MCH Student Elisabeth Seburg ‘LEND’s an ear at AMCHP

Elisabeth Seburg is a second year MPH student at the University of Minnesota School Of Public Health. She is in the Maternal and Child Health program as well as a fellow in the University of Minnesota Leadership Education in Neurodevelopmental and Related Disabilities (LEND) Program. As a trainee in two MCHB funded programs, Elisabeth tells us about her unique experience at AMCHP this year.

As a MCH graduate student and a LEND trainee, attending the 2012 AMCHP Annual Conference in Washington D.C was an incredibly valuable experience. I had the opportunity to connect with MCH leaders and learn about innovative MCH programs and initiatives across the country. My main take away from the conference is the importance of collaboration in public health work. From developing partnerships with community stakeholders to address local public health issues to sharing best practices between state Title V agencies, collaboration emerged as an essential component of MCH work.

While I attended many interesting and thought-provoking sessions at AMCHP, a power workshop on disability and women’s health stands out in my mind. The workshop, “Identifying Public Health Practices to Reduce Health Disparities in Women with Disabilities,” featured 3 speakers who shared work to address health disparities among women with disabilities. In addition to providing a good overview of disability-related health disparities, the session offered examples of initiatives to decrease these disparities. One example is the Initiative for Women with Disabilities (IWD) at the Elly & Steve Hammerman Health & Wellness Center, a health center for women with physical disabilities. IWD provides accessible health services to women with disabilities. Keeping with its holistic view of health, IWD also offers accessible activities to women with physical disabilities, such as adaptive rowing and belly dancing. I was excited to see a session on disability and health because my master’s project pertains to this topic, but, more broadly, the programs described in this workshop can serve as models for the field of MCH as we work to eliminate health disparities in women with disabilities.

For more information about IWD: http://iwd.med.nyu.edu/

For more information about disability health disparities: http://content.healthaffairs.org.ezp2.lib.umn.edu/content/30/10/1947.full

Our prenatal prospects: some thoughts

The “new” science of fetal orgins, as a  New York Times column by Nicholas Kristof describes, draws substantial correlations between many diseases (autism, schizophrenia, even obesity) and an infant’s uterine environment. Although research remains mixed, much of it indicates that life before birth has a substantial impact on later life course.

(FYI: Barker and colleagues were the first to describe this idea as the “fetal origins hypothesis“, back in 1995).

The uterine environment appears to affect how our genes express themselves (otherwise known as “epigenetic modification”). For example, stress experienced during pregnancy may actually predispose individuals to poor health outcomes. Consider a young woman, pregnant for the first time and living on Chicago’s south side. Her 9-to-5 may expose her to dangerous chemicals. A 90-minute commute may exacerbate this stress. She may find it difficult to quit smoking, eat healthily, or remember to take her prenatal vitamins as a result — compounding latent health risks for both herself and her unborn infant.

Here’s the deal. When we talk about the life course, we move beyond individual health to acknowledge the important impact of our environments — historical, economic, and social — on our health. Proponents of life course theory attempt to acknowledge all facets of health (physical, mental, spiritual) and work to explore the interactions between our biology and the world that surrounds us.

This past November, the Maternal and Child Health Bureau commissioned a concept paper on the lifecourse framework. It’s an important document that outlines LCT’s major concepts and ties them to MCH goals. You can read the full text here, in pdf form: http://mchb.hrsa.gov/training/documents/LifeCourseResourceSheet9-2010.pdf

For more on fetal origins and life course theory, check these links out:

http://www.time.com/time/health/article/0,8599,2020815,00.html

http://www.psychologytoday.com/blog/more-genes/200910/more-genes-i-so-what-is-fetal-programming

You’re getting your flu shot… Right?

With flu season upon us, Adam Ruban’s piece for NPR hit a nerve for this reader. As Ruban notes, “tens of millions” of expired H1N1 vaccine were destroyed this past summer — meaning that millions of Americans decided to forgo vaccination and take their chances with a potentially deadly flu strand. According to the CDC, H1N1 was responsible for approximately 274,000 hospitalizations and and 12,470 deaths between April 2009 and April 2010.

Those of us who chose not to vaccinate — and who were lucky enough not to contract H1N1 — have something called “herd immunity” to thank for our health. Basically, susceptible people rely on vaccinated people to stay healthy. Plenty of healthy people in America are now taking advantage of herd immunity, or at least, trying to.

In 2005, for example, an outbreak of measles — a disease once considered eliminated from America — infected 34 individuals in a small town in Indiana just a few miles from where I grew up. The cost of treating those individuals was $167,685, or $4,932 per patient. In 2008, a child in San Diego inadvertently infected an additional 11 children. The total cost for that outbreak? $10,376 per child.

