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Laboring Lungs
Asthma cases rise to epidemic levels.
Is it pollen or pollution?
By Orna Izakson
It's a reasonable notion that what's in our air affects how we breathe. And as the populations of Oregon and the U.S. grow, the quantities of pollutants in our air and the numbers of people with breathing problems are growing, too. Asthma is one of the canaries in the coal mine. The disease affects roughly 17 million people across the country, and in 1995 caused about 1.9 million emergency room visits, 500,000 hospitalizations and 5,500 deaths. Federal data show a major increase in the incidence of asthma between 1980 and 1994 -- 75 percent in adults, a whopping 160 percent in children up to age 4. It disproportionately affects children and blacks, and is more prevalent among women than men. Asthma's prevalence is expected to double in the next 20 years. It's being called an epidemic.  | |
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Cures vs. Controls
Asthma isn't considered curable, but it can be controlled very effectively with medication and lifestyle changes. Its triggers are well known, too, ranging from dust mites and pollen to pollution and exercise for some people. But a cure isn't the only thing about asthma that's elusive; no one knows exactly what causes it.
The Trust for America's Health, a nonprofit funded by groups including the Pew Charitable Trusts and the Rockefeller Family Fund, issued a report last month calling for better tracking of the disease to help answer questions including how air quality affects asthma clusters. "It's true that biomedical research is making great strides in treating people who suffer with asthma," the report says. "But the root causes of the disease and the reasons behind its wildfire spread are poorly understood. The first step toward closing this knowledge gap -- and in this sense asthma serves as a clarion call for addressing all chronic diseases -- is to pinpoint precisely where asthma is occurring, how frequently it crops up, what are the levels of related environmental factors and who (i.e., by ethnicity, age and geographic location) is afflicted with it." Trust's analysis found that states with the worst air for asthmatics -- for instance, high levels of smog, particulate and other airborne toxins -- often do the least to track the disease. Oregon is in the forefront in tracking, thanks to a $600,000 grant from the Centers for Disease Control in 1999 to fund development of an improved asthma-tracking program. Karen Burrell, who manages the Oregon Asthma Program, says that new surveys next year will gather enough information to make county-by-county comparisons. The Oregon Asthma Program estimates that 227,000 adults in Oregon have the disease. Women here are twice as likely to be affected by asthma as men; 11.3 percent of female adults have the disease, compared with 6.2 percent of male adults. Based on numbers from the Multnomah Educational Services District -- which oversees Portland-area schools -- 7.2 percent of children have asthma. If that number is applicable statewide, Oregon would rank just below the national average of 7.5 percent in childhood asthma.
Fatalities Rising
Asthma deaths in Oregon have been rising steadily since 1979. Then, 18 people per million Oregonians died of the disease; by 1998, the number was 28 per million. That's substantially higher than the national rate, which rose from 13 deaths per million population to 20 deaths per million in the same time period.
That's as much of a handle as the Oregon Asthma Program has on the disease here. To date they haven't collected the kind of information that would allow local comparisons. That's a problem for health analysts who want to see how different climates and pollution levels influence the disease-turned-epidemic. For instance, how does living one county south of the self-proclaimed "grass-seed capitol of the world" affect the asthma rate here? The only way to tell is to be able to compare a variety of factors including pollen levels among different communities, but data are not available on that fine a scale. That makes it hard to speak more than anecdotally about Lane County, but it seems likely that causes and triggers here are more of the natural variety than the human-caused.
Pollen and Exhaust
According to Environmental Defense's Scorecard (www.scorecard.org), Lane County looks relatively good in terms of air pollutants. The biggest problems here come from mobile sources like cars and trucks; indeed, the highest-risk air pollutant here is diesel emissions. Air quality is considered good 92 percent of the time; the remaining days are considered to have moderate air quality.
Dr. Alice Chou has been seeing asthma patients in the southern Willamette Valley for four years, and says that pollen seems to be a bigger issue for asthmatics here than pollution. She say she finds herself "very busy in April, May and June. April is the tree (pollen) season and June obviously is the grass season-- The biggest problems in the valley seem to be the grass pollens." Chou adds that field burning later in the summer is also a problem for some people. Eugene is one of two cities in the region -- and the only one in Oregon -- for which the National Allergy Bureau of the American Academy of Allergy, Asthma
and Immunology regularly tracks pollen counts. The daily data (along with seasonal charts) are available on the web at www.aaaai.org/nab/west.stm. The Trust report is available at http://healthyamericans.org. Happy Chickens
Local farmers meet growing demand
for healthy, drug-free birds.
