Tag: research analysis
Do you know about the number needed to treat? The world of medical stats is just as confusing – and seductive – as political stats. The raw value of a stat is often left out of the equation. For example, a study of 1,000 people finds that 6 people get a particular cancer and 4 of them die. Taking drug A as opposed to old drug B reduces that number from 4 to 3. 1/6 = roughly 16%. Since 15% is the benchmark of statistical significance in science (and many disciplines), the study can promote the finding that deaths are significantly reduced with new drug A. Never mind that the news is irrelevant for 994 study participants and in real numbers, we’re talking about one person. I believe even one person is certainly worth saving, but I use this example to highlight a very real problem with statistics. It’s all in your perspective, and when you view new drugs from a less popular statistic – the number needed to treat, or NNT – the picture sometimes changes. To use a real-world example I recently read in Time magazine, let’s look at statins. Statins have become a commonplace Rx for the post-40 crowd, and they’re especially popular for men. (By the way, this gender skewing is something I have a problem with, as just as many women have cardiovascular health issues and 1 in 3 women – period – die from heart disease.) Statins are used to reduce bad cholesterol, in the hopes that heart disease and subsequent heart attacks will be prevented. We’ve all seen the “30% reduced risk” in statin ads. But this isn’t 30% across the board – although that’s the perception and that’s why everyone’s on statins. Enter NNT. This 30% number is the number of people in one of the study’s control groups (there’s a statin-taking group and a placebo-taking group). Moreover, this is 30% in real numbers – meaning, of men who would have had the heart attacks anyway (a very small number), that number was reduced by 30%. It’s not a 30% reduction in total. But millions of men are taking statins. To prevent one heart attack, thousands of men who likely wouldn’t have a heart attack are taking statins. This is the number needed to treat. According to Time, 50 people have to take this drug to stop one heart attack (which, as Time points out, is not likely to be fatal). That’s 50 people needlessly popping a daily pill with untold side effects. Now, of those 50 people taking a drug to stop one heart attack that probably won’t be fatal, I wonder how many face serious, expensive and possibly life-threatening health problems. Of course, on the scale of the total population, 50:1 becomes many thousands of heart attacks prevented – but many hundreds of thousands facing unnecessary and dangerous side effects (and spending a lot of extra cash). That’s NNT, and that’s the true measure of a drug’s effectiveness and value. … Continue reading “It Takes a Village”
I saw an interesting piece over at ABC News. It’s not interesting because of the topic (“which vitamins are helpful, which are harmful”) but because media sources continue to offer the same retread of outdated vitamin lore as if it were breaking scientific information. I find it interesting that no one seems to have caught on – or, at least, no one is calling news sources on it. So let’s call them on it. You can check the article out (clickativity) for yourself, but essentially, the retread trucks out the same old three concerns: 1 – Vitamin E might hurt your heart 2 – Beta carotene/vitamin A can be harmful in excessive amounts if you smoke 3 – Too much calcium might cause kidney stones The article also states that some vitamins may be beneficial while others may not be (really?). To be fair, it’s a very complex issue, and science is always revealing new information. Hey, that’s a good thing. It’s really the beauty of science: think how much more we know now than even a decade ago about issues like aging, cancer and nutrition. Part of the problem with these oft-sensationalized three topics is that for every study which supposedly points to a health danger, there are plenty (if not hundreds) of studies which show no negative effect whatsoever. The point is, don’t just take someone’s word for it. I think the internet is one of the best things to ever happen for humans when it comes to health. It’s instant democratic participation in health information – makes it a lot harder for drug companies and vitamin manufacturers to be misleading, doesn’t it? That’s something we’ve all benefited from tremendously. Let’s take a look at the three supplements in this “news” article (actually, they are the three most popularly touted as being harmful, and have been for years). Of course, it’s an ongoing issue we’ll get in-depth with here, but consider: Vitamin E is “bad” for your heart? This study, which came out about two years ago, sent shockwaves around the world and made major headlines. It was also almost immediately criticized, with good reason. But, of course, that part didn’t make headlines. The study, which was not really a study at all – just a meta-review of several other poorly-conducted studies – found that high doses of vitamin E could be harmful to the heart. The funny, or perhaps just annoying, thing is that we’ve known for years that a certain type of vitamin E (yes, the one reviewed in the big headliner just mentioned) is actually a pro-oxidant and can be harmful. When d-alpha tocopherol (the most common form of supplemental E, by the way) gives up an electron, it becomes a pro-oxidant. I don’t think anyone should take this type of E, and sadly, it’s the most prevalent vitamin E supplement sold. The critical missing information is that E is actually a spectrum vitamin, just like B. There are eight “E’s” and all are necessary … Continue reading “Vitaminute”
Here is a razor-sharp example of excellent, detailed, honest medical research reporting. Unfortunately, with words like ergot and agonist, it’s also as relentlessly boring as a Del Monte fruit cup without the little pink “cherries”. No wonder people are confused about the latest medical findings! Where are the resources to interpret this jargon?
Oh yeah, here, that’s where! Whew.
And here. (An anonymous MD’s personal take on medical practice. Often quite interesting.)
And here. (Ok, so this one’s a little dry, but you can scope where we review studies.)
Anyway, this example in particular found that certain types of Parkinson’s drugs may cause major heart problems in certain types of patients. The good news is that a more effective Parkinson’s drug appears to be near completion thanks to the KDI breakthrough from last year (KDI is a protein that appears to play a role in preventing certain neurological problems). KDI treatment may even help prevent ALS and strokes.
There’s another huge issue surrounding Parkinson’s, Alzheimer’s and other neurological diseases that I want to draw particular attention to, because it’s infuriating. According to this article, scientists are having a hard time effectively researching potential causes and cures because industry lawsuits – from chemical companies to welding groups – jump all over medical studies that link environmental causes to these diseases. This is something you can personally help to change with this clickativity. It will take about 45 seconds. I think it’s more than worth it.
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[tags]Parkinson’s, KDI, Alzheimer’s, politics[/tags]
BUT NOT NEARLY AS EFFECTIVELY AS HEARTBURN PILLS
A large-scale study out of Britain has reported that taking popular heartburn medications like Tagamet and Pepcid AC can seriously increase your risk of bone fractures, because the drugs block calcium absorption.
Check out the article – here’s the clickativity.
Of course, the pill pushers contrarians say that a simple calcium pill can offset the damaging effects of heartburn medications. That’s classic – needing a second pill to address problems caused by the first pill, which is unnecessary in the first place.
An easy fix for heartburn is avoiding foods that cause it. Getting daily exercise, drinking plenty of water and avoiding alcohol are also good ways to avoid heartburn.
Each year, about 300,000 older Americans break a bone, and 60,000 of them will die from the injury.
Heartburn medications are a $10 billion-a year cash cow.
And surprise, surprise: Ole’ Denmark did a heartburn study last year but reported that heartburn medications are, wouldn’t you know, perfectly safe. I keep trying to give the motherland the benefit of the doubt, so I would like to cast doubt on this new British study, but seeing as how it was funded by the U.S. government and GlaxoSmithKline, I have to say, something is rotten in Denmark.
[tags] Tagamet, Pepcid AC, heartburn, pharmacology, calcium, osteoporosis [/tags]
Sara here. My Danish grandmother will be horrified by this post, but in my selfless devotion to you Apples, I’m taking that risk. And so, I have to ask: What is up with Denmark? (Huh? you ask. Just go with me on this.) I’ve noticed a strange trend over the last decade. This could be my own erroneous inductive research here – in fact, I actually hope so – but the Land of Lutefisk seems strangely supportive of Big Pharma and the status quo (sorry, Grams). First, two years ago, I heard about some “landmark” studies that came out of Old Dansk announcing that there is absolutely no link between autism and vaccinations containing thimerosal (a form of mercury). Nevermind that autism rates sharply increased around the same time that vaccines started being preserved with thimerosal. Nevermind that mercury poisoning symptoms and autism symptoms are virtually indistinguishable. Now, to be fair, the mercury/autism debate is hugely controversial precisely because we don’t have a definitive answer yet. I suspect the eventual conclusion may implicate thimerosal, at least as part of the equation. But, then, there was the fish study. Once again, researchers in Denmark came up with – er, concluded – that fish oil does not help those interested in reducing their heart disease risk. The study was a review, which is right up there with questionnaires in terms of scientific accuracy. Even worse, it was a review of cohort studies (cohort studies can have major problems with causation vs. correlation). Moreover, reading the fine print (not just the abstract), what the study essentially “discovered” was that people who are at a high risk for heart problems do benefit from fish oil, while people who are at a low risk do not. Now, think about that. In other words, people who don’t have a problem will not benefit from a solution. Kind of like how my grease-cutting counter disinfectant won’t do a great job of cleaning my freshly-scrubbed counters, either. But after this study was reported in the European Journal of Clinical Nutrition, amazingly, what got media attention was that fish consumption just doesn’t help heart issues. No one got excited about the additional finding that high-risk people can help their hearts with fish oil – just 40 to 60 mg a day can help! (That’s actually okay, since there are already hundreds of rigorously-conducted studies proving fish oil is good for reducing your heart disease risk.) The lesson: Apparently, 1) Create a study following less-than-ideal methodology, 2) determine absolutely nothing from it, and 3) leave out the important part and splash the meaningless part all over the news. Hey, if it looks like a duck…it might be a Danish study. Now, since then, there have been some pro-fish studies, so I’m willing to give the motherland the benefit of the doubt. Although I have seen several other pro-dairy, pro-drug, pro-status quo studies from Denmark, I will withhold judgment until more evidence presents itself. Except, now, hot off the presses, an … Continue reading “What’s Up with Denmark?”
I can’t tell you how furious I am about what I feel is the meat industry’s blatant disregard for human health. While I’m no vegetarian, I saw this study in the Archives of Internal Medicine, and let’s just say, I’m not buying the “Happy Cows” line.
The researchers looked at 90,000 women. That’s a huge study. They compared US and UK women, and here’s what they found:
Eating more than 1.5 servings of meat daily doubles a young woman’s risk of breast cancer. What concerns me is the type of cancer which had double the risk: hormone receptor-positive breast cancer. To me, that says something pretty sobering about the meat industry’s production habits.
Both the study, and the BBC News article that covered it, are cautious to merely “suggest” a link between eating red meat and increasing – doubling – the risk of breast cancer. It doesn’t take much to read between the lines here.
The reason I think this study is really important to highlight is not because I hope to bandy a statistic like “double the risk!” about. (Remember the Statistics Game: always consider context and relative risk or results.) It’s important because the women who ate high amounts of red meat had double the risk of hormone receptor-positive breast cancer. That is a big issue, namely, because the American meat industry uses growth hormone like it’s manna from Heaven. Growth hormone helps the animals get bigger, faster, which translates more profit – but I’m pretty skeptical about how this practice could possibly be in the interest of public health. I just wonder how these people sleep at night knowing their profits come at the expense of other human beings.
Personally, I believe it’s clear that human physiology supports being omnivorous. No culture anywhere at any time has done without some sort of animal flesh, whether it’s fish, beef or reindeer. So I’m not “anti-meat”. However, I am strongly opposed to the way meat is produced in this country: quickly, unethically, with little regard for the animals or the people eating the animals. That’s why I only buy meat that is free-range, local, organic and definitely hormone-free.
The researchers were careful not to draw any ultimate conclusions. I think we can probably begin to draw our own, with some additional critical considerations:
1) Processed meats generally contain a chemical known as heterocyclic acid, which has been shown to cause cancer;
2) Red meat, of course, contains iron, which can sometimes encourage the growth of some types of tumors (though this isn’t a significant concern, likely);
3) The standard line: “The biggest risk factors for breast cancer remain gender and increasing age.” This from specialist Maria Leadbeater, quoted in the BBC article. Fair enough.
