Why you are NOT in complete control of your health

In a world in which everyone’s opinion is valid, it can sometimes be difficult to separate truth from misinformation. When it comes to an understanding of the determinants of health, opinions vary from total abdication of responsibility …

“Not my fault” GIF
“Not my fault” GIF

to a belief that the individual is fully accountable (and responsible) for everything related to personal health.

Total blame GIF
Total blame GIF

That either extreme is untenable should be evident. For instance, the Daily Mail recently published a piece that acknowledges that apparently healthy people sometimes have unexplained deaths, once consideration of all relevant lifestyle factors is taken.

Another way to look at this is to think of the factors that impact on any decision one makes to adopt a healthier lifestyle. For instance, should you be interested in accepting the growing evidence of a more beneficial impact on personal and environmental health associated with a vegan lifestyle, you have to consider the relative affordability of vegan foods when you go out. The price that you pay for your vegetables, fruit and grains will be influenced by the level of VAT set by the government. When you need to quench your thirst, you might find that bottled water is more expensive than soft drinks. Obviously the state then has a role in setting policies that favour healthy choices.

Moreover, we find that certain communities are more at risk of certain medical conditions due to dietary or lifestyle practices across those communities.

This is something that Dahlgren and Whitehead discuss at length and present diagrammatically in their summary of the determinants of public health, shown below:

Dahlgren and Whitehead: The Determinants of Public Health
Dahlgren and Whitehead: The Determinants of Public Health

This gives a more comprehensive view and shows that health will be determined by:

  1. Non-modifiable factors such as age, sex and genes
  2. Individual lifestyle factors (diet, exercise, weight)
  3. Social and community networks (including where the individual lives)
  4. General socioeconomic, cultural and environmental conditions, which are largely influence by political factors

In view of these considerations, you might want to pause before making a judgment next time you discuss an individual’s health.

Improving Productivity through Intrusion?

The BBC has an interesting piece about the methods being used by companies to monitor employees and enhance productivity. These include the following:

  1. Logging keystrokes and using software to monitor the relationship between the help given to customers and whether they subsequently took loans or other offers.
  2. Tools to analyse e-mails, conversations, computer usage, and employee movements around the office
  3. Monitoring heart rates and sleep patterns to see how these affect performance
  4. Gathering “data exhaust” left by employees’ email and instant messaging apps, and uses name badges equipped with radio-frequency identification (RFID) devices and microphones
  5. Checking how much time employees spend talking, their volume and tone of voice, including whether or not they dominate conversations
  6. Embedded chips in their hands to open doors and use equipment
  7. Heat sensors at desks to monitor when employees are at their work stations

These are over and above the “routine” CCTV used by a lot of employers. The following video shows a live example.

Apparently there are benefits to employees, including providing evidence in disputes over harassment or discrimination claims; or where certain medical conditions have a serious impact on actual productivity. I would assume that the effective implementation of such approaches acts as a management substitute by reducing the need for direct line management in those organisations that employ such tools.

I’m personally interested to see which, if any, of these approaches will find their way into the pharmaceutical industry. I can see how they could easily be used in the manufacturing sector; but even within the retail sector there are already companies relying on electronic logging in and out of employees to monitor attendance.

There is a fine balance to be struck between protecting individual freedoms and ensuring that employees are productive. Employees at The Telegraph are said to have felt that the bar had been pushed too far in the intrusion direction. I guess time will tell where the pharmaceutical industry takes this going forward.

Childhood HPV vaccination ‘profoundly’ cuts cervical disease in young women

(Reuters Health) – – Young women who received human papillomavirus (HPV) vaccines as adolescents had significantly lower rates of a condition that’s a precursor to cervical cancer, in a nationwide study in Scotland.

“The magnitude of the effect is greater than expected,” study author Dr. Tim Palmer from the University of Edinburgh told Reuters Health by email.

Receiving three doses of the vaccine at the recommended ages of 12 to 13 was associated with “a profound reduction of cervical disease seven years later,” he and his colleagues report in The BMJ.

One of the most common sexually transmitted diseases, HPV doesn’t cause symptoms and usually goes away on its own. But the virus can cause cancer of the cervix, the fourth most common cancer in women, as well as cancers of the throat and penis.

Palmer’s team studied 138,692 women, about half of whom had been fully vaccinated against HPV either at ages 12-13, or later in their teens. At age 20, the women all had tests to look for abnormal cells on the cervix – called cervical intraepithelial neoplasia, or CIN – that can lead to cancer.

Rates of CIN were low overall. But compared with unvaccinated women, vaccinated women had an 89 percent lower rate of CIN grade 3 or worse (0.59 percent in unvaccinated women versus 0.06 percent in the vaccinated group), an 88 percent lower rate of CIN grade 2 or worse (1.44 percent versus 0.17 percent), and a 79 percent lower rate of CIN grade 1 (0.69 percent versus 0.15 percent).

Grades 2 and 3 are usually treated with surgery.

Girls who were vaccinated at ages 12-13 got a greater benefit: the vaccine was 86 percent effective for them, and 51 percent effective when given at age 17.

“The findings are dramatic and document a considerable reduction in high-grade cervical disease over time,” Julia Brotherton, medical director at VCS Foundation in East Melbourne, Australia, writes in an editorial published with the study.

In the U.S., many girls and boys don’t receive the vaccine at least in part because their parents may question whether it’s necessary to protect them against a sexually transmitted disease at an age when they think children shouldn’t be having sex, previous studies have found.

Scotland, which has an organized national cervical screening program, introduced a national immunization program against HPV in 2008, targeting girls aged 12 and 13, followed by a three-year catch-up program up to age 18.

The study also revealed a decreasing rate of disease in unvaccinated women. “This is called herd protection and is a function of the high uptake of vaccine in Scotland,” Palmer explained. Unvaccinated women are being protected because the spread of HPV between men and women has been interrupted because there are not enough susceptible women, he said.

There were an estimated 570,000 new cervical cancer cases globally in 2018, representing 6.6 percent of all female cancers, according to the World Health Organization, with about 90 percent of deaths from cervical cancer occurring in low- and middle-income countries.

These countries, however, do not have the resources to support organized screening, the authors write, highlighting the importance of developing vaccines against the most important cancer-causing HPV strains.

In February, the WHO and cancer experts called the HPV vaccine a “critical” health tool and said access to it should be scaled up as swiftly as possible, especially in poorer countries.

SOURCE: bit.ly/2WWlBLQ and bit.ly/2KEmDuH The BMJ, online April 3, 2019.

This article first appeared on Reuters Health on April 10, 2019