I love bacon

Blogging on Peer-Reviewed ResearchA reader, who happens to write one of the best-named blogs on teh tubes, pointed me toward an article I never would have seen. This parallels a news story we had here in the States late last year. So, since the story is getting press overseas (albeit late), it’s time to dust off the old post and update it a bit.

The story repeats the finding that processed meats increase the risk of colon cancer. This news comes from a large report published by the World Cancer Research Fund, which looks at data surrounding diet and cancer. It states that there is no safe level of processed meat consumption when it comes to colorectal cancer risk. It’s going to take a long time to parse through all the data, but since I love my processed meat, I’ll start there, and once again, my scientist colleagues will please forgive me for oversimplifying.

First, this is a huge report, pooling tons of data. One of the most important conclusions is regarding obesity and cancer risk, but that will have to wait until later.

Per USAToday, “every 1.7 ounces of processed meat consumed a day increases the risk of colorectal cancer by 21%.” Per the Daily Mail, “[e]ating just one sausage a day raises your cancer risk by 20 per cent.” What does that mean? “Risk” is a complicated concept in medicine. It is easy to draw overbroad conclusions from bits of data. When risk is measured, it is rarely intuitive–small percentages can indicate large increases in risk, large numbers can refer to small increases in risk–it depends quite a bit on the base line incidence and prevalence of the disease. A 50% increase in a disease sounds big, but in the right situation it can be big or small. For example, if your “usual” risk of disease A is 2/100, then a 50% increase makes your risk 4 in 100, meaning out of 100 people, 2 more get the disease then they would without the extra risk. If the “usual” risk is 10/100, then a 50% increase means 5 more people get the disease.

I hope you haven’t given up on me here. Keep reading…trust me…

Continue reading “I love bacon”

I don’t usually do this but…

…I really couldn’t resist sharing some fun links. I guess you’d call it blogrolling.

First, someone got a hold of the über-seekrit Expelled:Leader’s Guide, and started deconstructing it.

Next, Steve Novella once again eviscerates a wacky water-woo cult leader at NeuroLogica.

Panda Bear, M.D. has one of his usual lengthy must-reads.

Orac goes after the reductio ad Hitlerum arguments of Expelled.

Finally, N.B. explains why chemistry is everywhere, even in your hair.

Hey! Look! Science works! Zetia, not so much.

ResearchBlogging.orgI love this story because it shows how evidence-based medicine works, even in the face of corporate greed.

A while back I told you about a cholesterol study with negative results; that is, it failed to show a drug to be helpful. Intimately entwined with the study design was a potential conflict of interest on the part of the drug company, but science won out—data, after all, is data.

Then, few months ago, another set of (preliminary) cholesterol data was released by Merck and Schering-Plough, after much prodding, regarding their drugs Vytorin and Zetia.

Zetia has been quite popular. A certain number of patients do not tolerate “statin” cholesterol medicines, and are put on Zetia as an alternative. Zetia lowers cholesterol, but it has never been shown to improve important outcomes such as mortality, heart attack, stroke. That isn’t to say it might not do these things, it just hadn’t been studied. Statin cholesterol drugs have been studied, and have an excellent effect on outcomes.

Now, interesting new data is emerging. First, according to a study in the New England Journal of Medicine (NEJM) the companies’ marketing campaign appears to be working, at least in North America. Prescribing patterns have changed, with an increase in Zetia prescribing and in costs.

Continue reading “Hey! Look! Science works! Zetia, not so much.”

Malawi to curb fake AIDS healers

The Lancet (Vol 371:9615, March 8, 2008 p. 784) notes that the government of Malawi is working on legislation to prevent traditional and religious healers from deceiving people about AIDS. According to Mary Shaba, a Malawi health official, “when it [the proposed legislation] passes into law, all traditional healers claiming to cure AIDS will be dealt with…. The Act will regulate and protect people from healers who prescribe sex with albinos, the disabled or virgins as a cure for HIV and AIDS.”

According to the WHO, the HIV rate of about 14% in Malawi has helped reduce life-expectancy to 36 years.

Health officials say that traditional healers were involved in the drafting of the legislation.

This is huge. Really. If it works. There is so much bullshit out there about AIDS. The U.S. is full of HIV denialists, and their idiocy spreads to where it can do the most harm—Africa. Top African leaders, such as Thabo Mbeki have fallen prey to the denialists.

