Wednesday, February 26, 2014

The Workplace ECO Committee

I'm a member of the ECO Committee at my work. We try to come up with ways that we as employees and our employer alike can be more conscious of and therefore mitigate the negative impact we have on our environment. There's a few initiatives that we run, based on industry best-practices. These include:
  1. encouraging recycling and composting by staff => using signage to promote proper garbage sorting (what's really garbage, recyclable, and compostable) and providing relevant bins; 
  2. sorting of garbage by maintenance staff;
  3. running educational and awareness-raising campaigns using print and electronic media; 
  4. organizing agency-wide events such as Spring Clean-up Day, guest speakers, etc.; 
  5. working with management to improve certain policies (e.g., all computers are set up to always print double-sided, buy materials that are earth-friendly whenever possible). 
Our organization even has solar panels and a complex computer system to manage electricity use - after a few years, we are running a surplus, which can be sold back to the grid. This system can even calculate the C02 emissions that are saved.  

I am happy to say that my organization does quite a lot for the environment. This will eventually come full circle and positively impact human health. We on the committee are always grappling with ways in which we can improve as individuals and as an organization. I've recently been tossing three ideas around in my head.

The first is to encourage staff to bring in reusable containers and coffee mugs to use when buying lunch/hot drinks. This will reduce packaging, such as styrofoam that is recycled or thrown away. It necessitates staff remembering to bring these things in. I don't have great faith in memory unless we have adequate awareness-raising and incentive programs, at least at the outset.

The second is to create a green roof. We have lots of space on the roof and it is flat. I am guessing, however, that this will require quite an investment by the organization, in terms of buying materials and maintenance costs. I'm not entirely certain if it is structurally possible either. 

The last is a bit more contentious. The organization is not located downtown and many staff live in suburban or rural areas, which makes taking the car the only feasible option. One idea to reduce driving is to encourage people to park further away from work, and walk, say 10-20 min the rest of the way. This would involve identifying areas where staff are allowed to park for the entire day, without penalty from the City or other organizations. This is an idea that has come up in the child active transportation literature. I'm just not sure that it will be feasible without changing at least the organizational culture towards driving, and recognizing that this does not have to be an all or nothing endeavor - one or two days a week would be something!
Recently at a committee meeting, it was brought up that we don't always tangibly know how certain interventions translate into say C02 emissions savings (other than our electrical system). We've been basing our initiatives on best-practices, but yes, this is important to know. Especially in terms of where we divert most of our efforts. I plan to research this; something that is certainly out of my domain of expertise. Please, business/environmental/sustainability people, show me the way to the relevant science literature!

If you don't already have one, think about organizing an ECO (or green or whatever) committee in your place of work. It's about reducing impact on the environment, but ultimately it's about improving human health. You already do it a home, why not help your workplace and fellow co-workers?


Monday, September 16, 2013

The science of scientific reporting - we suck at communicating our results to the public

One of my favourite PhD comics is "The Science News Cycle." I think it adequately portrays one of science's fundamental flaws, communicating research findings to Joe Public. Or, in the case of the comic, grandma.

Knowledge exchange. Even the phrase is jargon. As researchers, we don't do it very well. We write up our research for the scientific community with the ultimate goal of publishing articles in scientific journals, and of course, eventually the Lancet or The New England Journal of Medicine. Although, most of us PhDs and post-docs are happy to have publications, period. 

Each discipline has its own jargon. You need to speak and of course understand the jargon to get published.  But what about cross-disciplinary endeavours? Can we understand each other? It's a resounding no. Take me for example. For topics related to but outside my domain of expertise, I often have difficulty reading and fully understanding what is being communicated to me (I had a PhD last time I checked). Statistical papers are my number one nemesis. I often come across papers with complex formulas derived from first principles, when all I am looking for is a more detailed "applied" understanding of the method. So, even within academia we speak foreign languages, it is no wonder Joe Public has a hard time. 

