Vaccine Wars

Compared to last week, I found this assignment much more intriguing.  I had heard about second-hand smoke countless times in the media, but this week's video addressed an issue more foreign to me: vaccinations.  I've always thought vaccinations were standard protocol, something everyone had done without question.  The only exception was a family I knew with specific religious obligations, one of which was not receiving standard immunizations for diseases like Hepatitis or Polio that were discussed in the video.  The video influenced the way I think about vaccinations not by changing my views, but by strengthening them.  I agree with the scientific perspective; I believe the proper immunizations are essential for every member of the human population for the sake of global public health.  

The video also introduced the concept of 'herd immunity.'  For instance, if a certain proportion of the population is vaccinated, disease will not spread and thus herd immunity is maintained.  However, when a critical number of people are not vaccinated, herd immunity crumbles and people are at risk.  Most of the people who don't vaccinate their children believe health is a private affair, not a public responsibility.  I agree that some personal health decisions should remain private.  From a scientific perspective, however, vaccinations are necessary for maintaining public health.  In the video, one health professional made a good point that while drugs treat the self, vaccinations treat the community.  To me, parents who choose not to immunize their children are selfish.  Not only do these families put their children at risk, but they also put entire populations at risk.  If you are not a health care professional, I believe it is ignorant to refuse immunizations when encouraged by your doctor.

I also really appreciated that the video addressed both sides of what has become a political issue.  The program interviewed young mothers who had chosen not to vaccinate their children for various reasons, and it emphasized the opinions of health providers.  Many women reported that they did not want their children immunized out of fear that their children would develop diseases like autism as advocated by celebrities and internet media.  The MMR triple shot vaccine was specifically publicized to have such an effect.  However, countless scientific studies in several different countries have shown no link between the vaccination--known to contain mercury--and autism.  Also, some parents believe their children do not need vaccinations like those for polio because the major outbreak of polio occurred decades ago.  It is true that some diseases are dead, like small pox, but it should be left to health care professionals to determine.

After watching the video, it is obvious that vaccination rates need to be increased to ensure global public health safety.  During lecture today, the speaker emphasized through the "Frieden Pyramid" that telling people what they can and cannot do is ineffective.  Therefore, instead of making it a law that all children must receive these immunizations, as a public health advocate I would work to change 'structures.'  For instance, since the public media has grabbed the attention of so many on the opposite end of the argument, I would use cultural and media messages about the importance of immunizations in order to advocate it.

Japan: Second-hand smoke indicative of lung cancer

This week we read the paper by Takeshi Hirayama titled "Non-smoking wives of heavy smokers have a higher risk of lung cancer: a study from Japan."  The study was a cohort study, measuring the difference in risk of disease over time.  The study followed a sample of 540 non-smoking wives aged 40 and above for 14 years in 29 health centre districts in order to assess the incidence of lung cancer in relation to the smoking habits of their husbands; it also addressed the dose-response relation.  The results indicated that non-smoking wives of husbands who smoke heavily were indeed at greater risk for developing lung cancer.  Interestingly, the risk was greater in agricultural families.  The experimenter determined that the  husbands' smoking habits did not increase their wives risk for other disease such as stomach cancer, cervical cancer, or heart disease.


There are two major things I found particularly interesting in this study.  The first is the finding that the risk was greater in agricultural families most likely due to the longer period of mutual contact between couples in rural families.  The study pointed out that in urban families, some couples meet only for a short period in the day.  I found this ironic because it suggests a wife is hurting herself by spending more time with her husband.  In addition, I thought the statistic that 73% of Japanese men were smokers, while only 15% of women was interesting.  To me, this was an important piece of information to readers as it suggests the problem of second-hand smoke is exaggerated between spouses in Japan verses, for instance, the United States.  This difference must be inherently a social construct, but I wish the experimenter had included a sentence explaining why there is such a difference.  I'm not sure what this statistic would be in the United States, but I would guess that the numbers are much closer.  Also, the p value 0.0001 describes the close relation between the amount husbands smoked and the mortality of their non-smoking wives from lung cancer.  As we learned in class, the p value measures the probability that something actually happened by chance alone and a small p value indicates a statistically significant relation.


As mentioned, the experimenter performed a cohort study. Every design has its own advantages and disadvantages, and in lecture we learned about the strengths and weaknesses of this design.  Because of its design, the experiment was able to assess the study of relatively common exposures and calculate incidence while examining--and ruling out--other possible outcomes linked to exposure.  The study required a large sample size, which was met, but although expenses were not mentioned, the fourteen-year long follow up was probably costly.    


Although it is never directly written, the p value and strong correlations between smoking husbands and non-smoking wives incidence of lung cancer suggests a causal relationship.  The mechanism by which second-hand smoke amounts to lung cancer is not stated, however, so this cause cannot be proven concretely.  Schneider explained how a large number of subjects is more likely to yield valid results compared to small numbers, and he also emphasizes that the stronger the association measured between exposure and disease makes for a cause-and-effect relationship; Hirayama meets both of these standards.  Hirayama also assesses the dose-response relationship between exposure and risk of disease, which Schneider states as additional evidentiary support for a causal relationship.  Thus, although cause and effect may not be proven, there is strong statistical evidence in support.    


 

Public Health Introduction

Hello!  My name is Shelby Graham and I am writing this blog as a sophomore here at Hopkins.  Unlike most, I am from a rural area just outside Louisville, Kentucky.  Throughout high school, my mornings consisted of 'mucking' out horse stalls and feeding the goats I received for my thirteen birthday (not your typical present).  In addition to academics, I am a varsity athlete and participant in Greek Life.  I am a member of the the field hockey team and Phi Mu.  Although I have decided to pursue a career in medicine, drawing and painting is my favorite hobby.  In the future, I hope to become a plastic surgeon; my idea of a bridge between art and medicine.

Freshman year I had trouble deciding what I wanted to study.  I knew I wanted to be pre-med, but could not decide on a major that interested me.  Originally I had planned on majoring in Writing Seminars, but, after talking with girls on my team, I became more and more interested in learning about public health, which I officially declared as my major this past fall.  I want to become a doctor, but the idea of preventing diseases before they even occur is intriguing and I want to learn more.  In simple terms, that is how I would define public health.  Just as the word 'public' itself suggests, the field does not just include a single focus.  But what attracts me most: it's unpredictable.  

The field of public health is still developing, yet so dynamic and complex.  Whereas clinical health focuses on the individual and curing diseases that already exist, public health instead hones in on populations and the prevention of disease.  Today, the population has become much more aware of what is healthy in terms of the environment and our own bodies.  There is greater emphasis on keeping the environment 'green' and also safer.  Public health studies have taught us the effects of smoking and second hand smoke, and even though smoking remains a problem, tobacco use has decreased substantially over the past few decades.

During our guest lecture on Tuesday, health was defined as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity".  I agree that this defines health, but especially public health.  It includes the scientific aspect of health, and also the inherently social and political portion.  In fact, sometimes the public health measures taken in response to problematic diseases outweigh the physical, or medical, 'cures'.  For example, in Tuesday's lecture I learned that in the 1940s, it was not the introduction of antibiotics like penicillin to the public that decreased mortality from infectious disease, but it was public health measures like sanitation and water filtration that caused improvement.

More than anything, these first three classes have shown me how I still have so much to learn about the field of public health, but I do know that my interest lies on the more medical side of the spectrum.  With the first few lectures behind me, I can say I have a much better understanding about the health policies involved in public health decisions as well as the environmental, poverty, and pyschosocial factors that play a role in public health issues.  I am looking forward to learning more about public health issues of today, like obesity, and also what the future holds for public health studies.