Articles by Dr Joe Kosterich

Hashtag Big Public Health

Those following me on social media may have noticed the hashtag that I have started- #bigpublichealth. Some have asked what does this mean and why have I done it.

Good questions. Below is my explanation.

We are forever hearing about big tobacco, big food, big pharma, big sugar and just to round it out big banks. These terms are used derisively to imply that the size of these amorphous groups is of itself a problem and that due to size, their influence is considerable.

There is some credence to this view. The lobbying power of the pharmaceutical industry is significant, especially on the USA. Allegations have surfaced about the behaviour of the sugar industry in paying researchers. The food industry, of course wants to protect its position. The tobacco industry has negligible power these days.

However, not one of these groups has the express backing of governments. Not one of … Read the rest


Sex, cars and e-cigarettes

It is interesting to apply current thinking to decisions taken years ago. Whilst our greater knowledge today can make previous behaviours and thinking seem odd or plain wrong, there are also instances when applying todays approach would have stopped progress.

In the 1960’s it became apparent that seatbelts reduced harm from use of motor vehicles. Whilst the vast majority of users, got from A to B safely, there were (and still are) vehicle collisions causing death or serious injury.

Wearing seatbelts was not subjected to randomised double blind placebo trials. It was not felt that use of a seatbelt required a doctor’s prescription. Use of seatbelts did not make using vehicles harm free. We did not know if there may be long term harms from use.

Yet not only was this form of harm reduction recommended, it was made compulsory.

In the 1980’s we saw the advent of HIV/AIDS. It … Read the rest


A sugar tax won’t fix the damage done by ‘public health’

A recent TV Program has again raised the issue of a sugar tax. All the usual public health suspects were of course in favour. They also bemoaned the influence of industry whilst complaining that they themselves do not get enough funding and lack clout.

It is difficult to know where to start. Public health is generously funded by government and is not particularly accountable.

Let us be crystal clear. It was not the food industry that introduced low fat dietary guidelines in the absence of any evidence in the early 1980’s. It was not big pharma or big sugar or big food. It was public health.  Whilst pretending to be small and powerless, the reality is that public health leverages the power of big government.

This has been evidenced by trials of doctors such as Garry Fettke in Tasmania and Tim Noakes in South Africa where complaints by elements in … Read the rest


Tobacco harm reduction and vaping: beyond a binary approach

In the Orwell classic Animal farm there was a binary notion that the animals lived by – “four legs good, two legs bad”. This eventually morphed into “four legs good, two legs better” as the pigs who became the lead animals began walking on two legs like the evil farmer they had replaced.

Binary thinking has a role in areas like engineering where unless a bridge or building is a certain strength it may fall down. However human biology is not quite as amenable to this approach. Notwithstanding that we are all similar, no two people (even identical twins) are exactly the same.

In seeking to treat or help people in medicine we need a variety of options. No antidepressant or antihypertensive works for everyone. Different approaches are required and we must tailor what is best to the individual. The more options we have the greater the number we can … Read the rest