[tags] breast cancer, beef, red meat, cancer, factory farming, growth hormone, omnivore, Maria Leadbeater, BBC, hormone receptor, heterocyclic acid, risk factors [/tags]
Lying, Twisting and Manipulating: The Statistics Game Drug Companies Play Faced with high insurance rates, long hours, endless paperwork, and high-pressure demands, doctors don’t have an easy time of it. If you’re blessed enough to have a thoughtful, proactive, cautious M.D., let them know, by all means. Doctors are inundated with free drug samples, bonuses and perks from Big Pharma, and even the most well-intentioned practitioner can face dilemmas. Case in point: even the most careful doctors are getting misleading information from many medical journals. It’s one of the most serious problems facing healthcare and medicine today. Scientists and medical experts are expressing increasingly loud concerns about the ethical standards of medical publications. Some journals and publications have essentially become an extended limb of advertising for drug companies. The problem isn’t just in the expensive pharmaceutical ads that provide a means of financial survival for scientific and medical news publications. Many of the studies themselves are funded directly by pharmaceutical companies, making the journals de facto supporters of such companies. Or, doctors participating in the studies also serve positions in various companies. It’s troubling enough that independent news sources, supposedly impartial and peer-reviewed by other scientists and medical experts, are vulnerable. But even government agencies aren’t immune. The CDC, FDA and NIH have all faced huge criticism in recent years for obvious conflicts of interest. How is Big Pharma getting away with this? Simple: we let them. Here is what frequently occurs: For starters, when companies fund studies of their own drugs – big shock – there are almost never unfavorable results. When there are, they’re simply omitted, or a new study is funded. A fairly recent review found that when a study is funded by the company producing the drug, positive results happen four times more often than when impartial studies by independent researchers are conducted. According to the Public Library of Science, an impartial public access resource (check it out in my Daily Reads at right), “between two-thirds and three-quarters” of the studies reported in the top journals are paid for by pharmaceutical companies. According to the Library, companies aren’t bold enough (or unwitting enough) to skew the results. They simply ask questions they know will yield the “right” results. How convenient. Another problem: even though journals are usually reviewed by colleagues, if companies are using the same study again and again, but presenting it in different ways, editors have no way of knowing. Editors try to maintain strict ethical integrity, but it can be next to impossible to know the origin, conflicts or “right questions” involved in some studies. Before I started Primal Nutrition, I served a stint as an editor of a large national health magazine, and I certainly empathize with editors – as my staff knows all too well, information is always changing and getting to the truth is a ceaseless quest that demands constant vigilance. Of course, the truth is worth it. The stakes – Americans’ health – are too high. Clearly, this is … Continue reading “Bite Me, Big Pharma”
Evolution is all about adaptation – to the environment, to circumstances, to stress and even (or especially) to food. In this context of adaptation, it’s truly amazing how “inventive” the human body has become in finding novel (and perhaps heretofore uncontemplated) ways to repair damage we do to ourselves through our diets and other lifestyle indiscretions. And most of these changes are less than a few hundred years old, which makes the adaptations even more remarkable. Let’s use cholesterol as an example. Cholesterol is actually very beneficial. Among other duties, it’s a necessary component of every cell membrane and it’s involved in hormone production. The body makes about 1400 mg a day just to keep up! Now let’s take a stressful lifestyle (show of hands, please), add in a bad diet and lack of exercise and we get an inflammatory process in the arteries that causes lesions. This inflammation problem is completely unrelated to amounts or types of cholesterol. Nevertheless, the ever-inventive human body adapts to this inflammation sequence by using cholesterol as a band-aid to cover up the lesions until healing can take place – which, of course, almost never happens since the silly human continues to live the same pro-inflammatory lifestyle. Eventually, the cholesterol band-aids harden (sclerosis), narrow the arteries and sometimes break off causing a heart attack. Of course, we blame the cholesterol for all this and embark on a national campaign to rid the body of this important substance instead of focusing on the foods (and other stresses) that promote inflammation in the first place! Now let’s consider fat. For years we believed fat was nothing more than nature’s way of storing