RFID and cancer

Who needs privacy concerns if RFID causes cancer. The small implantable microchips that have generated concern from privacy experts and readers of revelations alike have now been associated with sarcoma formation in animals.

A series of veterinary and toxicology studies, dating to the mid-1990s, stated that chip implants had “induced” malignant tumors in some lab mice and rats.

“The transponders were the cause of the tumors,” said Keith Johnson, a retired toxicologic pathologist, explaining in a phone interview the findings of a 1996 study he led at the Dow Chemical Co. in Midland, Mich.

Leading cancer specialists reviewed the research for The Associated Press and, while cautioning that animal test results do not necessarily apply to humans, said the findings troubled them. Some said they would not allow family members to receive implants, and all urged further research before the glass-encased transponders are widely implanted in people.

Published in veterinary and toxicology journals between 1996 and 2006, the studies found that lab mice and rats injected with microchips sometimes developed subcutaneous “sarcomas” — malignant tumors, most of them encasing the implants.

– A 1998 study in Ridgefield, Conn., of 177 mice reported cancer incidence to be slightly higher than 10 percent — a result the researchers described as “surprising.”

– A 2006 study in France detected tumors in 4.1 percent of 1,260 microchipped mice. This was one of six studies in which the scientists did not set out to find microchip-induced cancer but noticed the growths incidentally. They were testing compounds on behalf of chemical and pharmaceutical companies; but they ruled out the compounds as the tumors’ cause. Because researchers only noted the most obvious tumors, the French study said, “These incidences may therefore slightly underestimate the true occurrence” of cancer.

– In 1997, a study in Germany found cancers in 1 percent of 4,279 chipped mice. The tumors “are clearly due to the implanted microchips,” the authors wrote.

I’m pretty sure they’re referring to this study in mice in the first example. As usual the idiots writing science pieces can’t figure out how to link articles in the literature, or even mention useful information to help find the article like the journal name or an author. Worthless, I swear.

RFID didn’t need any more help being creepy. But two things should be considered before this becomes a major concern. First, is that enough of these have been implanted in dogs and cats that it strikes me as strange that this has not been observed yet in the pet population (I could only find one report and it’s not clear this is different from post-injection fibrosarcoma seen with vaccination in cats and dogs). Maybe now that we know to look such an effect might appear with systematic study. Second this result would be surprising since one would not predict the types of materials used in implantable chips would cause inflammation or be carcinogenic (unless someone screwed up), so it is unclear what the mechanism would be for carcinogenicity.

The things that are scary are that this has been observed inadvertently in multiple studies, the cancers are repeatedly sarcomas, and based on what the researchers have said, directly associated with the RFID implant. It’s enough that I would never agree to get an implant, not that I see any good reason to in the first place. Even a 0.01% risk of cancer would be crazy, since there isn’t enough of a benefit to the technology to justify the risk of tens of thousands of cancers a year if the technology were widely adopted. Here’s an instance in which the precautionary principle wins out. This technology should be frozen for human use until the cause of these results is better understood.

I should also point out that this is yet another example of crappy science reporting. Not because it wasn’t thorough, but because of the complete lack of transparency about the specific sources in the literature from which the reporting came. I think we should start writing emails to authors of articles that do this until the problem is corrected.

The antidepressant suicide link – busted?

The Washington Post reports on the apparent jump in suicide rates since antidepressants got a black-box warning in 2004 after some reports suggested an increased suicide rate in youths after the initial prescription.

The article here (goddamn WaPo still can’t figure out how to link anyone but themselves) shows a disturbing correlation:

METHOD: The authors examined U.S. and Dutch data on prescription rates for selective serotonin reuptake inhibitors (SSRIs) from 2003 to 2005 in children and adolescents (patients up to age 19), as well as suicide rates for children and adolescents, using available data (through 2004 in the United States and through 2005 in the Netherlands). They used Poisson regression analyses to determine the overall association between antidepressant prescription rates and suicide rates, adjusted for sex and age, during the periods preceding and immediately following the public health warnings.
RESULTS: SSRI prescriptions for youths decreased by approximately 22% in both the United States and the Netherlands after the warnings were issued. In the Netherlands, the youth suicide rate increased by 49% between 2003 and 2005 and shows a significant inverse association with SSRI prescriptions. In the United States, youth suicide rates increased by 14% between 2003 and 2004, which is the largest year-to-year change in suicide rates in this population since the Centers for Disease Control and Prevention began systematically collecting suicide data in 1979.

This is disturbing. However, the I don’t agree with the current interpretation of the problem.

NIMH’s Insel said it is possible that antidepressants are lowering the risk of suicide overall, even as they increase the risk among a subset of patients. New research to be published soon examines genetic factors that may put some patients at particular risk, he added.

