I Wish I Were Far From the Madding Crowd

April 27, 2010

Institute of Medicine report on “Bridging the Evidence Gap in Obesity Prevention” – is their framework comprehensive enough?

The Institute of Medicine is the health arm of the National Academy of Sciences.  On April 23, 2010, it released a report, “Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making.”

New Framework Recommended for Decision Making and Research on Obesity Prevention

http://www.nationalacademies.org/morenews/20100423.html

April 23, 2010 — To battle the obesity epidemic in America, health care professionals and policymakers need relevant, useful data on the effectiveness of obesity prevention policies and programs. A new report from the Institute of Medicine identifies a new approach to decision making and research that uses a systems perspective to gain a broader understanding of the context of obesity and the many factors that influence it.

http://www.iom.edu/obesityframework

Is the IOM systems approach missing what could be a large component of the system?

The Institute of Medicine states that it is adopting a systems approach to obesity prevention.  That sounds pretty comprehensive, right?

Well, maybe not.  Cutting to the chase, this report appears to be limited to looking at obesity prevention interventions and not all obesity causes.  The focus is entirely on caloric and energy balance.  But what if, as Dr. Robert Lustig and others have argued, what you eat and how it is metabolized are factors in the obesity epidemic?  Energy intake and energy expenditure might not reveal the whole picture.

And what about the possibility that environmental exposure to chemicals might be a factor?  Quickly skimming the report, I found Figure 4-5, “The obesity ‘system’: a broad causal map” (p. 4-12 (p.80) of the online version of the report) shows a blurry version of the diagram, but I was able to find the original on Slide 9 of the presentation, “System Dynamics Simulation in Support of Obesity Prevention Decision-Making.”

Bobby Milstein and Jack Homer, For Institute of Medicine Committee on an Evidence Framework for Obesity Prevention Decision-Making, Irvine, California, March 16, 2009
http://www.iom.edu/~/media/Files/Activity%20Files/PublicHealth/ObesFramework/IOMIrvine16Mar09v52MilsteinHomer.ashx

The “map” shows Prevalence of Overweight & Related Diseases being affected by two causes, Healthiness of Diet & Activity Habits and Genetic Metabolic Rate Disorders.

But what if metabolic rate disorders are not strictly genetic, but can be epigenetic or can be directly caused by chemical exposure?

That idea does not appear to have crossed their minds.  The framework and approach that are recommended look like they have merit, but I would argue that the authors are not looking at as large a system as they should be.

The environmental factors they do mention are along the lines of the “activity environment” and the food environment.”

Without acknowledging the effects exposure to chemicals might have on people’s propensity towards overweight and obesity the report is more limited than it should have been.  The focus is totally on social and behavioral interventions.  While diet and activity are probably the most important factors in obesity for most people, it appears that no thought has been given to the possibility that by reducing exposure to chemicals we might be able to prevent or at least reduce the rates and extent of overweight and obesity.

Links to Report Information

There are links to several different items here.  The links above are to a news release and the Institute of Medicine (IOM) Report web page (i.e. the page for the project/activity).  Links below are to the full text of the report online, the report recommendations, a four page report brief, as well as links to a webcast and podcast of the briefing on the release of the report, links to related resources (which duplicate some of the other links), and links to pages on the meetings that led to the creation of the report.

Full Report online

Report at a Glance

  • Recommendations (HTML)
  • Report Brief (4 pp.) (PDF, HTML)

Report: Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making

Released: April 23, 2010

http://www.iom.edu/Reports/2010/Bridging-the-Evidence-Gap-in-Obesity-Prevention-A-Framework-to-Inform-Decision-Making.aspx

A Framework for Decision-Making for Obesity Prevention: Integrating Action with Evidence

http://www.iom.edu/Activities/PublicHealth/ObesFramework.aspx

Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making

http://www.nap.edu/webcast/webcast_detail.php?webcast_id=420

April 23, 2010
Running Time: 00:58:04
Format: RealAudio (Requires free RealPlayer)  Podcast: (mp3)
To battle the obesity epidemic in America, health care professionals and policymakers need relevant, useful data on the effectiveness of obesity prevention policies and programs. A new report from the Institute of Medicine identifies a new approach to decision making and research that uses a systems perspective to gain a broader understanding of the context of obesity and the many factors that influence it.

