Public Health | Health Commentary

Chlamydia: A Disease Lacking Star Status

Wed, 01 Jul 2009 12:19:51 -0400

Why is it that some diseases never reach “star status”. Take the case of Chlamydia. Over a million cases in 2007 in the US says the CDC. Source of significant discomfort with long term issues around infertility, Pelvic Inflammatory Disease (PID), ectopic pregnancy and possibly endometriosis. Affects over 10% of teenage women. Spread by intimate contact. Treatment is as easy as a single pill (azithromycin) for patient and partners with a repeat in 6 months (25% recur). Chlamydia testing is widely available, legal in all 50 states for teens, costs between $40 and $90, and can now be done at home (swab mailed in for men and women). The National Chlamydia Coalition needs your help in spreading the word.

Smoking Out the Ad Industry

Mon, 22 Jun 2009 20:00:39 -0400

Money Talks

Last week, after decades of fighting dating back to FDA Commissioner David Kessler's valiant attempts, the FDA was finally granted authority to regulate tobacco. Congress passed the Family Smoking Prevention and Tobacco Control Act, which President Obama is now expected to sign into law.^1,2This landmark legislation controls elements of manufacturing, marketing, and advertisement of tobacco products. Specifically, it requires counter advertising on cigarette packages, bans giveaways of non-tobacco items (like sports paraphernalia) with the purchase of tobacco, and prohibits outdoor tobacco ads within 1,000 feet of schools and playgrounds.³

Even though some tobacco giants were supportive of the legislation, one industry is still fully engaged in the battle: the ANA, or the Association of National Advertisers.⁴ Their top gun, Dan Jaffe, says that this is "the most restrictive advertising bill ever passed in the US for a legal product".

The bill hits the magazine industry especially hard at a particularly critical moment. Ad spending overall in magazines dropped 21% in the first quarter of 2009. That figure still included tobacco advertising. Tobacco companies spent about 78 million last year on advertising in the US. Of that, 69 million went to magazines. The majority of the money- nine million- went to advertising in Maxim, followed by 8 million to Playboy, and about 4 million each to Men's Journal, Field and Stream, and Sports Illustrated.⁵

About 30 years ago, the US banned TV and radio commercials for tobacco. Money was shunted over to magazines and billboards. But in 2000, after an uproar over ads in magazines read by kids, the tobacco industry cut back on magazines and beefed up other promotions. With this new legislation, magazines with a significant readership of individuals under 18 will only be allowed to run "tombstone" ads for tobacco; that is ads with black and white text only. Even if the tobacco companies decide to continue these, the revenue magazines generate for these ads will be far less then traditional print ads.³

Why is the ANA drawing a line in the sand here, arguing that the new law would violate free speech? Because they correctly believe this could open the floodgates for other restrictions on advertising poor health behavior for unhealthy food and beverages. But here's the truth: If we really want a better health care system, and improved health in America, we have to change our behaviors, not just our media. The easiest and most efficient way to do that is to stop spending money to convince people to do things that we already know will make them sick.

For Health Commentary. I'm Mike Magee

References:

1. Layton L. Senate Approves Bill to Allow FDA to Regulate Tobacco. Washington Post. 12 June 2009.

2. Silberner J. Bill Gives FDA Control Over Tobacco. NPR. 10 June 2009.

3. Mundy A, Etter L. Senate Passes FDA Tobacco Bill. WSJ ONline. 12 June 2009.

4. ANA. Tobacco Legislation Passes House, and Now Moves on to the Senate. 31 July 2008.

5. Vranica S, Adams R. An Industry Fights Tobacco Bill. Wall Street Journal, B8. 18 June 2009.

When Swine Flu Returns in the Fall, How Bad will it Be?

Tue, 09 Jun 2009 17:00:42 -0400

Several years ago, when Bird Flu, viral strain H5N1, hit, I reported on it immediately. I provided several updates over the following 24 months.^1,2,3I did this not because of the numbers of people affected (many more birds died then did people) but because of the deadliness of this microbe. The bottom line for avian flu was, and at present is, that it has problems jumping from birds to humans. When it does, it is quite deadly for those humans. Luckily, human-to-human transmittance has been difficult and generally self-limiting.

Compare this with the recent Swine Flu, viral strain H1N1. It passes much more easily to and among humans but is not particularly deadly in its current form. Yet these viruses, whether Bird or Swine Flu, are always changing and always mutating. We have to understand what they are doing biologically in real time and stay one step ahead of them. And that is exactly what the CDC is doing with the current Swine Flu outbreak.⁴

Here is what we know about H1N1: the bug is pretty good at keeping itself alive by invading our nasal mucosal and spreading to other people when we sneeze. Walter Dowdle, a former chief of virology at the CDC describes H1N1 as "a real mutt" because genetically it is a mix of swine, human, and bird genes. The genetic structure of these viruses aren't enormous like the human genome. Their entire gene library consists of eight short strands of RNA. These in turn direct the production of only 11 proteins. They invade a cell, break apart, reassemble and, depending on their chemistry, may or may not destroy the cell.⁵

The reason that H1N1 is relatively mild right now is that it lacks the genes to produce two proteins that cause havoc for humans. The first, PB1-F2, weakens and destroys cell mitochondria - the cell's energy manufacturing site. The second protein, NS-1, attacks interferon, which is critical to an effective human immune response. Up until now, these proteins have only been found in Bird Flu. Experts say that it is unlikely that the current Swine Flu will go in this direction because it has never happened before.⁶
What is more likely is that the Swine Flu when it returns this fall, will have become resistant to the drug Tamiflu. The world has stockpiled the anti-viral Tamiflu in response to the threat of H5N1. Over the years, most seasonal viruses have quickly developed resistance to Tamiflu. If that occurs with Swine Flu, doctors and their patients in the US will likely rely on another anti-viral, Relenza. This drug is more expensive and must be taken with an inhaler. Or, older drugs like rimantidine will be used. These, too, have resistance issues of their own.^5,7,8

What we know for certain is that we have not seen the last of H1N1 Swine Flu. Thus far, it has spread fairly rapidly, but luckily without enormous human death and destruction. Thanks to concerns about the Bird Flu epidemic, we are more vigilant, have better testing, and take these viral threats very seriously- as we should.

For Health Commentary, I'm Mike Magee.

References:

1. Magee M. A Bird's Eye View Of Bird Flu. 19 July 2006.

2. Magee M. The Threat Of Bird Flu. 24 Aug. 2005.

3. Magee M. The Battle with Infectious Disease. 16 March 2005.

4. CDC H1N1 Flu. 5 June 2009.

5. McNeil D G. How A Mild Virus May Turn Vicious. New York Times, D6. 9 June 2009.

6. Guang-Wu Chen, et al. Influenza A Virus PB1-F2 Gene in Recent Taiwanese Isolates. CDC Emerging Infectious Diseases. 10 March 2004/.

7. GSK Corporation. Flu Treatment or Prevention.

8. CDC Emergency Use Authorization Of Relenza. 1 May 2009.