The Spiritual Anthropologist

Where Alcohol and Anthropology Meet

Revising Public Health Practice

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Sanitation, vaccines, control of various environmental factors that affect health, and much more have greatly improved our quality of life and our average lifespan. But while public health practice has come a long way, there are still numerous areas of improvement. Not only must public health practice improve in terms of communication with the public, but we must also work on improving how quickly scientific knowledge is used to update public health practice. Additionally, public health policy involving zoonotic disease (diseases which are contracted from animals) and protection of the health of livestock and pets, also requires serious attention.

Pseudoscience

The antivax movement, the push for homeopathy, and great deal of other pseudoscientific movements are hurting public health practice. While there’s still lot that we do not know about recent outbreaks of various diseases such as measles and whooping cough, medical science absolutely justifies the use of vaccines in the prevention of dangerous symptoms associated with these diseases. Meanwhile, the link between vaccines and autism has long since been debunked, and yet a large portion of the population still believes in it.

Furthermore, a number of people are choosing to forgo “traditional” medicine and instead use homeopathic treatment. Unfortunately, based on systematic review of available literature, there is no indication that homeopathy works any better than a placebo. There is also no scientific justification for a mechanism through which it should work. Homeopathy literally has every trace of active ingredient diluted out of the product, to the point where a person is just consuming a sugar pill. While the placebo effect can be a powerful medicine in and of itself, it is not a substitute for recognized gold standards of care.

Better science communication, and better education in philosophy, both should improve individual understanding of how science works and acceptance of standard medical treatments. However, there are still other issues. There are cases where our standard of care is outdated.

Living Systematic Review

One of the greatest concerns with public health practice is that it takes a very long time for new scientific evidence to become part of the public health practice. One estimate places the lag time between findings and implementation at 17 years.

Unfortunately, in order to alter public health practice, we need to have more than just a single investigation indicating efficacy. Public health practice relies heavily on systematic reviews. There are two options for systematic reviews. A systematic review can periodically be conducted to see if there’s additional information available. This option is the traditional route. Alternatively, a systematic review can be ongoing, where data is added at regular intervals and the conclusion is reevaluated.

This process is called a living systematic review. This option is fairly new. As of 2017, protocols for the process were still being developed. Elliott JH et al. 2017 discusses the importance of living systematic reviews (LVRs), and suggests that they may be most useful when there’s a lot of new research being done on a topic, when there’s still a lot that we don’t know about the topic, and when new information might change current protocol.

Maintaining Trust

Unfortunately maintaining trust is going to be difficult even if we can update our protocols more quickly. Long standing recommendations being overturned can be problematic because people may wonder why it took so long for the medical community to realize their mistake. Meanwhile constantly changing recommendations to fit new data could establish a view that the medical community is fickle.

People may also become even more confused about what to do for proper health. While this issue isn’t as problematic for people who regularly see a doctor for checkups, some don’t, and current medical recommendations do not actually suggest that they are necessary. This lack of necessity is likely to change if public health policy is updated on a more regular basis though, so this factor needs to be taken into consideration.

Call to Research Format

Even with living systematic reviews, new research needs to be conducted and we need to communicate limitations of existing research. One of the issues that prevents public health policy, and science as a whole, from being as up to date as possible, and evolving at a fast enough pace, is a failure to communicate. I have written numerous papers on concerns about current medical science practices and limitations of our understanding. These papers are not research papers in the normal sense. They fellow what I call the “call to action format.”

Most of my focus has been on vaccines. I’ve written on the issue with understanding recent measles outbreaks, as well as our limited understanding of how asymptomatic infections influence Whooping Cough epidemics. While there is a lot that we know about vaccines and their efficacy, there seems to be a lot that we do not know. And these unknowns are not being discussed in enough detail or frequency to drive new research that can be used to fuel living systematic reviews.

The Format

The first half of the call to research format is similar to a systematic review, but it’s more focused. It looks for specific gaps in our understanding, and summarizes them. It might take into account personal observations by the author, as well as specific questions that they have come across. Questions may also be pulled from existing systematic reviews.