Related Resources:

Report Briefs
Full Report
Project Website

Previous Meetings

March 17, 2010

EPA and Children’s Environmental Health

Lax regulations on toxics put kids at risk, experts testify

(from CNN’s “Paging Dr. Gupta” blog)

The above post concerns a hearing held to hear about a report from the Government Accountability Office (GAO) on EPA’s progress in protecting children from environmental threats.  It discusses the challenges EPA faces in protecting children’s health.  (To be fair, many people acknowledge that shortcomings in the Toxic Substances Control Act, or TSCA, are responsible for EPA’s being unable to protect children and others from environmental pollutants.)

I’m not usually one to plug particular networks, but I thought the following mentioned in the Dr. Gupta blog might be of interest.

CNN editor’s note: Dr. Sanjay Gupta looks at the environment and health in an upcoming hourlong investigation, Toxic Towns USA, airing April 24 at 8 p.m. ET

Documents from the hearing

Children are exposed to many sources of potentially-harmful environmental pollutants

from the GAO Report Highlights

Selected report contents:

  • Background
  • EPA Has Not Focused Attention on Children’s Health in Agencywide Priorities, Strategies, and Rulemakings

Includes a figure showing the steps where children are considered in the EPA rulemaking progress.  The report does note that some offices within EPA more consistently incorporate considerations for children’s health in their work than others, but notes that at least one other federal agency does not even seem to do that.

  • In Recent Years, EPA Has Not Fully Utilized Its Office of Children’s Health and Other Child-Focused Resources
  • Opportunities Exist for EPA to Lead and Coordinate National Efforts to Protect Children from Environmental Threats
  • Recommendations for Executive Action
  • Matter for Congressional Consideration
  • Appendix II
    EPA Policy on Evaluating Health Risks to Children
  • Appendix III
    Executive Order 13045 and Amendments
  • Appendix IV
    EPA Regulations Subject to Executive Order 13045

From GAO’s summary: “In 1997, Executive Order 13045 (from the EPA website) mandated that agencies place a high priority on children’s risks and required that policies, programs, activities, and standards address those risks. In response, the Environmental Protection Agency (EPA) created the Office of Children’s Health Protection and convened the Children’s Health Protection Advisory Committee….

“…While EPA leadership is key to national efforts to protect children from environmental threats, EPA’s efforts have been hampered by the expiration in 2005 of certain provisions in the executive order. For example, the Task Force on Children’s Environmental Health provided EPA with a forum for interagency leadership on important federal efforts, such as the National Children’s Study.”

GAO recommended that Congress consider the following:

Because EPA alone cannot address the complexities of the nation’s challenges in addressing environmental health risks for children, Congress may wish to consider re-establishing a government-wide task force on children’s environmental health risks, similar to the one previously established by Executive Order 13045….

Full Committee Hearing entitled, “Hearing on the Government Accountability Office’s Investigation of EPA’s Efforts to Protect Children’s Health”

The hearing mentioned in CNN’s blog – Held by the Senate Committee on Environment and Public Works, Wednesday, March 17, 2010, 10:30 AM EDT

[Webcast]

From the Committee’s Hearing page:

Chairman Barbara Boxer will convene the Full Committee for a hearing on the Government Accountability Office’s (GAO) investigation of the Environmental Protection Agency’s (EPA) children’s health program. The committee will also examine what can be done to strengthen protections for children.

Senator Bill Nelson (D-FL) is also expected to give testimony on the federal government’s role in investigating children’s health issues and how that can be improved.

