Tag Archives: public health

Cheaper cigarettes, roll-your-own tobacco slows smoking’s downward spiral

The Conversation

File 20170602 25652 xzeyql
While smoking in young Australians is declining, roll-your-own cigarettes are becoming more popular. from www.shutterstock.com

Simon Chapman, University of Sydney

Yesterday morning, Australia’s tobacco industry woke to the latest chapter in the book documenting its inexorable decline.

The Australian Institute of Health and Welfare released data from its 2016 National Drug Strategy Household Survey, which it has conducted every three years since 1985.

While it was always going to be hard to show even further decline in teenage smoking from what was an already very low level, it’s happened again.

The proportion of teenagers (aged 12-17) who have never smoked more than 100 cigarettes significantly increased between 2013 and 2016, from 95% to 98%. Smoking more than 100 cigarettes in a lifetime has long been used in Australia as a benchmark question to sort curious, experimental smokers from more committed and addicted smokers.

Younger people also continued to delay when they first smoked their first full cigarette. This increased in the 14 to 24-year-olds from 14.2 years in 1995 to 16.3 in 2016 (a statistically significant increase from 15.9 years in 2013).

Catch ‘em young

The tobacco industry knows it needs to attract and addict new consumers to replace those who stop smoking through quitting and death. As a 1981 report sent to the then vice-president of research and development at Philip Morris put it:

Younger adult smokers are the only source of replacement smokers … If younger adults turn away from smoking, the industry must decline, just as a population which does not give birth will eventually dwindle.

Australia’s plain packaging legislation, implemented in December 2012, was aimed at reducing teenage Australians taking up smoking. As the health minister who introduced it, Nicola Roxon emphasised in April 2010 when announcing the policy:

We’re targeting people who have not yet started, and that’s the key to this plain packaging announcement – to make sure we make it less attractive for people to experiment with tobacco in the first place.

As Australian young people have turned away from smoking, the tobacco industry is left scrambling for new ways to addict young customers to nicotine.

Total smoking levels remain level

The proportion of people of all ages who smoke was also not good news for the tobacco industry.

The percentage of people aged 14 and over who smoke daily is down from 12.8% in 2013 to 12.2% in 2016. While any decline is welcome, this was less than it should have been, and the first time in two decades that a statistically significant fall was not recorded.

There are several factors likely to be responsible for the previously brake-less downward slide in smoking.

Long-time campaigners Mike Daube and Todd Harper have set out nine strategies the Australian tobacco industry has used so it can keep earning from the deaths of two in three Australian smokers likely to die from using their products.

Two critical factors here are price discounting and the dramatic rise of roll-your-own tobacco.

How price discounting works

Plain packaging means brand differentiation is gone as all packs look the same, except for the written brand name. So, the ability of branding to convince gullible smokers that premium (expensive) brands are somehow “better” and worth spending more on than cheaper, budget brands goes out the window.

After plain packaging was introduced, there was an industry-wide decision to cut prices to compete with lower priced brands for market share. There were large tobacco tax rises in the run-up to plain packs being introduced (25% in 2010) and a further 12.5% each year from 2013 to 2016.

Again, the tobacco companies cut their margins by desperately trying to keep some brands below A$20 a pack, a price known to trigger quitting.

These practices may see renewed interest in floor pricing of tobacco products, when a price is set below which a product cannot be sold.

Rise in roll-your-own tobacco

Tobacco companies have also aggressively pushed cheaper roll-your-own tobacco by introducing loose tobacco with cigarette brand names. The tax in roll-your-own tobacco will rise from September 2017, which may see a further round of price discounting to try and stop people quitting.

The use of roll-your-own cigarettes has gone from 26% of smokers in 2007, to 33% in 2013 and to 36% in 2016. Lower price is one factor driving this, but so too are the quite erroneous beliefs that roll-your-own tobacco somehow contains fewer additives and is less harmful, an issue I will explore in my next column.

The increase in roll-your-own cigarettes since 2007 has been largest among smokers aged under 40 (increase of 82% for young adults and 70% for smokers in their 30s between 2007 and 2016). Between 2013 and 2016 roll-your-own use in smokers in their 30s jumped from 29% to 37%.

National campaign wheels fallen off

Sustained and adequately funded mass media campaigns are a vital component of strategies health authorities recommended to change health behaviours, like smoking.

And with smoking, one of the most obvious pieces of evidence comes from ex-smokers about why they stopped smoking. There are light-years between the answer that has always been given (concern about health) and everything else (cost, social unacceptability, pregnancy etc).

In this study of smokers in 20 US communities, 91.6% of ex-smokers nominated “concern for your own current or future health” as why they quit compared with 46.5% who nominated “pressure from family, friends or co-workers”.

Without large scale, on-going campaigns that reach large proportions of the population with unforgettable, motivating information about why smoking is so harmful, the core driver of quitting and not starting smoking may wane.

Regrettably, Australia’s world famous national tobacco campaign that started in 1997 and has been used by many other countries, has been mothballed since 2013 when the Coalition government took office.

Smokers still get sporadic small bursts of quit smoking ads on television in some states from state health departments. But they are not getting a fraction of the highly motivating exposures that were a big part of our earlier rapid declines. This absence is almost certainly a major factor explaining the slow down in people quitting smoking.

