 | | | | |  | An antidote to panics based on dodgy statistics and dubious arguments.
Edited by Rob Lyons. |  | | |  |  |
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| | | 17 August 2004 | Pollutants and brain disease
Panic: 'Pollutants cause huge rise in brain diseases' declared the UK Observer, headlining a report from researchers at the University of Southampton Medical School published in the journal Public Health. The study compared rates for two categories of deaths (including dementia and Parkinson's disease) across 10 countries, contrasting figures from the period 1979 to 1981 with 1995 to 1997.
They found a big increase in most countries across both categories. For example, there were around 3,000 deaths from these diseases per year in the 1979-81 period in England and Wales - which rose to 10,000 deaths per year in the 1995-97 period. Given that genetic changes could not have occurred this quickly, the researchers conclude that there must be an environmental explanation.
'This has really scared me', said Professor Colin Pritchard, the lead author of the study. 'These are nasty diseases: people are getting more of them and they are starting earlier. We have to look at the environment and ask ourselves what we are doing.'
Don't panic: This study does not examine any pollutant or even any single disease. It merely examines recorded deaths for these groups of diseases over two periods to look for trends, and then speculates about what might be causing these trends. The 'tentative explanation' the authors put forward is just that - tentative. It certainly does not warrant banner headlines.
The first thing to be pointed out is just how rare these diseases are. Consider the figures for England and Wales: in 1979-81, there were 171 deaths per million of the population from these diseases - or 0.017 per cent of the population. In 1995-97, this had increased to 0.034 per cent. As a percentage of deaths from all causes in women, the rise was from 1.67 per cent of all deaths, to 3.54 per cent - more than double what it was before, but still a small number given that this includes dozens of different diseases. (The equivalent figures for men are lower: 1.23 per cent and 2.61 per cent.)
Secondly, these diseases are overwhelmingly diseases of old age. In the 1979-81 period, in England and Wales, someone over the age of 75 was 13 times more likely to die from one of these conditions than someone in the 55-64 age group. In 1995-97, the over-75s were 24 times more likely to die than the 55-64 year-olds. The incidence of these diseases below the age of 55 is even smaller.
Thirdly, the authors are quite wrong to assume that environmental factors are key to the increase. The most important factor in the rising numbers of people dying from these conditions is that the population is getting older. To that extent, there is a real, but manageable problem of coping with an increasing number of people living with these conditions in the future.
But the next most important factor is surely one of labelling. The figures for Italy are quite dramatic in this regard. In 1979, in the 75+ age group, the rate of death from dementia-like illness was 45 per million. In 1995-97, the rate was 1,211 per million for the same age group. We can either conclude that there has been a marked change in diagnosis and death certificate practice in Italy - or that someone has been going round attacking Italian pensioners with a special dementia gun. The idea that any factor in the Italian environment could engineer a real 27-fold increase in a particular cause of death is laughable.
The cross-national comparisons are almost as bizarre. In the 1990s in Italy, 1.2 per cent of deaths were due to these dementia-like illnesses. In Canada, the figure was 2.6 per cent. Are people really more than twice as likely to die from these causes in Canada? Again, it is much more likely that differences in labelling and healthcare practice are to blame.
There may be changes going on in the death rates from these diseases, but the methods used in this report are simply incapable of detecting them - and a panicky search for some external cause is unnecessary.
Read: |  | Changing patterns of adult (45-74 years) neurological deaths in the major Western world countries 1979-1997 | | Public Health, June 2004 | | Pollutants cause huge rise in brain diseases | | Observer, 15 August 2004 |
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| | | 10 August 2004 | An injection of perspective
Panic: 'Chaos over 5-in-1 jab' declared the UK Daily Mail, reporting that the government plans to replace an existing four-in-one jab, protecting against diptheria, whooping cough, Hib and tetanus, with a new one that adds protection against polio. The new vaccine will also not contain the preservative thiomersal, a mercury compound, which has been linked to autism by studies in the United States - leading to suggestions that the current vaccine is not safe. Campaigners also raised fears of immune system overload in infants coping with five different vaccines at once. Jackie Fletcher, founder of the support group Justice, Awareness and Basic Support (JABS), told the Guardian: 'Increasing the combinations increases the potential for an adverse reaction and restricts choice for parents.'
