Swoon

The note below was written in response to Things Can Change, Perhaps. I know it was written by a staffer, but still. Happy Monday to me. __________________________________ Dear Ms. Stone:  Thank you so much for your kind words about my work in Congress.  I appreciated reading your blog post, which mentioned my work on  public health issues and tobacco use in particular.  Smoking is the leading preventable cause of death in America, and I have spent  my career in Congress working for legislation to reduce tobacco use and allow  regulation of tobacco by the Food and Drug Administration (FDA).  After decades  working to grant FDA oversight of one of the most lethal consumer products on the  market, I am delighted that the Family Smoking Prevention and Tobacco Control Act  was signed into law on June 22 (P.L. 111-31).   My legislation gives the FDA a comprehensive and flexible set of  authorities to bring meaningful and long-overdue changes to the  manufacture, promotion and sale of tobacco.  It will end the marketing  of tobacco to kids, stop manufacturers from calling cigarettes "light" or  "less dangerous" when they are not, and remove toxic ingredients such as  formaldehyde, benzene, and radioactive elements from cigarettes.   The FDA's new functions will be fully funded through user fees paid by the  tobacco industry.   I hope you will visit www.waxman.house.gov  and http://democrats.energycommerce.house.gov to learn more a bout P.L. 111-31 and other issues I'm working on.  You can count on me to continue to work for the goals  we share, and I look forward to staying in touch with you  on issues of concern. With kind regards, I am                                                                                       Sincerely,                                                                                       HENRY A. WAXMAN                                                                                       Member of Congress

 

Yes, Diet Affects Attention. Really.

This past week CNN's health blog ran a post by Sonjay Gupta, MD called "Does ADHD Come From Food?" While it's great that CNN and its well-known doctor have given this important issue such a visible platform, it is more than a little disconcerting that the link between diet and attention is presented as a new and unproven concept. The link is fairly well documented in the scientific literature, including this landmark study in The Lancet that was the basis for the strict EU food labelling laws that I've written about previously. All in all, there is a lot of evidence that while not all attention issues are due to foods, some probably are. 

The Feingold Association, which has been around for decades, was one of the first groups to organize around this issue. I encourage you to poke around that organization's web site, look at the evidence and read the "real life" stories. I especially like the story called Taylor's Fuzzy Brained Mice, in which a kid trained four mice to run a maze, then gave two of the mice small amounts of yellow food dye in their water. The results are pretty astonishing - the rats with the dye in their water took longer to run the same maze that they previously completed with times similar to the mice who drank regular water. Further, this confusion was reversed once the colored water was switched back to normal.

Of course, individual stories (called anecdotal evidence in scientific parlance) do not true evidence make. Therefore, the Feignold site also lists many well-conducted scientific studies evaluating the effects of the Western diet on ADHD and other health concerns. It's pretty damning.

And it's not just artificial colorings, flavorings, and preservatives that are suspicious. Nutritionists and dietitians also speculate that the hydrogenated oils found in many processed foods compete with the good fats, like those found in fish and nuts, for valuable real estate in the body. In what is probably an oversimplification of complex brain chemistry, here is one possible scenario: the neurons in your brain are sheathed in fat, which allows electrical impulses to efficiently travel from one neuron to another, resulting in smoothly functioning nervous system. The substitution of hydrogenated oils for the good fatty acids creates a different type of coating of fats around those neurons - replacing the supple, conducive covering provided by good fats - thus interfering with clear thinking and focused attention. Nutritionist Kelly Dorfman explains it all here.

Unfortunately, what is emerging is that eating optimally is not as simple as choosing fruits and vegetables. An article published last year in the journal Pediatrics (the journal of the American Pediatric Association), showed that even moderate exposure to certain pesticides was associated with ADHD. Time magazine wrote about the article here. The authors of the article hastened to point out that eating conventionally grown fruits and vegetables is still preferable to eating junk food. But it does raise the issue of health equity: if organic produce is truly superior, a healthy diet is out of reach for many people for financial reasons. This pushes the issue from one of choice to one of social justice.

In the past few years there have been a slew of reliable studies on the effects of diet on behavior, learning, and attention. The only thing that's remarkable here is the slowness of the medical profession to get on board with this concept.  It's time to move past the endless debate of cause and effect (which is kept alive by the deep pockets of the food industry, its lobbying leverage, and consumers' appetites for poor-quality food) to actually doing something about it. There are many important avenues to explore: why some people are more susceptible to food impurities than others and how those individuals can be screened; what alternatives exist to current colorings, flavorings, stabilizers, etc; and of course, restricting the presence of those impurities in our foods. That's what the Center for Science in the Public Interest is trying to do by lobbying the US Congress to ban certain artificial colorings used in foods. But until then, consumers can do something on their own: make wise food choices. Voting with your checkbook is a time-tested way to bring about change.

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Ruining it for the Rest of Us

In case you missed Dr. Paul Offit's interview on NPR regarding problems caused by those who don't vaccinate their kids.

I've written about herd immunity and the worries that we are losing it before:

The concerns are growing.