E-cigarettes

The latest stats show that while around 31% of smokers (ie 3.8% of the 14+ population) had ever tried e-cigarettes, 20% seemed to have done so out of curiosity (once or twice) with only 4.4% currently using them (the remaining 6.8% no longer use them). Just 1.5% of smokers were using e-cigarettes daily (0.8% of ex-smokers and 0.2% of never smokers).

There’s no evidence from these very small numbers that e-cigarette use is contributing to falling smoking in Australia.

The ConversationMany are concerned that the tobacco industry (which has bought into vapourisers big time) has a business plan to have smokers vape and smoke, not vape instead of smoking. If that plays out, increases in vaping may in fact act to further slow people from quitting smoking. The next few years will provide important information on this important issue.

Simon Chapman, Emeritus Professor in Public Health, University of Sydney

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

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Why researchers have a duty to try and influence policy

The Conversation

Simon Chapman, University of Sydney

Very early in my career, I was invited to afternoon tea with the head of the Commonwealth Institute of Health at Sydney University, where I worked. The best bone china was produced and pleasantries exchanged. The agenda soon became clear.

He laboured into a parable about the difference between young and old bulls when locked in a small yard. He told me young bulls run hard at the gate, exhausting and sometimes harming themselves.

But old bulls are generally patient and placid. They always know the farmer will open the gate and they’ll walk out and soon get among the pasture and the cows.

Young bulls should learn from old bulls, he told me.

I knew exactly why he’d called me. For some months, I’d been in the forefront of a small group of public health people who were confronting the advertising industry’s self-regulation body with data about the appeal of Paul Hogan, who fronted the massively successful Winfield cigarette advertising campaign. Hogan’s own TV program had huge appeal to children. The advertising campaign was, therefore, in flagrant breach of the industry’s own guidelines and so needed to be stopped.

After 18 months of trying to ignore us, we won. We quickly discovered while the advertising industry could ignore our letters, going public turned 10,000 watt arc lights on the self-regulation farce. Over that time the media often interviewed us. A headline after we won said our slingshot had cut down the advertising ogre. Hogan said he’d been sent from the field for kicking too many goals. That was in fact our argument.

My “young and old bulls” mentor later told me he’d been tapped by the Vice Chancellor to tighten the reins, after receiving complaints from connections with the tobacco industry.

Then, and even today, there still remain large remnants of the attitude in universities that scientists and researchers should avoid talking to the media. News media are frequently disdained by academics as trivialising and superficial, something from which those with ambitions of gravitas should keep well away.

A long history

The roots of this go way back. In 1905 Sir William Osler a foundation professor at Baltimore’s Johns Hopkins Hospital, warned against “dallying with the Delilah of the press”. More than 100 years later, a 2006 report by the UK Royal Society noted 20% of UK scientists believed colleagues who engage with the media are “less well regarded” by their peers.

Public engagement was something “done by those who were ‘not good enough’ for an academic career”. Those who did so were seen by some as “light” or “fluffy” and, wait for this, more likely to be women. While 60% of UK researchers wanted to engage with politicians about their research, far fewer (31%) wanted to engage with journalists.

The cocooned naivety of this position is quite staggering.

Knowing someone, but never meeting

Early in Nicola Roxon’s tenure as Australian health minister I approached her after a talk she gave at a conference. “I don’t think we’ve ever met,” I said. “No, but I feel I’ve known you all my adult life,” she replied.

This could have only meant she knew me through the media.

There is an abundance of research showing people get a huge amount of their information and understanding of health issues from the news media. Equally, most politicians and their advisors rarely read scholarly papers in research journals. They form their understandings of the issues in their portfolio in a variety of ways. But like us all, they are daily exposed to information and discussion about health and medicine through the media they consume voraciously every day.

I had an instinct about the importance of all this right from the beginning of my career and so quickly took to trying to get my research covered in the media; I gave high priority to making room in my day to provide commentary about the areas in which I worked.

Here, I quickly learned the constraints on time and space meant something richly nuanced and complex always needed to be condensed into just two or three sentences in print media reports, or 7.2 seconds in television news. When I started taking opportunities to write opinion page and feature articles, the access to my work and commentary on controversies in public health rapidly accelerated.

Visibility brings access

The visibility this brought opened many doors to senior policy advisors and politicians. I also frequently had the experience of dozens of people telling me across a day they had read and enjoyed a piece I’d written in a newspaper that morning, or a breakfast radio interview as they got ready for work. Most of these colleagues work in adjacent areas of public health and would have only occasionally read my research work in journals.

My own GP and other clinicians have often told me about patients who brought in one of my newspaper articles to ask about it. This was especially true about pieces I wrote on the risks and benefits of prostate cancer screening. This feedback inspired a 2010 book – Let Sleeping Dogs Lie?: what men should know before getting tested for prostate cancer. Colleagues and I published it as a free ebook and it’s been downloaded over 35,000 times.

My 85 articles in The Conversation have been read over two and a half million times. Just two of them have together been read over 1.8 million times. By contrast, the most read of over 500 papers I’ve published in peer reviewed journals has been read only 150,000 times. Many are lucky to get even 5000 readers. Being locked behind subscription paywalls doesn’t help.

