39 e-Letters

published between 2016 and 2019

  • An intervention, not an accident: Research into use of force by police requires understanding its context and counterfactuals

    In “Years of life lost due to encounters with law enforcement in the USA, 2015–2016,” Bui et al. estimate the public health impact of police use of force by a simple computation of the years of life lost by the people killed by police.[1] Unnecessary use of force by police is a problem demanding serious attention, and leadership in policing has responded with interventions and training in recent years to improve de-escalation techniques and reduce the incidence of unnecessary or unlawful use of force. Bui et al.’s analysis, however, fails to consider three key factors in these analyses: first, the distinction between necessary and unnecessary/unlawful uses of force; second, the potential impacts on years of life lost had the police not have intervened in these specific scenarios; and third, the broader impacts of police intervention on public health.
    Police may use lethal force when they have sufficient reason to believe that a person poses a risk of serious physical injury or death to another person. A reporter for The Washington Post concludes that “the vast majority of individuals shot and killed by police officers… were armed with guns and killed after attacking police officers or civilians or making other direct threats.”[2] Unnecessary or unjustified use of force by police are thought to account for about five percent of the total number of incidents of use of force,[2] with great skeptics acknowledging they are certainly fewer than 50%.[3] Including sensitivit...

    Show More
  • Length of Life is Affected by the Whole of Your Life

    It is bittersweet to see one’s predictions of a fall in life expectancy coming into being.
    I work on statistics, but also talk to patients regularly about their diets, lifestyles and
    environments. The medical service struggles to deal with the results of poor diet and
    pollution. Perhaps it is time for a health service to deal with the causes of illness.

    Ancel Keys crusaded against fats. He cherry picked data from only 6 of the available
    22 countries. Sugar was then used to make low fat food palatable. Fructose and
    galactose, in sugar, milk, corn syrup and fruit, are implicated in cancer, heart disease,
    dementia and diabetes.

    Are the NHS and social care the priorities? Perhaps money to buy good food is more
    important, and maybe we have too much medicine, not too little. I have seen patients
    taking up to 29 different drugs. No pharmacologist can work out how they interact.
    One patient took 5 drugs for his asthma. People complain of drug side effects and are
    just given more drugs to deal with these symptoms.

    The Depression was forgotten, and it was assumed we could keep becoming richer,
    until 2008. Similarly we cannot just extrapolate the increasing life expectancy figures.
    Public health improved after building reservoirs, chlorinating water, installing sewage
    systems, reducing overcrowding and setting up smokeless zones.

    However, chemical production has increased greatly...

    Show More
  • Concerns re: Kondo and Ishikawa - 2nd Editors' note

    This is the second E-letter from the Editors of the Journal of Epidemiology & Community Health concerning a paper by Kondo and Ishikawa [http://jech.bmj.com/content/early/2018/01/12/jech-2017-209943]. The paper examined the impact of an intervention to encourage people of lower socio-economic status attending pachinko parlours in Japan to undergo health checkups. The intervention, which was not controlled by the authors, used gendered stereotypes of the nursing profession and suggestive uniforms that play on women’s sexuality to encourage people to engage in health checkups. The study conducted was granted ethical approval by an institutional research ethics board.

    JECH condemns the use of sexism, gender and professional stereotypes and other forms of discriminatory practice or language for any purpose, including health promotion programs. The intervention studied in the article contradicts our principles. Concerns about this paper have been sent to us and we have published these as E-letters that are attached to the article.

    We have conducted an audit of our review processes and determined that an improbable chain of accidental human processing errors in the online editorial system meant that we failed to give this paper the usual scrutiny and oversight our submissions receive. In our time as Editors, we have overseen more than 10,000 manuscript submissions prior to this withou...

