public health


Surgeon General Nominee: Not Likely To Suffer From Invisibility

Dr. Vivek Hallegere Murthy (AP, provided by Brigham and Women's Hospital)

Dr. Vivek  Murthy (AP, provided by Brigham and Women’s Hospital)

The last surgeon general of the United States, Dr. Regina Benjamin, took flak for not doing more — or at least, given the limited powers of the office, for not speaking out more.  Forbes called her not just ineffective but “invisible.” New York Times food columnist Mark Bittman wrote a piece headlined “Our M.I.A. Surgeon General,” and accused her of failing to counteract lies by “Big Food” with the truth: that the American diet is making millions of us sick.

Somehow, I think that if President Obama’s new nominee for surgeon general, Dr. Vivek Murthy, is confirmed in the post, he will not have an invisibility problem.

First clue: The striking Reuters photo at the top of the Boston Globe profile of Dr. Murthy, who’s now 36 and affiliated with Brigham and Women’s Hospital and Harvard Medical School. He’s standing in his white coat outside the Supreme Court during the legal arguments over Obamacare in 2012, his arms crossed and his expression — well, judge for yourself. To me, he looks appalled, in a long-suffering way. (Dr. Murthy is not available for comment, but my personal interpretation is that anyone confronted often by the flaws and gaps of the American health care system tends to start looking appalled in a long-suffering way…)

Second clue, from Dr. Neel Shah, founder of the non-profit Costs of Care and a friend of the nominee:

One of the things I admire and love about Vivek is that he beats to the tune of his own drum and in many ways worked outside of the medical establishment in order to advance the interests of the American people….Doctors for America was largely an answer to the less progressive AMA.

Dr. Murthy is co-founder and president of Doctors for America, which describes itself as “a national movement of physicians and medical students working together to improve the health of the nation and to ensure that everyone has access to affordable, high quality health care.” The Globe notes that it began as Doctors For Obama in 2008, and that Dr. Murthy believes doctors should take more of the lead in efforts to improve the country’s health care system.

Other bona-fides, the Globe reports: Continue reading

Is It Time To Rethink Co-Sleeping?



By Sarah Kerrigan
Guest Contributor

Pediatricians and public health officials have long warned that “co-sleeping,” or sharing a bed with an infant, is unsafe.

But let’s face it: almost everybody does it. So perhaps the time has come for the public health message to focus less on advising against it and more on advising how to do it more safely.

Because despite all the finger-waggling, co-sleeping is, and will continue to be, extremely common.

For instance, a recent survey, “Listening to Mothers III,” found that about 41 percent of new mothers report that they always or often share a bed with their babies in order to be closer. A 2007 study in Los Angeles County found bed-sharing rates in the range of 70-80 percent across races. And it’s likely that bed-sharing rates are grossly underestimated.

In so many ways, sharing a bed with your infant makes sense. “There is no way I would have had the energy to get out of bed 3-5 times per night to go feed [my baby] in another room,” says Lee, a Boston mother who asked that her last name not be used due to what she says is bias against bed-sharers.

There’s no denying that there can be risks involved in sleeping in the same bed as your infant.

In the United States in 2010, 15 percent of all infant deaths were designated as Sudden Unexplained Infant Death, which includes SIDS, and some of these babies were likely in unsafe bed-sharing situations. “We feel a certain responsibility to work to prevent these deaths,” said Carlene Pavlos of the Massachusetts Department of Public Health.

But just as using a message of abstinence in place of sex education has been shown to be ineffective, so too might a one-sided message that only tells parents, “Don’t share a bed with your baby.” Without offering a positive message of how to make bed-sharing safer, and even its potential benefits, public health organizations may be neglecting a key element to saving babies’ lives. Another Boston-area co-sleeping mother, Lindsey, said: “The fear around (co-sleeping) prevents people from talking about it. I know in my case, I was doing it in an unsafe way for a while because I was afraid to ask for advice.”
Continue reading

Breaking News: FDA Takes First Steps To Ban Trans-Fat

Up until now, the FDA has deemed trans fat to be “GRAS” — Generally Regarded As Safe. Well, those days may be numbered. Medpage Today reports that the federal food and drug agency is moving to “eliminate partially hydrogenated oils — the main dietary source of artificial trans fat — in processed foods.”

Why? According to the FDA website:

Trans fat has been linked to an increased risk of coronary heart disease, in which plaque builds up inside the arteries and may cause a heart attack.



The Centers for Disease Control and Prevention estimates that a further reduction of trans fat in the food supply can prevent an additional 7,000 deaths from heart disease each year and up to 20,000 heart attacks each year.

In its inimitable bureaucrat-ese, the FDA website explains what today’s action means:

If FDA determines that PHOs are not GRAS, it could, in effect, mean the end of artificial, industrially-produced trans fat in foods, says Dennis M. Keefe, Ph.D., director of FDA’s Office of Food Additive Safety. FDA is soliciting comments on how such an action would impact small businesses and how to ensure a smooth transition if a final determination is issued.

