University of California Press Blog

How Everyday Products Make People Sick

Paul D. Blanc is Professor of Medicine and holds the Endowed Chair in Occupational and Environmental Medicine at the University of California, San Francisco. Blanc is also the author of How Everyday Products Make People Sick: Toxins at Home and in the Workplace, which was published by UC Press in January 2007. An updated and revised edition of the book will be published by UC Press in the fall of 2009.

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By: Paul D. Blanc

I recently completed the Preface to an updated edition of How Everyday Products Make People Sick: Toxins at Home and in the Workplace. I had several goals that I wanted to accomplish in doing so. First and foremost, I have been stunned (and a bit dismayed) to see how many emerging hazards originally alluded to in the pages of the initial edition of the book, only published early in  2007, have evolved into major news events over the ensuing months. Ranging from leaded toys to the toxic contamination of foodstuffs to worsening conditions in the workplace – these episodes are important to document each on their own merits.

But such an update alone might only serve as a litany of seemingly isolated events. Collectively, this recent history also serves to underline the sadly lax state of regulatory affairs at home in the United States and internationally as well. The poster child of ineffective regulation in the U.S., beyond question, has been the Consumer Product Safety Commission (CPSC). Time and again, I found myself coming back to the CPSC in the Preface (it plays a prominent role in the body of How Everyday Products Make People Sick, as well). But, unfortunately, even if the CPSC stands out, it is not alone: the Environmental Protection Agency (EPA), the Occupational Safety and Health Administration (OSHA), and the Food and Drug Administration (FDA) all have had their fair share of recent shortcomings when it comes to the protection of the environment and those trying to work and live in it. 

As I had the opportunity to speak about my work in follow-up to the original publication of How Everyday Products Make People Sick, one thing that I realized was that some things I had taken for granted and thus given relatively brief attention to in the book were, in fact, subjects about which many people were still unaware. This includes the rich histories of key longstanding work and environmental hazards such as lead and silica. Thus, I also used the new Preface as an opportunity to revisit some of these topics, as well as to address a few other questions that arose in relation to the book’s original contents.

One issue I do not resolve in this updated edition, however, is the unexpected ambivalence that the book’s title engendered in certain scientific-medical circles. How Everyday Products Make People Sick, I have been told more than once, “sounds like a ‘self-help’ book, when actually it is very well-documented and rigorous.” Most of these critiques give me the benefit of the doubt and assume that the title was hoisted upon me by some manipulative marketer deep in the recesses of the UC Press. I am taking this opportunity to publicly acknowledge that the title was my idea, and I stand by it - so I guess I will have to live with the critique. Anyway, I’m not sure I get the point: I always thought accurate knowledge was the cornerstone of effective self-help.

Author David Blumenthal Joins the Obama Administration

The U.S. Department of Health & Human Services announced that David Blumenthal will join the Obama Administration as the National Coordinator for Health Information Technology. As part of the American Recovery and Reinvestment Act, Dr. Blumenthal will oversee a new countrywide privacy-protected health information technology infrastructure.

Blumenthal states in the U.S. Department of Health & Human Services news release:

“I am humbled and honored to have the opportunity to serve President Obama and the American people in the effort to harness the power of health information technology to modernize our health care system. As a primary care physician who has used an electronic record to care for patients every day for 10 years, I understand the enormous potential of this technology. President Obama has laid out a vision of health reform that is both inspiring and long overdue. We cannot make that vision a reality without the help of our most advanced computer technology.”  

Dr. David Blumenthal was formerly, Samuel O. Thier Professor of Medicine and Professor of Health Policy at Harvard Medical School and a physician at Massachusetts General Hospital. He is also co-author of The Heart of Power: Health and Politics in the Oval Office, which will be published by UC Press in June 2009.

Listen to an interview with David Blumenthal, as he talks about his new book The Heart of Power.

As a special pre-publication offer, save 20% by entering the discount code 09W6936 upon checkout.

UC Press Podcast Featuring David Blumenthal

We are pleased to announce that Episode 18 of the UC Press podcast series is now available. In this episode, Chris Gondek of Heron and Crane Productions interviews David Blumenthal as he talks about how certain presidents changed health care policy in his new book, The Heart of Power: Health and Politics in the Oval Office.