And let’s make no mistake—the “intellectual” home of HIV denialism is the U.S. where the impact is nothing near what it is in Africa. When folks like Peter Deusberg and Henry Bauer (post to follow) spread their nonsense and lies in North America, people have access to all manner of information resources and doctors. Not so much in Africa. If an African leader gets taken in, it can affect policy and have immediate repercussions.

While the fight against AIDS usually focuses (properly) on prevention and treatment, getting rid of the woos isn’t such a bad idea, and working to co-opt traditional healers is a great idea. The traditional healers could be a potentially powerful force in combating AIDS. The faith-healing churches are another problem altogether.

Eat it raw! It’s…magic!

In case you haven’t heard, cooking food is bad–at least according to the raw food movement. This movement has developed over the last 5-10 years, and is still fairly fringe, but fad diets, restaurants, stores, and websites devoted to raw foods are flourishing. Let’s see what they’re up to.

According to one popular website, we should begin our story by thinking about a few questions:

What other animal on earth denatures its food by cooking?
What other animal on earth suffers from all the health challenges that we face?
What did people eat before there was fire?? They ate it RAW!

This is as good a place as any to start. The answer to question one is simple…none! To quote Sandy Templeton, my pathology professor, “Is this a good thing, a bad thing, or doesn’t it much matter?” I’ll report, you decide. Let’s add to that question–what other animal uses tools extensively to modify its environment? Uses medicines? Lives past its “natural” life span? Avoids disease through public health measures? Reads and writes books? None! Woo-hoo! We are actually different than other animals!

Question two, “health challenges”. OK, anyone out there grow up on a farm, or see any wild animals up close? Or read a biology book even? Animals are constantly battling disease. Humans are not unique in our “suffering”, although each species has its own health demons. Animals have parasites–lots of ’em. Animals suffer from horrible viral, bacterial, and prion diseases; animals starve in times of famine. They don’t usually, as far as we know, survive strokes and heart attacks–field mice don’t send a lot of their brethren to medical school.

Question three answers itself, so I guess I’m off the hook.

Continued below…
Continue reading “Eat it raw! It’s…magic!”

Cell Phones and Cancer – Scaremongering from the Independent

The Independent has yet another hysterical article about the potential link between cell phones and brain cancer. And I’ve been asked, what are we seeing here? Is this the early reporting of a potential public health threat? Or is it just more nonsense from a newspaper that wouldn’t know good science if it sat on it’s head? Both Ben Goldacre and I have felt the need to take on some piece of nonsense from the Independent, and their previous writing on “electrosmog”, a repeatedly disproven piece of crankery, diminishes their credibility on this issue.

And guess what else diminishes their credibility here? Only about every single aspect of this article. For one they start out with an irresponsible claim about the risks of cell-phone use that I won’t bother to repeat since it will just reinforce an unproven statement.

Second, where is this study? I looked for it. I searched for the author’s name in pubmed, and while he’s well-published, there’s nothing about cell phones.

Yet they claim the study has been published:

The study, by Dr Vini Khurana, is the most devastating indictment yet published of the health risks.

But then we find out that this study isn’t “published”, the results are just on a “brain surgery website”. After a little more digging I found it here published on Dr. Khurana’s webpage. Just a little reminder for the Independent, putting a paper on a webpage does not make it “published” in a fashion equivalent to publication in a scientific journal, and they would do well to correct this in their article. I know they won’t because I’ve noted a total lack of journalistic responsibility in their science coverage, but one can dream. Then I see this:

Professor Khurana – a top neurosurgeon who has received 14 awards over the past 16 years, has published more than three dozen scientific papers – reviewed more than 100 studies on the effects of mobile phones. He has put the results on a brain surgery website, and a paper based on the research is currently being peer-reviewed for publication in a scientific journal.

Currently being peer-reviewed? This means this paper is unpublished and merely submitted for review. Further, it’s a very strange move to take a paper that is being considered for publication to put it into the public domain. This means that it’s either been rejected from wherever was supposed to take it, or the author doesn’t realize this will likely sabotage its chances of being published. I simply don’t understand this move. Dr. Khurana appears to be a legitimate scientist, but that doesn’t make this any less inappropriate a method of publishing such a result. Since he hasn’t gone through proper peer-review channels before making this article available I think this means it’s fair game for me to criticize, and there’s plenty of room for that.

For one, he has an entire section on “Popular Press and the Internet” which consists of anecdotal reports of cancer clusters in the press, crank websites repeating false claims about cell phones and second-hand reporting on scientific articles. This is hardly a scientific approach to epidemiology or risk assessment, and should be dismissed out of hand as unworthy of discussion in a scientific paper. A review of the literature does not include citations of “www.EMF-Health.com”, no kidding, this is one of the sources he mentions. A website that sells the Q-link, a quack remedy for a nonexistent malady!