GAO documents

Environmental Health: High-level Strategy and Leadership Needed to Continue Progress toward Protecting Children from Environmental Threats
GAO-10-205,  January 28, 2010
Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 83 pages)

Environmental Health: Opportunities for Greater Focus, Direction, and Top-Level Commitment to Children’s Health at EPA

GAO-10-545T,  March 17, 2010
Summary (HTML)   Full Report (PDF, 12 pages)

EPA’s response

Peter Grevatt, the director of EPA’s Office of Children’s Health Protection, stated in his written testimony:

EPA agrees that the GAO report reflects well the early history and progress of the Agency’s children’s health protection efforts. The report accurately portrays the Agency’s challenges in addressing children’s  environmental health, and sets forth sound recommendations on steps that could be taken to better incorporate protection of children’s health as an integral part of EPA’s everyday business.

Grevatt also noted that EPA Administrator Lisa Jackson had designated the protection of children’s health as one of her top priorities.  He then described how EPA would implement its strategy to protect children’s health.

EPA’s strategy on children’s health (starts on p.4 of the testimony—specific components are listed under each item in the testimony)

  1. EPA will use the best science to ensure that regulations provide for protection of children’s environmental health by actively addressing the potential for unique childhood vulnerability and exposure. Our goal is to reduce negative environmental health impacts on children through rulemaking, policy, enforcement and research that focus on prenatal and childhood vulnerabilities.
  2. Protecting children through safe chemicals management.
  3. Coordinate national and international community based programs to eliminate threats to children’s health while measuring and communicating our progress.

Children’s health protection at EPA

Office of Children’s Health Protection website

Basic information about the Office of Children’s Health Protection

America’s Children and the Environment

(more…)

March 10, 2010

The Breast Cancer Money-Go-Round

An older story, but it would be worth finding out how much, if anything, has changed over the last few years.

The Breast Cancer Money-Go-RoundBy Lynn Landes (AlterNet) (Oct. 23, 2002)
“Racing for the cure, but running from the cause.”
Most of the well-financed breast cancer organizations make little or no mention of the non-genetic causes of breast cancer. Go to their websites. Read their literature. These organizations don’t focus on the environmental and pharmacological causes of this epidemic because it’s a dank dark alley that leads right to their corporate sponsors.
Landes cites the Green Guide, a publication of the Green Guide Institute: “National Breast Cancer Awareness Month was established by Zeneca, a bioscience company….”  Zeneca had “sales of $8.62 billion in 1997. Forty-nine percent of Zeneca’s 1997 profits came from pesticides and other industrial chemicals, and 49 percent were from pharmaceutical sales, one-third (about $1.4 billion’s worth) of which were cancer treatment drugs.”
Landes also notes that General Electric, Rhone-Poulec, Rohm & Hass, Eli Lilly Novartis, American Cyanamid, and Dupont have all profited from both sides of the breast cancer epidemic.  She further notes that NIH and CDC have tended to side with corporate conglomerates by focusing more on the detection and cure side of the equation than on the identification and elimination of environmental causes.

Another example of the blatant conflict of interest (from the Breast Cancer Fund’s “Atrazine, Frogs and Breast Cancer“)

Dr. Tyrone Hayes at the University of California at Berkeley has spent his career examining atrazine and its effect on the growth and development of frogs. He has shown that atrazine chemically castrates and feminizes male amphibians in the wild and in the lab. He suggests that atrazine-induced deformities result from the depletion of androgens and production of estrogens, perhaps after atrazine increases the activity of aromatase.

When Dr. Hayes presents his research, he often tells this story: The maker of atrazine is Syngenta, a multi-national agrichemical corporation. Syngenta was formed in 2000, when another multi-national called Novartis merged their Crop Protection and Seeds businesses with Astra Zeneca’s Agrochemicals. What is interesting and very disturbing, he argues, is that Novartis is also the producer of Femara, the breast cancer drug discussed above. And so, Dr. Hayes points out, the very company that produces atrazine (that “turns on” aromatase, thereby increasing estrogen which can lead to breast cancer cell growth) is also producing — and selling at great profit — a medication that has the opposite effect (to “turn off” aromatase).