You may subscribe to the monthly podcast feed that contains the individual episodes using your RSS aggregator or directly via the iTunes store.  You can listen to individual author interviews from the episodes at our podcast page.

Listen to an interview with David Blumenthal, author of The Heart of Power.

Public Health: Underappreciated and Underfunded

David Hemenway is Professor of Health Policy at the Harvard School of Public Health, Director of the Harvard Injury Control Research Center, and Director of the Harvard Youth Violence Prevention Center. His previous books include Private Guns, Public Health. Hemenway is also the author of While We Were Sleeping: Success Stories in Injury and Violence Prevention, which was published by UC Press in March 2009. In his fourth blog installment, he explains how important and unappreciated public health is.

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Underappreciated and Underfunded

By: David Hemenway

Public health has long been underappreciated; indeed, surveys show that few Americans have any idea what it is.  Although public health has been far more important than medicine (curative care) in improving our nation’s health, all college undergraduates know about career possibilities in medicine, but few know about careers in public health.

Why did I decide to write While We Were Sleeping?  It was to increase knowledge about public health by highlighting some of its successes.  Public health involves assuring that drinking water is safe, that pollution does not despoil the air, and that diseases such as smallpox, polio, measles and tuberculosis are kept in check.  It involves reducing rates of substance abuse, heart disease and obesity. 

The book illuminates the public health approach for dealing with one particular subset of health issues—injuries (including violence).  Although disease kills more people in the United States than injury, injury disproportionately kills the young.  If you die before the age of 40, you are more likely to die of an injury rather than a disease. 

The focus of public health is prevention.  While almost all the resources for medical care go to treating individual patients after they become ill or injured, public health deals with entire populations— while they are healthy.  The community is the patient, and the goal is to keep everyone in the community healthy.

To explain the difference in approach between public health and medicine, I often use an example from public health research on suicide.  When I give presentations to psychiatrists and other mental health professionals in Massachusetts, I ask why they think Arizona and many other states have higher suicide rates than Massachusetts.  The response is typically not an explanation, but a “they do? I didn’t know that.”  The focus of mental health providers is on the treatment of individual patients.  By contrast, public health is interested in understanding and improving the health of populations.  Both approaches are important.  By the way, the answer to the question is NOT that people in Massachusetts have better mental health than those in Arizona. 

One reason that public health is so underappreciated is that we can’t usually identify which specific individuals have been helped by public health measures.  If you don’t get sick at work because of improvements in indoor air quality, not only do you not know whom to thank, you rarely realize that you have been helped.  The same is true if you don’t get poisoned because the food is safe, or you don’t get run over because the walkway has been separated from the road.  These are all public health initiatives.

Thus a problem for public health funding, particularly compared to funding for medical care, is that there are no grateful public health patients.  I recently spent a few days at one of the leading Boston teaching hospitals.  Not only is every building named—after some rich benefactor rather than an outstanding physician or nurse-- but so is virtually every wing, floor, alcove and seminar room.  By contrast, two of the four buildings at Harvard School of Public Health remain unnamed.

The goal of While We Were Sleeping is to increase appreciation of, and maybe even funding for, an underappreciated activity that has been crucial for our societal advancement-- public health. 

Lessons for Activists

David Hemenway is Professor of Health Policy at the Harvard School of Public Health, Director of the Harvard Injury Control Research Center, and Director of the Harvard Youth Violence Prevention Center. His previous books include Private Guns, Public Health. Hemenway is also the author of While We Were Sleeping: Success Stories in Injury and Violence Prevention, which was published by UC Press in March 2009. In his blog entry below, Hemenway discusses how activists can help pave the way for new policies.

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Lessons for Activists

By: David Hemenway

I gave a talk in the James Marsh Professor-at-Large lecture series at the University of Vermont this year, discussing “While We Were Sleeping: Success Stories in Injury and Violence Prevention.”  A woman in the audience—whose passion is promoting breast feeding (La Leche)—asked if I could briefly summarize some of the lessons learned from the book for successful activism. Here are a half-dozen:

1) First, and most important, is that a determined individual can make a difference, can change the world for the better.  That is the principal lesson of the book.

