Friday, March 28, 2014

Clearing the air, and our heads.

I find it rare that I disagree with my public health colleagues. Oh sure, there's a disagreement here and there about the specifics, but it's been a while since the public health community has found itself fairly divided and kind of all over the spectrum on an issue. But it's happening now, all thanks to the e-cigarette.

While it's not entirely clear, the overall feeling I'm getting is that the public health community is preparing for a war against these battery-powered cigarettes. I could be wrong about this - but consider the official statements by certain key health organizations on the issue. The WHO cautions consumers against using e-cigarettes until proven safe and effective, and the American Lung Association's official statement on the twigs warns mostly against their potential harms. Advice from Health Canada and other agencies march to the same drum. 

Ok. So far, I'm towing the line. Warning against the potential harms of  product is fine. While it's certainly not something we do for every new product on the market, there's reason to think that e-cigarettes require extra oversight. One is loose labeling. We've seen some tests that show that e-cigarettes labeled as "nicotine-free" actually do contain nicotine, leading to a worry nicotine poisoning amongst the unsuspecting. 

One of the main concerns with e-cigarettes appears to be the potential for re-normalizing smoking. We've worked so long and hard to remove the cool factor from smoking, that we're terrified that this new product, with it's shiny lights and fun flavours, will bring smoking back into the mainstream. 

This fear however, has led to hasty activity and in my mind, a gross overreaction. I'm all for regulation ensuring people are getting a safe product, and that they know what they're getting, but jurisdictions (like Nova Scotia and Philadelphia)  are now moving towards banning e-cigarettes where they can. Let's be clear about what this means. People are now banning a product that 1) Has not been shown to be overall harmful, neither on an individual or population basis, 2) That may in fact have benefits to a population (i.e. smokers) who have substantially higher than average morbidity and mortality rates, and 3) Even if it does have direct health impacts on the user, it does not have a direct health impact on those around them, such as the case with regular cigarette smoke. 

I think it's time that public health takes a collective breath, and calm down. I know everyone wants to take a strong stance, but sometimes, it's ok to wait. Quitting smoking is hard - don't we owe it to the people trying to do the studies to find out if this can be an effective tool for smoking cessation? Even if it's not, are province-wide bans warranted? To be honest, while I am now aware of the some of the potential harms of e-cigarettes, when I first heard of them, I immediately thought "What a great harm reduction tool for people who smoke." I don't think we're ready to say that e-cigs are a benefit to society, but I'm surprised and disappointed to see how quickly and urgently we seem to be moving in the opposite direction. For most other contentious issues in public health, I rely on the science to back me up. Let's do the same for e-cigs.

Sunday, October 14, 2012

Falling behind without harm reduction

Last month, four AIDS advocacy programs and one former prison inmate took the unconventional, and rather inspired, step of suing the Canadian federal government for not providing a clean needle exchange program to the country’s prison inmates. Their argument, based on the premise that the government must provide prisoners access to the same healthcare services as would be available to them in the community, is unlikely to succeed in Canada’s courts. It does, however, bring to the forefront important public health issue.

Tuesday, May 1, 2012

Has it been four years already? Micronutrients Redux

There was an interesting article published by Slate late last week about a topic that I discuss in one of my first posts - the undeniably important role of micronutrients, particularly in developing countries, on global health. While there are many prominent issues that have a resounding impact on population health in many poor countries of the world, treatment deficiencies in micronutrients stands out due to it's relative economic feasibility.

Under New Leadership

On Monday April 16, 2012, the World Bank Group announced US nominee Jim Yong Kim as its next President, succeeding Robert Zoellick to become the twelfth leader of the world’s premier development organization. Despite his undeniably impressive accomplishments, the choice of Kim by the World Bank has been the brunt of much criticism, from the worlds of finance and international development alike.

Monday, April 30, 2012

Justice by Jury?

Let's start the week with a story hitting close to home. Jury selection starts today in Ottawa for what is sure to a be a complicated, long-lasting, emotionally draining, not to mention historic trial.

The accused in this case is 39-year old Jacques Mungwarere, arrested in 2009 in Windsor for his alleged participation in the 1994 Rwandan Genocide. Mungwarere specifically is accused to have participated in the mass killing in two schools and one hospital.

Friday, April 27, 2012

Justice for Sierra Leone

Advocates of international justice rejoiced this past Thursday, as some justice has been delivered to the former leader of the war-torn Liberia, Charles Taylor.

After being on trial for almost five years, the Special Court for Sierra Leone (SCSL) found Taylor guilty on 11 counts including terrorism, rape, slavery, use of child soldiers and other crimes against humanity. This verdict is significant not only being it represents the first head of state that has been convicted for atrocities that occurred in Sierra Leone during the civil war of the 1990s, but also as Taylor is the first head of state to be convicted of sexual crimes by an international tribunal.

Saturday, April 21, 2012

At Last, Potential Recognized: Micronutrients

Over the past several decades, micronutrients have never received the same media attention as other global health issues such as HIV/AIDs control or malaria. Yet despite their lack of fame, research in the field has proven repeatedly and consistently that micronutrients contain vital health benefits.