La confusion entre DT1 et DT2

Devinettes, indices et numéros discrets

Publié par Luc Perino, médecin généraliste, humeur du 03/04/2019

Première devinette.

Quelle est la maladie

  • dont on parle tous les jours sur tous les médias,
  • qui propose 25 millions d’entrées sur Google France,
  • qui fait l’objet de dix-mille publications par an dans de grandes revues scientifiques,
  • qui ne provoque aucun symptôme
  • et pour laquelle aucun médicament n’a la moindre efficacité ?

Si vous répondez le diabète, vous êtes à la fois étourdi et perspicace.

Etourdi comme la quasi-totalité des médecins, journalistes et patients qui ne savent pas que le mot diabète n’a aucune signification si l’on oublie de préciser de quel numéro il s’agit.

Perspicace, car c’est bien du diabète de type 2 (DT2) dont il s’agit. Cependant, dans tous les cas, vous avez tort, car le DT2 n’est pas une maladie, c’est simplement un facteur de risque pour d’autres maladies. C’est même un facteur de risque plus facile à éliminer que beaucoup d’autres.

Deuxième devinette.

Pourquoi oublie-t-on toujours de mentionner le numéro qui fait la différence entre ce facteur de risque gérable et la maladie auto-immune irréversible et gravissime qu’est le diabète de type 1 (DT1) ?

La réponse exige ici témérité et nécessite des indices.

  1. Premier indice. Pour faire disparaître le DT2, il faudrait réglementer sévèrement les sodas, l’automobile en ville, les distributeurs de sucreries, les écrans pour enfants, les aliments transformés, les escaliers roulants et tant d’autres succès de la technologie et moteurs de la croissance.
  2. Deuxième indice. Les médicaments du DT2 ne changent rien au risque de mortalité, mais le leurre individuel permet d’éviter les affres économiques du premier indice.
  3. Le troisième indice est lié aux gains faramineux du deuxième indice.

À ceux qui oseraient une réponse et proposeraient des solutions, il faudrait rappeler qu’aucun gouvernement au monde n’a encore imaginé de projet alternatif à la croissance.
On ne peut donc pas espérer mettre un terme prochain à la confusion entre DT1 et DT2.
Si je parle d’une science de faussaire, d’une terminologie trompeuse ou d’une médiatisation biaisée on m’accusera d’être un théoricien du complot.
Je devrai alors me contenter du principe de réalité en constatant que même la très austère HAS (Haute Autorité de Santé) ne parvient pas à la rigueur scientifique qui convient à ces deux diabètes si dissemblables, puisque le Conseil d’Etat a dû récemment abroger la fiche de transparence et les recommandations sur le DT2.

De quoi conclure que les numéros des diabètes seront discrètement oubliés pendant très longtemps et qu’il faudra plus longtemps encore pour oser affirmer que le numéro 2 n’est pas une maladie.

En Savoir Plus

Air pollution associated to psychotic experiences in young people

Association of Air Pollution Exposure With Psychotic Experiences During Adolescence

A new study finds that teens living in dirty air 70% more likely to have symptoms such as paranoia, the guardian reports. Image Duke University.

2019 Study Key Points

Question
Is exposure to air pollution associated with adolescent psychotic experiences?

Findings
In this nationally representative cohort study of 2232 UK-born children, significant associations were found between outdoor exposure to nitrogen dioxide, nitrogen oxides, and particulate matter and reports of psychotic experiences during adolescence. Moreover, nitrogen dioxide and nitrogen oxides together explained 60% of the association between urban residency and adolescent psychotic experiences.

Meaning
The association between urban residency and adolescent psychotic experiences is partly explained by the higher levels of outdoor air pollution in urban settings.

Abstract

Importance
Urbanicity is a well-established risk factor for clinical (eg, schizophrenia) and subclinical (eg, hearing voices and paranoia) expressions of psychosis. To our knowledge, no studies have examined the association of air pollution with adolescent psychotic experiences, despite air pollution being a major environmental problem in cities.

