We thank Mr. Barnett for his interest in our article, even
though his comments suggest he has not read it. Following
there are some notes on Barnett’s comments:
We have never received funds from the beverage industry, either for this research or for any of the several studies we have done on the relationship between alcohol and health.
Contrary to Barnett’s comments, we finished our article
a...
We thank Mr. Barnett for his interest in our article, even
though his comments suggest he has not read it. Following
there are some notes on Barnett’s comments:
We have never received funds from the beverage industry, either for this research or for any of the several studies we have done on the relationship between alcohol and health.
Contrary to Barnett’s comments, we finished our article
alerting against undue use of our research findings. In
particular, we stated in the final paragraph of the
manuscript: "As to the study’s practical implications, the
negative association between alcohol and suboptimal
health should not be used to promote even the moderate
consumption of alcoholic beverages".
Clinical advice and public policy on alcohol consumption is
a complex topic, which should be based on scientific
evidence (of which our article is just one small piece),
resources, and values or preferences of the people. Posing
the debate in visceral rather than rational terms (those
that integrates the above components of decision
making), as Mr. Barnett does, is getting out of the way for
evidence-oriented public policy.
,
I trust peers in the fields of Epidemiology and
Community Health will have ample opportunity to
scrutinize the hapless "study" from Spain published in
your journal this week as reported on BBC News web site
and I wish to foreshadow their likely findings of the
so-called scientists whose study linked more and more
alcohol consumption with "feeling healthier" as
laughable and very unscientific.
,
I trust peers in the fields of Epidemiology and
Community Health will have ample opportunity to
scrutinize the hapless "study" from Spain published in
your journal this week as reported on BBC News web site
and I wish to foreshadow their likely findings of the
so-called scientists whose study linked more and more
alcohol consumption with "feeling healthier" as
laughable and very unscientific.
I feel it is a great disservice to the global
community as well as to the goal of health education,
the penultimate responsibility of the public health
professional, to propose that indiscriminate and over
indulgence in alcoholic beverages could ever possibly
be linked to "healthier" anything.
Every 5th grade student knows alcohol is a poison and
will damage cells and organs upon entering the body.
Detrimental effects on the brain and nervous system
are well established. The fact that the body can
recover and continue to tolerate intake of the poison
and that the physical & psychological effects of
depression are masked by temporary "good" feelings is
equally well known. However, to report a link of a healthier outcome to
alcohol consumption and an even healthier outcome to increased consumption
serves only the financial interest of the beverage industry and may lull
the demented drinkers into a further fantasy that their drinking habit is
not only not a detriment to their health, but may some how improve their
health.
Certainly any sober person can use empirical evidence
to discredit that notion. If simple facts of reality
are going to be leapfrogged over just to play in the
scientists’ sandbox of childish notions, certainly less
important and less worthy publications can be used in
this way to publish that nonsense rather than risk
tainting the reputation of this fine journal.
This article is a concise and comprehensive glossary in the basic concept of health care. It
is an asset to teaching classes of public health. However, in this developing country we are
curious about your term "Primary Care". We are all working in a two million population catchment area for our services; the "Service Area" of the Institute. We named these the "Teaching Districts" of BP Koirala Institute...
This article is a concise and comprehensive glossary in the basic concept of health care. It
is an asset to teaching classes of public health. However, in this developing country we are
curious about your term "Primary Care". We are all working in a two million population catchment area for our services; the "Service Area" of the Institute. We named these the "Teaching Districts" of BP Koirala Institute of Health Sciences. In the
last seven years as trained
doctors, practising in population medicine, we have realized that there is no grading of care. Care has no level, either primary or secondary or tertiary. It is confusing for those who never worked with a population but still define its term. For us, illness is a process that needs every level of care at all times. The political definition of health care as "Primary
Health care" Almaata 78
was so convenient to all. Some forms of compromised care or homeopathic medicine in modern medicine are termed primary care. Do we, as health
professionals, understand what primary care is when some one is sick?