By Marina Taylor So, you've decided to eat healthier. If you eat chicken, you've heard all about GMOs, growth hormones and unsanitary factory conditions. But once you're at the store, the choices can still be confusing. If you care about what you're putting into your body, chicken man Aaron Silverman of Greener Pasture Cooperative (GPC) has some recommendations. When it comes to poultry, Silverman recommends looking for antibiotic-free, local, free-range birds active enough to burn their own fat. Read labels, visit farms if you can; you can even check your bird's rear cavity for fat deposits to discover how active it's been. Find an active, healthy bird and you'll be eating good, quality meat.  | |
. | | Another indicator of quality to look for is fat content and water ratio, says Silverman. Less active chickens living in shoebox cages have weaker muscular cell structure, and so absorb more water during production. That decreases the meat's flavor and quality, but increases poundage and profits. Silverman says free-range birds don't absorb water, and at GPC the excess fat is cut out in production. The GPC, a local organization, includes the Noti farm Creative Growers, chicken farmers in Yoncalla and Halsey, and a turkey farm in Crow. The cooperative supplies Marché, Sweetwaters, Long's Meat Market, Saturday Market and Portland restaurants with free-range, antibiotic-free poultry. Free-range means copying a natural habitat as closely as possible. Creative Growers keeps batches of 80 to 100 birds in several bottomless pens, which are moved around daily on a grassy field. The chickens get a chance to run after bugs and peck at weeds and seeds, enriching their diet and stretching their legs. Chicken, according to Silverman, also requires free range to thrive. Nutritional differences between free-range and conventional poultry are significant. In a USDA funded comparison performed by American Westech, Greener Pastures chickens have 30 percent less total fat than their conventional cousins, and what they do have includes "good fat." Free-range poultry has 100 percent more Omega 3 fatty acids, which are lacking in most processed food and are considered important antioxidants. Free-range poultry is also less prone to disease. "Keeping them moving, getting the water cleaned on a regular basis," says Silverman, keeps chickens free from ailments. "Our whole system is designed to their health." Large-scale commercial farms use antibiotics for health reasons, but also as a substitute growth hormone. In poultry, according to Petaluma Poultry, growth hormones have been illegal for more than 35 years. However, farmers discovered that "therapeutic" levels of antibiotics in healthy birds have a similar effect. Silverman says his birds reach their end weight in 6 to 7 weeks, the same time as those grown in cages on antibiotics. To keep up with a free-range bird, whose conditions are cleaner and less stressful, the caged bird has to be medicated. GPC meat is not certified organic, says Silverman, citing lack of customer demand and the extra effort for certification. Their supplemental feed is mostly organic, not genetically modified, and includes protein rich, cold-processed fishmeal. "Chickens are omnivores," says Silverman. "The broilers have high metabolisms and need more energy, and the amino acids (of fish meal) for balanced nutrition." If you've ever kept chickens, you'll remember that hungry T-Rex look in their eyes; it's not an entirely herbivorous lineage. "Most organic chickens [in supermarkets] are actually raised conventionally [in cages with antibiotics]-- " says David Hoyle, field manager at Creative Growers. "With the biggest commercial producers of chicken, two days after they've designated what an organic chicken would be, they switch the feed. Six weeks later they've got organic birds on the shelf." If you are used to paying $1.29 a pound for Rocky or Fircrest birds, the prices of free-range chicken may come as an economic shock. A Greener Pastures whole 5 pound bird sets you back a hefty $15. Silverman says that will feed six people on his farm three meals. "It's about how you cook; first we'll roast it, then a chicken salad, and finally a stock with the bones and extras. It requires a change in how you look at, how you prepare your food," he says. Will natural chicken ever be economically competitive with the big farms out there? "Never," says Silverman, "and actually we have no desire to be. It's a different product, and you get what you pay for." Testing Negative
Education, anonymous testing and behavior
changes help reduce new HIV cases.
By Orna Izakson At precisely 9 am on any given Tuesday, Pedro Doperoy opens the doors of White Bird Clinic and tells the people waiting on the benches outside that if they're there for anything but anonymous HIV testing, they're waiting for the wrong thing. In late July, a small group was waiting for his announcement. They were ushered into a lounge, given a wad of papers with a numbered, bright yellow sticker on top, and told what to expect. This is anonymous testing, Doperoy says. You cannot use the results of this test for documentation of your HIV status. Keep the piece of paper with your number on it; it is the only way of tying you to your test and you will not be able to get your results without it. It will take two weeks for results. You'll meet with me to fill out a form with basic information like your age, education and risk history. I don't want to know your name.
