Thursday, January 14, 2010

A Different Curve from Dr. Alfred Sommer

Dr. Sommer and Professor Alcabes agree on a number of public health Issues. Both are highly critical of both the insurance and pharmaceutical industries and support the sort universal health care that is common in all other developed, industrial nations. Their approaches to the epidemiological issues are, however, quite distinct. Dr. Sommers accepts studies of the Body-Mass Index as indicative of a dangerous and costly 'epidemic' of obesity whereas professor Alcabes questions its direct correlation with increased incidence of diabetes or heart disease. Dr. Sommers praises Mayor Bloomberg's expensive anti-smoking crusade in N.Y.C whereas Prof. Alcabes questions whether the tax funds couldn't be spent on more useful measures with more lasting public health benefits like ready-access to routine medical care and better clinical practice. Dr. Sommers accepts findings about the deleterious effects of second-hand smoke which prof. Alcabes regards as dubious. Dr. Sommers goes out of his way to warn diners that rich carrot cake is not a healthy substitute for chocolate cream tortes, an admonishment which Prof. Alcabes would consider tantamount to "Please, folks, do not enjoy yourself and feel as fearful and guilty as possible when you do." Dr. Sommers is a big fan of Dr Frieden, current director of the Center for Disease Control (and a former colleague) whereas Prof. Alcabes puts him down. Although Dr. Sommer's discussion of the genetic component of disease disposition seems rather race-based and out of sync with the views of both Prof Alcabes and the notable Harvard-based evolutionary biologist Richard Lewontin- it is sufficiently obtuse, tangled and hedged to be only mildly offensive. All this confirms my view of Philip Alcabes as the Samuel R. Delany of the epidemiology crowd.

Dr. Sommers, however, does provide a lot of useful information. For example, the great decline in the common epidemic diseases which use to kill millions of people every year occurred before the vaccines now deployed to prevent them were put into widespread use. Improvements in standards of living- public sanitation, diet, housing and better working conditions- did the bulk of the work, at least in the developed world. He also points out the absurdity of spending 10's of billions of dollars researching new drugs and other prospective hybrid therapies but only a tiny fraction of that to find out which of them works most effectively in routine clinical settlings.

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