What is the future of Public Health? I am working in an Health
Institution which produces doctors and other health
professionals. As a doctor trained in Public Health, I find it challenging to impart to students how this discipline is going to help improve the public's health in our situation.
Water:- donation or loan needed to find the source and build a distribution system.
What is the future of Public Health? I am working in an Health
Institution which produces doctors and other health
professionals. As a doctor trained in Public Health, I find it challenging to impart to students how this discipline is going to help improve the public's health in our situation.
Water:- donation or loan needed to find the source and build a distribution system.
Air:- heavily poluted by non-regulated industries and low quality fuel.
Food:- dependency on imports has increased five times, qualities of dumped food is the way of survival.
Civic Norm:- Political instability in a country where there is a migration from rural hilly areas
to urban areas in search of jobs without any planning. This has created chaos, pushing
all saleable human resources out of the country.
Most of the time, the students discuss whether they will be able to help
people. This article is thought provoking and should prompt health
professionals to look inside themselves. Where lies the problem in Public Health?
Global surveillance in chronic or acute infectious are really important
issues.Working in the area of pidemiology in one of the least developed
country, one important issue that remains for me is to strengthen the system to
collect, analyse
and report data scientifically, so that magnitude can be measured
quantitatively,rather than the subjective impressions of professionals.
Global surveillance in chronic or acute infectious are really important
issues.Working in the area of pidemiology in one of the least developed
country, one important issue that remains for me is to strengthen the system to
collect, analyse
and report data scientifically, so that magnitude can be measured
quantitatively,rather than the subjective impressions of professionals.
Do we have enough infrastructures for a surveillance system?
We are planning a 'patch up' approach for example with polio.What will
happen after five years, once the project is over in a country
where not a single laboratory is available to test the polio
virus be it from the wild or vaccine initiated? Our country's capacity to take the initiative
is decreasing. A vertical approach is prominent
and one more silent epidemic of chronic diseases
will not be tackled the way it should be, because there is no
institution to tackle such a problem. Identifying the problem is one step
but to build resources so that it can continue on its own is another. A surveillance system can not be
isolated without improving the overall health system.
Editor,
The results of this study may be interesting but when one
considers that junior ranks (e.g. privates) make up the majority of the British armed forces then I do not believe that this represents the true figures.
If these results were taken from the original contact list as supplied by the Ministry of Defence, then there are questions related to the sample group. I believe that one of the o...
Editor,
The results of this study may be interesting but when one
considers that junior ranks (e.g. privates) make up the majority of the British armed forces then I do not believe that this represents the true figures.
If these results were taken from the original contact list as supplied by the Ministry of Defence, then there are questions related to the sample group. I believe that one of the original problems with this group was the fact that many of the addresses supplied were out of date.
I wonder whether the same results would be reflected if a study were performed on the War Pension Agency records for ill gulf war veterans?
Phil Garner R.G.N., Cert Ad Ed, F.E.T.C.
VETNET
ill gulf war veteran - not in one of the lower socio-economic groups
Editor,
As a new grad, I found the idea of adding a glossary section to your journal to be insightful and encouraging. Just from an operational standpoint alone, it will allow both researchers and readers to clarify meanings of certain phenomena, variables, and terms used as building blocks for hypotheses, research questions, and theoretical frameworks. This tool will also provide means to elucidate nuances...
Editor,
As a new grad, I found the idea of adding a glossary section to your journal to be insightful and encouraging. Just from an operational standpoint alone, it will allow both researchers and readers to clarify meanings of certain phenomena, variables, and terms used as building blocks for hypotheses, research questions, and theoretical frameworks. This tool will also provide means to elucidate nuances and obscurities by setting certain limitations which allows for a common focus.