There is another explanation – a mixture of confirmation bias and post hoc ergo propter hoc reasoning. The main offender, yet again, is a meta-analysis.
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WSJ and anti-government conspiracies

Leave it to AEI writing for the WSJ editorial page to allege a grand conspiracy of the government against pharmaceutical companies. Their proof? The government wants to compare the efficacy of new drugs to older ones to make sure they’re actually better.

The reauthorization of the State Children’s Health Insurance Program (Schip), created in 1997 to cover children from lower-income families who make too much to qualify for Medicaid, is up for renewal this fall. Tucked into page 414, section 904 of the House bill is a provision to spend more than $300 million to establish a new federal “Center for Comparative Effectiveness” to conduct government-run studies of the economic considerations that go into drug choices.

The center will initially be funded through Medicare but will soon get its own “trust fund.” The aim is to arm government actuaries with data that proponents hope will provide “scientific” proof that expensive new drugs are no better than their older alternatives. The trick is to maintain just enough credibility around the conduct of these trials to justify unpopular decisions not to pay for newer medicines.

While there’s nothing inherently wrong with this sort of fiscally minded clinical research, Medicare is no ordinary payer: It dictates decisions made in the private market. So as the government begins tying its own payment decisions to the results of its own studies, there’s a great temptation to selectively interpret data and arbitrarily release results. Clearly, this obvious conflict of interest demands even more outside scrutiny and transparency than has been the usual fare when it comes to government research.

Yes, because private research is so much more transparent than studies performed by the government. Gottlieb’s example of a government hit on expensive drugs, was of all things, the Women’s Health Initiative.

More insane conspiratorial nonsense from AEI and the WSJ below the fold.
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Cato is shocked, shocked! To find wait times for care in the US.

The NYT reports on the differing wait times between high-cost cosmetic procedures in dermatology, and low-cost potentially life-saving screenings for melanoma and other skin cancers.

Patients seeking an appointment with a dermatologist to ask about a potentially cancerous mole have to wait substantially longer than those seeking Botox for wrinkles, says a study published online today by The Journal of the American Academy of Dermatology.

Researchers reported that dermatologists in 12 cities offered a typical wait of eight days for a cosmetic patient wanting Botox to smooth wrinkles, compared to a typical wait of 26 days for a patient requesting evaluation of a changing mole, a possible indicator of skin cancer.

Dr. Michael J. Franzblau, a dermatologist in San Francisco, said doctors typically charged $400 to $600 for a Botox antiwrinkle treatment, for which patients pay upfront because insurance does not cover it.

Meanwhile, doctors have to wait for health insurance to reimburse them for mole examinations, for which they receive an average of $50 to $75, Dr. Franzblau said.

What’s then great is to see the “market solves all problems” types at Cato try to wrap their heads around this astonishing instance in which the market doesn’t provide good for all and cute dancing little elves.

With regard to Medicaid, it’s easy to see what’s interfering with the price mechanism: Medicaid prices are set by state governments, and so they don’t change to eliminate shortages (i.e., waits) the way market prices might. The same is largely true of private coverage: those prices are set by insurers, who mostly just track the prices that the federal government sets through the Medicare program

But then why would there still be shortages for patients who come with cash in hand? The price mechanism seems to be working for cash-paying Botox patients, but not for cash-paying ambulatory clinic patients. One possibility is that there might be spillover effects that affect cash-payers in markets dominated by third-party payment and rigid prices. But then wouldn’t we see cash-only ambulatory clinics emerge to capture those customers? If not, that suggested supply constraints to Peter and me.

Oh yeah, it must be the influence of medicare to blame! If it weren’t for the bad influence of those dirty socialists the private insurers would be reimbursing preventative care with gold dubloons!

Or, maybe, just maybe, the market doesn’t provide goods equally between between socioeconomic strata. Maybe, just maybe, people who can afford 600 dollar botox injections receive faster more prompt care than the average schmo looking to figure out what some growth is. Maybe this is a sign that the profit-motive in medicine leads to shortages of care for more important needs and poorer patients as the profitable low-hanging fruit will always be more appealing than dealing with insurance companies and the average peons off the street who may not be able to pay their medical bills.

Cato can blame “markets dominated by third-party payment and rigid prices”, and there is some truth to that, but the bigger problem is that fighting with insurance companies for reimbursement with their “mommy may I” and 10% routine rejection policies is a hassle. It’s just easier to take rich people who want botox injected into their face than practice the routine preventative care that is critical for keeping healthcare costs down. It’s a sign that our medical priorities are screwed up, the private insurance based system is not providing adequate care, and the right type of medicine is being discouraged. It’s also ironic that as much as Cato complains about wait times in Canada (wait times for “emergency” cataract surgery – oh noes!), they aren’t nearly as quick to judge a market systems critical flaws as those of a socialized one.

