Because most Donald Trump appointees to Federal government department and agencies were filled with incompetent, ethically-challenged, science-denying individuals, his appointment of Brenda Fitzgerald as CDC Director was, more or less, taken by the science and medical community with a sigh of relief. She wasn’t anti-vaccine. She seemed to understand the role of public health in the USA. And she was a doctor. Trump could have done much worse, as we’ve seen in other departments.
Firearms mortality, either murder, accidental or suicide, has always been a public health issue in the USA. There have been several good epidemiological studies that have examined whether gun control regulations and firearms mortality risk are related – and the results are surprisingly vigorous.
From recent epidemiological research, there is some convincing evidence that establishes a correlation between state-level gun control regulations and firearms mortality rates. However, the link is not as black and white as one might wish – the relationship between firearms regulations and mortality depends on the quality of the law.
The nation’s leading public health organization, the Centers for Disease Control and Prevention (CDC), is essentially prevented from analyzing and publishing any epidemiological research that would help us understand what, if any, links there are between gun control and firearms mortality. The Republican dominated congress have done everything they can to prevent the CDC from using any funds to study the issue.
Furthermore, because the CDC cannot (or will not) fund research into gun control, it has lead to a chilling effect on gun control research in academia. According to the Washington Post, “young academics were warned that joining the field was a good way to kill their careers. And the odd gun study that got published went through linguistic gymnastics to hide any connection to firearms.”
Donald Trump’s record on appointments for science and medical positions has been horrific, at best. His choice of Tom Price for Health and Human Services was terrible for healthcare. Anti-science individuals were also appointed to serve as EPA Director and Secretary of Energy. But recently, Trump appointed Surgeon General and will appoint a CDC director, both of whom appear to be good, though not perfect picks.
From a purely non-political standpoint, those of us on the science side wanted a few basics in the new Surgeon General and CDC director:
Have a respectable medical and/or public health background.
Provide full-throated support for immunization programs
Several people have asked me whether having school mandates is in tension with the idea of vaccine informed consent . The answer is no. While school mandates have some effect on parental autonomy, the doctrine of informed consent should not be conflated with autonomy.
The mumps vaccination program started in 1967 – before that there were about 186,000 cases reported each year (and that number might be low because of underreporting). Once mumps vaccinations were commonplace, the incidence of the disease fell by over 99%. For those who think that better sanitation or whatever caused decreases in diseases, I think that 1967 is fairly recent, and it’s clear that the vaccine itself started the precipitous drop in mumps outbreaks. Since the start of the vaccine era, annual mumps cases in the USA hovered below 1,000 during most years. But over the last 10 years, there has been a noticeable uptick in annual cases, with a high of over 6,000 cases in 2006.
Let’s examine the mumps outbreaks and see what may be the cause. Spoiler alert – expect Andrew Wakefield’s name to appear.
The agency focuses its attention on infectious disease control partially through advocacy for vaccines. The staff of 15,000 scientists, researchers, physicians, and US Public Health Services commissioned officers, are dedicated to investigating infectious diseases, food borne pathogens, environmental health, occupational safety and health, health promotion, injury prevention, and public health educational activities – all are designed to help improve the health of Americans and people across the world.
CDC officials are often the first responders to ground zero of dangerous infections. They are generally the first scientists who determine the proper course of treatment for novel diseases, while monitoring its spread across a geographic area. They are warriors in the fight against diseases across the world, including Zika virus and many others.
A significant part of the CDC’s mission involves attacking public health problems globally. In today’s interconnected world, a disease that shows it’s ugly head in an isolated village in the Amazon can be transported to a major city in another country in less than 36 hours. This take money. And this takes manpower.
Once Trump was elected, along with a Republican Senate and House, most of us in healthcare knew that Obamacare was probably doomed. I don’t think it will be easy for the Republicans, now that they’re in power, to actually dismantle Obamacare, especially some of the more popular provisions such as elimination of the pre-existing conditions as a disqualification for receiving health insurance.
Also, there are over 20 million Americans who have taken advantage of health insurance from Obamacare, and I think it would be almost impossible for the Republicans to cut them off. But I may be delusional about the limits of Republican dislike of poorer Americans.
Setting aside healthcare insurance, what else may be impacted by Tom Price? Well, the Department of Health and Human Services is responsible for many of the important health care institutions that matter to me and my readers. Some of the major institutions under the HHS umbrella are:
The National Institutes of Health (NIH) – the nucleus of biomedical and health-related research in the USA. Much of the research at NIH, which has an impressive world-wide reputation, serves as the foundation of much of what we know about human health and disease.
The Centers for Disease Control and Prevention (CDC) – if you are a reader of this website and blog for the past 5 years, you know I, and many others, have tremendous respect for the CDC. It functions as the frontline, first responders if you will, for any disease that appears in the world. It is made up of some of the leading scientists, public health specialists, and thought leaders in healthcare, who give their careers to help humanity. And, of course, they set vaccine policy for this country. The CDC has tremendous influence on public health across the globe.
The Food and Drug Administration (FDA) – the primary regulator of pharmaceuticals, medical devices, food, diagnostics, supplements, and many other areas, it is one of the most powerful agencies in the world for protecting the health of consumers.
The Centers for Medicare and Medicaid Services (CMS) – the federal agency that administers the Medicare program along with advising the states on Medicaid and other public health care programs.
Tom Price will have significant influence on much of the science of medicine, let alone the financing of health care in the USA. There is one thing in Price’s background that give us some significant insight as to how he’ll run his department – let’s just say, it’s not good. Yeah, none of us of would have predicted this.
Over the past few months, the Zika virus, a mosquito borne disease that is passed from the mother to the developing fetus, has become the focus of a lot of attention because of the danger it poses to the fetus. There are no vaccines or treatments for the virus, so the best we can do is stop the carrier, two species of the Aedes mosquito. Probably the best way to prevent Zika virus spread is with genetically modified mosquitoes, the Frankensquito.
Even though mosquitoes are the main way to be stricken with the Zika virus, it is even crazier than that. Men and women who contract the disease can then transmit it sexually to their partners. So even those who are nowhere near the Zika carrying mosquitoes may be at risk of getting the virus.
However, as fluoride became more available, especially in the forms in toothpaste and various mouthwashes, it has become time to review water fluoridation benefits and risks – especially as it becomes one of those “things” that cause concerns with the public.
As I’ve mentioned literally a few hundred times in this blog, the very highest level of research is a meta (or systematic) review, which tries to identify, appraise, select and synthesize all high quality research evidence relevant to a particular question or hypothesis in medicine. Systematic reviews of high-quality randomized controlled trials are critical pieces of evidence that forms the basis of science-based healthcare.
Systematic reviews are best when they select hundreds or even thousands of research studies over decades of clinical studies, eliminating studies with bias (or pointing out the bias), and combining data from the best of the best. Now it’s time to look at one of the newer meta-reviews regarding water fluoridation benefits and risks from the Cochrane Collaboration, probably the premiere group that produce systematic reviews.
Using data from a wide variety of resources (from clinical trials to peer-reviewed studies to recommendations from public health organizations), the Cochrane Collaboration attempts to find the best and least biased data to answer a question. In case you’re wondering who is this “Cochrane,” they are either a group of brilliant scientists trying to provide better data for medicine or dentistry. Or they’re a cabal of evil wizards, hiding from the world in a dungeon in one of Big Pharma’s creepy castles in New Jersey. My guess it’s the former. Continue reading “Water fluoridation benefits and risks – a systematic review”
Professor Dorit Reiss has written another wonderful article here clarifying that there really is a lack of conflict between so-called “informed consent” and public health mandates to keep citizens (especially children) safe from infectious diseases. It could not be clearer (at least to me) that informed consent does not trump the needs of the greater good.
In the Star Trek Movie, the Wrath of Khan, Spock and Kirk had this conversation:
Spock: Do not grieve, Admiral. It is logical. The needs of the many, outweigh…
Kirk: The needs of the few.
Spock: Or the one.