The review by Britton and McKee(1) asserts a general causal relationship
between episodes of high dose alcohol intake (binge drinking) and
cardiovascular deaths, based on universal physiological mechanisms. They
claim that this causal relationship explains the dramatic fluctuations in
cardiovascular deaths in Russia and (less dramatic ones) in Poland. We
could not agree more that an assessment of the patte...
The review by Britton and McKee(1) asserts a general causal relationship
between episodes of high dose alcohol intake (binge drinking) and
cardiovascular deaths, based on universal physiological mechanisms. They
claim that this causal relationship explains the dramatic fluctuations in
cardiovascular deaths in Russia and (less dramatic ones) in Poland. We
could not agree more that an assessment of the pattern of drinking should
be included in future studies, but we recommend caution in interpreting
the evidence presented in their review.
First, the definitions of binge drinking used in the studies included
in the review vary widely, and some of them probably do not represent a
distinct population of binge drinkers, such as ‘unable to perform job
properly' or ‘being registered as a heavy abuser'. Studies using such
heterogenous definitions of exposure are not "combinable".(2) These
unreliable definitions do not distinguish between binge drinkers and
regular heavy drinkers or dependent moderate drinkers, all of which are
treated as quite separate populations in their review of mechanisms for
cardiac mortality.(3) Combining these studies cannot, in our view, answer
the question whether binge drinking is related to cardiovascular deaths.
Second, it is far from clear to which extent the reviewed studies
controlled for important confounding factors. It is very likely that
people who were "unable to perform their job properly" or were registered
as "heavy abusers" also differed from the reference group in many factors
that confound the association with cardiovascular disease. Poor diet and
malabsorption of nutrients, unsatisfactory employment and social
exclusion, low educational achievement, chain smoking or inadequate
housing could all co-vary with episodes of high dose alcohol intake. It
is unlikely that all such factors could adequately be taken into account
by adjusting for a limited set of variables.
Third, the specificity of the association between binge drinking and
sudden deaths is problematic. The reference cited to support this point in
fact examined sustained heavy drinking, rather than binge drinking.(4)
Sustained heavy drinking is rare in Russia.(5)
Given all these problems, the statement that the association is
"strong and consistent" and "fulfills the criteria of causality" is
misleading. There is simply not enough evidence for this.
The origins of the hypothesis that binge increases the risk of
cardiovascular death are based on the mortality crisis in Russia. However,
it ignores the important dissociation between the mortality trends in men
and women and the gender gap in drinking. All data from Russia are
consistent in one aspect: men drink much more than women (in fact women in
Russia drink relatively little compared to the UK).(5) However, the
magnitude of cardiovascular mortality fluctuations has been the same,
proportionately, for men and women in Russia.(6) Given the consistently low
consumption in women, it is difficult to see how the massive mortality
changes could caused primarily by alcohol.(7) This is critical to the
argument of Britton and McKee because the hypothesis they developed had
the initial aim of explaining the massive mortality changes in Russia.
To date, we are aware of two prospective cohort studies on alcohol
and mortality in Russia, neither of which provide any support for the
hypothesis. In the Russian Lipid Research Clinic Study cohort, there was
no suggestion of an increased mortality in the highest category of alcohol
intake (which, given the drinking pattern common in Russia, would probably
include binge drinking).(8) In our analysis of the Novosibirsk MONICA
cohort, binge drinking (measured as the average alcohol intake on typical
occasion) was related to increased risk of death from injuries and
accidents but not from cardiovascular disease (submitted manuscript). In
the light of the present evidence, it is not likely that binge drinking
can explain the paradox of high cardiovascular mortality in Eastern
Europe, certainly not on the scale proposed by the reviewers. Acute
effects of alcohol may include some cardiovascular deaths but it is
unlikely that binge drinking caused the several hundred thousand extra
cardiovascular deaths that occurred above the long term rates in Russia
between 1987 and 1994.(6)
No one would dispute the gravity of the health crisis in Eastern
Europe or the harmful effects of drinking on many health outcomes.
However, the current state of knowledge does not (yet?) justify the
conclusion that binge drinking causes large numbers of deaths from
cardiovascular disease.