Who are the ‘influencers’?

A few years ago, colleagues and I researched the characteristics associated with peer-voted “influential” researchers. We invited all Australian researchers who had published 10 or more papers in particular fields of public health to name five Australian researchers who were “most influential” in each of these fields. We then interviewed the top five from each field.

Overwhelmingly, nearly all said they believed researchers had a responsibility and even a duty to produce work that might help shape policy and practice. Most of these were very comfortable in actively pursuing media opportunities to bring understanding of their work to the public. Those who weren’t comfortable in the media were very happy for others to do this on their behalf.

This approach started with choosing research questions they hoped would provide strategically useful information to inform policy. Their approach then passed through the necessary steps of grant application craft to best ensure it was funded through the highly competitive National Health and Medical Research Council process that now sees only 17% of applications funded.

These two steps are meat and potatoes for all funded research.

But it was in post-publication behaviour where influential researchers differ. They actively promote their work – not just to other colleagues in seminars and conferences, but to the public and those who might act on it politically.

And after all, isn’t helping evidence-based policy and practice the whole point of wanting to do the research in the first place? Why else would you bother?

Don’t just ‘stick to the facts’

Some critics of researchers with media profiles argue researchers should just “stick to the facts” in media interviews. Our study participants saw this as naïve because “people always want to know what the policy implications are”.

A total of 94% of those we interviewed disagreed with the view it was inappropriate to express opinions in the media about public health policy. Journalists might begin with a research finding or an expert clarification of a new report. But they invariably then asked what needed to be “done” about the problem, typically by government.

Journalists and audiences would meet with incredulity any researcher who tried to end an interview when there were questions about policy reform “oughts”, or claimed to have no opinion on what should be done. We expect those who know most about health problems to have views about what should be done to solve them and the courage to put these forward, even if they imply criticism of governments or powerful interest groups.

Speak up, speak up

Trump’s recent gagging of all government environmental agency staff is surely the start of a process that will spread to government funded universities in the USA. There has never been a more important time for researchers all over the world to speak up about their work, it’s implications and how societies and governments should act on it.

I’ve just published a collection of 71 of my essays and op eds across a large variety of public health issues. Like this column, the book is called Smoke Signals, and is published by the Sydney University Press imprint, Darlington Press. It’s available in paperback or as an ebook.


This article will be the subject of ABC Radio National’s Ockham’s Razor on Sunday, February 26, 2017 at 7.45am.

The ConversationSimon Chapman, Emeritus Professor in Public Health, University of Sydney

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

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Coles wants $1 maximum bets for pokies – so why won’t the pokie-makers play ball?

The Conversation

Charles Livingstone, Monash University

Wesfarmers, operator of Coles and other retail brands, reportedly wants to pursue harm-prevention modifications to its poker machines. It has asked five pokie manufacturers, including Aristocrat Leisure, for help in trying out games with a maximum bet of A$1.

All have refused, apparently citing costs.

Like Woolworths, Coles – which operates the pokies through its hotels – is a major player in this space. It operates more than 3,000 machines in Queensland and South Australia. But, seemingly unlike Woolworths, Coles is concerned about these machines’ potential for harm.

A true money-spinner

Woolworths, through its subsidiary ALH Limited, operates more than 12,000 pokies across Australia. Net revenue from these is around $1.1 billion per year; the business is a 75:25 partnership with the Mathieson family’s businesses.

Coles’ revenue from its machines is much lower – around $185 million.

Pokies are great money-spinners for hotels, clubs and casinos in Australia, and increasingly internationally. But the technology behind them is not particularly novel. Contemporary pokies are quite straightforward computers, albeit housed in a novel case and with a customised display.

What makes them different is their software, which uses well-established psychological principles to make them “attractive” to punters.

But the features that make pokies “attractive” also make them addictive. The Productivity Commission has estimated that 42% of pokie revenue comes from people with a serious pokie addiction – and another 20% comes from those with a developing habit.

Manufacturers have acted in the past

Given pokies’ computerised basis, the manufacturers’ refusal to work with Coles is remarkable.

Like all companies in the business, Aristocrat Leisure prides itself on its innovative capacity. Through its then-European subsidiary Aristocrat Lotteries, Aristocrat developed and provided the Multix game terminal to Norsk Tipping, the Norwegian gambling operator, from 2008 onwards. Aristocrat sold the business in 2014.

The interesting aspect of the Multix terminal is that it was intended to provide a much safer and less harmful slot-machine-like product. These replaced the existing slots, which the Norwegian government nationalised and withdrew from operation in July 2007.

The machine provides a platform for multiple games, imposes a statutory limit on how much people can spend, and operates on an account-only basis. Users can track spending and reduce their daily limits if they want to be careful. Thus, it incorporates a host of consumer safety and harm minimisation/prevention measures.

Closer to home, the Victorian government introduced a reduced maximum bet limit and reduced load-up limits in 2009. Aristocrat, along with other manufacturers, had to find a solution for these new requirements. That wasn’t very difficult.

The game software required some alteration, and cabinet artwork had to be reconfigured in some cases. It cost somewhere in the tens of millions, but there were no publicly aired complaints and it was implemented smoothly. For a business that makes around $2.6 billion a year, that was small change.