Bad news for lying “Family Values” associations

One of the problems with denialists is that they simply can’t accept that science doesn’t conform to their ideology. For instance, it’s not enough to just be morally opposed to abortion, the anti-choice organizations have to misrepresent risks of the procedure, including promoting the false link (NCI) between abortion and breast cancer.

Recently, Talk to Action exposed the lies of Crisis Pregnancy centers, and the dishonest tactics they use to misrepresent the services they offer and lie about the risks of abortion. These centers which use federal money to misrepresent the science, are nothing more than a taxpayer-funded anti-choice scam.

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Is the FDA responsible for hundreds of thousands of deaths?

No. But the WSJ would like you to believe so.

One libertarian talking point I hear a lot (Cato of course loves this story), and is repeatedly pushed by the WSJ, is that the market and consumers should decide the safety and efficacy of drugs – not dirty gov’mint bureaucrats who want nothing but death and suffering for cancer patients. The latest is this commentary from Ronald Trowbridge and Steven Walker which has some fun with math to suggest the delay in approval of cancer drugs has led not to dozens, or hundreds, or thousands, but hundreds of thousands of premature deaths.

Is there any basis in fact for these accusations? Is the FDA somehow worse than Hitler? Hmmm.
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AMA and Prescription Data Mining

It’s a few weeks old, but I just came across this oped in the San Francisco Chronicle by Robert Restuccia and Lydia Vaias. They’ve painted a big target on the American Medical Association for its role in prescription data mining. It’s important to note exactly what AMA is doing here, because, from the oped, it appears that AMA is simply selling lists of doctors that are later enhanced for prescription mining purposes.

Few people recognize the role the AMA plays in making physician information available to companies that use it for pharmaceutical marketing purposes. The AMA sells information from its physician “Masterfile” to health information organizations that pair the identifying information with prescribing records from pharmacies and sell the whole package to pharmaceutical companies, a practice commonly called “prescription data-mining.”

Let me note that basically every non-profit with a membership sells lists. You can search for these lists on Direct Magazine’s Listfinder, which has over 60,000 “datacards” from businesses and non-profits. The fact that other organizations sell membership data doesn’t excuse AMA’s actions, but I think what’s happening here is that the activists are targeting AMA because the “health information organizations” and pharmaceutical companies are difficult to influence without passing legislation.

Nevertheless, AMA’s opt out program smacks of bogusity, and those of you who are doctors (AMA member or not), should be upset about it:

Last year, in response to this growing pressure, the AMA created an “opt-out” measure, called the Prescribing Data Restriction Program. Difficult to navigate, poorly publicized, with only a quarter of physicians are aware of it, and used by less than 1 percent of doctors, the opt-out program is a step toward reform, but a small and inadequate one. The program does not bar the sale of prescriber information to pharmaceutical companies; it merely requests and then relies on the industry to prevent the transmission of this data to its sales teams.

AMA’s move recalls what the Direct Marketing Association did to prevent people from opting out of telemarketing. DMA created the “telephone preference service,” poorly publicized it, make it difficult to enroll, etc. And then when the Federal Trade Commission proposed a national Do-Not-Call Telemarketing Registry, DMA said it wasn’t necessary and that the private sector had created a better opt out system.

So, doctors, take the time to opt out. Why? Because if you don’t, AMA will claim that you don’t care about having your information sold, and that people who complain about prescription data mining and the like are just fringe lunatics!

Hat tips: US PIRG, PAL, Consumerist.

Does Smoking Cannabis Cause Schizophrenia?

Blogging on Peer-Reviewed Research

A lot of people are talking about a new study showing a 40% increase risk of “psychosis”, which I first heard news of in this story, from the Daily Mail:

A single joint of cannabis raises the risk of schizophrenia by more than 40 percent, a disturbing study warns.

The Government-commissioned report has also found that taking the drug regularly more than doubles the risk of serious mental illness.

Overall, cannabis could be to blame for one in seven cases of schizophrenia and other life-shattering mental illness, the Lancet reports.

Something sounds a little off. Let’s see what this Lancet study says.
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Are metrics in medicine a good thing?

The Washington post reports on new efforts by insurance companies to rate doctors performance and their policies that penalize doctors for performing poorly according to their metrics.

After 26 years of a successful medical practice, Alan Berkenwald took for granted that he had a good reputation. But last month he was told he didn’t measure up — by a new computerized rating system.

A patient said an insurance company had added $10 to the cost of seeing Berkenwald instead of other physicians in his western Massachusetts town because the system had demoted him to its Tier 2 for quality.

In the quest to control spiraling costs, insurance companies and employers are looking more closely than ever at how physicians perform, using computers, mountains of health claims and billing data and sophisticated software. Such data-driven surveillance offers the prospect of using incentives to steer patients to care that is both effective and sensibly priced.

Now, on the surface, many people might say this is a good thing. But I will argue, that this kind of superficial measurement of performance will not only demoralize doctors but adversely affect patient care:
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