Then I see this statement:

In other words, if cell phones interfere with aircraft and hospital electrical equipment (even at quite a distance), how can it be that they don’t interfere with the electrical equipment of the head (i.e., the brain, when held for extended periods of time right next to this

Who’s done with this guy now? Do you even have to go on after a statement so absurd? This reflects a fundamental misunderstanding of physics and biology and a terrible argument from analogy. It’s an especially bad analogy as the evidence seems to be that cell phones have no effect on plane equipment to the point the FAA has long considered dropping the ban. Finally there is very little physical basis for a carcinogenic link between these radiofrequencies and cancer, so what would be the mechanism? The EM bands used by cell phones are non-ionizing, and do not have a physically plausible mechanism for causing cancer.

So far we only a couple pages in, have incredibly questionable sourcing and a terrible argument from analogy, l’ve already dismissed this as unworthy of consideration, should we bother to keep going? Ok, maybe a little further.
Continue reading “Cell Phones and Cancer – Scaremongering from the Independent”

A history of denialism – Part II – Tobacco companies

To continue to explain how terribly misguided Mooney and Nisbet are about ignoring denialist campaigns I think it’s time to go over the history of one of the most effective denialist campaigns ever. That is the concerted effort by the major tobacco companies (RJ Reynolds, Brown & Williamson, Lorillard, Phillip Morris, and British American Tobacco) to spread misinformation about the health risks associated with smoking.

Fortunately for those who study denialism, one of the results of the Tobacco Master Settlement all the internal memos of four of the largest tobacco companies have been released to the public and exist as free searchable databases.

Within these documents one can find some true gems of denialist strategy second only to Wedge Document for their unintentional disclosure of their dishonest tactics. For instance from “NEW DIRECTIONS” A presentation of the tobacco institute staff June 25th, 1981:


And this gem from Brown and Williamson “Smoking and Health Proposal” from 1969:


Throughout these documents you see a similar theme every time. Science comes out that is harmful to their profits, such as the 1964 Surgeon General’s report on tobacco and health was to be opposed no matter what the results. The writing is schizophrenic, while they seem to be convinced of their righteousness and the safety of smoking, they write about actively pursuing and eliminating the carcinogens in tobacco smoke, making filters that will be safer, and consider strategies of admitting to the danger of cigarette smoke. As the science becomes more damning they just shift the message to one of righteousness of personal liberty while their own research confirmed the risks to nonsmokers from environmental tobacco smoke.

What does this have to do with Mooney and Nisbet telling us to ignore the cranks like the DI or the Heartland Institute? It shows that even when the majority of people understand and believe the science – for instance the evidence showing cigarettes cause cancer has been believed by around 90% of Americans for decades – well-funded denialist campaigns can still be highly effective in disrupting appropriate regulation, legislation, and dissemination of accurate public health information.

Global warming denialists using some of the same think tanks the tobacco companies used, and even some of the same shills such as Steven Milloy and Fred Singer (now working for the Heartland Institute) are capable of waging the same kind of war on legitimate science as they did for the tobacco companies. Only after years of work from public health authorities, scientists and interest groups, as well as vicious fighting over legislation, civil litigation and the actions of whistleblowers were the tobacco companies largely declawed in their campaign against scientific truth. It certainly wasn’t by ignoring them, and letting them act unopposed, or letting the polls dictate a non-existent victory that they were finally defeated. And that is the danger of the message we’re currently getting from the framers. It’s the worst possible strategy for opposing denialism, it’s dangerous, historically-ignorant, and will lead to disaster.

Despite the fact that the majority of Americans believed in the link between cigarettes and cancer the the tobacco companies’ denialist campaign worked for a long time, and here’s how they did it…

Continue reading “A history of denialism – Part II – Tobacco companies”

Sexually transmitted diseases—they’re successful, we’re not

Sexually transmitted diseases (STDs) are frighteningly common, as highlighted by a study released by the CDC earlier this month. The U.S. is in a unique position: few countries have the resources we do to prevent and treat STDs, and few countries squander such resources so effectively.

Let me give you a brief front-line perspective.