2) Second, it won’t be easy.  It is amazing that for virtually every success in the book, there was determined opposition.  Perhaps someone should write a book on the “anti-heroes” who fought so hard to prevent the elimination of phossy jaw to child workers or eye injuries to child hockey players.  The lesson for activists is to never tire of protesting.

3) A third lesson is to try to find committed leaders, or high-profile people, to push for the change.  Suicide prevention in the Air Force was successful because the chief of staff decided it was a high priority; goalies in hockey began wearing protective facemasks because the greatest goalie of them all led the way.

4) A fourth lesson is to focus on vulnerable populations. Many of the success stories involve protecting children—from motor vehicle injuries, scalds, fires, electrocution, poisoning and falls. It is much harder to “blame the victim” when the victim is under 5 years old.   
 
5) A fifth lesson is to involve as many groups as possible to support the effort.  Many of the major successes—reducing youth homicide in Boston, reducing pedestrian injuries in the Netherlands, lowering the child injury rate in Sweden—were due to many individuals and agencies acting together in a shared mission.

6) A sixth lesson is to get good data.  Data are critical for gaining the support of the media, the public and politicians; for helping to determine the optimal initiatives; and for evaluating those initiatives.  

Of these six lessons, I believe the most important is Lesson #2.  It always takes longer than you hope, so you should never give up hope.  In the words of the bastardized Latin version of the Harvard fight song: “Illegitimi non carborundum,” or “don’t let the bastards grind you down.” 

The Business of Being Born

 

While going over the marketing plan for, Birth Models that Work, I came across a website recommended by one of the authors. The website was the official homepage for the documentary, The Business of Being Born, which was produced by actress and former talk show host, Ricki Lake and directed by Abby Epstein. The documentary explores the history of midwifery and shows a contrasting perspective from the delivering at a hospital birth model we are so accustomed to today. The film also shows how health care and insurance companies helped to increase the use of maternity wards while ostracizing midwives.

Little did I know, another author from Birth Models that Work, Robbie Davis-Floyd makes a few appearances throughout the film. It was a pleasant surprise! As a medical anthropologist at the University of Texas at Austin, and an expert in child birth and midwifery, Davis-Floyd examines the different players in the medical field that make a difference with regard to U.S. birth models.

The stats were clear: in 2006, 99% of all births in the U.S. were delivered by doctors in hospitals, while nearly 1 in every 3 births are delivered by cesarean section. However, the U.S. still has one of the highest death rates in births compared to other industrialized countries where midwives are more prominent. If you want more information about birth models or would like to watch this film, go to The Business of Being Born. If you would like to read the latest scientific evidence about birth models that work, go to http://www.ucpress.edu/books/pages/10482.php.

By: Lindsay Wong, E-Marketing Coordinator, UC Press

Public Health Research and Injury Prevention

David Hemenway is Professor of Health Policy at the Harvard School of Public Health, Director of the Harvard Injury Control Research Center, and Director of the Harvard Youth Violence Prevention Center. His previous books include Private Guns, Public Health. Hemenway is also the author of While We Were Sleeping: Success Stories in Injury and Violence Prevention, which was published by UC Press in March 2009. In his blog entry below, Hemenway discusses how research helped change policies in public health.

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Public Health Research and Injury Prevention

By: David Hemenway

I describe more than 30 public health heroes in While We Were Sleeping.  Almost all of these individuals were activists, who struggled to make the world safer—and succeeded.  But I feel a little bad, because I barely mention the injury experts and researchers who also do such important work.  So last year when I gave a talk about the book to an audience of injury researchers at an international conference in Mexico, I emphasized how data and research studies were critical for most of the successes. 

Data and research are crucial for (1) documenting the problem, (2) targeting policies and (3) evaluating the interventions. Here are a couple of examples from just one injury area—motor vehicle crashes.

Graduated Drivers Licensing:  Young drivers are very dangerous.  Data showed that 16 year-old drivers had almost ten times the crash risk of 40 year-olds, and almost three times the crash risk of 19 year-olds. One reason for the higher risk was lack of experience, but the way to gain experience was by driving.  What was needed was a way to gain experience while minimizing risk.  Research also showed that young drivers were at particularly high risk (a) during the first few months of driving, (b) at night, and (c) when other young people (and no adults) were in the car.  So graduated licensing systems were created to allow youth driving, but limit their driving in these high-risk situations.  Studies of states that initially adopted these systems showed such large benefits (e.g., 30% decreases in injuries and death) that within a decade every U.S. state adopted Graduated Licensing.