The second half of the paper is a discussion on potential theories on the matter, and studies that can be conducted. The discussion isn’t as detailed as a research proposal, but a single call to research paper could have many suggestions on types of research that can be performed. There should be at least enough detail that a person reading the paper could take the suggestion and turn it into a full research paper.

Zoological Public Health Policy

The second half of this discussion is going to focus on a different aspect of public health. A lot of Americans have pets. While these figures are old, at least as of 2006, approximately 60% of Americans had some kind of pet, according to Gallup. 44% of Americans specifically own a dog, and 29% own a cat. And almost 80% of pet owners have both a dog and a cat.

The lack of information on how many people even have pets is one example of how public health policy needs to be improve. But why is such information important? What do pets have to do with public health? We can look to an article by A. S. Deller, who wrote an interesting piece on zombies, but not quite the zombies of science fiction. Various pathogens alter the brain function of their hosts and actually create what might as well be considered zombies. One such pathogen is Toxoplasma gondii (toxoplasmosis or T. gondii). This pathogen does affect humans, but the way in which it impacts its human hosts is not well known.

According to the CDC, 11% of of the population, aged six and up, have experienced a T. gondii infection. The pathogen can be contracted from eating exposed food, but a major source of infection is zoonotic (animal) sources. While T. gondii doesn’t cause humans to become zombies and seek out cats, it does seem to have neurological effects. In humans, the pathogen seems to be associated with increased risk of psychological conditions such as schizophrenia.

The length in time that it’s taken to even realize the issue, and the lack of protocol developed to deal with it, goes back to the first half of this discussion. Public health policy isn’t being updated fast enough. But the problem also shows that we need to be hyperaware of potential threats from pets, as well as livestock.

There is work being conducted on creating a vaccine for T. gondii, but it’s far from complete. I think that there are two reasons why there is currently no vaccine. One is simply the difficulty in creating the vaccine. The other is in the failure to consider it a problem. Yes, T. gondii infects a lot of our pets, but the public health community never really considered that too much of an issue, because we didn’t consider the potential risk to humans.

But we also need to be more aware of the risks that diseases pose to our pets. We need to make sure that vaccine schedules are up to date, that they receive the right vaccines, enough vaccines, and not too much vaccines. We have a responsibility to protect our pets, because they did not choose to live with us. And therefore public health practice really should dedicate more of its attention to veterinary public health. There are programs available, including MPH-VPH programs, but the attention paid to zoonotic disease, especially risks to pets and risk from pets, simply isn’t enough.

The Absurd Opposition to Circumcision

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Both the CDC and the WHO have produced recommendations for circumcision. While there isn’t enough information to create a full plan of action, recommending universal circumcision, the science is fairly solid when it comes to counting the claims of anti-circs. I use that term because in many cases, the kind of science denial seen among anti-cutters is no better than that seen among anti-vaxxers. And because of the degree of science denial, and other political issues, I’ve decided to finally write a public health article on the topic.

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Further Discussion on the Measles Outbreak

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In my first article on the measles outbreaks in the Pacific Northwest, I argued that measles vaccination rates have declined little since 1995. Here I’d like to expand on that idea, and comment on specific claims made by various sources.

Is the Washington Post Right?

Twitter seems to have stored a clip that cannot be found in the actual article being linked to in Dr. Pan’s tweet, so I am including it here. According to the summary, “lax state laws have helped drive down vaccination rates across the pacific Northwest.” What the article does state is the following.

The Pacific Northwest is home to some of the nation’s most vocal and organized anti-vaccination activists. That movement has helped drive down child immunizations in Washington, as well as in neighboring Oregon and Idaho, to some of the lowest rates in the country, with as many as 10.5 percent of kindergartners statewide in Idaho unvaccinated for measles. That is almost double the median rate nationally.

So is the article being truthful? Well, I’d say it’s an “alternative fact.” Consider the following graphs.

Washington State Vaccination Rates

I gave an overall analysis of immunization rates at the HHS region and state levels, in my first article. But I want to go into a little more detail about Washington State’s vaccination rates. First off, in the last couple of years, there’s been a rise in volatility, but it’s hard to tell whether this rise is out of the ordinary. When people cite such a short length of time and argue that there’s been a “decline” in vaccination rates, it’s no better than when people look at a few years of cold winters and say “look, the Earth is cooling!” A proper analysis does not look at a few data points. It looks at how those data points compare to the overall known data set.