And here’s more from the Medpage Today story:

On the basis of a review of scientific evidence and findings from expert panels, the agency made a preliminary determination that the oils “are not generally recognized as safe for use in food” and should be eliminated, FDA Commissioner Margaret Hamburg, MD, said on a conference call with reporters.

The decision “is very welcome and strongly supported by massive scientific evidence that trans fat has many adverse effects on health,” Walter Willett, MD, DrPH, of the Harvard School of Public Health, said in an email to MedPage Today. “Trans fat has no place on the table, and this step will help make the diets of Americans safer.” Continue reading

Mass. Rolling Out Registry To Track Who Got Which Vaccines

In the United States, the flu season can range from November through March, and even past March in some years. Here, a CDC employee receives a flu vaccine from CDC Staff Nurse. (James Gathany/CDC)

 (James Gathany/CDC)

“Hello. Just for your information, Massachusetts is rolling out a statewide database that will track everybody’s vaccines — it’s expected within the next few months — and you can opt out if you want, but otherwise, it will keep track of which vaccines you’ve gotten.”

That shpiel was my assignment at our school’s flu vaccine clinic yesterday, and I dutifully reeled it off several hundreds times to people waiting in line for their shots and sprays. Most commonly, the response was an indifferent nod; a few people seemed downright pleased and grateful, and one — exactly one — person sounded incensed and asked for more information about opting out.

In case you, too, are potentially incensed, or just naturally curious, the new vaccine registry is called the Massachusetts Immunization Information System, and I’m happy to report that its helpdesk actually did answer helpfully and promptly when I just called its number, 617-983-4335. The registry has been in the process of enrolling health-care providers over the last couple of years, I was told, and now has about one-third of the state’s providers enrolled.

Also: The law that creates the registry stipulates that patients must be informed when their doctor starts sharing their vaccine information with the state, and can limit that sharing if they choose.

The Boston Globe wrote back in 2011 that Massachusetts, normally a frontrunner on public health issues, is oddly lagging on its vaccine registry. Public health reporter Kay Lazar wrote:

State lawmakers, facing opposition from insurers, failed for the past two years to act on the proposal, which would assess a fee on health insurance plans to raise the estimated $1 million to $2 million a year needed to run a registry.

But now insurers have dropped their opposition, and supporters, worried that federal funding for the project will dry up, have ratcheted up their lobbying for the state’s financial support, suggesting that, for the first time, Massachusetts will join the rest of the country with a registry that physicians say is essential. Continue reading

The Checkup On Shots: Vaccine Updates, Facts And Fictions

Somehow, over the last few years, one of modern medicine’s greatest achievements has turned into one of modern American parents’ most fraught subjects.

In this episode of The Checkup, our podcast on Slate, we offer Shots: Vaccine Facts And Fictions, in which we attempt to have a rational, fact-based discussion about some of the vaccines you may encounter in the immediate future: the flu vaccine and, if you have pre-adolescent children, the HPV vaccine.

(To listen to The Checkup now, click on the arrow above; to download and listen later, press Download; and to get it through iTunes click here.)

This year’s flu vaccines offer consumers more choices than ever: there’s a nasal version, a quadrivalent (four-strain) option, a “short-needle” option and an egg-free vaccine for people with allergies, among others. And even though it still feels like summer in some parts of the country, doctors are urging people to get their flu shots early.

The HPV vaccine was introduced seven years ago but, according to the CDC, only about half of girls are getting one or more doses, and only about one-third are getting the full three-dose course. This despite word from public health officials that it’s highly effective for preventing HPV — the most common sexually transmitted infection in the U.S. and a principal cause of cervical cancer — and so far, pretty safe. (It’s recommended for boys as well as girls, both because boys can spread HPV and because there’s a notable rise in HPV-related cancers in older men. See: Michael Douglas and oral sex. )

Doctors say a variety of obstacles stand in the way of more widespread use of the HPV vaccine. There remains the stigma of a vaccine for a sexually transmitted infection.  Also, when you’re talking about an 11-year-old,  preventing cervical cancer may seem less urgent than, say, preventing measles. Finally, there’s a general sense of “vaccine fatigue” among parents bombarded with so many official recommendations and competing agendas.


For more info, check out this HPV fact sheet created by our intern, Rachel Bloom:


Readers, please let us know how you’re handling vaccines for your family this year. Anything we can learn from your experience?

CDC: Millions Acquire Antibiotic-Resistant Infections, Thousands Die Annually

The CDC reports today that more than two million people a year in the U.S. get infections that are resistant to antibiotics and at least 23,000 people die as a result.

In a new report called Antibiotic Resistance Threats in the United States, 2013, the public health agency ranks the antibiotic-resistant germs most threatening to human health. Here’s more from the CDC website:

The threats are ranked in categories: urgent, serious, and concerning.
Threats were assessed according to seven factors associated with resistant infections: health impact, economic impact, how common the infection is, a 10-year projection of how common it could become, how easily it spreads, availability of effective antibiotics, and barriers to prevention. Infections classified as urgent threats include carbapenem-resistant Enterobacteriaceae (CRE), drug-resistant gonorrhea, and Clostridium difficile, a serious diarrheal infection usually associated with antibiotic use. C. difficile causes about 250,000 hospitalizations and at least 14,000 deaths every year in the United States.

