Michael Laiosa, PhD, School of Public Health
"Identifying Developmental Toxicants to the Immune System so Pregnant Women can Produce Healthy Babies without Spending 40 Weeks in a Bubble"
February 9, 2010
1. A mode of intervention mentioned during the presentation was nutrition, but much of the fresh food sources today are contaminated (agricultural, genetically modified foods) and people lack access to foods. Not such a simple intervention?
I agree that referring to nutrition is not a simple intervention because of the many reasons cited above. However, my points are:
- If the choice is fresh beans from a non-organic farm, or beans in an aluminum can lined with BPA, I would always say the fresh ones are preferable.
- There are many "good" foods and "beneficial" foods that can be used to overcome potential environmental exposure. Even if they are non-organic, I believe a more wholistic approach to health should include better nutritional education, particularly early on in pregnancy. I suspect (though am far from an expert on this), that most expectant women are not getting quality information unless they seek it out themselves.
- There are many natural compounds in certain foods that have excellent anti-oxidant properties that are beneficial for health. I include in this list, EGCG found in green tea, indole carbinols in cruciferous veggies like kale, broccoli, cauliflower, etc., resveratrol in grapes, pomegranates, and red wine. This list is no where near complete. Part of my research is designed to help test which of these compounds are best for improving health in populations at risk for environmental exposures, and how best can we deliver these healthful factors to people that need them. (Pills, nutritional education, subsidies for low income people to buy fresh and organic foods?)
The point is, I don't know the answer, but will be working on it, and hope others in SPH can collaborate on these broad, complex issues that involve natural science, social science, social welfare, nursing, and education.
2. Will preventing these health problems prevent the money spent on healthcare or push it back for the next problem?
The testable hypothesis is that IF you prevent all non-biological environmental exposures during early development, THEN there will be a decrease in diseases like cancer, autoimmunity, heart disease, asthma, obesity, allergy, and many more. If you were actually able to do this, unemployment for medical professionals would jump to 50%. The problem is how do you prove this hypothesis on a broad scale, and how do you actually employ it? We have to start somewhere, and the first major gap in our knowledge is what exposures are actually harmful, and what diseases does that lead to, and in which people. Once we know that (and we actually know quite a bit), then the real work starts with figuring out how to prevent these types of exposures. (See also answer to question 4 below).
3. If painting while pregnant, is latex-based paint safe, and assume oil-based is not?
All paints are volatile, meaning vapor chemicals in the paints are released into the air that we then breath. Oil base more so than latex. Certain colors/tints more than others. Whether painting is harmful to developing children is an area of controversy. Is a little OK, but a lot bad? Certain studies seem to suggest that, but are far from conclusive, and also are not good at defining little versus lots. Also, risk of disease is still very slight even in those who are more highly exposed. The best advice is to use common sense and precaution. If a pregnant women or young child is in a house that is being painted, be sure room(s) being painted are well ventilated during the application and for an extended period of the drying process (perhaps several weeks). But, this is frankly one of the lesser concerns of mine overall -- but, it does bear mentioning.
4. How does scientific information get translated to public health and the interactions of government policy and regulation?
I did not have much time to speak about this, and also should add that I am not an expert in this area. However, what I do know is that our chemical regulatory laws in this country are broken. It is not even a question of funds. Even if the FDA and EPA were fully funded, the laws that govern chemical regulation are outdated, and easily avoided. If one is curious about this topic, I would read the Milwaukee Journal Sentinel series on Bisphenol A or BPA. They have done a thorough job documenting the health effects of this one chemical, the efforts to regulate it, and the reasons that it cannot be regulated at this time without change in law.
The good news for BPA is that public information has come to the front and center during the last several years, and has caused the market place to shift somewhat. Many BPA containing products have been or are in the process of being phased out. In other words, if consumers are well informed and educated, they will force decisions to be made. Also, many of these decisions are being forced on producers in many localities and states. In other words, if the federal government cannot fix a known problem, then it is up to grass-root efforts to facilitate change.
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"Health Literacy: A Hidden Public Health Crisis"
April 21, 2010
Health Policy Brief (referenced during OPH presentation)
1. "Health literacy" depends on general literacy BUT even people with good reading and comprehension skills still have to master basic biologic and health-related knowledge to understand their illness, medications, and treatment fully. Current studies indicate that the general public has a poor grasp of the body and how it works, so what is the process for bridging this divide?
The above question does raise 2 excellent points: health literacy depends on general literacy, but in addition, a good understanding of medical knowledge and human anatomy/biology is required to understand most health issues, which the general public lacks. So...how to bridge that divide?
First, it's critical to acknowledge that gap in understanding and public's basic knowledge of how the body works. This helps to understand that health literacy is not a problem that impacts only certain people who can't read; it also prevents us from attempting to identify those who may be impacted. Health literacy impacts all of us.
Second, to address this gap is to present information in a more patient-centered approach versus a medical-centered approach. Medical-centered approach means that we communicate a health disease/condition starting with a disease description, followed by statistics, and ending with treatments/effectiveness. Here's an example:
Idiopathic hypereosinophilic syndrome is a disorder which the number of eosinophils increases to more than 1,500 cells per microliter of blood for more than 6 months without an obvious cause. People of any age can develop idiopathic hypereosinophilic syndrome, but it is more common in men older than 50. The increased number of eosinophils can damage the heart, lungs, liver, skin, and nervous system. Without treatment, generally more than 80% of the people who have this syndrome die within 2 years, but with treatment, more than 80% survive. Heart damage is the principal cause of death. Some people need no treatment other than close observation for 3 to 6 months, but most need drug treatment with prednisone or hydroxyurea.
A patient-centered approach would mean we communicate the same information in a manner that allows patients to relate the new information to something they already know ("subsumption," similar to David Ausubel's theory on adult learning). This would mean giving a very general and simplistic explanation about the disease first, relating it to something more common. In this case, relating the disease to what the patient already knows about blood and blood cells first, and then getting more specific about their disease and what they need to know (limiting it to 3 main points at a time) allows for greater understanding.
Thirdly, my personal opinion is that patients should not have to have an understanding of anatomy and physiology in order to manage their health. It is hard to imagine, but think back before you became aware of these concepts...many patients did not study anatomy and physiology, and went to focus on other topics that we, in turn, know nothing about. Our job as health care professionals is to assist patients in managing their health, recognizing that we need to adjust how/what/when we communicate to them. The first time someone is faced with a new diagnosis, or under stress because their loved one is in a hospital, is not the best time to begin learning a new subject. Think about this: would any of us really absorb a lesson in finance 101 when our mom/dad/kids are in the hospital with a health problem?