Third Brake Light: Data showed that rear-impact collisions accounted for more than 20% of all collisions.  In the late 1970s, in scientific trials with taxicab and telephone company passenger cars, a random sample was provided with center, high-mounted brake lights.  Those cars with the new brake light were rear-ended about half as often as cars without the third brake light.  Based on these studies, the federal government mandated a center high-mounted stop lamp on all new passenger cars.  Studies find that this requirement prevents some 25,000 motor vehicle injuries per year.

One of my favorite injury prevention heroes is John Paul Stapp (1910-1999).  A physician and Air Force colonel, in the 1950s he became the fastest man on earth, traveling faster than a speeding bullet.  Using himself as a human guinea pig, on a test track in New Mexico in 1954, Stapp strapped himself in for his twenty-ninth and final sled ride.  In five seconds he accelerated to 632 mph, then was brought to a complete halt—in 1.4 seconds.  He suffered (temporarily) complete red out, as nearly every capillary in his eyeballs burst.  But his feat showed that humans could tolerate more than 25Gs, and that air force cockpits needed to be re-designed so that pilots would survive such a deceleration. 

Stapp became an instant celebrity, featured on the cover of Life magazine and in a Hollywood movie.  He used his fame to promote automobile safety.  He even persuaded the Air Force to build an automotive testing facility, and he conducted the first-ever crash tests using dummies.  How did he persuade the Air Force to spend so much money on automobile safety?  By providing data and studies showing that more Air Force pilots were being killed in traffic accidents than in plane crashes.

Data and research are key to policies that improve safety.  While my book hardly discusses the work of injury control researchers, there is little doubt that good data and good science typically provide the foundation for endeavors that successfully save lives.

Success Stories in Injury and Violence Prevention

David Hemenway is Professor of Health Policy at the Harvard School of Public Health, Director of the Harvard Injury Control Research Center, and Director of the Harvard Youth Violence Prevention Center. His previous books include Private Guns, Public Health. Hemenway is also the author of While We Were Sleeping: Success Stories in Injury and Violence Prevention, which was published by UC Press in March 2009. In his blog entry below, Hemenway discusses some success stories he mentioned during a visiting lecture.

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By: David Hemenway

Everything is about economics?

Last week I gave a lecture about “While We Were Sleeping” at Saint Michael’s, a small liberal arts college in Vermont.   The talk was to a full house of economics faculty and students, a number of whom who were being inducted into the Omicron Delta Epsilon honor society.  There was also a dinner with students, faculty, the president and other college administrators.  Everyone was so welcoming, and I was extremely impressed by the caliber of the students, and how much they liked their college experience.

Because the audience was primarily economics majors, I tried to make my talk relevant to their studies.    What does a talk about advocates and activists who have helped make the world safer—by helping to reduce motor vehicle deaths, burn injuries, violence, suicide, industrial accidents, etc—have to do with what the students were studying?

Fortunately I am an economist, so I made sure that one of the heroes I talked about was a labor economist—John B. Andrews—who successfully promoted taxation rather than prohibition as a way to reduce the use of white phosphorous, which was causing an horrific workplace poisoning known as “phossy jaw.”  One historian has written that Andrews  “orchestrated the most significant legislative success achieved by advocates of workers’ health in the early twentieth century.”

I also talked about some possible lessons for economists.  Some of the successes illustrated the power of the market.  For example, improved ski boots and bindings (something these Vermont students had an interest in) dramatically reduced lower leg injuries between 1960 and 1980.  Sometimes, however, the market cannot be relied on, when, for example there is poor consumer information or large externalities.  The U.S. government had to require that automotive manufacturers install collapsible steering columns in cars in the 1960s, and that tobacco manufacturers produce cigarettes that were fire-safe in the 2000s. Vermont was the second state to pass such a cigarette law. 

Often, however, the issue is not more or less government, but smarter government.  For example, when the government buys or builds mass transit, roads or bridges, they can make them more or less safe for workers and for travelers.  The Washington D.C. metro, for example, was specifically –and successfully--designed to deter crime and violence.