“Antibiotic resistance is rising for many different pathogens that are threats to health,” said CDC Director Tom Frieden, M.D., M.P.H. “If we don’t act now, our medicine cabinet will be empty and we won’t have the antibiotics we need to save lives.”

In addition to the toll on human life, antibiotic-resistant infections add considerable and avoidable costs to the already overburdened U.S. health care system. Studies have estimated that, in the United States, antibiotic resistance adds $20 billion in excess direct health care costs, with additional costs to society for lost productivity as high as $35 billion a year. The use of antibiotics is the single most important factor leading to antibiotic resistance. Up to 50 percent of all the antibiotics prescribed for people are not needed or are not prescribed appropriately. Continue reading

Family Meal Boost: Lower Depression, Eating Disorder Risk In Girls

The concept of “the family meal” remains elusive — more nostalgia than reality — for many modern families. But it’s still worth striving for, according to a recent analysis by public health researchers at Tufts, who found that frequent family meals can reduce the likelihood that teenagers, particularly girls, will develop problems ranging from alcohol and tobacco use to eating disorders and depression.



Despite the benefits, researchers report that less than 60 percent of children eat five or more meals with their parents each week.

I asked the lead researcher, Margie Skeer, an assistant professor of public health and community medicine at Tufts University School of Medicine, a little about her analysis, published in the Journal of Youth and Adolescence. Here, lightly edited, is what she said:

RZ: What happens at family meals that may be protective against risky behavior, like substance abuse, or other mental health problems?

MS: If family meals are frequent and consistent, mealtime can serve as a conduit for open, ongoing communication, where people come together to not only eat, but to talk about their day. In this regard, mealtimes can provide for a baseline level of communication, whereby parents/guardians can learn about the everyday, ongoing aspects of their children’s lives — both important and ordinary. This can create an environment that allows for the development of three crucial features of the parent-child relationship. Continue reading

Back To School, And To Controversy Over Lunch

Just in time for the start of school, the Associated Press reports that schools have been dropping out of the $11 billion National School Lunch Program, which increased “the availability of fruits, vegetables, and whole grains in the school menu,” according to the program’s fact sheet. The national lunch program gave school districts reimbursements for each meal that fit its guidelines.
school lunch

“Some of the stuff we had to offer, they wouldn’t eat,” Catlin, Ill., Superintendent Gary Lewis told the AP. He said his school district saw a 10-12% drop in lunch sales, translating to $30,000 lost under the program last year.

The new guidelines set limits on calories and salt, phase in more whole grains and require that fruit and vegetables be served daily. A typical elementary school meal under the program consisted of whole-wheat cheese pizza, baked sweet potato fries, grape tomatoes with low-fat ranch dip, applesauce and 1 percent milk.

The AP reports that 1% of the nation’s districts had plans to drop out of the federal program, and a further 3% were considering it due to costs and complications with implementation. Continue reading

Let Them Sell Pot: 181 Applicants For Mass. Medical Marijuana Shops

The latest tally: 181 individuals or groups have applied to the state department of public health to establish medical marijuana dispensaries in Massachusetts. The state will ultimately grant 35 licenses, reports WBUR’s Lynn Jolicoeur:

(“Caveman Chuck” Coker/flickr)

(“Caveman Chuck” Coker/flickr)

DPH will announce next month which applicants can move on to the final phase of the application. That process will be much more rigorous and will include identifying a community where the planned dispensary location fits in with local zoning rules.

DPH Commissioner Cheryl Bartlett acknowledged that it might be difficult to open a dispensary in a town or city that has instituted a one-year moratorium. The moratoriums are allowed by law for communities to finalize zoning restrictions for dispensaries. But DPH plans to approve up to 35 dispensaries by January and wants to see them open within four to six months of then.

Jolicoeur talked to one applicant who said he wants to debunk some of the stoner stereotypes with his pot shop: Continue reading

Opting-Out Of Vaccines; Dipping Below Herd Immunity

Graphic Credit: Jan Willem Tulp

Graphic Credit: Jan Willem Tulp

With more and more families opting out of vaccinating their kids, one of the most sacred of public health goals, the concept of herd immunity, is being threatened.

A recent piece in Scientific American featured tantalizing graphics — on view above — illustrating this scary trend.  According to this analysis, the vaccination rates in some states — Oregon, West Virginia and Colorado, for instance, are shockingly low. So low, in fact, that they’ve dropped below the “herd immunity” levels (or what is thought to be the safe threshold) for MMR (measles, mumps and rubella) and DTP (diphtheria, tetanus and pertussis).

So what’s the deal with herd immunity?  According to the CDC, a population has reached herd immunity when a sufficient proportion is immune to a particular infectious disease.  Immune population members get that protection either by being vaccinated or by having a prior infection.

The epidemiological concept is based on this logic: Continue reading