You may be familiar with the quote: "Data is not the plural of anecdote," from Roger Brinner. Based on my training and experience, you cannot plan programs or develop policy based on an anecdote, or an n of 1. But all too often, journalists reduce research to anecdotes, a story of how Sally used shark-fin soup to cure cancer and now lives life to the fullest with her three-legged, rescued cat named Jesus. Journalists do this because it's catchy, simple to understand, and brings the story to the reader or listener at a personal level; plays on emotions and perhaps, past experiences. Vincent Lam, award winning author and emergency medicine doctor, recently spoke about the importance of a narrative to a room full of Queen's University medical students, emphasising that telling a story can make you a better doctor. Anecdotes break through the jargon. But all too often, messages get twisted or misunderstood anyway.  

 I don't claim to know how to do this. I don't know how to report research results responsibly AND make them interesting AND catchy AND easy to understand. It's something I struggle with as an epidemiologist and public health researcher, especially with a topic as complicated as obesity.   

Obesity is not a behaviour like smoking. One of its main contributors is diet, but unlike smoking, we can't quit eating. It's complex. Take, for example, the work the Foresight Group has done to characterize obesity as a complex, adaptive system (CAS), complete with feedback loops. 

A CAS is defined as being: "composed of many heterogeneous pieces interacting with each other in subtle or non-linear ways that strongly influence the overall behaviour of the system" (SCPHRP, 2011)

I think this CAS perspective is important, but its incredibly messy. How in the world can we talk tangibly about this to the public? 

When considering obesity as a CAS, two basic principles also need to be underlined (SCPHRP, 2011):
1) Single interventions probably won't work on their own
2) Many small changes may lead to cumulative improvements

So, what does this mean? Reporting the results of single studies, then reducing them to anecdotes probably won't help in making things clearer. In fact, I think this is what we're doing when we do that:

Cartoon by Jim Borgman, first published by the Cincinnati Inquirer and King Features Syndicate 1997 Apr 27; Forum section: 1 and reprinted in the New York Times, 27 April 1997, E4.

Perhaps we need a new field - a degree that comprises an undergrad, masters, and PhD, which merges epidemiology, population health, and journalism/communication, and miraculously turns people into Dr. David Katz. Maybe we should stop making a big deal out of single studies? Open access journals are increasing and researchers are also paying traditional publishers to have their articles be made open access, so I doubt this is feasible. What are your thoughts? Should we only be reporting the results of well conducted systematic reviews and some how developing them into short narratives? How should we be reporting complex aetiological and intervention population health research that engages the public? Government Office for Science (2007). Tackling Obesities: Future Choices – Project Report 2nd Edition FORESIGHT Programme

Friday, April 5, 2013

Tips for safely commuting by bike

I am sharing a modified presentation that I did some time ago for my old Toastmasters club in Ottawa.  I am passionate about active transportation and cycling in particular, and promote it as often as I can. This presentation is based on a blog post in Bicycling Magazine (hopefully it's okay that I used it and modified it a bit :S) set to one of my favourite songs by Queen (again, hopefully this isn't a copyright issue but I thought  the song was too perfect to pass up, we'll see if I have to take it down at a later date). 

Sunday, March 3, 2013

Do the right thing Tim Hortons

cc image

It's that time of year again, yes it's "Roll up the Rim to Win" at Tim Hortons.  For anyone who is unaware of this phenomenon, Tim Horton's is a Canadian coffee institution (I have no idea why, but I still buy it) and Roll up the Rim to Win is a marketing ploy to get us to buy more coffee. Every time we buy a coffee, we're essentially playing the lottery, to win anything from donuts to a BBQ or even a car.  I believe that Americans are also subjected to this chaos, but I'm not sure how much Tim Hortons has infiltrated our southerly neighbours. In Canada, having a Tim Hortons is more important than having a hospital, police department, or grocery store.   