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Beautiful AND Smart

Standard prescription bottle

As someone who makes a living with words it pains me to say this, but here goes: one picture really is worth a thousand words. This is especially true in my line of work, medical and scientific communications, where pictures and graphics are necessary to reach audiences with low literacy, low vision, or impaired thinking due to age, strokes, or even getting up in the middle of the night to tend to a sick child.

I am so impressed with all the good design being applied to medical issues these days. For example, Wired magazine recently ran a competition to re-design some of the most common laboratory test results. The amazing team at Information is Beautiful was the winner for its remarkably useful re-dos of some of the most common lab reports into graphics that not only clearly explain the lab findings, but tell you what they mean and what you can do about them, if say, your triglycerides are higher than they should be.

Redesigned tests results. Wired magazine

Target prescription bottles

This application of design know-how to practical health products is not only a visual treat, it is a potentially lifesaving tool. Deborah Adler, the designer behind Target's re-imagining of the prescription pill bottle,  was inspired to take on this task for a school project after her grandmother accidentally took her grandfather's medication. Target's nifty system of colored rings, one color for each family member, is designed to counter that problem, which is amazingly common - a poll conducted for Target found that 60% of prescription drug users have taken their medications incorrectly.

The Grocery Manufacturing Association is releasing new food labels that are much clearer in their declarations of saturated fat, sugar, calories, and so on. Unfortunately, these labels, while a great improvement over the current ones, fall short of what the FDA suggested. But still, in an area as crucial to health as food labeling, I'm willing to take some innovation and hope that future iterations will be even better.

Grocery Manufacturing Association's new food labels

Expanding out from graphics to interactive applications, web sites are getting better at incorporating plain language and snappy illustrations to allow low-literacy users access to the information, and the use of video and audio podcasts enable concepts to be demonstrated or spoken, which is useful for visually impaired or non-literate individuals. The US government has an ongoing plain language initiative, which should result in its websites, forms, and information being delivered in a more accessible way.

So hats off to the communicators of the world who are applying their technical skills to some tricky problems. Medical knowledge is no good if the patient does not understand it, is confused by complicated protocols, or can't read the name on a prescription bottle.

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Erector Sets for All!

The Global Village Construction Set can be used to make 50 different machines. DIY. Open Source.
Image source.

My sister (hi, Anna!) sent me a link to Open Source Ecology. As it is described on their Wiki, OSE is "a movement dedicated to the collaborative development of tools for replicable, open source, modern off-grid resilient communities."

Yeah, I didn't really know what that meant, either. But it looked interesting, so I dug further. Basically what these enterprising folks are doing is creating a set of basic machine parts, such as wheels, hinges, hoses, motors, and so on from which you could build the 40 most essential tools - including an endloader, a tiller, and a brick maker - that are needed to construct and run an entire village. Even a tractor. Or a single, walk-behind tractor for small plots of land or uneven terrain.

For anyone who has ever played with an erector set or Legos (not the kits! just a box of different pieces),  you can envision the possibilities that can be made from interchangeable parts.

OSE is  group of designers, farmers, engineers, and construction people. Their information, drawings, and videos are open sourced and available on the Internet to anyone. Yay!

This project speaks to me because one of my degrees, design science, focused on just this type of engineering - creating, on a tight budget, something that fills a specific need. I love seeing how people are putting their basic engineering and construction skills to work to create a benefit that many can enjoy. This project brings to mind the wonderful Design for the Other 90% and the Rural Studio project at Auburn University, other examples where individuals have put their collective brainpower and skills to use in creating useful dwellings and machines inexpensively for the common good.

What does this have to do with health? Plenty! Sometimes the limitations to health are mechanical. After all, digging wells, making bricks for homes or latrines, and tilling ground for a garden are quite labor intensive without machines. If a community could invest in and share one tool kit, there could be lots of projects that would benefit many. From OSE

"...most of the technologies needed for a sustainable and pleasant standard of living could be reduced to the cost of scrap metal + labor."

Scrap metal plus labor? Sounds like a good deal. It also sounds like something larger funders could get behind. There is a way for small donors (read: you and me) to support this interesting work on the website, but it would be great to see a McArthur Prize or a sizeable grant push this work further.

Here's a video from OSE's site:


Global Village Construction Set in 2 Minutes from Open Source Ecology on Vimeo.


After reading a bit more about this group, I realize I'm somewhat late to the party. The founder has been a TED speaker and they've been widely written about. Let's hope an infusion of new interest will accelerate their already admirable progress.

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Correction: 16 January 2001: I was contacted by OSE and learned, among other things, that one of the founders, Marcin Jakubowski, will be speaking in late February at the TED conference.

Every 43 seconds...

...someone dies from gun violence.

What an eye-catching public health campaign.

To bad it's not in the United States.

Things Can Change, Perhaps

Tobacco drying. Image courtesy of CDC.

Recently, our family took a step into the modern age by opening a subscription to an online movie outlet so that we can stream movies over the Internet to our television. All this means is that we have spent way too much time over winter break watching movies that we missed when they were released or that we've seen before and of which we are especially fond. Such is the case of the The Insider, Michael Mann's recounting of the beginning of the sea change in opinion against the big tobacco companies.

