Saturday, January 20, 2007

Chlorinated water a cancer risk?

We're all gonna DIE!

Odd that drinking water has been chlorinated for about a century while lifespans have soared, though

We can add swimming pools to the ever-growing list of things we like that are bad for us, with a new study showing chlorinated water may increase the risk of bladder cancer. Staff at the Municipal Institute of Medical Research in Barcelona have found chemicals, most commonly chlorine, used to disinfect water can produce by-products that have been tied to increased cancer risk. Dr Cristina Villanueva today said the findings were the first to suggest the chemicals could be harmful when they were inhaled or absorbed through the skin, as well as when they were ingested.

The most prevalent chlorination by-products, chemicals called trihalomethanes (THM), could be absorbed into the body through the skin or by inhalation, the researchers said. To investigate lifetime THM exposure and bladder cancer risk, they matched 1219 men and women with bladder cancer to 1271 control individuals who did not have the disease, questioning them about their exposure to chlorinated water via drinking water, swimming pools, showering and bathing. The researchers also analysed the average water THM levels in the 123 municipalities included in the study.

People living in households with an average household water THM level of more than 49 micrograms a litre had double the bladder cancer risk of those living in households where water THM concentration was below 8 micrograms a litre, the researchers found. THM levels of about 50 micrograms a litre were common in industrialised societies, they said. Study participants who drank chlorinated water were at 35 per cent greater risk of bladder cancer than those who did not, while use of swimming pools boosted bladder cancer risk by 57 per cent. And those who took longer showers or baths and lived in municipalities with higher THM levels were also at increased cancer risk.

When THM was absorbed through the skin or lungs, it may have a more powerful carcinogenic effect because it did not undergo detoxification via the liver. "If confirmed elsewhere, this observation has significant public health implications in relation to preventing exposure to these water contaminants," the researchers concluded.


The anti-MMR gravy train derailed

Revealed: How more than £15million of legal aid funding was spent by lawyers trying and failing to prove that the MMR vaccination causes autism.

Five years ago, supporters of Dr Andrew Wakefield’s claim of a link between the MMR vaccine and autism used to argue that ‘the evidence was stacking up’ in support of this theory. In fact, the only evidence that was stacking up was evidence against the link: more recently a series of robust epidemiological studies showing no reason to suspect that MMR caused autism has been supplemented by rigorous virological investigations failing to demonstrate any link (1, 2). Meanwhile, another stack of evidence has emerged, revealing how legal aid funding bankrolled the campaign against MMR.

Two significant developments occurred over the Christmas period in the long-running MMR saga – both related to the activities of the investigative journalist Brian Deer. It was Deer who, in The Sunday Times in February 2004, first exposed Dr Wakefield’s failure to disclose the conflict of interest arising from legal aid funding for the study published in the Lancet in February 1998 that launched the MMR-autism scare. In a subsequent ‘Dispatches’ documentary broadcast by Channel 4 in November 2004, Deer raised further questions about Dr Wakefield’s funding and about the ethical conduct of his research (as well as revealing his association with quacks and charlatans in the USA).

On 22 December 2006, in response to a request initiated by Deer under the Freedom of Information Act, the Legal Services Commission revealed for the first time details of how more than £15million of legal aid funding was spent by lawyers attempting to make a case that MMR had caused autism in more than 1,000 children (3). This case collapsed in September 2003 when the LSC finally realised that there was no possibility of the case succeeding on the basis of the research commissioned by the lawyers and refused further funding. On 2 January this year, Dr Wakefield announced his withdrawal from the libel action he had launched against Deer and Channel 4 over the ‘Dispatches’ programme, agreeing to pay costs of £500,000 (borne by Dr Wakefield’s medical insurance firm) (4). Let’s look first at the libel debacle.

Dr Wakefield’s abandonment of his claim that Deer’s documentary had misrepresented him follows earlier setbacks in the progress of his libel action (5). In November 2005, Justice Eady refused an attempt by Dr Wakefield’s team to postpone the hearing of his libel claim until after his appearance before the General Medical Council, on associated disciplinary charges (for my view on Dr Wakefield’s appearance at the GMC see Stop witch-hunting Wakefield). The judge was highly critical of what he described as Dr Wakefield’s wish ‘to use the existence of libel proceedings for public relations purposes, and to deter other critics’ while trying to delay the case, thus denying Deer the opportunity to defend himself. Dr Wakefield had tried to take advantage of his ongoing libel claim to deter critical commentary on the case in the press, on the radio, even on the Department of Health’s website.