Hopeful Trend
Doperoy also drops a hopeful factoid: Since he began working as White Bird's HIV coordinator and counselor in 1986, the number of tests coming back positive for the virus have plummeted. Back then, he says, between 15 and 20 people got the bad news in any given month. In 2000 and so far in 2001, only one person has found out she or he was HIV-positive in the entire year.
Doperoy attributes the change to education and behavioral changes, especially regarding intravenous drug use. The problem is far from over across the country: "I would say that things within the United States have improved," he says. "But there is currently an increase in the incidences of HIV and also there's at least half a million people in the United States who aren't even aware that they're HIV positive because they haven't been tested." But Oregon is doing well. "Within this state, people appear to be testing regularly and the numbers for exposure are down," he says. According to Lane County Public Health, the number of people in Lane County with full-blown AIDS peaked in the early to mid-1990s, with 31 cases in 1992, 46 cases in 1993, 31 cases in 1994 and 27 cases in 1995. Most years since 1988 have had numbers in the teens. But the new millennium's numbers are hopeful: only nine cases in 2000, five cases since June 30 of this year. In all, 287 Lane County residents have been diagnosed with AIDS since tracking began; 171 of them have died. According to the Oregon Health Division, Lane County has the second highest numbers of AIDS cases and deaths in the state. It is preceded by Multnomah County, and followed by Washington, Clackamas and Jackson counties. In total, 4,586
Oregonians were diagnosed with AIDS as of 1999; the most recent year for which statewide data were available; 2,654 of those people have died.
Expanded Reporting
Anonymous testing has its drawbacks for tracking purposes, as there's no way to know for sure how many tests are of different individuals rather than people coming back repeatedly. The Oregon Health Division in October begins an expanded HIV reporting system under which people testing positive -- even anonymously at places like White Bird -- will be asked to give enough information about themselves to help the state keep track of trends and deliver services to people who need them.
But anything less anonymous than the purely anonymous testing offered at places like White Bird has always been controversial. Doperoy says that in the 1980s people were leery of using their names on HIV tests for fear that they would lose medical insurance if they tested positive. Valerie Haynes, the healthcare director for HIV Alliance in Eugene, says intravenous drug users and "people in sexual minority groups -- are very fearful about large organizations or the government having lists of names attached with their HIV status and other factors that may have contributed to them acquiring infection." Her group's concern with expanded HIV tracking isn't the misuse of names associated with HIV, she says, but rather that people at greatest risk will worry that the government will know all about them. HIV Alliance prefers a system using "unique identifiers," a set of numbers that would follow an individual through the system but not be tied to their name. The number would function like the PIN numbers people have for the ATM cards, although Haynes suggests that such a number could be based on a formula using the person's birth date and Social Security number. "We understand the need for getting a true picture of what's happening with the epidemic," she says. "But we just feel like a unique-identifier system that doesn't have any names attached to it would be less intimidating to people in high-risk groups." Haynes says it's a shame the Oregon Health Division didn't explore such a system more thoroughly when it decided on expanded HIV reporting. But if HIV Alliance's fears are borne out and high-risk folks don't go through that system, she believes there may be opportunities to change the program down the line. White Bird's Doperoy seems unconcerned about the October shift. "The fact of the matter is there's no way, if you're doing an anonymous test, to force the person to give you that information," he says. "If the person chooses to walk out, you cannot physically detain that person or force that person to provide you with detailed information such as name, birth date or address." Back in the clinic on that recent Tuesday morning, the imminent testers sit in their chairs, read the literature that accompanies the paperwork and wait until a woman comes to call them by number to the needle that will draw their blood. White Bird has already found its one HIV-positive person for the year; hopefully none of them will bump the number up. Killer Bras
