of an ultimate answer, the issue gets more complex as more questions are introduced throughout the film. How is the food produced? Does it come from a farm with green pasture and a red barn like the one in the product’s advertisements? Why can’t we understand the “Nutrition Facts” on the label? Just because it’s lying on supermarket shelves, is it really safe to eat?

And probably the scariest questions of all: If we ever learn all these scientific names for carbs, sugars, fats and proteins, can we really understand what our food is made of? Is the information on the label reliable? Are food regulation agencies trustworthy?

Unfortunately, evidence has shown that they are not.

Food, Inc. shows us that approximately 10 billion animals (chickens, cattle, hogs, ducks, turkeys, lambs and sheep) are raised and killed in the US annually. Nearly all of them are raised on factory farms under unwholesome, inhumane and unsanitary conditions that facilitate contamination and the spread of diseases among the animals’ filthy and overcrowded pens.

Factory farm operators typically feed these animals with antibiotics, growth hormones and starchy grains to promote their growth and keep the overall costs of production low. But the way in which these animals are fed directly affects the quality and safety of the meat and diary products we consume.

In addition to being unsafe to our food system, these industrial farms are also dangerous for their workers, embrace animal cruelty, pollute surrounding communities, and contribute significantly to global warming, due to greenhouse emissions for food transportations across the country and even the world.

And what about vegetables and grains? Well, Food, Inc. also shows how some of our most important staple foods and produce have been fundamentally altered and genetically engineered in order to resist pesticides. They have also been injected with preservatives, in order to last longer. Is it really safe to have them at our supermarkets and kitchens, along with meat and milk produced from cloned livestock?

What have food regulation agencies like the Food and Drug Administration and the U.S. Department of Agriculture done? Nothing. Food, Inc. shows us that the chairmen from these agencies used to work for these big food industries, which were reluctant to show their sides of the story in the film.

In this polemic context, Robert Kenner’s Food, Inc. exposes America’s industrialized food system and its broad effects on the American society, which range from consumer health and environment sustainability to issues deeply related to the American economy, public policy and politics. The film was released on 2008, but its material goes back to the extensive research of investigative journalists Eric Schlosser and Michael Pollan, respective authors of the best sellers “Fast Food Nation: The Dark Side of the All-American Meal” (2001) and “The Omnivore’s Dilemma”(2006).

The film has received full support from the so called “organic food movement” that has grown in America during the past decade, especially among the young, the educated and the upper-middle class. Non-profit organizations are trying to expand the healthy eating movement to the lower classes, which can’t afford to buy and cook naturally grown products since industrialized food is cheaper, by promoting community supported agriculture programs.

As Eric Schlosser says on the movie companion book, “the food industry is, by far, the most important industry in every society. Without it, you can’t have any other industry. All the others depend on people being able to eat.” The nation’s system of food production concerns the people’s most basic need, and for this reason, its business practices have a profound impact on society and public health.

In Food, Inc. we meet Barbara Kowalcyk, whose 2 year old son, Kevin, died from E.coli poisoning after eating a hamburger. The movie showed that data from the Center for Disease Control and Prevention estimates that 76 million Americans are sickened, 325,000 are hospitalized and 5,000 die each year from foodborne illnesses.

And the issue of safe and healthy eating extends to a much larger scale. Some people blame economics for bad eating habits that a lot of Americans practice, but when looking at the long-term list of harms, cheap food is much too expensive. Other CDC data from the movie estimates that about one third of the Americans born on the year 2000 will develop diabetes as a result of a high calorie, sugar laden processed foods diet and lack of exercise, which results in larger bills for treating heart diseases, obesity and diabetes. Outside of consumption, cancers, autism and neurological disorders are associated with the use of pesticides amongst low paid farm workers and their communities. This not only reduces labor productivity in the long run, but most of these workers are also illegal immigrants with no health insurance or social security, which constitutes a delicate human rights issue.

