Randomness is lumpy

Randomness is lumpy. Can you imagine anything less random than a bunch of trees all growing in a matrix each 2 metre apart, perfectly 2 metres apart. Or, if you dropped a handful of jelly beans and each one fell, perfectly 3 cm apart from each other.  Unlikely, and not "random". So why are we so surprised in public health (and life in general) when we see a "cluster"  (a time space aggregation) - isn't this what we should expect to see?   But then if we believe there is a cause behind everything is anything truly random or do we just not the reason determining the outcome.   See this nice article at 3quarks daily for more.

Evidence of the fragmentation of public health perpsectives?

Plotinus, a "neoplatonist" believed that the ultimate good was a return to the "one" - the experience of the world in its holistic coherence, without fragmentation into silos and fragments defined by narrow human interests and perspectives.  I was reminded of this when I read two articles in the March, 2012 issue of the American Journal of Public Health - first

Project-Based Housing First for Chronically Homeless Individuals With Alcohol Problems: Within-Subjects Analyses of 2-Year Alcohol Trajectories by Susan E. Collins et al describing how providing housing to people with alcohol addiction problems, without requiring them to be abstinent of alcohol (as many welfare programs require) resulted in decreased alcohol use.  This was an example of ensuring the addiction did not stigmatise the user and further lower their living standards and reinforce their alcohol use.  

In the same issue, Michael Ong et al publish Estimates of Smoking-Related Property Costs in California Multiunit Housing in which they attempt (with a 22% response rate) to estimate the impact of smoking renters on property costs.  They calculate that "implementing statewide complete smoke-free policies may save multiunit housing property owners $18 094 254 annually."   

An amoral editorial on decision aids for screening in BMJ

The BMJ just published my rapid response to an editorial on decision aids for screening - such as bowel cancer screening.  I was surprised that the BMJ (the journal I would probably choose to have on a desert island if only allowed one journal) published an editorial that was blind to the ethical issues associated with public health screening. My response is pasted below or you can read it in the BMJ.