If you didn't burn yours in the '60s, you might want to put it away now, because "Bras cause breast cancer. It's open and shut," say medical researchers Syd and Soma Singer in a story by William Thomas for NewHeavenNewEarth (www.nhne.com) The Singers note the highest death rates from breast cancer are in North America and northern Europe, with the developing world catching up fast. The World Health Organization reports that chemical toxins are the primary cause of cancer. But poisons accumulating in breast tissue are normally flushed by clear lymph fluid into large clusters of lymph nodes nestling in the armpits and upper chest. The Singers found that "because lymphatic vessels are very thin, they are extremely sensitive to pressure and are easily compressed." Chronic minimal pressure on the breasts can cause lymph valves and vessels to close. "Less oxygen and fewer nutrients are delivered to the cells, while waste products are not flushed away," Syd Singer notes. After 15 or 20 years of bra-constricted lymph drainage, cancer can result. Beginning in May 1991, the Singer's 30-month "Bra and Breast Cancer" study interviewed some 4,000 women in five major U.S. cities. All were Caucasian of mostly "medium income" ranging in age from 30 to 79. Half had been diagnosed with breast cancer. Almost all of the women interviewed were unhappy with the size or shape of their breasts. Women who chose a bra for appearance, ignoring soreness and swelling, had twice the rate of breast cancer of those who did not. But the most startling statistic was that "three out of four women who wore their daytime bras to sleep contracted breast cancer." So did one out seven women strapped into a bra more than 12 hours a day. Bra-free women have just a one in 168 chance of being diagnosed with breast cancer, says Singer. "Don't sleep in your bra!" Syd Singer pleads. "Women who want to avoid breast cancer should wear a bra for the shortest period of time possible -- certainly for less than 12 hours daily." One woman told the team, "My tits will sag all the way to my navel without a bra." But surgeon Christine Haycock at the New Jersey College of Medicine says that inherited traits -- not ligaments or breast size -- are the reason some breasts give in to gravity. Bouncing bosoms help clear the lymphatics.
From the Bottom Up
Saying it's "the decent thing to do," Eugene organizers are stepping up their campaign for universal health care in Oregon. Signatures are being gathered to put the Health Care for All-Oregon initiative on the 2002 November ballot.
Efforts to establish a national health insurance plan have failed, so grassroots groups in 17 states are working to force the issue from the bottom up. Organizers say the popularity of the movement away from private health insurance is being driven by rising insurance costs, a growing number of uninsured people and exorbitant salaries for managed care executives. The Oregon campaign is getting a boost from national speakers such as Dr. Bob LeBow, immediate past president of Physicians for a National Health Plan. He spoke in Eugene in July, saying, "One of the great myths in the folklore of American health care is that we in U.S. have the best health care system in the world -- because everyone can go to the emergency room. The World Health Organization ranked us 37 last year. The U.S. remains unique among developed countries in failing to provide all its residents with health insurance." An estimated 16 percent of Americans have no health insurance and those underinsured must live in fear of financial ruin should they become seriously ill, says local organizer Ruth Duemler. "More than 50 percent of all bankruptcies are related to health care costs," says Duemler. "In Oregon, school districts have been especially hard hit by the steeply rising costs of health insurance premiums. The Springfield school district insurer asked for a 47 percent increase, Junction City 34 percent and for government employees statewide I understand it is over 20 percent." Duemler says the Maine Legislature just passed and the governor signed a bill to require the Legislature to put together a universal health care plan. And in Massachusetts, where their measure lost by 1 percent (up against a $5 million industry campaign) a new initiative will require the governor and lawmakers to lose their health benefits if the same benefits are not provided for all the people. Informational meetings are at 7 pm the fourth Friday of each month at EWEB and the next is Aug. 24. Feed Your Clothes?
Textile manufacturers have invested millions of dollars researching fabrics that are toxic to bacteria, fungi and other organisms, but new research on impregnating fabric with bacteria could lead to the world's first self-cleaning clothes. In a story by Eugenie Samuel in the July 5 New Scientist journal (www.newscientist.com), researchers say some bacteria could live, breed and eat up the dirt and sweat on clothing. Other bacteria might secrete waterproof and protective coatings to extend the life of clothing and produce antiseptic for bandages. Researcher Alex Fowler at the University of Massachusetts at Dartmouth says he has been successful in injecting bacteria into fibers, and the bacteria go dormant if they are not fed. But keeping the bacteria alive over time remains a problem. For some other strains, you might have to douse the fabric with additional nutrients occasionally. "You could end up having to feed your shirt instead of wash it," says Fowler. Alex Lightman, CEO of Charmed Technology, a California-based fashion company that designs futuristic outfits, says the market may not be ready for a living suit just yet, but he thinks it's a great idea.
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