Consumer marketing. It's everywhere. That's not my problem for once. The problem I have is that I and many others make a concerted effort to reduce garbage in landfills by bringing in our own travel mugs. This initiative totally dissuades anyone from doing any good. The other day, I brought in my mug,  got it filled, but was given an empty cup anyway, to "roll up". I paused for a minute. Do I say, "nah, just keep the cup," thereby allowing the server to keep it for herself or give to the next guy for free and he/she happens to win the Rav4? I couldn't take that chance (I live in a capitalist society after all), so I took the cup, rolled up the rim, won a coffee, saved the rim and threw the rest of the cup out.  That totally defeats the purpose of bringing in my own mug - now when I go for a coffee break at work, I don't bring my own mug.  Tim Horton's you are undermining me!    

The take-home message for Tim Hortons is that they should be environmentally responsible and devise a secondary way to roll up the rim for those who bring in their own mugs. A colleague at work suggested "spinning a wheel." I like that idea, or even providing a mini rim (the thing you keep anyway if you win) so that you don't end up throwing out the entire cup!   Do it Tim Hortons, do the right thing.

Saturday, January 12, 2013

On Obesity Panacea: Measuring change in child weight status in relation to local environmental factors

Just recently a colleague and friend of mine, Travis Saunders, asked me to guest post on his blog: Obesity Panacea - a highly cited obesity blog, hosted by the Public Library of Science Blog Network. The post highlights a portion of my PhD work investigating how change in child weight status relates to local environmental factors. You can access the post here. The papers on which my post focus on can be found below. Carter MA, Dubois L, Tremblay MS, & Taljaard M (2012). The Influence of Place on Weight Gain during Early Childhood: A Population-Based, Longitudinal Study. Journal of urban health : bulletin of the New York Academy of Medicine PMID: 22806452

Carter MA, Dubois L, Tremblay MS, Taljaard M, & Jones BL (2012). Trajectories of childhood weight gain: the relative importance of local environment versus individual social and early life factors. PloS one, 7 (10) PMID: 23077545

Tuesday, November 20, 2012

The precautionary principal in the garden of obesogens

*Safe* water bottles?
Creative Commons image

Today's post is a follow-up to the previous post on the pervasiveness of environmental contaminants and pollutants and the potential link to obesity, particularly in utero. As I left off, much research remains to be conducted to definitively link specific industrial chemicals (known endocrine disruptors), which are highly prevalent in our society, to obesity.

The precautionary principal is used to protect public health and has various interpretations. In general, it says that complete evidence of harm does not have to exist before steps can be taken to protect members of society from harm (Weir et al, 2010). In this post, I'd like to discuss a Canadian-specific framework for applying the precautionary principal in relation to suspected obesogens, public health, environmental health, and our overall North American lifestyle.

 Historically, there has been a general failure in North America and Europe to determine potential negative public health and environmental effects from industrial chemicals before manufacture and widespread use (Wordsworth et al, 2007).  This likely explains why every person or animal that has ever been tested has had detectable levels of endocrine-disruptors in their bodies.
"An analysis by the Environmental Protection Agency in 1998 found that, of the 3,000 chemicals that are used in the highest volumes in the United States (3), forty-three per cent had no testing data at all that would establish their basic toxicity. Only 7 per cent had a full set of safety tests (4). For chemicals used in lower volumes, even less information was available (5)." (Wordsworth et al, 2007).
The European Union is no better. And we Canadians don't have a lot to be proud of either:
More recently, in September 2006 the Canadian government concluded one of the most extensive reviews of substances ever undertaken. The government identified more than 4,000 suspect chemicals in Canada with the potential to be persistent, bioaccumulative and “inherently toxic” (8)." (Wordsworth et al, 2007).
Does this mean that the precautionary principal is not relevant? If the link between certain endocrine-disruptors and obesity is found to be causal, is it already too late? I think it's a no to both, but truly unfortunate to have to put ourselves in this situation in the first place. Applying the principal, particularly when it has to do with the environmental sector and public health, is far from straightforward, as you will see.