In this sense, this is the industry that needs to be regulated the most, because it determines the health of the consumers who eat its products, the health of the workers who make its products, the health of the environment, animal welfare, the sustainability of the economy that trades its products, and so much more.

Having lived in Venezuela for my entire life, when I first came to study in the United States I used to think that American supermarkets were the best. So much food and so many different kinds of products was exciting and overwhelming. Back at home we only had one kind of milk, and here I can choose from skim, to half and half, two percent, soy, vitamin D, and the list goes on. Vegetables come already cut and ready to cook, and so does the meat; there is no need to go to the fruit market or the butcher’s. Soup is sold in cans, and it is microwaveable. And so are the Thai noodles, pesto pasta, chicken potpie and even rice!

But my perspective on this “food heaven” completely changed after watchingFood, Inc. and researching more on the American food industry. I might only have one kind of milk back home, but at least I know that it doesn’t have any artificial grown hormones like rBGH[1]. I might have to cut and wash my tomatoes, but at least they are fresh and free from preservatives. I might have to actually grind and marinate the meat when I make burgers back at home, but that’s not much of a problem if it’s keeping me from getting an E. coli infection from a frozen patty.

It is a good thing that the food movement in America is continuously growing, especially among the young. The public should keep on working along with the food industries and the government to get healthy foods on the supermarket shelves at the same prices at which unhealthy fast foods are sold on the drives through.

A change in the society’s mentality is the key to achieve this ultimate goal. Initiatives for community gardens and local farmers markets should be supported, making healthy foods more available in low-income neighborhoods; and at the same time, industrial foods should be made more expensive by ensuring that they reflect their true costs to society. Education in schools and communities must raise public awareness on how important it is to eat healthy and demand for laws that ensure food regulation, animal welfare and environmental sustainability, forcing the big corporations that control the food production system to embrace healthier, more environmental friendly, and still profitable, business practices.

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[1] Recombinant bovine growth hormone (rBGH) is a genetically engineered, artificial growth hormone injected into diary cattle to increase their milk production. Approximately 22% of all diary cows in the US are injected with the hormone, but 54% of large herds use it. Cows injected with rBGH show higher levels of IGF-1, another hormone linked to colon and breast cancer. (Weber, Karl. Food, Inc.: How Industrial Food is Making s Sicker, Fatter and Poorer – And what can you do about it. Pg. 08. Participant Media, 2009.)

So.. What's your major? Mine is Public Health.

My name is Isabella Ciuffetelli and I'm a Public Health freshman at Johns Hopkins University. Yes, you got that right, my major is Public Health. This blog is to write about what I learn about Public Health in my Introduction to Public Health class on Spring Semester 2012; and I'll also be posting interesting news, quotes and articles that can be related to Public Health.

Coming from Venezuela a lot of people back at home don't understand what is a major in Public Health, because we don't have such a career back at home. My friends and family continuously ask me "What's that thing that you're studying?", and sometimes they even shoot for the scary question, "What can you do with that afterwards?"

Well, and I sigh before answering,"Public Health is the world, at least in the way I see it!" My major is so broad; it has to do with sustainability and the conservation of the environment, public policy, advocacy and the law, the grounding sciences like epidemiology, biostatistics and ecology, national security (if you want to talk about bioterrorism and biological weapons), or even business administration, if you are into hospital management. So yes, I'm studying the world, from the public health approach in order to make it a better place, a place where people can be healthy and happy, as cliché as it sounds.

What can I do afterwards with that? Well, I'm still not sure of what I'm doing, but I can go to medical school, or law school, if my passion for the social sciences proves to be stronger than that one for the natural sciences, or I can get an MBA or a Masters in Public Health, if I decide that planning and management work better for me, or I can work for the CDC and do research for outbreaks and contagious diseases. I can even work in non-profits for promoting global health or international development. The health sector is so large, and there is so much to do in it asides from being a medical practitioner!