Objectives
To examine the association between exposure to air pollution and adolescent psychotic experiences and test whether exposure mediates the association between urban residency and adolescent psychotic experiences.

Design, Setting, and Participants
The Environmental-Risk Longitudinal Twin Study is a population-based cohort study of 2232 children born during the period from January 1, 1994, through December 4, 1995, in England and Wales and followed up from birth through 18 years of age. The cohort represents the geographic and socioeconomic composition of UK households. Of the original cohort, 2066 (92.6%) participated in assessments at 18 years of age, of whom 2063 (99.9%) provided data on psychotic experiences. Generation of the pollution data was completed on October 4, 2017, and data were analyzed from May 4 to November 21, 2018.

Exposures
High-resolution annualized estimates of exposure to 4 air pollutants—nitrogen dioxide (NO2), nitrogen oxides (NOx), and particulate matter with aerodynamic diameters of less than 2.5 (PM2.5) and less than 10 μm (PM10)—were modeled for 2012 and linked to the home addresses of the sample plus 2 commonly visited locations when the participants were 18 years old.

Main Outcomes and Measures
At 18 years of age, participants were privately interviewed regarding adolescent psychotic experiences. Urbanicity was estimated using 2011 census data.

Results
Among the 2063 participants who provided data on psychotic experiences, sex was evenly distributed (52.5% female). Six hundred twenty-three participants (30.2%) had at least 1 psychotic experience from 12 to 18 years of age. Psychotic experiences were significantly more common among adolescents with the highest (top quartile) level of annual exposure to NO2 (odds ratio [OR], 1.71; 95% CI, 1.28-2.28), NOx (OR, 1.72; 95% CI, 1.30-2.29), and PM2.5 (OR, 1.45; 95% CI, 1.11-1.90). Together NO2 and NOx statistically explained 60% of the association between urbanicity and adolescent psychotic experiences. No evidence of confounding by family socioeconomic status, family psychiatric history, maternal psychosis, childhood psychotic symptoms, adolescent smoking and substance dependence, or neighborhood socioeconomic status, crime, and social conditions occurred.

Conclusions and Relevance
In this study, air pollution exposure—particularly NO2 and NOx—was associated with increased odds of adolescent psychotic experiences, which partly explained the association between urban residency and adolescent psychotic experiences. Biological (eg, neuroinflammation) and psychosocial (eg, stress) mechanisms are plausible.

Stopping human-caused air pollution would prevent 5.6 million premature deaths per year

Effects of fossil fuel and total anthropogenic emission removal on public health and climate

If humans stopped emitting air, an astonishing 5.6 million premature deaths per year due to global outdoor air pollution could be prevented, according to research published Monday.

About 65% of these deaths are due to burning of fossil fuels, with the remainder due to such activities as biomass burning and agriculture. Eliminating human-caused air pollution would also significantly reduce drought in monsoon regions, but it would allow more sunlight to reach the surface, increasing Earth’s surface temperature by at least 0.36°C (0.65°F). Overall, the effects would be hugely beneficial, Wunderground reports.

Significance

We assessed the effects of air pollution and greenhouse gases on public health, climate, and the hydrologic cycle. We combined a global atmospheric chemistry–climate model with air pollution exposure functions, based on an unmatched large number of cohort studies in many countries. We find that fossil-fuel-related emissions account for about 65% of the excess mortality rate attributable to air pollution, and 70% of the climate cooling by anthropogenic aerosols. We conclude that to save millions of lives and restore aerosol-perturbed rainfall patterns, while limiting global warming to 2 °C, a rapid phaseout of fossil-fuel-related emissions and major reductions of other anthropogenic sources are needed.