This graph shows the volatility in the last few years. And perhaps there’s something in the 2012 blip, however it doesn’t seem to be enough to explain the timing of the outbreak, especially since overall vaccination rates are a an average of annual rates. That means that year-by-year variations are smoothed over multiple years.

Better Data Needed

In order to make any more conclusions, a lot more data will be needed. Pockets may be on the county level, or the nodes may be even smaller. If that’s the case, there could still be a change in distribution that my analyses aren’t capturing. But if that’s the case, then it doesn’t seem reasonable that they’d be having such an impact on larger scale outbreaks. We can think of very small communities, within a very large population, almost as individuals.

A Serendipitous Experiment has come out of these recent outbreaks. According to Ars Technica, the recent spike in cases, and widespread attention and concern, has caused a massive increase in vaccinations. So not only should we see an increase in vaccination rates in the coming data sets, but we should see a decline in pockets as well.

Now, the issue is that even if source of the recent outbreaks is something other than the antivax sentiment, we should see a decline in cases, because the vaccine does a good job at preventing symptoms. And that’s why we should ensure that vaccination rates are high. But this result also will cloud any data. A proper analysis would therefore have to adjust for changes in vaccination, if the goal is to see if perhaps the pathogen is becoming more virulent.

Asymptomatic Infection Analysis

Especially because of the recent outbreak and rapid changes in vaccination rates among certain populations, now is the time to take action in analyzing asymptomatic infections. As I’ve mentioned in my paper on whooping cough, asymptomatic infections are poorly understood and studied. While there are certainly differences between whooping cough and measles, and their associated vaccinations, there’s still something we should see, if we took a random sample of the population: infection rates should be significantly lower among vaccinated individuals than in unvaccinated individuals. And how different they are can give us greater insight into how well the current vaccine is working to stop the measles infection.

To give some insight into what we could find, I recently came across a paper studying measles vaccination in Taiwan, presented to me as justification for current understanding of measles vaccination. What the person failed to notice is that based on a random sampling of the population, rather than a survey of cases, it seems that the basic reproduction rate is not driven below one, suggesting an inability to generate herd immunity. One reason that I use “seems” is that I’m currently trying to double check with the authors to see if this was an estimate in the case of 100% vaccination or not.

The disconnect between the apparent “eradication” of measles in the United States, and the general recognition by the medical community that a 95% vaccination rate should generate herd immunity, may suggest that asymptomatic infection is indeed a problem. And that’s why we really need to do a wide-scale analysis in the United States.

On the Scientific Perception and Reality of Whooping Cough

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The following is a draft research proposal to investigate the scientific perception and reality of the efficacy and efficiency of B. pertussis vaccines and the prevalence of asymptomatic infections. I have written extensively, both on The Spiritual Anthropologist, and over at Politicoid, on the topics of vaccine efficacy and science, especially concerning issues with the way vaccine efficacy is researched and on the potential threat of asymptomatic infections, and have been striving to publish new research, rather than just summarizing existing research.« Continue »

The Human Gut Microbiome

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Introduction

Over the last couple of decades, we have learned a lot about the human gut microbiome. Rather than simply being a collection of commensal organisms, the gut microbiome (GMB) is now thought to be involved in a number of important metabolic roles, including nutrient extraction, immunity, and possibly even the regulation of sleep and mood. The degree with which negative health outcomes have been associated with a dysbiosis, or the dysfunctional GMB, and the degree with which different organ systems interact with the GMB, suggest that we should consider it to be as important as an organ, if not actually an organ itself. Dysbiosis is therefore not a minor inconvenience that may cause discomfort, but a syndrome or disease that must be treated to maintain proper health. Further research on gut microbiome dysbiosis should be undertaken, including research into new diagnostic tools. The first half of the paper will summarize part of the discoveries made in the field of research on the GMB. The second half of the paper will use those findings to suggest further research.« Continue »