The Tasmanian pokie industry has recently undergone a similar transformation, again without too much fuss.

Perhaps the reduction from $10 bets to $5 bets didn’t threaten the industry too much. And reducing the load-up limit from $9,949 to $1,000 in Victoria was a no-brainer.

Why won’t the manufacturers play ball?

There may be many reasons for the manufacturers’ refusal to agree to Coles’ request, but it is clear the vanguard for the Australian pokie industry lies in New South Wales – particularly with lobby group ClubsNSW. Club businesses operate 70% of NSW’s 95,000 pokies. These made their operators $5.8 billion in 2014-15, of which the clubs made around $4 billion.

Pokie games are upgraded regularly, and the machines themselves tend to be turned over every five years or so. Even putting aside maintenance and upgrades, selling around 20,000 machines every year to clubs and pubs in NSW would earn the manufacturers around $500 million. So, losing a share of that business would be something to avoid.

A successful trial of $1 bets could demonstrate that pokie harm could be reduced. If that occurred, the revenue model for NSW club businesses that rely heavily on pokie revenue would be rattled.

When the Productivity Commission recommended $1 maximum bets and pre-commitment as likely good responses to pokie addiction and harm, the gambling industry, led by ClubsNSW, railed against them as unproven and experimental.

That wasn’t true, even then, as the industry well knows – it funded the original research. But why not seize the opportunity to acquire some more useful evidence through a trial?

The harm pokies cause is widespread and tends to affect those already under significant stress. Moving to $1 bets is a good first step toward reducing this harm, and Coles acknowledges it can’t continue in this business unless it finds a way to reduce avoidable harm.

There are many other ways to limit harm, however, as the manufacturers know full well. They’ve been innovating to make their products as “attractive” as possible for the last 100 years or so.

If they wanted to, they could also lead the way in making machines safe, and fun. Perhaps the super profits might be wound back. The operators would be able to claim they really do care about their customers’ wellbeing.

Clearly, that’s a claim Coles is keen to make. The manufacturers? Maybe not so much.

The ConversationCharles Livingstone, Senior Lecturer, School of Public Health and Preventive Medicine, Monash University

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

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Alan Jones goes after wind farms again, citing dubious evidence

The Conversation

Simon Chapman, University of Sydney

Last week, Sydney radio announcer Alan Jones lambasted those concerned about climate change and what he called “renewable energy rubbish”.

Jones has been loose with the facts in the past, having been Factchecked in 2015 after confusing kilowatts with megawatts and quoting a cost for wind power he later confessed “where the 1502 [dollars per megawatt hour that he stated] comes from, I have absolutely no idea”.

Jones, who chaired the much hyped but poorly attended 2013 national rally against wind farms in June 2014 (see photo) told his listeners last week wind farms are “buggering up people’s health”.

He also said “harrowing evidence” had been given by sufferers to the 2014-15 Senate Select Committee on Wind Farms chaired by (now ex-) Senator John Madigan. He along with Bob Day, David Leyonhjelm, Chris Back and Nick Xenophon have been vocal opponents of wind farms.

Their report predictably savaged wind farms, while Labor Senator Anne Urquhart’s minority report was the only one I found to be evidence-based.

Jones then went on to interview Dr Mariana Alves-Periera, from the private Lusophona University in Portugal (world university ranking 1,805, and impact ranking 2,848) whom he described as a distinguished international figure.

She was “recognized internationally” and had published “over 50” scientific papers over 30 years, something of a modest output. Jones, who may or may not have read any of these publications, told listeners her findings were “indisputable”, there was “no opposing scientific evidence” and again in emphasis, “none of [her papers] have been disputed” to which Alves-Periera agreed instantly “no they haven’t”.

This is an interesting interpretation of the scientific reception that has greeted the work of the Lisbon group on the unrecognized diagnosis of “vibroacoustic disease” (or VAD), a term they have made their own.

I first encountered Alves-Periera when she spoke via videoconference to a NHMRC meeting on wind farms and health in 2011. She spoke to a powerpoint presentation which highlighted the case of a schoolboy who lived near wind turbines. Her claim was the boy’s problems at school were due to his exposure to the turbines, as were cases of “boxy foot” in several horses kept on the same property.

Intrigued by this n=1 case report, I set out with a colleague to explore the scientific reception that “vibroacoustic disease” had met. We published our findings in the Australian and New Zealand Journal of Public Health 2013.

We found only 35 research papers on VAD. None reported any association between VAD and wind turbines. Of the 35 papers, 34 had a first author from the Lusophona University-based research group. Remarkably, 74% of citations to these papers were self-citations by members of the group.

In other words, just shy of three quarters of all references to VAD were from the group who were promoting the “disease”. In science, median self-citation rates are around 7%. We found two unpublished case reports from the group presented at conferences which asserted that VAD was “irrefutably demonstrated” to be caused by wind turbines. We listed eight reasons why the scientific quality of these claims were abject.

In 2014 Alves-Periera and a colleague defended their work in a letter to the journal and I replied. They described themselves as the “lead researchers in vibroacoustic disease”. But as we had shown, they are almost the only researchers who were ever active on this topic, with self-citation rates seldom seen in research.