In November and December 2006, Justice Eady made further rulings allowing Deer’s application to see copies of key documents – including clinical records of children involved in the Lancet study and other documents that Dr Wakefield had been required to make available to the GMC investigation. The fact that Dr Wakefield’s withdrawal from the libel action followed so closely on Deer’s team gaining access to these documents suggests that they were supportive of Deer’s case.

One unfortunate aspect of the collapse of the libel action is that this information will remain secret – at least until Dr Wakefield’s appearance before the GMC (now scheduled for July). Nevertheless, Dr Wakefield’s libel volte face is a dramatic vindication of Deer and his carefully documented exposure of the anti-MMR campaign.

The LSC’s disclosures confirm that the major beneficiaries of the anti-MMR litigation (payments were made from 1992 up to 2004) were the lawyers. They received some two thirds of the £15million total (£8million to solicitors, £1.7million to barristers). The bulk of the revenues accruing to solicitors went to the Manchester-based firm Alexander Harris, where one partner, Richard Barr, played the leading role in coordinating the anti-MMR campaign from the outset. Barr also pursued the claims of alleged victims of the use of organophosphates in farming and of former soldiers with Gulf War syndrome (with equal lack of success). He has subsequently left Alexander Harris and has apparently abandoned the anti-MMR cause.

The LSC provides a detailed account of how a further £4.2million was claimed in ‘fees and expenses’ by more than 60 experts retained by the lawyers in the quest to justify their claim for damages against the vaccine manufacturers by proving a link between MMR and autism. The key payments – amounting to a total of nearly £1.7million - went to around a dozen prominent campaign supporters (6). In principle, expert witnesses are supposed to provide objective evidence to the courts. In practice, it is clear that, in the case of the anti-MMR litigation, legal aid funding went largely to those supportive of the anti-MMR campaign.

The notion that serious science could result from research sponsored by legal aid funding and administered by lawyers is nonsense. The team of experts assembled by Barr did not include a single recognised autism specialist, paediatrician, vaccine specialist, virologist or paediatric gastroenterologist who has a current public appointment or is currently in practice. (Indeed, many of the experts have long retired, though several have embarked on new careers as professional expert witnesses.) When the LSC finally called a halt to the litigation in September 2003, it belatedly acknowledged that ‘in retrospect, it was not effective or appropriate for the LSC to fund research’, conceding that ‘the courts are not the place to prove new medical truths’ (7).

To any observer not familiar with the world of law, what is striking is the sheer scale of the payments received by the witnesses in this case, which contrasts sharply with standard incomes in the medical and scientific world. To enable a rough comparison, in the UK in the 1990s, the basic income of a mid-career researcher at a university or medical school would have been around £50,000 to £60,000 a year; a clinical psychologist would earn perhaps £30,000 to £40,000. What emerges is a cultural gulf between the largely public sector worlds of medicine and science, on the one hand – with low incomes, austere working conditions, meetings in shabby hospital or university seminar rooms, with institutional tea and sandwiches – and, on the other hand, the glitzy world of the law, in which highly paid professionals meet in luxury hotels with lavish hospitality and everybody claims handsome expenses (and after some quibbling, the LSC pays up).

Dr Wakefield received a total of more than £400,000 for his contribution to the case (equivalent to several times his annual income in the 1990s). He claims that he charged at the rates recommended by the British Medical Association for such work (between £47 and £100 per hour) (8). If he worked full time at this rate, his receipts would cover between two and four years exclusively devoted to the case. (Indeed, he indicates that his final award from the LSC was £100,000 less than he claimed.) Yet he was employed by the Royal Free up to December 2001, when he was reported to have taken up a post at Dr Jeff Bradstreet’s treatment centre in Florida (he has since moved on to another private clinic in Texas). According to Dr Wakefield, he donated the income he received from the litigation to support the foundation of a research unit dedicated to bowel problems in autistic children, first (unsuccessfully) at the Royal Free and later in the USA. According to Deer, the accounts of these organisations reveal that he was a recipient of funds from them rather than a donor.

The biggest single earner from the litigation was Professor John O’Leary who set up the firm Unigenetics to process requests from parents to test bowel and other specimens for traces of measles virus that Dr Wakefield believed would confirm his MMR-autism hypothesis. Indeed, the publication in 2002 of two papers by O’Leary’s team purporting to demonstrate measles fragments in autistic children appeared to many parents – though not to sceptical experts – to provide powerful evidence for the Wakefield theory. Two recent papers have conclusively refuted O’Leary’s findings (1,2). The recognition by the LSC that it could not rely on the results from O’Leary’s laboratory was one of the key factors in its decision to abandon the litigation. These tests ultimately failed to confirm a link between MMR and autism in a single child and left more than a thousand families with dashed hopes. Professor O’Leary and his colleagues received more than £700,000. No further publications in this field have emerged from his department.