Abstract

Anthropogenic greenhouse gases and aerosols are associated with climate change and human health risks. We used a global model to estimate the climate and public health outcomes attributable to fossil fuel use, indicating the potential benefits of a phaseout. We show that it can avoid an excess mortality rate of 3.61 (2.96–4.21) million per year from outdoor air pollution worldwide. This could be up to 5.55 (4.52–6.52) million per year by additionally controlling nonfossil anthropogenic sources. Globally, fossil-fuel-related emissions account for about 65% of the excess mortality, and 70% of the climate cooling by anthropogenic aerosols. The chemical influence of air pollution on aeolian dust contributes to the aerosol cooling. Because aerosols affect the hydrologic cycle, removing the anthropogenic emissions in the model increases rainfall by 10–70% over densely populated regions in India and 10–30% over northern China, and by 10–40% over Central America, West Africa, and the drought-prone Sahel, thus contributing to water and food security. Since aerosols mask the anthropogenic rise in global temperature, removing fossil-fuel-generated particles liberates 0.51(±0.03) °C and all pollution particles 0.73(±0.03) °C warming, reaching around 2 °C over North America and Northeast Asia. The steep temperature increase from removing aerosols can be moderated to about 0.36(±0.06) °C globally by the simultaneous reduction of tropospheric ozone and methane. We conclude that a rapid phaseout of fossil-fuel-related emissions and major reductions of other anthropogenic sources are needed to save millions of lives, restore aerosol-perturbed rainfall patterns, and limit global warming to 2 °C.

40 years after exposure, Pesticide linked to higher breast cancer risk

DDT and Breast Cancer: Prospective Study of Induction Time and Susceptibility Windows

According to a recent study, DDT exposure before puberty may have increased the breast cancer risk for women in their 50s. Study is the latest to suggest early-life exposures, even prior to birth, may hold the key to understanding who gets diseases, Environmental Health News reports.

2019 Study Abstract

Background
In a previous Child Health and Development Studies report, p, p’-DDT was associated with a fivefold increased risk of premenopausal (before age 50 years) breast cancer for women first exposed before puberty. Here we extend our observation to breast cancer diagnosed during early postmenopause (ages 50–54 years) to determine whether age at diagnosis modifies the interaction of DDT with age at exposure.

Methods
We conducted a second prospective, nested case-control study in the Child Health and Development Studies (153 incident breast cancer cases diagnosed at ages 50–54 years and 432 controls matched to cases on birth year). These were analyzed separately and pooled with our previous study (129 breast cancer cases diagnosed at ages 31–49 years and 129 controls matched on birth year). Blood samples were obtained during pregnancy (median age, 26 years), 1–3 days after delivery from 1959 to 1967 in Oakland, California. Serum was assayed for p, p’-DDT, o, p’-DDT, and p, p’-DDE. Odds ratios (ORs) below are given for doubling of serum p, p’-DDT. All statistical tests were two-sided.

Results
For early postmenopausal breast cancer, p, p’-DDT was associated with risk for all women (ORDDT 50–54 = 1.99, 95% CI = 1.48 to 2.67). This association was accounted for by women first exposed to DDT after infancy (ORDDT 50–54 for first exposure after infancy = 2.83, 95% CI = 1.96 to 4.10 vs ORDDT 50–54 for first exposure during infancy = 0.56, 95% CI = 0.26 to 1.19; Pinteraction DDT x age at first exposure = .01). In contrast, for premenopausal breast cancer, p, p’-DDT was associated with risk among women first exposed during infancy through puberty, but not after (ORDDT<50 for first exposure during infancy = 3.70, 95% CI = 1.22 to 11.26, Pinteraction DDT x age at first exposure x age at diagnosis = .03).

Conclusions
p, p’-DDT was associated with breast cancer through age 54 years. Risk depended on timing of first exposure and diagnosis age, suggesting susceptibility windows and an induction period beginning in early life. DDT appears to be an endocrine disruptor with responsive breast targets from in utero to menopause.