Other experts have taken a different view of the group’s work. One of the world’s leading acousticians Geoff Leventhall who also spoke at the NHMRC’s 2011 meeting, wrote in a 2009 submission to the Public Service Commission of Wisconsin about the Lisbon group’s VAD work.

The evidence which has been offered [by them] is so weak that a prudent researcher would not have made it public.

Another expert said:

vibroacoustic disease remains an unproven theory belonging to a small group of authors and has not found acceptance in the medical literature

And most recently, the UK’s Health Protection Agency said the:

disease itself has not gained clinical recognition.

Leventhall concluded his review by saying:

One is left with a very uncomfortable feeling that the work of the VAD group, as related to the effects of low levels of infrasound and low frequency noise exposure, is on an extremely shaky basis and not yet ready for dissemination. The work has been severely criticised when it has been presented at conferences. It is not backed by peer reviewed publications and is available only as conference papers which have not been independently evaluated prior to presentation.

Jones told his listeners the reason wind turbines are not installed on Bondi Beach, down Sydney’s Macquarie Street or Melbourne’s Collins Street was because governments “know they are harmful to health”. His beguiling logic here might perhaps also be the same reason we don’t see these iconic locations given over to mining or daily rock concerts. Most people would understand there are other factors that explain the absence of both wind turbines, mines or daily rock concerts in such locations.

Jones has given air time to a Victorian woman who is a serial complainant about her local wind farm and who has written:

Around the Macarthur wind farm, residents suffer from infrasound emitted by the turbines, even when they’re not operating.

At a time when we are seeing unparalleled increases in renewable energy and reductions in fossil fuels all over the world, one wonders why this is still public discussion in Australia.

The ConversationSimon Chapman, Emeritus Professor in Public Health, University of Sydney

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

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New study: no increase in brain cancer across 29 years of mobile use in Australia

The Conversation

Simon Chapman, University of Sydney

Earlier this year, Australia saw a whirlwind tour from the electromagnetic radiation from mobile phones alarmist Devra Davis. Davis is an international champion of the belief that populations bathed in radiation emitted by mobile phones face epidemics of disease – particularly brain cancer.

Davis’ concerns were the focus of an ABC Catalyst program which attracted widespread criticism, including from me and Media Watch. The Catalyst presenter Maryanne Demasi was nominated for the Australian Skeptics bent spoon award.

At the time of the Catalyst program for which I declined to be interviewed, I had my hands tied behind my back because, with colleagues in cancer research, I had a paper in preparation examining the possible association between the incidence of brain cancer in Australia and the inexorable rise of mobile phone use here over the last three decades. Releasing our findings would have jeopardised publication, we could say nothing about what we had concluded.

Today the paper is published in early view in Cancer Epidemiology. Here’s what we set out to examine and what we found.

We examined the association between age and gender-specific incidence rates of 19,858 men and 14,222 women diagnosed with brain cancer in Australia between 1982-2012, and national mobile phone usage data from 1987-2012.

In summary, with extremely high proportions of the population having used mobile phones across some 20-plus years (from about 9% in 1993 to about 90% today), we found that age-adjusted brain cancer incidence rates (in those aged 20-84 years, per 100,000 people) had risen only slightly in males but were stable over 30 years in females.

There were significant increases in brain cancer incidence only in those aged 70 years or more. But the increase in incidence in this age group began from 1982, before the introduction of mobile phones in 1987 and so could not be explained by it. Here, the most likely explanation of the rise in this older age group was improved diagnosis.

Computed tomography (CT), magnetic resonance imaging (MRI) and related techniques, introduced in Australia in the late 1970s, are able to discern brain tumours which could have otherwise remained undiagnosed without this equipment. It has long been recognised that brain tumours mimic several seemingly unrelated symptoms in the elderly including stroke and dementia, and so it is likely that their diagnosis had been previously overlooked.

Next, we also compared the actual incidence of brain cancer over this time with the numbers of new cases of brain cancer that would be expected if the “mobile phones cause brain cancer” hypothesis was true. Here, our testing model assumed a ten-year lag period from mobile phone use commencement to evidence of a rise in brain cancer cases.

Our model assumed that mobile phones would cause a 50% increase in incidence over the background incidence of brain cancer. This was a conservative estimate that we took from a study by Lennart Hardell and colleagues (who reported even higher rates from two studies). The expected number of cases in 2012 (had the phone hypothesis been true) was 1,866 cases, while the number recorded was 1,435.

Using a recent paper that had Davis as an author we also modelled a 150% increase in brain cancer incidence among heavy users. We assumed that 19% of the Australian population fell into this category, based on data from the INTERPHONE study an international pooled analysis of studies on the association between mobile phone use and the brain. This would have predicted 2,038 expected cases in 2012, but only 1,435 were recorded.

Our study follows those published about the United States, England, the Nordic countries and New Zealand where confirmation of the “mobile phones cause brain cancer” hypothesis was also not found.

In Australia, all cancer is notifiable. At diagnosis, all cases must by law be registered with state registries tasked with collecting this information. It has been this way for decades. So we have excellent information about the incidence of all cancers on a national basis.

The telecommunications industry of course also has information on the number of people with mobile phone accounts.