extra calories for some future famine. That would be a handy little adaptation in and of itself if that’s all it were. But when you do the math, you see that it doesn’t require a lot of fat to survive or even migrate for long periods. A 165-pound person with only 13% body fat has 21.45 pounds of fat. Being generous and assuming that you need a minimum 3% just to carry on basic survival functions, that leaves 10% or 16.5 pounds of fat to live off. At 3500 calories per pound of fat and 100 calories per mile walking, you’d theoretically have enough fat to survive weeks and migrate several hundred miles. So maybe fat has another purpose, and this is where my friend Art De Vany’s description of fat as a toxic waste site (my words) comes in. Modern humans have so thoroughly altered foods to focus on simple carbohydrates (sugars) that we now consume hundreds of excess grams of it every day. As Art has explained, the body recognizes excess sugar (glucose) as a toxic load – and remember, it doesn’t take a whole lot of it to be excessive – and the body starts the adaptive process of secreting insulin to take sugar out of the bloodstream and deposit it into the muscles. Two problems arise immediately: First, there’s not … Continue reading “Mark Sisson Is Not Afraid of Fat”
MY 12-YEAR-OLD MANAGES TO DO IT, AND HE’S PROBABLY TAUGHT THE DOG
A recent piece in the Los Angeles Times just goes to show how much room for improvement there is in the medical business…that is, the medical establishment. (Sometimes I have to remind myself.) The gist of the article is that doctors are among the most resistant to using email. Teachers, professors, lawyers – even car mechanics are more likely to use email as a way to improve and increase communication with their students, clients and customers. Yet when it comes to giving patients a helping hand by opening up the lines of communication, the medical establishment is exceptionally hesitant. Evidently, this “new” email technology is so advanced, you’ll just have to be (pun alert)…patient.
One of the Bees put it bluntly: “What is it with the medical industry’s refusal to join the world we all actually live in?”
Now, I understand that hospitals might be worried about their practitioners being inundated or wasting precious time. Like teachers, cops and nurses, docs have plenty of paperwork to do already. Here’s the obvious challenge: doesn’t that signify a need for innovation, not resistance?
Frankly, I was surprised when my G.P. volunteered his personal email address. (He’s one of the scant 25% of doctors who use email with patients.) I’ve challenged him on some things, sent him some studies, and he’s gained insights. Likewise, I’ve learned really valuable “insider” information about drugs, medical history, and what doctors really think about their patients.
Hospital and HMO executives say that the “danger” of email is that it could become very time-intensive and run the risk of burdening doctors with administrative questions instead of health questions. There’s also the issue of liability. And of being a grown-up.
But the Times article found that, generally at least, doctors are open to email. Here’s the real deal: It’s not the doctors who have a problem with it – it’s the executives. These are big boys and girls, and when they cop to pathetic excuses like “these things are just very new” – I’m actually embarrassed for them. Very new? Yes, just like cell phones and CDs.
Wouldn’t email be a great way to make the patient and doctor invest more in each other? I’m sure some whiz 20-year-old out there could even come up with some cool community interface not unlike what we’re doing here.
Of course, that would require taking some responsibility.
[tags] Mark Sisson, Los Angeles Times, medical establishment, doctors, email, HMO, technology, medical industry, hospitals, innovation, healthcare [/tags]
People like to use eggs in words like eggscellent, eggxactly and eggstatic.
Poor eggs. I recommend using them in your meals instead – and think beyond breakfast on occasion. Eggs are slowly regaining favor after their Humpty-Dumpty fall during the whole cholesterol paranoia of the 1960s, 70s and 80s.
We know that they contain valuable protein, vitamins and minerals: stress-busting selenium, antioxidant E, and eye-healthy lutein among them.
Because I am an egghead (sorry), I’m proud to bring you the latest findings from a study Mark pointed out to the Bees in the Journal of Nutrition. In a study that was randomized (good), controlled (great), and cross-sectional (nice), scientists found that a daily egg gave people’s eyes a boost with lutein and zeaxanthin (an antioxidant from the carotenoid family) and didn’t raise their serum cholesterol. Not that we worry too much about cholesterol anyway. That’s right – we don’t lose sleep over cholesterol! Just one of the many MDA ongoing health debates you might want to check out in the forum.
Matt Bonnington Photo
So scramble, Apples!
[tags] lutein, zeaxanthin, carotenoids, antioxidant, cholesterol, egg, protein, selenium, vitamin E, Journal of Nutrition, nutrition study [/tags]