Category: Medicine

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.
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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 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.
Continue reading “The antidepressant suicide link – busted?”

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.

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.
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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:
Continue reading “Are metrics in medicine a good thing?”