While touring Australia, Davis was confronted with the “flatline” incidence data on brain cancer. Her stock response was that it was far too early to see any rise in these cancers. She was here to warn us about the future.

However, prominent Sydney neurosurgeon Dr Charlie Teo would appear to disagree about it being too early. He told Andrew Denton on ABC-TV’s Enough Rope in 2008:

If you look at the science on mobile phones and the link with brain cancer, it is quite compelling … we know that radiation causes cancer, but it takes about ten years for it to develop, so we know that EMR electromagnetic radiation is going to take at least ten years to create brain tumours and possibly longer fifteen, twenty years.

In cancer epidemiology, the concept of the latency (or lag) period is well known. This refers to the time that it takes between initial exposure to a potentially carcinogenic agent (like cigarette smoke, asbestos, or nuclear radiation) and excess cases of cancers of interest to appear.

Davis would appear to be arguing that we would see a sudden rise many years later. That is not what we see with cancer; we see gradual rises moving toward peak incidence, which can be as late as 30-40 years (as with lung cancer and smoking).

For example, as I showed in a recent Conversation piece, this paper also reports on central nervous system cancers (including brain cancers) in those exposed to atomic bomb radiation in Japan in 1945. This graph shows 110 of 187 cases (58.8%) were diagnosed in the first 40 years (before 1985) (so before 40 years).

https://datawrapper.dwcdn.net/yJ7ej/3/

The incidence and type of cancers of those exposed to atomic bomb radiation varied over the years. And this quote from the methods section shows that there were another 27 who died before 1958 from central nervous system cancers, within 13 years of the bombs.

We excluded 73 tumours in individuals who were not in Hiroshima or Nagasaki at the time of the bombings, 35 individuals who did not have available organ dose estimates, and 27 individuals who died or were diagnosed before January 1, 1958.

Note here that A-bomb survivors were affected by ionising radiation (that is, radiation of sufficient energy to produce ionisation). This is where the energy is strong enough to remove electrons off their atoms or molecules, including causing DNA damage. Mobile phones produce non-ionising radiation which is low energy, sufficient only to ‘excite’ the electrons enough to make them just heat up.

We have had mobiles in Australia since 1987. Some 90% of the population use them today and many of these have used them for a lot longer than 20 years. But we are seeing no rise in the incidence of brain cancer against the background rate.

The ConversationSimon Chapman, Emeritus Professor in Public Health, University of Sydney

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

 

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Here’s why we don’t have a vaccine for Zika (and other mosquito-borne viruses)

The Conversation

Suresh Mahalingam, Griffith University and Michael Rolph, Griffith University

As Zika fear rises, especially in the wake of the World Health Organization last night declaring a state of public health emergency, people are inevitably asking why we don’t have a vaccine to protect against the mosquito-borne virus.

Zika is generally a mild illness, causing fever, rash and joint pain, which usually resolves within seven to ten days. It was originally restricted to small outbreaks in the Pacific islands, Southeast Asia and Africa.

Due to the previously low impact of the virus and the estimated US$160-500 million it costs to develop a vaccine, Zika vaccine has not been on the radar. Other severe and potentially fatal mosquito-borne diseases such as malaria, dengue, and West Nile virus affect millions of people each year and have been a higher priority.

That has all changed with the recent “explosive” spread of Zika in the Americas and the potential link with microcephaly (reduced head size and brain damage) in babies of pregnant women who were infected.

Now we’re playing catch up on the research needed to develop vaccines. We know very little about how Zika replicates, how it causes disease, or how the immune system protects against infection.

So what is the status of Zika vaccine development? And how does this compare with the other mosquito-borne viruses that continue to have such a devastating impact on the world’s health?

Vaccine development

The ideal vaccine induces a strong response from the immune system, gives long-term protection with few doses, and causes no side effects. Though quickly developing such a vaccine is rarely this simple.

Zika

It’s early days, but scientists from the Public Health Agency of Canada, the Butantan Institute in Brazil, and the US National Institutes of Health have started work on Zika vaccines. These research teams may have vaccine candidates ready for initial clinical trials towards the end of the year.

Although full regulatory approval of a successful vaccine would take many years, it could potentially be used in public health emergencies within a year.

Yellow fever

The yellow fever vaccine, developed in 1938, has been highly successful at protecting against the virus, which can cause bleeding, jaundice, kidney and liver failure and, ultimately, death. Of the 44 countries at risk of yellow fever in Africa and the Americas, 35 have incorporated Yellow Fever vaccines into infant immunisation programs.

It is a live vaccine, in which a “weakened” virus induces a protective immune response against subsequent infection.

The Yellow Fever vaccine successfully protects against the virus, but is .
UNAMID/Flickr, CC BY-NC-ND

Live vaccines generally give strong protection, but safety is a significant issue, particularly in people with a weakened immune system.

Dengue

Dengue fever is a widespread tropical disease caused by dengue virus, which is transmitted by mosquitoes. Late-stage clinical trials of dengue vaccines are underway, and a vaccine has recently been licensed for use, but so far only in Mexico.

The field is littered with promising but failed vaccines that could not provide protection against the major strains of dengue virus. Nonetheless, there is hope that one will be available more widely in the coming years.

Chikungunya

Chikungunya virus has recently emerged as a serious human pathogen, causing fever and excruciating pain in the joints that can last months.