Martin Bobak
Department of Epidemiology and Public Health University College London 1-19 Torrington Place London WC1E 6BT, UK
Woody Caan
Directorate of Public Health Barking and Havering Health Authority
London, UK
References
1 Britton A, McKee M. The relation between alcohol and cardiovascular
disease in Eastern Europe: explaining the paradox. J Epidemiol Comm Health
2000;54:328-332.
2 Egger M, Smith GD, Phillips AN. Meta-analysis: principles and
procedures. BMJ 1997;315:1533-1537.
3 McKee M, Britton A. The positive relationship between alcohol and
heart disease in eastern Europe: potential physiological mechanisms. J R
Soc Med 1998;91:402-407.
5 Bobak M, McKee M, Rose R, et al. Alcohol consumption in a
national sample of the Russian population. Addiction 1999;94:857-866.
6 Leon DA, Chenet L, Shkolnikov V, et al. Huge variation in Russian mortality rates 1984-94: artefact,
alcohol, or what? Lancet 1997;350:383-388.
7 Bobak M, Marmot M. Alcohol and mortality in Russia: is it different
than elsewhere? Ann Epidemiol 1999;9:335-338.
8 Deev A, Shestov D, Abernathy J, et al.
Association of alcohol consumption to mortality of middle aged US and
Russian men and women. Ann Epidemiol 1998;8:147-153.
We thank Mr. Barnett for his interest in our article, even though his comments suggest he has not read it. Following there are some notes on Barnett’s comments:
We have never received funds from the beverage industry, either for this research or for any of the several studies we have done on the relationship between alcohol and health.
Contrary to Barnett’s comments, we finished our article a...
Dear Editor
, I trust peers in the fields of Epidemiology and Community Health will have ample opportunity to scrutinize the hapless "study" from Spain published in your journal this week as reported on BBC News web site and I wish to foreshadow their likely findings of the so-called scientists whose study linked more and more alcohol consumption with "feeling healthier" as laughable and very unscientific.
...Dear Editor,
This article is a concise and comprehensive glossary in the basic concept of health care. It is an asset to teaching classes of public health. However, in this developing country we are curious about your term "Primary Care". We are all working in a two million population catchment area for our services; the "Service Area" of the Institute. We named these the "Teaching Districts" of BP Koirala Institute...
Dear Editor,
What is the future of Public Health? I am working in an Health Institution which produces doctors and other health professionals. As a doctor trained in Public Health, I find it challenging to impart to students how this discipline is going to help improve the public's health in our situation.
Water:- donation or loan needed to find the source and build a distribution system.
Air:- heavil...
Dear Editor,
Global surveillance in chronic or acute infectious are really important issues.Working in the area of pidemiology in one of the least developed country, one important issue that remains for me is to strengthen the system to collect, analyse and report data scientifically, so that magnitude can be measured quantitatively,rather than the subjective impressions of professionals.
Do we have enough in...
Editor,
The results of this study may be interesting but when one considers that junior ranks (e.g. privates) make up the majority of the British armed forces then I do not believe that this represents the true figures.
If these results were taken from the original contact list as supplied by the Ministry of Defence, then there are questions related to the sample group. I believe that one of the o...
Editor,
As a new grad, I found the idea of adding a glossary section to your journal to be insightful and encouraging. Just from an operational standpoint alone, it will allow both researchers and readers to clarify meanings of certain phenomena, variables, and terms used as building blocks for hypotheses, research questions, and theoretical frameworks. This tool will also provide means to elucidate nuances...
The review by Britton and McKee(1) asserts a general causal relationship between episodes of high dose alcohol intake (binge drinking) and cardiovascular deaths, based on universal physiological mechanisms. They claim that this causal relationship explains the dramatic fluctuations in cardiovascular deaths in Russia and (less dramatic ones) in Poland. We could not agree more that an assessment of the patte...
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