All change is not growth; as all movement is not forward.
- Ellen Glasgow
Pity the poor Public Health research scientists! They just do not get any respect. An essay in the New England Journal of Medicine points to four reasons why Public Health research is rarely celebrated with outpourings of enthusiasm:
Reason #1: The benefits of Public Health tend to lie far in the future. We need to invest resources now in order for our children to reap the rewards later. Not a popular concept these days.
Reason #2: The names and faces of the people who will benefit are not known. The entire population might be healthier, but there is no way to know who, exactly, will remain healthy.
Reason #3: The people behind the initiatives are often unknown. Since the benefits are widespread and diffuse, there are only a few well-known heroes like Jonas Salk or John Snow.
Reason #4: People often resist altering the status quo. We do not like change even when it might be to our benefit.
Solid science often runs headlong into strongly held beliefs. This conflict came to mind recently as the Wisconsin legislature passed a bill to legalize direct-to-consumer sales of raw, unpasteurized milk.
The backers of the legislation hope to return raw milk to the societal acceptance it had in the 1920s, claiming that raw milk tastes better, is more natural, and has health benefits. Raw milk supporters also believe that pasteurized milk is less healthy than raw milk and might cause "everything from allergies to heart disease to cancer, but when Americans could buy Real Milk, these diseases were rare." Unfortunately for this particular argument, the leading causes of death in 1920 did include heart disease and cancer, as well as influenza/pneumonia, tuberculosis, stroke, kidney disease, accidents, diarrhea/enteritis, premature birth, and childbirth related conditions. The diarrheal diseases and infant deaths associated with contaminated raw milk consumption led to the pasteurization of all milk sold commercially in the United States.
So, what is the Public Health perspective? The CDC reports that raw milk can be contaminated with pathogenic bacteria including Brucella, Campylobacter, Listeria, Mycobacterium bovis, Salmonella, Shiga toxin-producing E. coli, Shigella, Streptococcus pyogenes, and Yersinia enterocolitica. At least 45 known outbreaks were reported to the CDC which resulted in over 1,000 illnesses and at least two deaths over a recent seven year period.
We all take risks every day. None of us is obligated to minimize our own personal exposure to things that might kill us. There are those who are well aware of the risks and still continue to smoke, sleep in the same bed with their infants, refuse to use seatbelts, drink and drive, decline vaccinations, forego exercise, abuse drugs, and eat poor quality diets.
I suspect, though, that the underappreciated Public Health scientists will continue to plug away, hoping to find ways of breaking through our resistance to living better, longer — and safer — lives.
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Hemenway D, New Engl J Med 2010 (May 6); 362:1657-1658.
The following is feedback received for this blog:
Interesting observation you have concerning raw milk. There are a lot of factors that I believe you may have overlooked to reach the conclusions you made. Raw milk advocates have research on their side as well, it is just being ignored. If you would take the time to research it a bit more thoroughly, I believe you would come to a much different conclusion than your current one.
- Karoline Rehm
Karoline - Can you share references to the research you mentioned?
- Ron Stubbers