As with Zika, chikungunya was long considered unimportant because of its limited geographic distribution. Its dramatic expansion over the past decade, particularly in Southeast Asia and the Americas, has led to mobilisation of the vast medical research capabilities of the United States in response to the threat of it becoming established there.

Chikungunya vaccine development is proceeding rapidly, with a number of vaccines entering clinical trials. Researchers have reported early successes, but we are at least several years away from getting an approved vaccine.

Malaria

The big one is malaria, which kills more than 400,000 people a year. Scientists have been working on malaria vaccines for decades.

The RTS,S vaccine, developed by Glaxo Smith Kline, was successful in clinical trials and may soon be routinely used.

However, it only worked for some patient groups and provided only partial protection. Given its partial efficacy, there is debate in the medical community about the vaccine’s value.

The search continues for better vaccines.

Why is it so difficult to develop vaccines?

There is no recipe for the perfect vaccine. Despite the ever-increasing sophistication of vaccine technology, vaccine development often comes down to “suck it and see”. Many vaccines look promising in pre-clinical testing, only to fall over during the slow and expensive clinical trial process.

For many infectious diseases, we still don’t know what type of immune response is the most effective in providing protection. Since vaccines induce a protective immune response against infection, this can make vaccine design very difficult.

Vaccine safety is a major issue. “Live” or “attenuated” vaccines that involve a related or weakened version of the pathogen are often the most effective. But there is still the potential for these vaccines to cause disease, especially in recipients with weakened immune systems.

Vaccines go through a long process of clinical trials and assessment by regulators before they are approved for routine human use. This is a necessary process, but it sets a very high bar for approval. One of the most successful vaccines ever produced – the smallpox vaccine – is a live vaccine and would probably not have been approved by today’s regulators due to safety concerns.

Smallpox was eradicated in 1980.
Pan American Health Organization/Flickr, CC BY-ND

For dengue, there is an additional complication. People previously infected with dengue are at risk of developing much more severe disease when infected with a second, related dengue strain. Similarly, dengue vaccination could also lead to enhanced disease, rather than protection, when a person subsequently encounters the virus. This additional safety concern has markedly complicated and slowed dengue vaccine development.

Urgent priority

Zika causes mild fever in humans that on its own does not make a strong argument for a vaccine. But the possible link to microcephaly in unborn children, even though not yet definitely confirmed, makes vaccine development – and necessary funding – an urgent priority.

It’s also important to fund basic research to provide a necessary springboard for current and future vaccine development programs.

In the meantime, people in affected areas, including travellers, should take care to avoid mosquito bites by wearing long clothing and using repellents, bed nets and window screens.

The ConversationSuresh Mahalingam, Principal Research Leader, Institute for Glycomics, Griffith University and Michael Rolph, Senior research fellow, Griffith University

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

 

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What if Sydney University’s complementary medicine research shows it’s useless?

The Conversation

Simon Chapman, University of Sydney

The Faculty of Medicine at the University of Sydney has just announced A$1.3 of funding from Blackmores, the complementary medicine manufacturer, for a Chair in Integrative Medicine (a blending of evidence-based conventional and complementary medicine). It will be named after the company’s owner, Maurice Blackmore.

The Dean of the Faculty, Bruce Robinson, has given a coherent and persuasive account of why research in this area is of importance to modern medical practice. Nearly a quarter of Australians with chronic health problems use complementary and alternative medicine (CAM) and the bewildering range and often changing nature of these products are often of unknown efficacy, and may have important adverse or beneficial interactions with prescribed medicines. Still, more of the “worried well” regularly use unnecessary vitamins and other dietary supplements, often achieving little other than the generation of expensive urine in consumers and handsome profits in manufacturers.

Robinson is correct in arguing that medical practitioners and students know little about what a significant proportion of their patients are using and about whether these preparations help, harm, generate only placebo effects or simply waste patients’ money. And he is absolutely correct in making it clear from the beginning that the relationship will be at “arm’s length”, with Blackmores having no say in the research projects selected, in vetting the results produced, or in any post-publication researcher communications about those results. But there is already a great deal of evidence about a large number of complementary and alternative medicine preparations being useless, and about how faith in their magical properties can too often cause people with serious health problems to stay away from “conventional” evidence-based treatments of known effectiveness.

Complementary and alternative medicine manufacturers continue to produce and promote many of these substances, paying no heed to the evidence for their uselessness. Conventional medicines (so-called “ethical pharmaceuticals”) have to pass through onerous regulatory hurdles to prove both safety and efficacy. With the exception of the United States and New Zealand, prescribed medicines cannot be advertised directly to consumers. While the complementary and alternative medicine industry has to satisfy concerns about safety and toxicity, it does not have to satisfy standards of efficacy and can promote useless products in often quasi-mystical and vague language.

The University of Sydney needs to be extremely careful that its association with Blackmores does not turn into a “CAM-wash” exercise, where any adverse research findings on efficacy or interactions are ignored by the company, with the products not being withdrawn or the promotional language unchanged. There are social and financial costs in the mass consumption of unnecessary and ineffective “medicines”. The pages of medical journals routinely expose such drugs in the conventional medicines area. Many are highly sceptical that far too many players in the complementary and alternative medicine industry are the historical siblings of snake-oil medicine. For the Blackmores-University of Sydney association to repudiate that concern, it will be important to see evidence that the evidence-based and ethical principles at the heart of medical research are both shared and acted upon by the company.