Finally, I talked about the “law of unintended consequences.”  While economists often emphasis the bad unintended consequences of attempts to improve on the market, the unintended consequences of many of the successes in “While We Were Sleeping” were beneficial.  For example, the passage of motorcycle helmet laws not only reduces motor cycle injury, but almost invariably reduces motorcycle theft.  I had the students think about and explain why this would be the case.

One of the nicer aspects of writing this book has been the opportunity of making presentations in various locations and to various audiences.  I did not even know Saint Mike’s existed before my talk there, but it seems like a hidden gem.  

Article with Robert Davis, author of The Healthy Skeptic

On Sept. 22, The Atlanta Journal-Constitution writer, Helena Oliviero chatted with Robert Davis, author of The Healthy Skeptic: Cutting Through the Hype About Your Health (UC Press, June 2008). In the article, Davis examines the myths of dark chocolate and hair color, among other things. While an excerpt of the article is posted below, you can find the full story "Emory Teacher Questions Foods' Benefits" here.

HARD TRUTHS

We recently asked Davis about some popular medical claims:

The claim: Dark chocolate prevents heart disease.

The Healthy Skeptic: Small, short-term studies — virtually all of them funded by the chocolate candy industry — suggest dark chocolate, which contain antioxidants known as flavanols, may have some beneficial effects on your cardiovascular system when consumed in large quantities. This doesn’t mean you are less likely to have a heart attack 10 or 20 years down the line.

Bottom line: There’s no evidence a little chocolate now and then is bad for you. But remember: Chocolate should viewed as candy — not medicine.

The claim: High cholesterol is bad for you.

The Healthy Skeptic: There is much more to heart health than cholesterol. Only half of people who have had heart attacks had high cholesterol levels.

Bottom line: You should know your number but not be obsessed with it. If you have high cholesterol, it does not mean you will drop dead from a heart attack. And if you have low cholesterol, it does not mean you can eat whatever you want.

The claim: Vitamin B gives you more energy.

The Healthy Skeptic: Vitamins help convert carbohydrates into energy, but they are not a source of energy. Only food supplies energy. A normal diet and multivitamin provides sufficient Vitamin B to covert carbs into energy.

Bottom line: You do not need extra doses of Vitamin B. You can get what you need from your diet and daily multivitamin.

The claim: Blueberries will prevent Alzheizmer’s.

The Healthy Skeptic: Blueberries have antioxidants. They are perfectly good to eat and one of the many fruits we should eat, but there’s no basis to suggest that blueberries are better than you than strawberries or watermelon or that it will prevent Alzheimer’s.

Bottom line: Stop being fixated on any one fruit and focus on your overall diet and getting a variety of fruits and vegetables.

The claim: Red wine is good for your heart.

The Healthy Skeptic: There is some evidence that a glass of wine every night may be good for your heart, but the risk of drinking too much is far greater than drinking just the right amount.

Bottom line: If you want to drink a glass or two of wine, that’s fine and it may be beneficial, but any more is probably not a good idea.

The claim: Sunscreen prevents cancer.

The Healthy Skeptic: Sunscreen prevents sunburn and can prevent squamous skin cancer but there is not strong evidence that it prevents the very serious melanoma.

Bottom line: Avoiding sun, staying in the shade and wearing wide-brimmed hats are more effective measures. Sunscreen should not be a first defense.

The claim: Teflon pans cause cancer and birth defects.

The Healthy Skeptic: The production of Teflon involves a chemical called perfluorooctanoic acid (PFOA), and studies in rodents show that it may cause cancer and birth defects. Virtually all Americans have PFOA in their blood but the levels tend to be extremely low — about five parts per billion. That’s up to 25,000 times less than the amount demonstrated to cause harm in lab animals.

Bottom line: Don’t throw out your Teflon pans, and don’t worry about it.

The State of Health Atlas Named Best Public Health Book by the British Medical Association

Diarmuid O'Donovan's The State of Health Atlas won first prize in the public health category of the British Medical Association's 2008 book competition. The judges called the book “a superbly accessible, beautifully produced, highly informative and well-written compendium of world health statistics", and said, "It will be of interest to a wide range of professionals and students in many areas. It is excellent value for money and should grace the book shelf of everyone who cares about human health.” The awards ceremony took place on September 9.