Don't panic: There are two panics here. The first is that mercury in the old vaccine, in the form of thiomersal, is harmful. The evidence against thiomersal is based on reports condemned by the American Academy of Paediatrics as containing 'numerous conceptual and scientific flaws, omissions of fact, inaccuracies and misstatements'.
The amount of mercury involved is so tiny that it simply could not be toxic, even to an infant. There is no evidence that it is harmful. It is not used in the new vaccine simply because it is incompatible with the polio element that has been added. However, by even implying that vaccines containing mercury should be withdrawn on a precautionary basis, the government has lent credence to the notion that thiomersal could be harmful.
The second panic is that the immune system of infants could be overloaded by a new multiple vaccine. This is similarly without substance. Newborn babies face a large number of potential infections, even in the process of being born. To counter this they already have the capability to deal with many different threats, a capability which develops further within a few days of birth. On the other hand, immune responses to some infections, like Hib, are much weaker in babies than they are in adults. For that reason, the vaccines used are specially designed to encourage immunity by stimulating well-developed parts of the immune system instead. This is also the reason why early vaccination is very important.
A review published in the journal Pediatrics concludes: 'Current studies do not support the hypothesis that multiple vaccines overwhelm, weaken, or "use up" the immune system. On the contrary, young infants have an enormous capacity to respond to multiple vaccines, as well as to the many other challenges present in the environment.'
While it is assumed that multiple vaccines must be more harmful, developments in protein chemistry mean that all the usual vaccines taken today, 11 in all, use fewer immunity-triggering proteins than just one vaccine (smallpox) did in the past. It seems that problems are found even where there has been progress.
Any conceivable harm caused by these vaccines is far outweighed by the harm done by the diseases they prevent. As Jennie Bristow notes elsewhere on spiked, we can fret about the slim possibility of vaccine damage precisely because of the remarkable success of the vaccination campaign. What this debate requires is an injection of perspective.
Read: | | Doctors try to head off new vaccine row, | | Guardian, 10 August 2004 | | Addressing parents' concerns: do multiple vaccines overwhelm or weaken the infant's immune system?, | | Pediatrics, 1 January 2002 (pdf format) | | Three cheers for the five-in-one jab, | | by Jennie Bristow |
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| | | 6 August 2004 | Return of the mad cow panic
Panic: 'Experts warn of wider CJD threat', reports BBC News. The CJD Surveillance Unit has looked into the case of a man infected with the prion protein suspected of causing the disease. The man, who had no symptoms of vCJD when he died, had received a blood transfusion from someone who had died of vCJD. The new report says that his genetic make-up was not the same as those who have developed symptoms, suggesting that more people may be carrying the disease. Professor James Ironside told BBC News, 'It's absolutely possible that there may be a new epidemic, because the cases we've seen so far may only be those who are unusually susceptible or have the shortest incubation periods'.
Don't panic: The number of deaths from vCJD has been in decline over the past four years - not that there were very many to start with. The first cases, three in total, were identified in 1995. The number of deaths rose to a peak of 28 in 2000, but has fallen since. There have been three deaths this year, and 142 in total over the course of a decade.
Far from suggesting a new epidemic, the latest report seems to indicate that even if the prion protein thought responsible for the disease is present in an individual, some other factor must also be present for the disease to develop. In March, researchers presented the results of tests done on 12,000 tissue samples at Derriford Hospital in Plymouth. Just three showed signs of prion infection. If only a small proportion of the small number infected actually develop the disease, that would be one explanation for the tiny number of cases to date - and why we need not worry about a wider outbreak.
Despite protestations from CJD researchers to the contrary, the spin put on this latest report seems like scaremongering at a time when it is becoming apparent that vCJD is not the mass killer suggested in the past. At one time, epidemiologists suggested that millions would die from vCJD - but a more recent estimate is that 540 people would die in total. At the current rate of cases, even that revised figure seems a long way off.
While there is much fretting about potential epidemics, the measures taken to prevent an epidemic have been disproportionate and occasionally have caused more harm than good. For example, the use of disposable surgical implements may have led to one death while the risk of transmission by this route was described as 'theoretical'. Rules on who can give and receive blood have been tightened up, and some blood products are now imported specifically because of the vCJD threat. Schemes to eradicate BSE from cattle, while not solely concerned with human health, have cost billions of pounds.
It is suggested that 'mad' cows have spread vCJD - but it is the panic attached to this rare disease that is truly bonkers.