Though the detailed figures have not previously been available, it has long been known that Dr Wakefield and Professor O’Leary had derived a substantial income from the litigation. Perhaps the most valuable revelation in the LSC’s recent document concerns payments to a number of individuals who have provided Dr Wakefield with vital public backing at key moments in the unfolding controversies surrounding MMR over the past decade. Many of these Wakefield supporters had not declared that they were beneficiaries of the litigation, though this might be considered a significant factor.

Dr Kenneth Aitken (£230,000) was formerly a clinical psychologist at Edinburgh children’s hospital but now works in private practice. He is closely associated with the burgeoning world of autism quackery in Scotland (9). He supported the Wakefield position at one of the Medical Research Council investigations and at the Scottish Executive inquiry in 2001. Dr Carol Stott (£100,000) was engaged on postgraduate research in autism in Cambridge before her suspension for sending abusive emails to Brian Deer. She has collaborated with Dr Wakefield on a number of articles published in anti-vaccine journals and runs a pro-Wakefield website. She has recently been appointed ‘associate professor’ at Dr Wakefield’s new clinic in Texas.

Dr Peter Fletcher (£40,000) was head of the committee on safety of medicines in the 1970s and emerged from retirement to endorse Dr Wakefield’s critique of MMR safety in 2001. He is regularly quoted by anti-MMR journalists, but refuses to speak to anybody critical of the Wakefield campaign. Dr Peter Harvey (£10,000) was an adult neurologist at the Royal Free who examined the children in Dr Wakefield’s Lancet study. He subsequently took early retirement and now has a practice in Harley Street providing expert testimony in relation to litigation claims. He has provided occasional endorsement for Dr Wakefield’s claims in the press and on television.

Mr Paul Shattock (£8,000) is the parent of an autistic son and a retired lecturer in pharmacy who provides urine tests of no known scientific value purporting to provide a guide to dietary treatments for autism from his HQ in the University of Sunderland. He is a long-standing public promoter of the Wakefield campaign. Dr Richard Halvorsen is a private GP in central London who runs a business selling measles, mumps and rubella as separate vaccines to parents rendered fearful of the triple jab by the anti-MMR campaign (of which he is a vocal supporter). He received only £6,000 from the litigation. However, a clinic just north of London providing a similar service was at one time reported to have a turnover of £17,500 a week (though it is now defunct since its proprietor, Dr David Pugh, was imprisoned for fraud in 2005 and struck off the medical register last year).

What emerges from these documents is that there does not appear to be a single professional supporter of the Wakefield campaign who was not also a beneficiary of the anti-MMR litigation. If Dr Wakefield’s British supporters appear a rather undistinguished bunch, they are paragons of professional virtue and integrity by comparison with Dr Wakefield’s US backers, such as Drs Bradstreet (£22,000), Krigsman (£17,000) and Geier (£7,000) (10).

It is not surprising that Brian Deer has attracted hostility from Dr Wakefield and his supporters. It is sad that he has also been denounced by a few parent campaigners who continue to regard Dr Wakefield as a hero. In truth Deer has emerged as a forceful champion of families affected by autism by exposing the truth about a campaign that has caused enormous distress to parents of children with autism as well as provoking unwarranted anxieties about MMR. While leading autism specialists and organisations have been largely ineffectual and much of the media (from Private Eye to the Daily Mail, from the Telegraph to BBC Radio 4’s Today programme) has been duped by Wakefield at one time or another, Deer has provided an invaluable service by revealing how much cash and cynicism has surrounded the campaign against MMR.

Much relevant documentation can be found on Brian Deer’s website and further background on the anti-MMR litigation and the personalities involved is provided in my book, MMR and Autism: What Parents Need To Know, published by Routledge, 2004.



Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

Trans fats:

For one summary of the weak science behind the "trans-fat" hysteria, see here. Trans fats have only a temporary effect on blood chemistry and the evidence of lasting harm from them is dubious. By taking extreme groups in trans fats intake, some weak association with coronary heart disease has at times been shown in some sub-populations but extreme group studies are inherently at risk of confounding with other factors and are intrinsically of little interest to the average person.

The use of extreme quintiles (fifths) to examine effects is in fact so common as to be almost universal but suggests to the experienced observer that the differences between the mean scores of the experimental and control groups were not statistically significant -- thus making the article concerned little more than an exercise in deception


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