The origin of modern social medicine, represented by Hygiene and Public Health, can be traced back to the European social medicines, products of their social mobilization after the Industrial Revolution. Nevertheless, mainstream current social medicines, and particularly their primal source of research methodology, US public health schools, are not, seemingly, faithful successors of the originator in their inclination toward biological reductionism and market economy. This paper, for the purpose of bridging this gap, surveys the rising of European social medicines and illustrates the history of US public health schools, clarifying their academic discontinuation in the early 20th century.
Social consensus is considered to be a necessary condition for a policy to be introduced and implemented effectively. This is the case with the approval, regulation and prohibition of certain advanced medical research and technology, especially when they could invoke moral disputes in society. Public policies on organ transplantation, definition of death, euthanasia, genetic screening and diagnosis, and human stem cell research are recent examples. The concept of consensus, however, is elusive, along with the measures to secure it. Technocratic decision making, as a paternalistic activity frequently led by experts, sometimes poses a challenge to democratic decision making, supposedly based on a well-informed and rational public. It also remains to be proved whether public involvement in policymaking can be a solution to ethical value conflicts in society. From the perspective of policy sciences, this paper first introduces the concept of consensus, especially consensus on moral issues in pluralistic societies, and its implications to public policy, including citizen participation in decision making. Then, it briefly explains the historical background with which social consensus and public involvement have increasingly flourished in the field of technology assessments and technology policy making, including biomedical technology. Next, major institutions, governmental and nongovernmental, involved in the ethical aspects of medical research and technology, are presented along with their efforts for citizen participation. Finally, the paper discusses some of the future agendas on this issue.
Objectives and Methods: The associations between dietary intake and urinary excretion of sodium (Na), potassium (K), calcium (Ca), magnesium (Mg), and phosphorus (P), and the major dietary sources derived from the urinary minerals were studied in a nutritional survey of 219 Japanese females aged 27-84 years, who completed anthropometric measurements, a one-day dietary record, and a 24hr urine collection. Results: The minerals excreted in the urine were significantly and positively correlated with each other, in which Na excretion was correlated with K and Ca excretion (r=0.490 and r=0.482, respectively, p<0.01) and Ca excretion was correlated with Mg excretion (r=0.526, p<0.01). The ratios of urinary exertion to dietary intake of Na, K, Ca, Mg, and P were 81.5%, 62.7%, 24.5%, 21.7%, and 56.1%, respectively. The dietary intake and the urinary excretion of the minerals expressed per body weight (kg) were significantly and positively correlated (Na, r=0.267; K, r=0.460; Ca, r=0.181; Mg, r=0.245; P, r=0.351, p<0.01). Further examinations using chief component analysis for food intake showed several significant positive correlations, including between Na intake and the intake of vegetables, noodles, and seasonings (r=0.332-0.381, p<0.01); between K, Mg and P intake and the intake of vegetables, fruits, and potatoes (r=0.332-0.533, p<0.01); and between Ca intake and the intake of bread and dairy foods (r=0.428, p<0.01). In addition, significant positive associations were found between Na excretion and the intake of confectionaries, nuts, and seeds (r=0.223, p<0.01). Weak correlations were also found between K excretion and the intake of vegetables (r=0.296, p<0.01); between Ca and P excretion and the intake of meat, oil, and fats (r=0.135, P<0.05; r=0.193, P<0.01, respectively), and between Mg excretion and the intake of bread and dairy foods (r=0.137, P<0.05). Conclusions: Findings from this study indicate that, while urinary excretion of Ca and Mg is unlikely to be a reliable biochemical marker of dietary intake, the levels of urinary excretion of Na, K, and P can be reflective of the intake of salt, vegetables, and meats, respectively. The urinary excretion of the minerals, particularly Na, K, and Ca, may be highly linked to salt intake in Japanese females.
Objective: Absorption of cadmium is increased by deficiency of iron in animals, but it is uncertain that the same phenomenon occurs in humans. The purpose of this study is to investigate the relationship between cadmium and iron in the body and to evaluate the influence of dietary habits. Methods: Twenty-five healthy women, aged 20-23 years, were selected by excluding those with renal disease and habitual constipation. They participated in the dietary intervention study to estimate tolerable weekly intake of Cd for 3 weeks in the same dormitory. At 3 months before, at 0 Day, at the 12th Day of the study and 9 months after the study, health check-ups were performed, and Cd in the blood and urine, hemoglobin (Hb), serum iron (iron) and serum ferritin (ferritin) were measured. Results: Cd concentration in the blood (B-Cd) showed a significant correlation with Cd concentration in the urine (U-Cd), and inverse correlation with the body iron storage, such as Hb, iron and ferritin. A food frequency questionnaire showed that no subject showed insufficient dietary intake of iron. Subjects who had eaten grain, millet and brown rice showed higher levels of B-Cd and U-Cd and low levels of Hb, iron and ferritin. Conclusion: Absorption of Cd tended to increase according to a low level of body iron storage among healthy young women.
Objectives: The chlorination of river water in purification plants is known to produce carcinogens such as trihalomethanes (THMs). We studied the river system of the Watarase, Tone, and Edo Rivers in regard to the formation of THMs. This river system starts from the base of the Ashio copper mine and ends at Tokyo Bay. Along the rivers, there are 14 local municipalities in Gunma, Saitama, Ibaragi and Chiba Prefectures, as well as Tokyo. This area is the center of the Kanto plain and includes the main sources of water pollution from human activities. We also analyzed various chemicals in river water and tap water to clarify the status of the water environment, and we outline the problems of the water environment in the research area (Fig. 1). Methods: Water samples were taken from 18 river sites and 42 water faucets at public facilities in 14 local municipalities. We analyzed samples for volatile organic compounds such as THMs, by gas chromatography mass spectrometry (GC-MS), and evaluations of chemical oxygen demand (COD) were made with reference to Japanese drinking water quality standards. Results: Concentrations of THMs in the downstream tap water samples were higher than those in the samples from the upperstream. This tendency was similar to the COD of the river water samples, but no correlation between the concentration of THMs in tap water and the COD in tap water sources was found. In tap water of local government C, trichloroethylene was detected. Conclusions: The current findings suggest that the present water filtration plant procedures are not sufficient to remove some hazardous chemicals from the source water. Moreover, it was confirmed that the water filtration produced THMs. Also, trichloroethylene was detected from the water environment in the research area, suggesting that pollution of the water environment continues.