    Show More
  • Authors' responses

    In this paper we sought to explore the idea that the delivery of health promoting interventions could be tailored in ways that might increase uptake among hard-to-reach populations, potentially helping to reduce health inequalities. In hindsight, we realise that the specific intervention used in this study was extremely inappropriate. We acknowledge that the intervention involved drew on stereotypes for female nurses, reinforced the objectification of both women and nurses, thus reinforcing gender inequalities. We also acknowledge criticism that some of the terms we used in translating our paper into English caused offense to some readers.

    We are deeply sorry for our poor judgement and for the negative impacts of this paper. As health inequalities researchers, we are very concerned about the macrosocial determinants of health inequality and recognize that gender inequalities are one such determinant. While it has been very difficult for us to receive such a negative response to our paper, we are grateful to those who have helped us understand its limitations and how we can avoid these in future.

    Response to Tsujimoto and Kataoka
    We thank the Tsujimoto and Kataoka for their comments. While we agree that it would be helpful to formally test for gender differences in the effect of the study intervention, we are unable to conduct such an analysis since permission to use the data, as approved by the ethics board, has now expired. As we discuss in the paper...

    Show More
  • A typical example of unethical study and a wrong editorial decision

    We read the article published online in Journal of Epidemiology and Community Health by Dr.Kondo and Dr.Ishikawa with great sorrow and have major concern on the authors' unethical design by regarding young women wearing sexy nurse costumes as a form of acceptable behavioural intervention. As an experienced clinician who can fully appreciate the difficulty in motivating clients for health check-up, the proposed incentive/strategy is totally unethical which insults all ladies and is a strong humiliation to our professional nurses and even to the respectable Japanese culture. We can hardly believe why this kind of study with major methodology flaw can obtain an ethical approval and even being accepted and published by an esteemed journal like Journal of Epidemiology and Community Health. We are terribly sorry to say that this kind of practice is totally unacceptable in clinical medicine and academic world, hence I am writing to ask for a more serious explanation from the Editor on the Journal's and his standpoint on this classical "black" and "white" issue. The authors should be adviced to withdraw this paper as soon as possible, otherwise the integrity of future studies published in the Journal may be unnecessarily affected.

  • Critique of Kondo and Ishikawa's article

    I am writing to express my strong concern on the article "Affective stimuli in behavioural interventions soliciting for health check-up services and the service users' socioeconomic statuses: A study at Japanese pachinko parlours," authored by N. Kondo and Y. Ishikawa (2018). Seeing an article which encourages the objectification of women being published in this peer-reviewed journal is both shocking and disappointing. In that article, the authors suggest that an intervention involving "young female staff" wearing "sexually attractive nurse costumes"/ "erotic nurse costumes" could be effective in "soliciting" men to engage in health check-ups. I am extremely disappointed by the use of such methods, as well as such terms, in Kondo and Ishikawa's study, and strongly in doubt that they are objectifying and inappropriately sexualising women and the nursing staff in Japan.

    It is clear that ethics and code of morality are always the first and the top priority in research. Involving ethically incorrect practices (i.e., asking young women to wear erotic nurse costumes to engage men in healthcare service in this case) and even providing supportive evidence for their effectiveness to the public via an open-access journal are by no means acceptable. Despite my disappointment in the authors and the relevant private healthcare company using those gender-stereotyped practices, I am also provoked by the indifference of th...

    Show More
  • Concern about interactions and true effect of heroic stimuli

    We read an article recently published online in Journal of Epidemiology and Community Health by Dr.Kondo and Dr.Ishikawa with great interest and appreciate the authors' efforts to seek effective interventions for socioeconomically vulnerable people to have a health check-up. They suggested "hedonic stimuli" promote socially vulnerable people to have health check-up services. The "heroic effect" in this research directed to one gender only (mostly). We consider they should have performed the analysis which compares the difference of the intervention effect between on male (sensitive to this heroic stimuli) and on female (insensitive to the stimuli) in order to consider interactions (e.g. simply wearing healthcare staff's costumes). We believe that the difference in effect size between genders is the true intervention effect arisen from the "hedonic stimuli". We suggest it should be investigated using the original data of Table 2.