IMMDS Review listens to Professor John Abraham about Primodos

Independent Medicines and Medical Devices Safety Review Oral Hearing, 27th November 2018

The Independent Medicines and Medical Devices Safety Review is Chaired by Baroness Julia Cumberlege CBE DL.

In February 2018, the Secretary of State for Health and Social Care, the Rt Hon Jeremy Hunt MP, announced a review into how the health system responds to reports from patients about harmful side effects from medicines and medical devices. The announcement in the House of Commons follows patient-led campaigns on the use of the hormone pregnancy test Primodos, anti-epileptic drug sodium valproate and surgical mesh.

About Primodos

  • Read and/or download the full study (free access) Oral hormone pregnancy tests and the risks of congenital malformations: a systematic review and meta-analysis, F1000Research, First published 31 Oct 2018, 7:1725, DOI:10.12688/f1000research.16758.1.
  • Read and/or download the full study (free access) The Primodos components Norethisterone acetate and Ethinyl estradiol induce developmental abnormalities in zebrafsh embryos, nature, Published 13 Feb 2018, DOI:10.1038/s41598-018-21318-9.
  • To read some real stories told by the Primodos victims, go to this post comment section.  Read our posts tagged primodos.

Fracking linked to increased hospitalizations for skin, genital and urinary issues

Unconventional natural gas development and hospitalizations: evidence from Pennsylvania, United States, 2003–2014

According to a new study, rashes, urinary tract infections, and kidney stones requiring hospital stays are more common in areas with more drilling, Environmental Health News reports.

Highlights

  • Long-term exposure to unconventional drilling may be harmful to population health.
  • Genitourinary and skin-related hospitalization rates increase with drilling.
  • Healthcare professionals should encourage exposed individuals to seek care early.
  • Research into the causal mechanisms is warranted.

Abstract

Objectives
To examine relationships between short-term and long-term exposures to unconventional natural gas development, commonly known as fracking, and county hospitalization rates for a variety of broad disease categories.

Study design
This is an ecological study based on county-level data for Pennsylvania, United States, 2003–2014.

Methods
We estimated multivariate regressions with county and year fixed effects, using two 12-year panels: all 67 Pennsylvania counties and 54 counties that are not large metropolitan.

Results
After correcting for multiple comparisons, we found a positive association of cumulative well density (per km2) with genitourinary hospitalization rates. When large metropolitan counties were excluded, this relationship persisted, and positive associations of skin-related hospitalization rates with cumulative well count and well density were observed. The association with genitourinary hospitalization rates is driven by females in 20–64 years group, particularly for kidney infections, calculus of ureter, and urinary tract infection. Contemporaneous wells drilled were not significantly associated with hospitalizations after adjustment for multiple comparisons.

Conclusions
Our study shows that long-term exposure to unconventional gas development may have an impact on prevalence of hospitalizations for certain diseases in the affected populations and identifies areas of future research on unconventional gas development and health.

IMMDS Review listens to Dr Jesse Olszynko-Gryn about Primodos

Independent Medicines and Medical Devices Safety Review Oral Hearing, 26th November 2018

The Independent Medicines and Medical Devices Safety Review is Chaired by Baroness Julia Cumberlege CBE DL.

In February 2018, the Secretary of State for Health and Social Care, the Rt Hon Jeremy Hunt MP, announced a review into how the health system responds to reports from patients about harmful side effects from medicines and medical devices. The announcement in the House of Commons follows patient-led campaigns on the use of the hormone pregnancy test Primodos, anti-epileptic drug sodium valproate and surgical mesh.

About Primodos

  • Read and/or download the full study (free access) Oral hormone pregnancy tests and the risks of congenital malformations: a systematic review and meta-analysis, F1000Research, First published 31 Oct 2018, 7:1725, DOI:10.12688/f1000research.16758.1.
  • Read and/or download the full study (free access) The Primodos components Norethisterone acetate and Ethinyl estradiol induce developmental abnormalities in zebrafsh embryos, nature, Published 13 Feb 2018, DOI:10.1038/s41598-018-21318-9.
  • To read some real stories told by the Primodos victims, go to this post comment section.  Read our posts tagged primodos.