Weir et al (2010) propose a framework for applying the precautionary principal in Canada (10 Guiding Questions). There are two parts. The first assesses the degree of certainty to which the relationship between a risk (in this case certain chemicals) and harm (obesity and other potential health outcomes) can be considered causal. They use Sir Bradford Hill's 9 criteria for causation. Anybody with an epidemiology background should know what these are. I'm not going to list them here, simply because they're not really necessary for what I am going to talk about. What I am interested about is the second part, the remaining 9 questions, and Weir et al's discussion.
2. Is the harm associated with the suspected exposure serious?
3. Is the suspected exposure widespread?
4. Is there an observed increase in the incidence of the suspected harm that is temporally associated with increased exposure?
5. Is the harm associated with the suspected exposure difficult to treat or reverse?
6. What are the economic and non-economic costs and benefits of action and non-action?
7. Are the proposed control measures proportional to the level of risk? Are the economic costs of removing the exposure minimal? Are the health and societal costs of removing the exposure minimal?
8. Are comparable situations being treated similarly according to a standard of practice?
9. Is the level of the protective measures consistent with equivalent areas in
which scientific data are available?
10. If precautionary measures are adopted, is there any new evidence to reduce the level of uncertainty about harm and benefit?

Going by these questions, yes obesity is serious and yes exposure is widespread. I would say that at this point, #4 can only be answered in animal studies. Obesity has been difficult to treat and reverse and it has multiple determinants. Number 6 and 7 are where it starts to get tricky. Because obesity has multiple determinants (i.e. is complex) and because of lack of evidence, it's hard to say whether decreased use of these chemicals would result in less obesity and related diseases and therefore lower healthcare costs and other indirect costs like absenteeism/presenteeism. 

Weir et al contend that the appropriateness of applying the precautionary principal increases "when the economic and social costs of removing the exposure are small relative to the suspected harm." These chemicals no doubt make life easier for us - are we willing to give up a certain level of convenience to live without them, at least until adequate replacement substances are found (I have faith in technology to remedy this gap rather quickly)? Are we willing to knowingly gamble with our economy? I could answer for myself, but I'm sure that many others would disagree, some with valid points. 

At the same time, Weir et al add that appropriateness of applying the principal increases "when the health costs of removing the exposure are minimal; and when, in addition to the uncertain harms, there are known health, economic or social harms caused by the exposure." I can't see health costs associated with removing obesogens; worse case,  procedures with medical equipment made with obesogens are no longer possible until replacement substances are found. Obesogens also have known negative impacts on the environment and suspected health impacts that go beyond obesity. I am unaware of comparable situations that could be used to address #8 (that doesn't mean there aren't any), and we're not even close to answering #9 and #10 yet. 

This is only the tip of the iceberg. Based on this quick run-through, I hope you grasp the complexity of this problem. What do you think? Is it too late to apply the precautionary principal? Is applying the principal even relevant for obesity, or worth the potential negative social and economic effects? Is not applying it worth further environmental damage?
Weir E, Schabas R, Wilson K, & Mackie C (2010). A Canadian framework for applying the precautionary principle to public health issues. Canadian journal of public health. Revue canadienne de sante publique, 101 (5), 396-8 PMID: 21214055

Friday, October 19, 2012

Pervasiveness of environmental contaminants: what does this mean for obesity?

Everybody knows that obesity results from energy in being greater than energy out, right? Okay, we know that it's a lot more complex than that, but what if obesity could arise separate from this? We're pretty wedded to the idea that diet and physical activity are major risk factors, so it may be a little disconcerting to learn that a new body of research suggests that being exposed to "obesogens," chemicals in the environment (usually man-made), may program us to be fat. In this first post, I will provide a very basic overview of obesogens, leaning heavily on two reports. In the second post of this two-part series, I will discuss what this means in terms of the precautionary principal versus level of evidence.

