Friday, April 27, 2007


I suffer from a chronic iatrogenic illness. As would be clear to everyone who knows his Greek, iatrogenic illness is illness caused by what doctors do. Usually it is illness caused as a side-effect of medication. As far as we know, iatrogenic illness is universal. All medications have side-effects. The iron law of medication is: "No side effects = No main effects". If we banned all medications that had side effects we would have no medications.

But the hysteria over side-effects never lets up for all that. Aspirin was once thought to be very safe but it does appear to cause some bleeding in the stomach EVERY time is it used. So despite aspirin's very great benefits and the long recognized great safety of it, doctors everywhere for a long time would recommend it only with the greatest hesitation. For routine pain relef they would generally recommend paracetamol instead. We now find, however that paracetamol causes liver damage. The neurosis about small but generally harmless side effects in aspirin has, in other words, exposed people to SERIOUS side effects in paracetamol.

So, as blind Freddy should be able to see, it is the tradeoff that is important. Side-effects that are very rare or side effects that cause little harm should be disregarded if the medication provides significant benefit.

You would think that doctors, of all people, would recognize that and maybe many family doctors do, but many medical researchers certainly do not. If they see a side effect that is found in only one in a thousand people, they will rush to press with warnings not to use that medication. And that is doubly absurd when we realize that very rare effects may be random events anyway. A rare side-effect may not be a side effect at all. If one woman in a thousand is said to get cancer out of taking HRT, what are we to make out of the 999 women who did NOT get cancer from it? Surely they prove that HRT does NOT cause cancer!

And most of the unending stream of scare stories rely on an assumption that is KNOWN to be false. They conclude from a correlation between two things that the correlation indicates causation. Because some studies have found a very slight correlation between taking HRT and getting cancer, for instance, the hysterics claim that HRT causes cancer. Yet "Correlation is not causation" is just about the first thing anyone learns in a course on statistics. For instance, recent history indicates that people have both been living longer and getting fatter. Getting fatter and living longer are correlated. So does getting fatter prolong life? To be consistent the hysterics would have to claim that! That women who take HRT might tend to have more health anxieties to start with and that those anxieties (whether justified or not) might be the problem (if there is a problem) is just not considered.

There is no such ambiguity in the case of real iatrogenic disasters of course. How many women who took thalidomide during the critical periods of gestation delivered normal babies? Not many. How many people who in their youth were frequently given old-fashioned medications containing arsenic (as I was) are now free of skin cancer? Not many.

So we should ignore the attention seekers who are constantly pretending that tiny fluctuations in their statistics reveal iatrogenic disasters going on. There will of course be real iatrogenic disasters in the future (Thalidomide was approved by many national health authorities) but listening to the attention-seekers will just deflect us from gaining the real benefits that medication can also deliver.

Hope for autism

It would help to know more about which categories of autism were helped by which aspect of the treatment but the evidence that SOME treatment works for some children is encouraging

Toddlers found to have autism who undergo intensive teaching programmes from the age of 3 can raise their IQ by as much as 40 points, according to a three-year study. The research found that intensive, early education, which costs about 30,000 pounds a year per child, also led to “significant positive changes” in language, daily living skills, motor ability and social skills.

The study, conducted by the University of Southampton, will put pressure on the Government to help to fund early intervention for autistic children. It often costs households more than 30,000 pounds a year as one parent is forced to give up work completely to oversee about 40 hours of tuition a week. Most of the money is spent on hiring tutors and a course supervisor who shapes the programme for the child and assesses its progress.

It is the first major study of its kind in Britain, although thousands of families are known to be using the programme, the best known of which is applied behaviour analysis (ABA). It breaks down learning into tiny chunks, using imitation and reinforcement to encourage autistic children to communicate, then speak and follow commands, before moving on to more advanced skills.

Half the 44 autistic children had the treatment for two years, significantly starting at the age of 30-42 months. That is usually the time at which families who suspect their child may be autistic are struggling to get a formal diagnosis.

The children in the study ranged from the high-functioning, with better communication skills and higher IQs, to the low-functioning with poor speech and few social skills. All had a formal diagnosis of autism.

The researchers found that early intervention was more effective with the higher-functioning children who had a higher mental age and better social skills, although all benefited to some degree. [A possible "fudge" there. Overgeneralized results probable]

The first group of children in the study were given 25 hours of one-to-one treatment a week from between three and five tutors, and also from their parents, all using the principles of ABA. This is fewer hours than the 40 a week most parents sign up to. The control group had received the basic speech or language therapy normally offered by local education authorities.

As well as improved communication and social skills, more than a quarter of the children showed “very substantial improvements” in their IQ. In one case IQ increased from 30 to 70, in another, from 72 to 115. Most of the population has an IQ of between 85 and 115. “This form of teaching can, in many cases, lead to major change,” said Professor Bob Remington, deputy head of the University of Southampton School of Psychology. “In practice, the positive changes we see in IQ, language and daily living skills can make a real difference to the future lives of children with autism.”

With one in a hundred children thought to be suffering from some form of autism, the costs are potentially very high. However, John Wylie, chief executive of TreeHouse Trust, a school for autistic children, said: “It has to be compared with the cost of looking after someone with autism which conservative estimates put at 3 million pounds over their lifetime. Spending the money at a time when it can make a difference is surely better than pouring it about when it can make little difference.”



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.


No comments: