Archive for the ‘Health Research’ Category

LGBTQ-Inclusive Sex Education for Maryland Schools

March 12, 2018

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In Maryland, all youth, regardless of gender identity or sexuality, deserve the right live healthy lives and thrive in school. For lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth, this can be difficult.

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Research shows that this population is disproportionality at risk of experiencing dating violence and contracting sexually transmitted infections (STIs), including HIV. The CDC furthers this by stating that in 2015, 81% of the youth ages 13-24 who were diagnosed with HIV were gay or bisexual men.

Additionally, a survey on school climate conducted in 2015 found that Maryland public schools are not safe for most LGBTQ students, with 61% of LGBTQ students reporting that they were verbally harassed because of their sexual identity and 45% because of their gender expression. Furthermore, only 1 in 4 students reported being taught positive information about LGBTQ people in school. A hostile school environment can lead to mental health issues for LBGTQ youth, higher absentee and drop-out rates, and even suicide.

Providing LGBTQ-inclusive sex education to middle and high school students is a vital component in empowering this population to thrive.

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With an inclusive curriculum, students obtain medically accurate and age-appropriate information on sexual health that integrates LGBTQ needs. LGBTQ youth learn about health risk behaviors that impact them and how to protect themselves against STIs. Equally important, all students are given the opportunity to explore topics related to sexuality and gender identity in a setting that positively depicts LBGTQ individuals. This helps dispel stigmas and negative stereotypes frequently tied to the LGBTQ community and builds a more welcoming and inclusive school environment.

Picture4Four states and Washington D.C. have passed legislation that mandates public schools provide sex education that respects and addresses the needs of all genders and sexual orientations.

It’s time for Maryland to follow suit and create similar legislation mandating inclusive sex education. In addition, funds should be allocated for the development of supporting materials, resources, and training for educators and school administrators. Research should be conducted alongside these changes to evaluate the impact LGBTQ inclusive-sex education has onSTI/HIV infection rates and bullying in Maryland schools. With these actions, we can help bridge the gap to providing LGBTQ youth with an equal opportunity to live healthy and successful lives.

 

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Could Biology Explain Racial Health Inequalities?

March 10, 2018

The consistently greater risk for infections and cancer among men of African ancestry compared to all other ethnic groups in the world suggests fundamental biologic causes that supersede social and geographic influences. One of the most popular arguments for the notion that race is a “social construct” is derived from the point made by the geneticist Richard Lewontin, to the effect that intra-racial genetic similarity among individuals classed within any given “race” typically accounts for only about 7% of genetic similarity. Lewontin concluded from this that racial classification is “meaningless.” While his data concerning intra-racial vs. interracial genetic similarity were correct, the inference from this data that racial classification is meaningless is widely referred to by evolutionary biologists today as “Lewontin’s fallacy.” Indeed, 7% of the genetic material consists of several thousand genetic loci, which is quite an impressive amount of genetic material.

Random studies have found higher Testosterone levels in African American men and higher Testosterone and Estrogen levels among African American women together with low Dehydroepiandrosterone levels (DHEA) compared to their racial counterparts, could explain the health inequality. DHEA levels decrease with old age and low levels are said to reduce body’s immunity against diseases increase the risk for infections and cancer; DHEA levels have been found to be particularly low in African Americans, increasing their vulnerability to diseases. This understanding is key to prioritizing health services to this community. We need policies to address early childhood education including health education; access to healthy food and eating right, and performing work and out of work activities according to your biological capabilities. We need to help people understand their biology and how it affects their health and behaviour and they can take advantage of their differences.racial differences

I advocate for health education and services to reach out to African American communities in their homes, work, schools, and churches. Early screening of African American women, for Breast cancer, Endometrial cancer, and Ovarian cancer and earlier screening of Lung cancer Prostate cancer and other common cancers among African American men; after reaching the age 40.

Featured picture by KANGSTAR

Data for Decision-making: Repeal of the Dickey Amendment

March 10, 2018
March for our livesImage source: https://marchforourlives.com/

Every single day, guns claim the lives of almost 100 Americans. For each death, there are at least two more Americans injured. Though experts generally agree that this represents a pressing public health concern, there is an astounding lack of research on gun violence and potential policy solutions in the United States. A non-partisan think tank recently released a report highlighting the limitations of our gun control research—creating a “fact-free environment” in which both sides of the political debate can choose facts and figures that support their policy goals.

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This infographic, based on the RAND Corporations report, illustrates the evidence gap in linking gun policies to outcomes. Image source: https://www.vox.com/policy-and-politics/2018/3/2/17050610/guns-shootings-studies-rand-charts-maps

The Dickey Amendment, a rider included in a 1996 federal spending bill, is largely responsible for this lack of research. The amendment states that, “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention (CDC) may be used to advocate or promote gun control.” The National Rifle Association (NRA) strongly supported the amendment as a way to impede research that would lead to gun control measures, like a groundbreaking 1993 study that demonstrated an association between home gun ownership and increased risk of homicide. While the Dickey Amendment does not explicitly forbid research support, subsequent budget cuts to the CDC led to a broad interpretation of the amendment that has had a chilling effect on research for two decades.

Public health and medical professionals know that public health solutions require data and evidence. Over 100 medical associations, including the American Public Health Association, have called for the repeal of the Dickey Amendment. Democratic lawmakers are also pushing for repeal in the House of Representatives.

The debate over gun control has spiked since the February 2018 school shooting in Parkland, FL, and student survivors are calling for policy action. They are many ways to get involved:

  1. Contact your representative in the House and ask him or her to support a 2017 bill introduced by Stephanie Murphy that would repeal the Dickey Amendment.
  2. Raise awareness. The March for Our Lives movement is a student-led grassroots organization created in response to the Parkland school shooting. They have organized a march on March 24, 2018, in Washington, DC, as well as parallel marches in several other cities to refute the status quo and demand change.
  3. Be an informed consumer and support the several organizations that have cut ties with the NRA, who oppose research on gun violence and gun control measures.

Ultimately, this issue should not be partisan—all Americans should recognize the importance of research to inform evidence-based policy.

You Can Always Ask: “Right to Try” Act of 2017

August 18, 2017

Out_of_dangerJust before the August recess, the U.S. Senate, in a rare show of unity, passed the FDA funding bill, which included the Trickett Wendler Right to Try Act of 2017.  The bill received little public attention, although versions of the law have passed in 37 states. It would require the federal government to facilitate terminally ill patients’s access to experimental agents. This access would be granted through bypassing the standard U.S. Food and Drug Administration (FDA) procedures and limiting the manufacturer’s liability. The experimental agents must have completed Phase 1 trials, which only prove safety. 

The Goldwater Institute, the patient advocacy group behind RTT (Right to Try), believes that bureaucratic procedures interfere with patients’ ability to access treatment. However, from 2010-2014, the FDA facilitated 5,995 requests for access to investigational therapies, with a 99.5% approval rate and a median turnaround time of 4 days. These statistics remained constant through 2016. A manufacturer’s refusal is the main reason patients don’t get access to drugs.

 

Stakeholders opposed to the RTT, including the American Society of Clinical Oncologists (ASCO), the Compassionate Use Advisory Committee (CompAC), Public Citizen and the FDA, maintain that the existing procedures work and that reducing regulation and adverse event reporting requirements is dangerous. Notably, the pharmaceutical industry has been noncommittal on this issue. 

The RTT Act fails to safeguard patient safety and attempts to weaken FDA oversight of drug development. Physicians and patients already have the right to ask through FDA regulated channels. RTT laws do not require drug manufacturers to provide their products to patients. Despite the liability limitations, manufacturers may still be worried about the risk of adverse effects that could jeopardize both public opinion and future approval of drugs. Providing patients with no other options access to potentially life-saving medications is imperative but passing this ill-conceived Act is reckless. 

Sugar-Sweetened Beverages’ Low Taxes in Maryland May Be a Poison for Children and Adults

March 12, 2017

Other group member: Mujan Varasteh Kia

In 2015, 30% of the people in Maryland were clinically obese. Sugar-Sweetened Beverages (SSB) is strongly associated with obesity which can lead to the number one leading cause of preventative deaths (1 in 4 deaths) due to heart disease, stroke, type 2 diabetes, and certain types of cancer, and can play a role in preterm delivery.

A constructive SSB taxation policy can help to reduce many of the obesity-related health problems and alleviate the amount of money spent to treat these cases long-term. The goal is that “increasing [the tax] will discourage individuals, especially children, and teenagers, from excessive consumption of these beverages.” Currently, Maryland imposes a 6% sale tax on SSBs. No significant reduction in obesity has been recognized as a result of this taxation. It has been argued that the sales tax is too little to prevent people from reducing their bad habits which urges the need for a more substantial taxation to reduce soda consumption. In a study, they found that participants would buy fewer SSBs with 20% tax and would completely eliminate their SSB consumption if 50-100% tax was implemented.

Shortly after Mexico passed soda tax law in 2013, there was an average 12% decline in soda sales and a 4% increase in bottled water purchases. The soda industries have argued that soda taxation is not going to “change the behaviors that lead to obesity,” and that the public will find their calories elsewhere. However, in the studies they referred to the taxes were too small or they were applied in the form of sales taxes that could have gone unnoticed by the consumers.

Philadelphia was the first big city in the nation to pass a soda taxation policy in 2016. Despite the approximate $5 million advertisements against this taxation by The American Beverage Association, a non-profit campaign was created with the help of the former New York City Mayor, Michael Bloomberg to support the soda taxation law. We also urge the Maryland state legislature to support and follow the same initiatives as those of Philadelphia mayor’s 1.5-cents-per-ounce levy on SSBs. These policies may not fully eliminate the obesity crisis, but even a small reduction in soda consumption will make a difference.

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Image credit: Philly.com

 

 

National Health Reform in Mexico

March 12, 2017
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Photo credit: The Yucatan Times via google

 

In 2003, Mexico legalized a health reform policy that endorsed the introduction a health insurance mechanism called Seguro Popular de Salud (SPS).   SPS was designed to secure universal health coverage (UHC) for all citizens.

Dr. Julio Frenk, who was then the secretary of the health, led the team of reformers who drew upon years of accrued evidence to build support at the federal level through successful lobbying efforts and by sidelining opponents in the executive and legislature.  Their efforts proved successful at ensuring the program’s adoption into policy.

However, one issue of fragmentation in health services provision was not adequately addressed. Prior to the policy’s adoption, formal workers received services through either the Social Security Institute (IMSS) or the Institute for Social Security and Services for Civil Servants (ISSSTE).  Informal workers received health services under public assistance or from the private sector, with no financial protections. 

Frenk and his team pushed for a nationally integrated insurance scheme through the  Family Health Insurance Scheme (FHI) run by the IMSS that would be independent from a competitive market for services provision.  Threatened by Frenk’s competitive model , the IMSS and Ministry of Health providers resisted. So, rather than becoming a national insurance scheme, SPS was left to function as a subsidy service for the poor.

SPS has recorded notable successes in increasing coverage for mostly informal workers and for the poor. However, the program can ensure greater coverage and financial protection through risk sharing across the entire Mexican population. Additionally, the introduction of consumer choice through competition will ensure greater efficiency in service provision. To achieve these, the federal government must secure buy-in from the IMSS and MOH unions  to pass a nationally integrated insurance scheme that ensures a maximal pool and adequate competition among providers.

 

Emergency Funding for Zika Virus Response

August 19, 2016
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Source: wh.gov/Zika

On February 22nd, the Presidential office requested $1.9billion in emergency funding to support activities related to Zika virus, but these efforts have dangerously stalled in Congress. To date, nearly $600 million has been redirected by the Obama administration to fund Zika related research, front line response efforts, and vaccine development. More than half of this money was redirected from within the U.S. Department of Health and Human Services (DHHS).

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Source: Healthcareit

On August 3rd, Sylvia Burwell, DHHS Secretary, informed Congress that due to the delay in approving the emergency funding, the DHHS had been forced to further reallocate up to $81 million from other programs, including the National Institutes of Health. This was extremely important because it could impact the progression of the vaccine studies currently underway, as Secretary Burwell suggested in her letter to Congress. Her letter also outlined the response by the CDC and predicted that they too would be out of Zika funding by the end of the fiscal year (Sept 2016).

 

Funding approval for Zika virus related activities from the U.S. is more urgent than ever. As of August 17th, the U.S. has confirmed 14 cases of locally acquired Zika virus disease – all from Florida. This was after the U.S. Centers for Disease Control (CDC) announced on August 2nd that an additional $16 million was awarded to 40 states and territories to support Zika related public health activities.

So what can you do? It is time we let our political leaders know that their constituency will not wait any longer. Follow Secretary Burwell’s lead – petition your local congressional representatives (House, Senate) and let them know this is an issue you care about. Or submit pre-formatted online petitions at Project Hope and AmeriCares. And spread the word and call to action amongst your peers.

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Source: Project Hope

 

Use the Ballot Initiative Process To Pass a Soda Tax in California

August 19, 2016

Since 1990, adult obesity rates in California have increased nearly 250%. Over a similar period, type 2 diabetes and prediabetes rates have also risen steeply. Abundant research indicates that consumption of sweetened beverages contributes significantly to these and other public health problems. For example, the Nurses’ Health Study found that people who drank soda daily developed type 2 diabetes at almost twice the rate of people who did not.

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Source: Daily Infographic

One tool to reduce sweet beverage consumption is to impose a tax on purchases of sugary drinks. A recent study found that Mexico’s soda tax reduced purchases of sugary beverages by as much as 17% in low-income households. A statewide soda tax could likewise help reduce Californians’ soda consumption. A statewide tax would be more effective than local regulation, because people cannot as easily evade a statewide tax by driving to another jurisdiction to buy groceries.  Further, proceeds from the tax could fund other statewide public health efforts and perhaps inspire similar measures in other states.

Unfortunately, the obstacles to legislative enactment of such a tax are formidable. Since 2009, the beverage industry  has spent more than $117 million nationwide to defeat proposed taxes. Statewide soda taxes have been introduced several times in the California legislature, but were defeated or withdrawn in the face of intense beverage industry lobbying.

For this reason, Public Health Advocates, the leading stakeholder supporting a soda tax in California, should launch a campaign to enact a soda tax via statewide ballot proposition, thus bypassing the legislature and taking the matter directly to the voters. A 2013 Field Poll found that 68 percent of Californians would support a soda tax if the proceeds were used to fund school nutrition and exercise programs.

A statewide ballot proposition would, of course, also face fierce soda industry opposition. But the recent success of a local soda tax initiative in Berkeley, California, which 75 percent of voters approved, provides a model for how advocacy groups can take on the beverage industry and win.

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Source: Bruce Azizuki, In Motion Magazine

The same grassroots organizing tactics that worked in Berkeley could help build statewide support for a soda tax – and enable California to become a public health pioneer.

Failure of Ethics or Well-Supported Medical Intervention? The Debate on Supervised Injection Sites in Ottawa, Ontario

August 19, 2016
Image obtained from www.cbc.ca, Johnathan Hayward/Canadian Press

Photo Credit: Johnathan Hayward/Canadian Press

Supervised injection sites have been the topic of fiery debates across Canada for over a decade- but now we are feeling the heat here in Ottawa. Former Conservative Health minister Tony Clement once famously referred to Vancouver’s Insite program as a “failure of ethical judgment.”  However, since the landmark Supreme Court ruling in 2011 to allow Insite to continue operating, citing its ability to save lives with no discernable negative public health impacts, discussions about creation of new supervised injection sites have cropped up in nearly every major Canadian city.

Several Ottawa Community Health Centers, including Sandy Hill, have put forth proposals for supervised injection sites. However, Ontario Health Minister Eric Hoskins has stated that he will not consider any proposals that have not first been vetted at a municipal level.  Although Ottawa Mayor Jim Watson has historically been against the facilities, a vote held by the Ottawa Board of Health in June 2016 was overwhelmingly in favor of safe injection sites, leading the Mayor to soften his stance on the issue slightly. However, several key public figures, including local law enforcement, remain opposed to the idea.

Photo credit: M-J Milloy, TML Daily Newspaper

Photo credit: M-J Milloy, TML Daily Newspaper

Scientific literature from Insite, as well as from 90 other cities around the world with supervised injection sites, is consistently demonstrative of the benefits of these centers. Safe injection sites reduce deaths related to overdose, reduce new transmission of blood-borne diseases such as HIV and Hepatitis C, reduce health care costs, and increase likelihood of addicts seeking definitive treatment for their addiction. There has been no evidence to support the idea that they increase crime or violence. These statistics should hit home for us in Ottawa, as the 2012 Toronto and Ottawa Supervised Consumption Assessment Study (TOSCA) demonstrated that Ottawa has one of the highest rates of HIV and Hepatitis C among IV drug users in Canada, and rates of opioid overdose continue to climb.

As the final City Council decision approaches, these coming weeks represent a critical time for the future of supervised injection sites in Ottawa. Safe injection sites save lives, and now is the time to loudly advocate on their behalf. In this situation, withholding a scientifically and economically sound intervention from those struggling with addiction would be the true failure of ethics.

The Fate of Frozen Embryos

August 19, 2016

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An estimated 600,000 to two million frozen embryos are stored at fertility clinics and cryopreservation facilities in the United States. Some are destined for implantation but many will remain frozen in perpetuity because no one is willing to decide their fate. Intense disagreement over when life begins entangles these embryos in a complex web of legal, ethical, moral and religious debate and results in decisional paralysis. In contrast to Australia and the United Kingdom, the U.S. has no state or federal policies to regulate management of unneeded frozen embryos and the pendulum of support swings from one extreme to the other. Fertility clinics have inconsistent practices and professional societies such as American Society of Reproductive Medicine (ASRM) and American College of Obstetricians and Gynecologists (ACOG) have produced only position statements. With approximately 60,000 babies born via IVF each year and 4-6 frozen embryos for each live birth, the quantity of frozen embryos in storage will grow exponentially if we continue to allow indecision to be the de facto policy.

Federal or state regulations to manage the large population of unneeded frozen embryos is unlikely because religious and right to life groups wield strong political and financial power in this contentious debate.  The onus is on ASRM and ACOG to develop and enforce a comprehensive policy requiring an advance directive prior to creation of any embryos.  The directive, completed by the couple, will determine the fate of the embryos – disposal, donation for stem cell research, or donation to another couple –  if they are not used within a 5 year period.  In addition, the directive must address contingencies such as divorce or death.  Accreditation of fertility clinics predicated on policy compliance will be the mechanism for enforcement.  Only a clear, firm stance will turn the tide from benign neglect to thoughtful action.