Continue reading “Sexually transmitted diseases—they’re successful, we’re not”

Gardasil is a good idea

What if we had a vaccine against cancer? Or even against some cancers? Wouldn’t this be a huge news story, with people everywhere clamoring for the shot? Maybe…

Or maybe, some people could find a way to turn that smile upside down. Gardasil, the new vaccine approved for prevention of certain cancer-causing strains of the Human Papilloma Virus (HPV), is the first widely available vaccine aimed directly at preventing cancer. (The Hepatitis B vaccine also helps prevent liver tumors, but that’s another story.) Gardasil can prevent cervical cancer, certain mouth and anal cancers, and perhaps other cancers of the naughty bits. So, who wouldn’t love that?

The Religious Right is who. You see, the infection that leads to these cancers is usually spread by sexual contact. Thats right, sex. SEX!! And sex is a big no-no for the fundies, at least outside of making babies with your opposite-sexed spouse.

But as much as I dislike fundamentalism, most of the “mainstream” fundamentalist groups have taken a more nuanced stand on Gardasil.

For school vaccination requirements, Christianity today favors an “opt-in” policy, while Focus on the Family sets a vaguer, “let the parents decide” policy. Both groups, quite wisely, recognize that the vaccine is valuable and that evangelical children are at risk for HPV. The Family Research Council also has an “opt-in” policy with the additional honesty of explaining why they do not like an “opt-out” policy. All of the groups do seem to over-emphasize potential negative arguments, however. Cost comes up as an issue–as it should with any medication. But if the vaccine prevented, say, ovarian cancer, I don’t think anyone would focus much on the price.

“The wages of sin is death”, and while most Christians do not subscribe to a literal interpretation of this idea, it does infuse the Right’s decision-making, perhaps blinding them to the benefits of this vaccine. In order for the vaccine to be effective, it must be given before the onset of sexual activity (which can even mean touching “down there”). While none of us likes to think about our kids having sex at 14, it may happen, and to punish them with cancer seems, well, excessive.

An “opt-in” policy for vaccinations is not a good approach to public health. Vaccines work by protecting people before they may be exposed, and by creating herd immunity. Everything that can be done to encourage vaccination should be. Opt-in carries an implication that the vaccine is either unimportant or of uncertain utility. Opt-out, while less negative, makes it too easy for people do put off a decision until it is too late.

As with any vaccine, safety and efficacy are important. And, as with any disease, education is an excellent public health measure. Mandatory sex education would go a long way toward preventing sexually transmitted diseases and unwanted pregnancies. I wonder how Focus on the Family feels about that?

I hate orange urine

Urinary tract infections (UTIs) are a very common problem, especially in women. The link provided offers some very good information, but briefly, women’s urethrae (the tube the urine comes out of), are closer to the rectum than those of men (who have a built-in “spacer”). This allows bacteria from the colon to creep over to the urinary tract and cause burning, pelvic pain, frequent urination, etc. I treat UTIs daily. Most are uncomplicated, but some are quite serious (usually in the elderly and chronically ill). As medical problems go, I love UTIs. When a healthy, young woman comes in with the usual symptoms, a quick test can confirm the diagnosis, and, usually, three days of inexpensive antibiotics fixes it. The patient is happy, I’m happy, everyone’s happy. But then there’s the orange stuff.

A few years back, a medication called “phenazopyridine” became more widely available as an over-the-counter drug. It is marketed to treat the symptoms of UTIs. It turns urine and other body fluids bright orange. This medication is useful for reducing the symptoms of UTIs, but does not cure them. The FDA does mandate certain labeling for the OTC preparations, but I can tell you from experience, the subtlety of this distinction is, well, subtle. Fortunately, you don’t have to rely on my experience. Someone bothered to study the question. Most patients do not realize the difference between treating the symptoms and treating the disease. This leads to delay of treatment, and the infection can become more serious. To add insult to injury, phenazopyridine’s orange pigment interferes with the most common tests we use to diagnose UTIs.

In discussions of medical ethics, the concepts of “paternalism” and “patient autonomy” are often thought of as being in opposition to each other. It is sometimes in the name of autonomy that medications are made more easily available to patients by skipping the physician prescribing process. (Also, over the counter meds are quite profitable). This can be very useful for medications such as ibuprofen, or Plan B (post-coital contraception), but any time you cut out the expert, certain risks accrue. Paternalism isn’t the opposite of autonomy. The two work together. Patients see me for my expertise. They don’t consult me about movies, art, or (thankfully) religion—just medicine. They do this because I’m the one with the training. Giving a patient knowledgeable advice is not paternalistic—it’s what they came here for. I don’t paternalistically command my patients to do anything. I dole out advice, and they are free to follow it or not.

Orange urine not only removes the expert, it fools the patient. It does not increase autonomy, it actually decreases it by deceiving the patient, perhaps causing them to become more ill.

<End of rant>