March 7 interview with Dr. Hayes on NPR (transcript & podcast) about the neutering effects of atrazine on male frogs.

State of the Evidence 2008 (edited by Janet Gray and published by the Breast Cancer Fund) is a report on environmental exposures linked to increased breast cancer risk.  You can download a PDF version from the Breast Cancer Fund’s website.

Rethink Pink NOW! Saner Solutions to Breast Cancer (Huffington Post, Oct. 21, 2009)

Helen Cordes discusses how the major breast cancer awareness programs avoid discussing environmental causes (as well as the impact of mammograms and mammography advice on breast cancer).

Critics such as veteran women’s health advocate and writer Barbara Ehrenreich note that AstraZeneca, long a leader in the global multi-billion-dollar breast cancer pharmaceuticals market, founded National Breast Cancer Prevention Month–the generator of Pink October frenzy–in 1985, when then-Zeneca was also in the business of making pesticides deemed “probable human carcinogens” by the EPA. NBCAM is still controlled by AstraZeneca and its single-minded ‘get-your-mammogram’ mantra echoed by cosponsoring radiological and oncology associations and cancer establishment organizations. Other breast cancer heavy-hitters such as the American Cancer Society and the Susan G. Komen Foundation are also too influenced by corporate backers, say critics such as Pink Ribbons Inc. author Samantha King and No Family History author Sabrina McCormick. The result (seen most clearly in NBCAM materials) is that breast cancer’s environmental causes are avoided or downplayed to focus instead on directives to get mammograms, stay fit, and when diagnosed, obey conventional treatment regimens. (emphasis added)

While personal actions are important, why not actually prevent cancer from developing in the first place by reducing exposure to carcinogens?  For example, benzene is defined by the National Toxicology Program as a known human carcinogen, and yet the NTP profile on benzene (see the profile for references) notes:

Benzene is used as an additive in gasoline, but it also is present naturally in gasoline, because it occurs naturally in crude oil and is a by-product of oil-refining processes. The percentage of benzene in unleaded gasoline is approximately 1% to 2% by volume.

In 2002, U.S. imports of benzene totaled over 4 billion liters (1.1
billion gallons), which greatly exceeded exports of 6 million liters (1.6 million gallons). This trend continued in 2003, during which 4.5 billion liters (1.2 billion gallons) were imported and 110 million liters (29 million gallons) were exported.

The U.S. Environmental Protection Agency’s Toxics Release Inventory listed 1,008 industrial facilities that released benzene into the environment in 2001. Reported benzene releases decreased from 34 million pounds (15,400 metric tons) in 1988 to 6 million pounds (2,700 metric tons) in 2001. In 2001, reported emissions to the air totaled 5 million pounds (2,300 metric tons), and reported discharges to surface water totaled 19,000 lb (8.6 metric tons).

And that’s just one chemical!

March 2, 2010

Endocrine Disruption Prevention Act of 2009

Important legislation authorizing the National Institute of Environmental Health Sciences to conduct a research program on endocrine disruption was introduced in the 111th Congress this past December.

Title: A bill to amend the Public Health Service Act to authorize the National Institute of Environmental Health Sciences to conduct a research program on endocrine disruption, to prevent and reduce the production of, and exposure to, chemicals that can undermine the development of children before they are born and cause lifelong impairment to their health and function, and for other purposes.

Both versions of the bill were introduced on Dec. 3, 2009, and were referred to committees in their respective chambers.

The bill has been endorsed by The Endocrine Society and the American Medical Association.

Here’s a bill status widget from OpenCongress.org:

S.2828 Feed-icon-10x10

Endocrine Disruption Prevention Act of 2009

  • Introduced: December 02, 2009
  • Status: Introduced
  • Next step: Senate Passes
  • Latest action: Sponsor introductory remarks on measure. (CR S12324)
  • Sponsor: Sen. John Kerry [D, MA]
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