CBC (the Canadian Broadcasting Company) aired a documentary earlier this year that discussed the puzzling results of scientists researching endocrine-disrupting chemicals. Their original projects were not about fat, but their lab animals turned out to be unusually heavy after being exposed to these chemicals. The documentary can be accessed here. You can have a sneak-peek by viewing the trailer below.

We know that fat tissue acts like an endocrine organ. Since endocrine-disrupting chemicals include a wide variety of substances it is difficult to generalize mechanisms of actions. The Endocrine Society gives the following broad definition (Diamanti-Kandarakis et al, 2009):

"An endocrine-disrupting substance is a compound, either natural or synthetic, which through environmental or inappropriate developmental exposures alters the hormonal and homeostatic systems that enable the organism to communicate with and respond to its environment."

 In general though, it is thought that obesogens mimic hormones, which can increase the size of fat cells, increase the number of fat cells or negatively affect appetite, metabolism, and/or food preferences (Holtcamp, 2012). Much of the evidence to date has been from animal studies, but there are many epidemiological studies linking exposures of 15-20 chemicals during fetal and infant development to infant and child weight status (Holtcamp, 2012). Take for instance, smoking during pregnancy - there is fairly persuasive epidemiological evidence linking this to obesity in children (Oken et al, 2008).  There is also some evidence for an effect of endocrine-disrupting chemicals on adult weight status; however this is a burgeoning area of research that is need of more studies (Tang-PĂ©ronard et al, 2011). 

Obesogens (those in addition to the byproducts of smoking) are found everywhere - in industrial solvents/s and their byproducts (PCBs), plastics (BPA), plasticizers (phthalates) in PVC, organotins, pesticides (atrazine, DDE), surfactants used to reduce friction (PFOA), and pharmaceutical agents (DES) (Diamanti-Kandarakis et al, 2009)(Holtcamp, 2012). We are exposed to these chemicals by drinking contaminated water, eating contaminated food, breathing contaminated air, or coming into contact with contaminated soil.  In industrial areas, chemicals can leach into the soil and contaminate the ground water, and may bio accumulate in both humans and animals. The web of contamination is so complex that areas considered "prestine"and remote from the original site that produced the chemical, have been found with levels of the chemical (Diamanti-Kandarakis et al, 2009). Many of these obesogens are also found in items we may or may not use every day. Examples include: medical devices, some canned foods, cash register receipts, designer handbags, items made of Gore-tex(TM), wallpaper, vinyl blinds, tile, and vacuum cleaner dust, air fresheners, laundry products, personal care products, items with Scotchgard(TM) (e.g. carpets, furniture, and mattresses), non-stick cook-ware, and microwaveable food items. There are also potential dietary obesogens including phytoestrogens (soy) (Diamanti-Kandarakis et al, 2009) and MSG (monosodium glutamate) (Holtcamp, 2012).  
Many endocrine-disruptors demonstrate an inverted U-shaped dose-response association. This means that with medium "doses" of the chemical, obesity risk increases. But at low and high doses, the risk decreases. This likely depends on the chemical and other factors as some endocrine-disruptors have been found to increase risk at very low or very high levels.  Estimating the level of exposure that leads to a negative outcome is complex in a living, human population. It depends on sex, age at exposure, length of exposure, the mix of chemicals one is exposed to, and innate lag between exposure and effect (Diamanti-Kandarakis et al, 2009), to name a few

The link between these chemicals and obesity can only be considered exploratory and hypothesis-generating at this point. Nonetheless, endocrine-disruptors can be detected in all animals and humans (Diamanti-Kandarakis et al, 2009). Some researchers link this to the fact that even individuals on the low end of the BMI distribution are increasing in weight (hinting that obesogens may be the cause of everyone increasing weight on a population scale). I'm not so sure that this link can be made given the drastic change in our food system and our increasingly sedentary lifestyle. I'll delve more into what this may mean in the next post. Holtcamp, W. (2012). Obesogens: An Environmental Link to Obesity Environmental Health Perspectives, 120 (2) DOI: 10.1289/ehp.120-a62