In view of the sensitivities involved over potential reputational damage, the Faculty would do well to appoint an external audit committee to periodically review the relationship and to provide the Faculty with a report on the impact of the research program on the way Blackmores responds to the research it will have supported.

Editor’s note: please ensure your comments are courteous and on-topic. The Conversation

Simon Chapman is Professor of Public Health at University of Sydney.

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

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Faulty risk assessment

by Tim Harding B.Sc

Risk’ may be defined as the probability of something bad happening multiplied by the resulting cost/benefit if it does happen.  Risk analysis is the process of discovering what risks are associated with a particular hazard, including the mechanisms that cause the hazard, then estimating the probability that the hazard will occur and its consequences.

Risk assessment is the determination of the acceptability of risk in two dimensions – the likelihood of an adverse event occurring; and the severity of the consequences if it does occur,[1] as illustrated in the diagram below.

risk assessment diagram

By way of illustration, the likelihood of something bad happening could be very low, but the consequences could be unacceptably high – enough to justify preventative action.  Conversely, the likelihood of an event could be higher, but the consequences could low enough to justify ‘taking the risk’.

In assessing the consequences, consideration needs to be given to the size of the population likely to be affected, and the severity of the impact on those affected.  This will provide an indication of the aggregate effect of an adverse event. For example, ‘major’ consequences might include significant harm to a small group of affected individuals, or moderate harm to a large number of individuals.[2]

A fallacy is committed when a person focuses on risks in isolation from benefits, or takes into account one dimension of risk assessment without the other dimension.  To give a practical example, the new desalination plant to augment Melbourne’s water supply has been called a ‘white elephant’ by some people, because it has not been needed since the last drought broke. But this criticism ignores the catastrophic consequences that could have occurred had the drought not broken. In June 2009, Melbourne’s water storages fell to 25.5% of capacity, the lowest level since the huge Thomson Dam began filling in 1984. This downward trend could have continued at that time, and could well be repeated during the next drought.

247138-d17bfa2a-b8bd-11e3-8a33-c23c348170ff

Melbourne’s desalination plant at Wonthaggi

No responsible government could afford to ‘take the risk’ of a major city of 4 million people running out of water.  People in temperate climates can survive without electricity or gas, but are likely to die of thirst in less than a week without water, not to mention the hygiene crisis that would occur without washing or toilet flushing.  The failure to safeguard the water supply of a major city is one of the most serious derelictions of government responsibility imaginable.

A similar example of fallacious reasoning is in the area of climate change, where the public debate wrongly focusses on whether the science is true or false, rather than on the risks and consequences of it being true or false. This video explains the fallacy quite well.

Other examples of this fallacy are committed by the anti-vaccination and anti-fluoridation movements, often accompanied by conspiracy theories.  They both focus on the very tiny likelihood of adverse side effects without considering the major benefits to public health from the vaccination of children and the fluoridation public water supplies.  No adult or teenager has ever died or become seriously ill in Australia from the side effects of vaccination or fluoridation [3]; yet large numbers of people have died from the lack of vaccination.[4] The allegation of a link between vaccination and autism has been discredited, retracted and found to be fraudulent.  The benefits of fluoridation are well documented. The risks of general anaesthesia for multiple tooth extractions are not to be idly contemplated for children, and far outweigh the virtually nonexistent risk from fluoridation.[5]


[1] This is based on the Australian/New Zealand Standard for Risk Management.

[2] State Government of Victoria (2007) Victorian Guide to Regulation 2nd edition. Department of Treasury and Finance, Melbourne.

[3] In 2010, increased rates of high fever and febrile convulsions were reported in children under 5 years of age after they were vaccinated with the bioCSL Fluvax® vaccine. bioCSL Fluvax® has not been registered for use in this age group since late 2010 and therefore should not be given to children under 5 years of age. The available data indicate that there is a very low risk of fever, which is usually mild and transient, following vaccination with the other vaccine brands: Agrippal®; Fluarix®; Influvac®; and Vaxigrip®.  Any of these vaccines can be used in children aged 6 months and older. This and further information on flu vaccination is available here.

[4] The former Commonwealth Chief Medical Officer, Prof. Jim Bishop has argued that the flu vaccination program “changed dramatically the flu outlook for this country”, with admissions to intensive care from swine flu falling from 681 in 2009 to just 60 in 2010, and hospitalisations dropping from nearly 5000 to 600. Swine flu killed 191 Australians in 2009 and 36 in 2010. In contrast, seasonal flu killed 1796 Australians that year – but, unlike swine flu, the victims were mainly the frail and elderly. Prof. Bishop cautioned that one in every three hospital patients were “perfectly fit and well” before they caught swine flu, which was severe in pregnant women, teenagers who had lost their innate childhood immunity and indigenous people who tend to suffer underlying health problems. Three pregnant women died of swine flu, and 280 ended up in intensive care.  

[5] https://theconversation.com/fluoride-conspiracies-activism-harm-to-children-17723

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