  • Criticism of Kondo and Ishikawa article

    I felt deeply offended after reading ‘Affective stimuli in behavioural interventions soliciting for health check-up services and the service users’ socioeconomic statuses: a study at Japanese pachinko parlours’ by Kondo and Ishikawa (Kondo N, Ishikawa Y. J Epidemiol Community Health 2018; 0:1–6. doi:10.1136/jech-2017-209943). As a Japanese woman and a registered nurse, I found phrases such as ‘young women wearing mildly erotic nurse costumes’ or ‘solicitation by young women wearing sexy nurse costumes’ to be derogatory and disrespectful. If the authors needed to clarify the point of their hypothesis on the possible relationship between sexual stimuli and health behaviours, which is already disturbing enough as a research topic, it would be enough to mention ‘a person wearing mildly erotic clothes’ or ‘invitation by persons wearing sexy costumes.’ When the authors add (and the editors retain) such words as ‘young women’ or ‘nurses’ to describe the distinctive features of the intervention, they tacitly accept and capitalize on stereotypes and prejudices against young women and nurses, and assume that readers will share such insulting views as well. I was very disappointed that the paper was developed by the authors, reviewed by peer reviewers, and accepted in its current form by the editor-in-chief of the Journal of Epidemiology and Community Health. I sincerely hope that the authors, reviewers, and editor-in-chief give some more thought to how social disparity could persist...

    Show More
  • Concerns re: Kondo and Ishikawa - Editors' note

    The paper by Kondo and Ishikawa uncritically investigates a public health program that contradicts the journal’s values. We are aware of the concerns raised and have already begun to address them, with more action to come. We are conducting an audit of our editorial processes to determine where errors were made and will be publishing e-letters that articulate the concerns about the paper. The Editors have attached the statement below to the paper as an ‘Editorial Note’. This represents an interim measure to assert our principles. In the coming days, we publish additional E-letters to provide more detail on the actions we will take to ensure that we are consistently upholding these principles going forward.

    The Editorial Note reads:

    “The study reported in this article examines a health intervention which uses gendered stereotypes of the nursing profession and suggestive uniforms that play on women’s sexuality to encourage people to engage in health checkups. The intervention was not under the control of the authors and the study was approved by an institutional research ethics board.”

    “The Journal of Epidemiology & Community Health condemns the use of sexism, gender and professional stereotypes and other forms of discriminatory or exploitive behaviour for any purpose, including health promotion programs. In light of concerns raised about this paper, we are conducting an audit of our review process and will put in place measures to ensure that the m...

    Show More
  • Response to Barberio et al's claim that there is no link between fluoridation and hypothyroidism

    Barberio et al1 report a study which – in contrast to our own study2 - shows no relationship between fluoride intake and hypothyroidism. However, Barberio et al study is limited by the methods used for identifying hypothyroidism prevalence, fluoridation status and sample sizes.

    Barberio et al utilised three methods to determine hypothyroidism prevalence: self-report and two biomarkers: thyroid-stimulating hormone (TSH), and free T4 blood results. This is problematic as self-report is unlikely to provide accurate prevalence data when compared to clinical diagnosis data, as used in our study4; and there are a number of studies demonstrating that self-reported estimates of thyroid functioning are unreliable. Further, the self-report question does not appear to differentiate between under and over active thyroid functioning. The biomarker data only included individuals with un-medicated hypothyroidism; consequently, the sample is unrepresentative of the population. The analysis of this data provides correlations between the biomarkers TSH, T4 readings and fluoride exposure in a sub-sample of respondents, assuming that all respondents received uniform levels of fluoride. From our data, we observed wide variability within fluoridated areas. This may explain why in table 2b, none of the variables, including age and sex, were predictive of TSH levels. This contradicts Barberio et al’s own data on what is predictive of hypothyroidism and the Canadian Health Measures Survey...

    Show More