Vaccine Wars (Blog 3)

This blog deals with the benefits and the risks of vaccines as discussed in “Vaccine Wars”. The program looks at the different views of vaccines. Some people believe that there are a lot of health issues that stem from vaccinations, including serious problems such as autism. There are parents, teachers, Public Health officials, and scientists who are all involved in the debate. The program looks at the beliefs and practices, as well as the research that has been done.

I have been in various countries and have been required to have multiple vaccines; some countries will not allow you to enter without certain vaccines. After seeing the diseases that can be prevented by vaccines really affected my views of vaccines. In an area in India, a very large portion of the population had polio – a disease that does not even exist in North America because of vaccines. It was not uncommon to see people unable to walk. Also, in Canada children are vaccinated in school – the only people who did not get vaccinated were those with medical conditions; there were never moral debate about vaccines. Thus I was surprised to see on the program that parents are very anti-vaccinations and that it can be a very serious battle to get people to be vaccinated. However, the program did not change my views about vaccines.

Herd immunity is the idea that if most of the population is vaccinated it would minimize the spread of disease because fewer people are at risk. Naturally if most people are protected or immune to a disease and the disease is more readily controlled the general population does not have to fear diseases that could have severely harmed the population. Polio is again the perfect example: it used to be rampant but with the vaccine, it is no longer an issue.

Vaccinations are different than other personal health decisions because it also affects others. For example, cancer patients are very susceptible to diseases and face dire consequences if they are infected. However if everyone is vaccinated/immune the likelihood of cancer patients becoming ill is diminished. Currently, parents and health care providers are the people who are in the decision process on whether or not a child will be vaccinated. Similarly since everyone has rights, no one can be forced to be vaccinated. However, those choosing not to be vaccinated put others in society at risk. This raises the question whether vaccinations should be an individual choice given its overall impact over society.

Vaccination rates could be increased by more advertising of the benefits of vaccines. There could also be incentives to be vaccinated, like getting a free check-up. Getting people to return for booster shots, especially in India, proves to be a challenge. Simply doing things, like ensuring getting vaccinated is convenient, helps a lot; obviously people are more likely to do something if it is convenient. For example, an easy way of doing this is every time someone goes to the doctor, the doctor would check which vaccines someone needs and administer them at the same time as addressing the original needs of the patient.

Parents/patients are often concerned about side-effects (which are usually minor) or do not think that vaccinations are necessary because the disease is uncommon and there is herd immunity. Physicians want their patients to be vaccinated so they do not get sick. Healthcare systems want people to be vaccinated so that diseases are less common and are unable to spread.

Second-Hand Smoke (Blog 2)

This blog discusses effects of second-hand smoke. The information regarding the effects comes from two different sources: Hirayama’s report, “Non-smoking wives of heavy smokers have a higher risk of lung cancer: a study from Japan” and Chapter 6 in Schneider’s book, Introduction to Public Health.

Hirayama’s study followed 91,540 wives of smokers from 1966-1979. These women were 40 and above and did not smoke themselves. The study found that men who smoke heavily (>20 a day) had a higher risk of lung cancer but not stomach cancer, cervical cancer or ischemic heart disease. The advantage of how this study was designed it incorporated of women of different ages. People are not going to develop lung cancer overnight; therefore looking at women who have been with smokers for different lengths of time was beneficial for accurate results.

I was surprised at the results stating that wives of smokers in agricultural settings are more at risk than the women in urban areas. By definition women in urban areas are in more contact with others (and particulate matter) than rural women. The proportion of smokers in urban areas is reasonably the same as it is in rural areas (or at least what I have observed). So if the proportion of smokers are reasonably the same in both rural and urban areas (who are more at risk), why would more rural ladies have lung cancer? Yifan Ding (from the Institute of World Development and Research Center) seems to have an answer for that question – economic reasons.

Ding published the paper “Social and Economic Disparities”. (http://www.eolss.net/Sample-Chapters/C13/E4-25-04.pdf) She found that there is an economic disparity between people living in urban and rural areas. Rural people having a lower income level than those living in urban settings. Now how does this relate to Hirayama’s study? Well, most studies pay the participants in studies, as Christine Grady (PhD in bioethics and is in charge of human subjects research at the National Institutes of Health) states that “not only [is it]... ethical to pay people, it might be unethical not to pay them”. (http://stanmed.stanford.edu/2008summer/just_another_lab_rat.html) While this study did not pump participants with untested drugs, it is unlikely that the participants were not paid. If someone is short on money - mostly rural women, (as Ding showed in her paper) they are willing to jump at chance to make money. The study would have wanted similar numbers of non-smoker women with non-smoker husbands, non-smoker women with smoker husbands and women with smoking habits (their husbands not specified). Poorer women are more likely to tell those running the study whatever necessary to ensure their ability to participate. Thus one cannot guarantee that all the female participants were not smokers or did not have other conditions that would increase their chances of cancer. Therefore, the study should have considered the different economic statuses as an error possibility.

Schneider also discusses the problems that come with human studies, such as lifestyle and other conditions that would affect the human subjects and thus messing with the correlation results. Schneider’s comments do not necessarily support or reject Hirayama’s results. Her comments simply remind us that there are other factors, not just the specific ones that a study considers and that should be taken into account.

Introduction (Blog 1)

Hi! My name is Kathryn (Kat) Pedde. I grew up on a farm outside a small town in Canada. I am a freshman at Johns Hopkins University and I am planning on majoring in Public Health. As I am interested in Public Health, I am in Introduction to Public Health and am blogging about issues we cover. This blog will draw information from my individual experiences:

1)      Since I grew up on a farm with both grain and cattle, I will most likely discuss cattle treatment. Their treatment is surprisingly similar and great for comparison to public health.

2)      The Canadian health care is very different than American healthcare. The comparisons should be interesting.

3)      Someone close to me is dealing with epilepsy and all of its complications. Therefore she knows the ‘ins and outs’ of the American health care system. I have permission to blog about her experiences. In order to respect her confidentiality, her name will be changed Amanda. All of the information pertaining to her condition will be approved by her.

4)      My parents work a Canadian aid organization that operates worldwide. As such, I have been to various developing nations: Rwanda, Kenya, the Democratic Republic of Congo and India. While in these countries I learned about their health care systems. The purpose of my visit to India was to look at different health options – public care versus private care.

Public Health covers a multitude of aspects. Unlike doctors who solely focus on treating a particular patient, the Public Health field looks at an entire population. The Public Health field’s goal is improve the quality of life for the general population. One of the most obvious ways they do this is attempting to control diseases. They do this through vaccines and tracking disease to isolate cases and a multitude of methods of disease control. However, Public Health does not solely focus on a population’s physical. The field also deals with environmental conditions, mental health issues and social issues.

I am interested in Public Health because of my association with the aid organization. There are a lot of issues that all aid organizations must deal with when working in a country. There are common traits that can be found in the areas that I worked in: having too many children, lack of interest in vaccines, disease control, malnourishment and all of the issues that come with it, etc. Having people learn about these issues and culture of an area with knowledge of Public Health would be very beneficial.

The first three classes focused on what Public Health is and some of the issues that the field deals with, as well as the difficulties face. I find the class very interesting as some of the topics that we covered were new for me. For example: the fact that not everyone has access to health care. Canadian health care has “universal coverage for medically necessary health care services provided on the basis of need, rather than the ability to pay”. (http://www.hc-sc.gc.ca/hcs-sss/index-eng.php) Unlike the USA, in my province, it is illegal to pay for health care. I look forward to learning more in this class.