Clearly, the costs of not vaccinating are high. So why don’t we vaccinate?

Okay, it’s not just Jenny. Although there is no scientific evidence to suggest a link between thimerosal and autism, plenty of parents think otherwise. And media blitzes like this one add fuel to the fire:

It’s playing at movie theaters in big cities starting today — have you seen it yet?

Don’t let the glitzy ads fool you. The flu vaccine is safe. It’s safe for most populations, including infants, pregnant women, and the elderly.

It’s also free for UMN students, staff, faculty — and their families — at Boynton’s convenient walk-in clinics.  So what are you waiting for?

Lancet retraction of article linking autism and MMR vaccines 12 years later: A symptom of a bigger problem?

On February 2^nd, the British medical journal The Lancet issued an official retraction of the article published 12 years ago that theorized the links between MMR vaccines, gastrointestinal inflammation, and autism, based on results from a study of 12 children. The retraction came after Britain’s General Medical Council ruled that Dr. Andrew Wakefield (the lead author) acted “dishonestly and irresponsibly” when he paid children at his son’s birthday party to have blood drawn, and had shown a “callous disregard” by subjecting children to invasive and unnecessary procedures. The Lancet released this statement¹ regarding Wakefield’s actions:

“It has become clear that several elements of the 1998 paper by Wakefield et al. are incorrect, contrary to the findings of an earlier investigation. In particular, the claims in the original paper that children were ‘consecutively referred’ and that investigations were ‘approved’ by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record.”

Wakefield’s paper had significant consequences. After the paper was published in 1998, vaccination rates in British children dropped from around 90% to below 70% in some areas, and the number of measles cases in England and Wales skyrocketed from 56 in 1998 to 1,370 in 2008.² In spite of the body of research by different scientists in different populations – including a study that replicated key parts of Wakefield’s original paper – that concludes there is no link between MMR vaccine and autism¹, fears of vaccination danger persist.

The controversy surrounding this article highlights a problem in the system of scientific research and peer review: political and financial influence on research. It is a slippery slope from accepting funding for research to developing a serious conflict of interest related to personal financial gain (or to success as defined by those footing the bill). At the time the original article was published, Dr. Wakefield was encouraging parents to request single vaccines for each disease while he was simultaneously filing for a patent on a single measles vaccine and receiving payments from lawyers planning to sue the manufacturers of the triple MMR vaccine.³

The peer review process is currently not capable of detecting this kind of fraud and cannot be relied on exclusively to provide independent and objective assessments of research like that of Wakefield’s.^4,5 Expecting individuals to exercise intelligent skepticism and critical reading skills is not enough; well-respected journals like The Lancet lend considerable credibility to research simply through publishing¹, and so must develop scrupulous standards to ensure they are doing their best to provide the public with honest science².

Comic, artist, and scientist Randall Munroe counsels: “You don’t use science to show you’re right, you use science to become right.” When researchers, institutions, corporations, and governments abandon this principle, the door is opened for doubt, rumor, and distrust. The controversy over Wakefield’s paper clearly indicates this distrust. According to Robert Field, professor of Health Management and Policy at Drexel University, “Unfortunately, the idea that vaccines cause autism is already out there and the damage has already been done…Years of research have clearly disproven a vaccine-autism link, yet many people continue to believe in it. If all of that research hasn’t changed their minds, The Lancet’s retraction is not likely to make much difference.”⁶

For more information on autism and vaccines, visit:

http://www.cdc.gov/ncbddd/autism/topics.html.

1. Park, Madison. “Medical journal retracts study linking autism to vaccine.” CNN, February 2, 2010 1:29 p.m. EST http://www.cnn.com/2010/HEALTH/02/02/lancet.retraction.autism/index.html\
2. Opinion. Wall Street Journal, Feb 3^rd 2010. http://online.wsj.com/article/SB10001424052748704022804575041544115791952.html
3. A Welcome Retraction [editorial]. New York Times, February 5, 2010. http://www.nytimes.com/2010/02/06/opinion/06sat3.html
4. Dangers of over-dependence on peer-reviewed publication [editorial]. Nature 1999; 401: 727.
5. McCook, Alison. “Is Peer Review Broken?”. The Scientist. February 2006. http://www.the-scientist.com/article/display/23061/.
6. Childs, Dan and Cox, Lauren. “Lancet Retracts Controversial Autism Paper: Retraction of 1998 Wakefield Study May Not Sway Those Who Fear Vaccine-Autism Link.” ABC News Medical Unit.  Feb. 3, 2010. http://abcnews.go.com/Health/AutismNews/autism-vaccines-lancet-retracts-controversial-autism-paper/story?id=9730805.