Tuesdays with Tim

Tobacco and the decline of heart disease

Submitted by Tim.Byers on Tue, 01/31/2012 - 09:15

In the January 5, 2012 issue of the New England Journal of Medicine Drs.

Four good wishes for 2012

Submitted by Tim.Byers on Fri, 12/30/2011 - 13:51

This is the time when we make resolutions and wishes for the New Year.  I am not big on resolutions, but I do like wishes.  Here are four good wishes I will offer:

  1.  I wish for stability.  The World has enough challenges now, and we don’t really need any big bad surprises in 2012.  A year of unusual stability that could enable us all to move predictably forward would be good.
     
  2. I wish for a new attitude about health care.  The growing cynicism about our health care system has eroded public confidence to the point where effective

Criminal Indifference

Submitted by Tim.Byers on Wed, 11/30/2011 - 14:39

You Seinfeld enthusiasts might be familiar with the crime of “criminal indifference.”  That was that charge against Jerry, Elaine, George, and Kramer in the final episode of the Seinfeld series.  They were convicted, of course, based on their many examples of self-indulgent indifference to others over the years.

The term “criminal indifference” came to mind to me today as I read a new report about how tobacco settlement and tax funds are being used in the United States.   That report (“A Broken Promise to our Children”, available online at

Drug Money

Submitted by Tim.Byers on Fri, 11/04/2011 - 13:01

There are now historic shortages of many prescription drugs in the United States.  The reasons for these shortages are said to be complex, but really they are pretty simple.   It is about making money.  Here is the story in a nut shell:

Pharmaceutical companies make most of their money on brand-name drugs.

Humbled again by the second tail

Submitted by Tim.Byers on Tue, 10/25/2011 - 07:07

In statistical testing of any intervention trial it is best to consider that either benefit or risk might result from the intervention.  With any set of possible outcomes from a trial, there is a distribution of possible values ranging from low-likelihood extreme benefits to low-likelihood extreme hazards, with the more likely outcomes of either no effect or only modest effects residing in the middle.

Unspoken Love

Submitted by Tim.Byers on Wed, 09/21/2011 - 12:35

My favorite definition of epidemiology is that it is the story of human suffering with the tears wiped away.

A sketch on a napkin: visualizing the U.S. Prevention System

Submitted by Tim.Byers on Tue, 08/30/2011 - 08:56

There has been a lot of attention on the question of evolving the patchwork of systems we now have for health care in the U.S. into a more rational and coherent single system.  As we strain to visualize a more functional future U.S. Health Care System, maybe we should also take a stab at more specifically designing the U.S.

Cheers for a Public Health Home Run

Submitted by Tim.Byers on Fri, 08/12/2011 - 14:17

I am a baseball fan, so I love to jump to my feet and cheer a home run.

I just now opened up the August 11 issue of the New England Journal of Medicine.  There is a clear public health homerun in the lead article (Prevention of HIV-1 infection with early antiretroviral therapy.  Cohen MS et al.  NEJM 2011; 365:493-505).  

This paper describes a randomized controlled trial done in 9 countries.  Partners who were discordant for HIV infection (i.e., one partner was infected and one not) were randomized to receive antiretroviral treatment right away

Downstream Prevention

Submitted by Tim.Byers on Mon, 07/18/2011 - 08:52

There is an old metaphorical story about prevention that involves dead bodies in a river.  I first read this story as an MPH student in 1978, somewhere deep in the stacks of journals at the University of Michigan School of Public Health.

Since Last Tuesday

Submitted by Tim.Byers on Tue, 06/28/2011 - 08:06

It has been more than a couple of Tuesdays since I last wrote.  Lots have happened, and lots are on my mind.

Since I last wrote I have traveled to exotic places – Scotland and Pueblo.  One to address the Royal Society of Edinburgh on cancer prevention and one to facilitate planning about community health workers.  Both were fun.

Then there was the NCI site visit for our Cancer Center renewal: 30 peer reviewers judging our $45 million funding request, and only 8 hours to get it right.  Apart from their shuttle bus not showing up, the visit went very well.&

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