For those of you who haven't seen it, The Insider takes place in the mid-to-late 1990s. The story revolves around a high-level Brown and Williamson research scientist, Jeffrey Wigand, who told the truth about his employer and the tobacco industry first in a deposition in Mississippi (where the Attorney General was suing tobacco companies to get them to pony up for Medicaid expenses for illnesses related to tobacco use) and then during a Mike Wallace interview on 60 Minutes. The plot becomes more complicated when 60 Minutes aired a heavily edited version of the original interview because its parent organization, CBS/Westinghouse, was concerned about potential lawsuits from the tobacco company. The original interview, which strongly indicted big tobacco as being fully aware of (and working to enhance) the addictive properties of its products and gave evidence that the CEOs of the big seven tobacco companies perjured themselves in a congressional hearing, was aired a few months later. However, it was only aired after other news outlets discredited the smear campaign against Dr. Wigand that was orchestrated by his former employer and outed 60 Minutes as caving to corporate interests.

It was a public health story, corporate whistle-blower story, and a journalism ethics story all rolled into one big messy ball of a movie. And, for the most part, it was true.

What is iconic of that time is the image of the seven tobacco CEOs (referred to as the Seven Dwarfs) standing in the Hon. Henry Waxman's hearing and perjuring themselves by declaring, under oath, that nicotine is not addictive. Below is a Youtube video of this historic moment that exposed these corporations for what they are - makers of nicotine delivery devices.

I was working at the American Cancer Society when these events began unfolding, but honestly, I didn't appreciate the magnitude of them at the time. Sure, everyone knew that tobacco use was the number one cause of cancer and that nicotine was addictive and that tobacco companies wanted to addict people - especially young people - in order to replace customers that would inevitably die. But the power and influence of the tobacco companies were formidable and those of us in public health held slim hope that a right-leaning Congress would support public health over big tobacco.  Fortunately, there were some visionaries who could see the far-reaching effects of the rulings, visionaries who never gave up the fight despite personal and professional hardships.

Because what emerged from all this was a deal of historic proportions: in 1998, the attorney generals of 46 states and the big tobacco companies signed the Tobacco Master Settlement Agreement, (MSA) in which the tobacco companies agreed to pay $246 billion over 25 years to the states, desist from marketing to youth, end all outdoor advertising (remember cigarette billboards?) and other sanctions. Four other states had individual agreements that predated the 1998 MSA. The money has been used to  bolster Medicaid, fund campaigns against smoking and smoking cessation programs, and other health-related items.

So that's the good news.

There is some bad news, too. In fact, there is a lot of bad news. In recent years, criticism has grown against financially strapped states because they are diverting the MSA money away from its intended uses. In fact, they are diverting MOST of it from its intended use. This from the Campaign for Tobacco-Free Kids, which publishes an annual report on how the money from the MSA has been used:

"Our latest report, issued November 17, 2010, finds that the states have cut funding for tobacco prevention and cessation programs to the lowest level since 1999, when they first received tobacco settlement funds.

"The states this year (Fiscal Year 2011) will collect $25.3 billion in revenue from the tobacco settlement and tobacco taxes, but are spending only two percent of it — $517.9 million — on programs to prevent kids from smoking and help smokers quit."

Of course, the tobacco companies love this. Fewer education and smoking cessation programs mean more cigarette consumers. And that is exactly what has happened. Any progress made in reducing smoking has slowed or even stalled. From Campaign for Tobacco-Free Kids' most recent report:

"The CDC recently reported that the adult smoking rate in 2009 was 20.6 percent – essentially unchanged since 2004 when 20.9 percent smoked.   This is a troubling development after decades of progress in reducing adult smoking rates.  While smoking among high school students has declined by 46 percent from a high of 36.4 percent in 1997, 19.5 percent of high school students still smoke and declines have slowed in recent years, according to the CDC. "

So looking at the movie again, during a different phase of my life, is an interesting experience. On one hand, it is an affirming experience because the daily minutiae of working in public health for governments or non-profits can be slow and frustrating. There can be a lot of waste, bureaucracies to wade through, and we all lose sight of our goals from time to time. Therefore, The Insider reminded me that things can change, albeit with great difficulty and usually not very quickly, but every now and then we can hit it out of the park and score big for public health.

On the other hand, watching the movie was incredibly frustrating because by all accounts, politics as usual have minimized the effects of this landmark settlement.

Ultimately, though, if you're looking for an influx of optimism that sometimes good does prevail, or just an interesting way to spend a few hours with a real-life dramatic story, I recommend revisiting The Insider. It is dated a bit - the cell phones look like shoeboxes, the fax machines spit out curly paper, and everyone's eye glasses are so outdated that they're coming back in style again. But the outcome of this David and Goliath story has changed how the world views Big Tobacco and saved many, many lives in the process. Not as many as could have been saved, but it's been at least a baby step in the right direction.

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Tangent: During the research process for this post, I was reminded what a staunch advocate for health we have in California Representative Henry Waxman. He has been in the trenches for years, holding hearings and crafting legislation in order to protect our health and welfare.  He has been a good public servant and we could use more like him.