IMMDS Review listens to Professor Carl Heneghan about Primodos Studies

Independent Medicines and Medical Devices Safety Review Oral Hearing, 27th November 2018

The Independent Medicines and Medical Devices Safety Review is Chaired by Baroness Julia Cumberlege CBE DL.

In February 2018, the Secretary of State for Health and Social Care, the Rt Hon Jeremy Hunt MP, announced a review into how the health system responds to reports from patients about harmful side effects from medicines and medical devices. The announcement in the House of Commons follows patient-led campaigns on the use of the hormone pregnancy test Primodos, anti-epileptic drug sodium valproate and surgical mesh.

About Primodos

  • Read and/or download the full study (free access) Oral hormone pregnancy tests and the risks of congenital malformations: a systematic review and meta-analysis, F1000Research, First published 31 Oct 2018, 7:1725, DOI:10.12688/f1000research.16758.1.
  • Read and/or download the full study (free access) The Primodos components Norethisterone acetate and Ethinyl estradiol induce developmental abnormalities in zebrafsh embryos, nature, Published 13 Feb 2018, DOI:10.1038/s41598-018-21318-9.
  • To read some real stories told by the Primodos victims, go to this post comment section.  Read our posts tagged primodos.

IMMDS Review listens to Journalist Jason Farrell about Primodos

Independent Medicines and Medical Devices Safety Review Oral Hearing, 26th November 2018

The Independent Medicines and Medical Devices Safety Review is Chaired by Baroness Julia Cumberlege CBE DL.

In February 2018, the Secretary of State for Health and Social Care, the Rt Hon Jeremy Hunt MP, announced a review into how the health system responds to reports from patients about harmful side effects from medicines and medical devices. The announcement in the House of Commons follows patient-led campaigns on the use of the hormone pregnancy test Primodos, anti-epileptic drug sodium valproate and surgical mesh.

About Primodos

  • Read and/or download the full study (free access) Oral hormone pregnancy tests and the risks of congenital malformations: a systematic review and meta-analysis, F1000Research, First published 31 Oct 2018, 7:1725, DOI:10.12688/f1000research.16758.1.
  • Read and/or download the full study (free access) The Primodos components Norethisterone acetate and Ethinyl estradiol induce developmental abnormalities in zebrafsh embryos, nature, Published 13 Feb 2018, DOI:10.1038/s41598-018-21318-9.
  • To read some real stories told by the Primodos victims, go to this post comment section.  Read our posts tagged primodos.

IMMDS Review listens to Professor Neil Vargesson about Primodos Studies

Independent Medicines and Medical Devices Safety Review Oral Hearing, 27th November 2018

The Independent Medicines and Medical Devices Safety Review is Chaired by Baroness Julia Cumberlege CBE DL.

In February 2018, the Secretary of State for Health and Social Care, the Rt Hon Jeremy Hunt MP, announced a review into how the health system responds to reports from patients about harmful side effects from medicines and medical devices. The announcement in the House of Commons follows patient-led campaigns on the use of the hormone pregnancy test Primodos, anti-epileptic drug sodium valproate and surgical mesh.

About Primodos

  • Read and/or download the full study (free access) Oral hormone pregnancy tests and the risks of congenital malformations: a systematic review and meta-analysis, F1000Research, First published 31 Oct 2018, 7:1725, DOI:10.12688/f1000research.16758.1.
  • Read and/or download the full study (free access) The Primodos components Norethisterone acetate and Ethinyl estradiol induce developmental abnormalities in zebrafsh embryos, nature, Published 13 Feb 2018, DOI:10.1038/s41598-018-21318-9.
  • To read some real stories told by the Primodos victims, go to this post comment section.  Read our posts tagged primodos.