Read: | | Experts warn of wider vCJD threat, | | BBC News, 6 August 2004 |
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| | | 28 July 2004 | Rampant scaremongering
Panic: 'Britain is facing an epidemic of sexually transmitted diseases as the safe-sex message fades and treatment clinics are forced to turn more people away', reports The Times (London). Figures from the UK Health Protection Agency suggest that the number of cases of sexually transmitted infections (STIs) rose by four per cent in 2003. Compared to 1995, cases of syphilis are up over 1,000 per cent, gonorrhea is up 150 per cent, chlamydia by 190 per cent, genital herpes by 15 per cent, and genital warts by 27 per cent. The rises are blamed on declining awareness of safe sex and long waiting times at sexual health clinics. There are also concerns that these figures may hide many more cases - particularly of chlamydia, which is often symptomless.
Don't panic: The most serious of these diseases is syphilis but the absolute numbers are still small - there were about 1,500 cases last year. The rises in other diseases are substantial, but not nearly as spectacular in relative terms. Rates of genital herpes, once regarded as the Next Big Thing after AIDS, are essentially static.
The recorded increase in sex disease seems to be largely a result of increased awareness, rather than an increase in rates of infection. This makes particular sense in the case of chlamydia, a disease you would probably never know you had unless you were specifically tested for it. For example, there was a sharp and sudden increase in chlamydia diagnosis at the end of the 1990s - rising by 20 per cent in men between 1999 and 2000 (totalling 27,702 cases), and by 26 per cent in women (totalling 36,928 cases). This was precisely the time that the Department of Health started its posters-in-pub-toilets campaign encouraging women to have the chlamydia test, and when the Public Health Laboratory Service (PHLS) organised a pilot involving 18,000 sexually active women between the ages of 16 and 25 to examine the prevalence of chlamydia in the UK.
'There was a lot of publicity about the availability of screening, so people were presenting themselves', Dr Pimenta of the PHLS told BBC News in 2001. The 'crisis' in sex clinics is partly down to more STI-free people going for testing. These are the 'worried well', people who needlessly seek tests for STIs because scare propaganda constantly tells them they're at risk from STIs. Between 1991 and 2001 the clinic workload increased by 155 per cent, but diagnoses increased by less than half this amount, at 61 per cent.
This seems to be a bad case of sexual morality disguising itself as a health panic. When AIDS and genital herpes don't work as a scare anymore, bring on chlamydia.
Read: | | HIV and sexually-transmitted infections, | | Health Protection Agency, 21 July 2004 | | Sex disease hits one in ten, | | BBC News, 17 September 2001 |
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| | | 20 July 2004 | Binge boozing
Panic: Binge drinking is creating a culture of 'thuggery and intimidation' according to UK home secretary David Blunkett, interviewed in the Observer. Blunkett says there has been a rise in 'lager loutettes', as more and more women drink unsafe amounts of alcohol. The number of women found to drink more than 21 units of alcohol per week has apparently risen from 14 per cent to 33 per cent. Blunkett added that the stereotype of women as a calming influence on violent male drunks was fading fast, leading to more crime.
Don't panic: A Cabinet Office report produced in 2003 notes that, while drinking levels have been rising since 1945, they are still substantially below consumption levels in 1900. Per capita consumption in the UK is still lower than that in Ireland, France and Germany. In fact, most of the population drinks less than the abstemious levels recommended by the Department of Health, and 4.7million Brits are teetotal.
Binge drinking is defined as drinking twice the recommended daily allowance in one sitting. For men, this means roughly four pints of ordinary-strength beer or one bottle of wine. For women, it means three pints or two-thirds of a bottle of wine. While drinking to excess frequently is certainly a bad idea, these definitions of binge drinking lump together ordinary social drinking with alcoholism.
What the government has been keen to promote is a late-night culture as a way of reviving city centres after years of decline. Unfortunately for them, this hasn't led to a sophisticated café culture but to super-pubs shifting large quantities of lager and alcopops to crowds of young people looking to let their hair down. With so many inebriated people in a relatively small area, it is not hard to find someone embarrassing themselves or getting into a fight.
But whether this is a major social problem, or even particularly different from the past, is to be doubted. While levels of violent crime haven't changed much, what has changed is the fear of violent crime - something which Blunkett seems only too happy to stoke.
| | Bingeing women fuel crime, | | Observer, 18 July 2004 | | Alcohol Misuse: Interim Analytical Report, | | Prime Minister's Strategy Unit, September 2003 |
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