HRT CREEPING BACK INTO FAVOUR

The article below is very direct evidence of the benefits of estrogen therapy -- and estrogen is of course at least a major component of HRT. It shows that taking estrogen reduces calcification in your arteries quite a lot. And they've got the pictures to prove it! So does that mean that HRT has been officially rehabilitated as helpful with circulatory problems? It does but it would be too embarrassing to admit it straight out after the scare stories of recent years. So the authors note that estrogen has many other effects -- implying that there are "other risks" (e.g. stroke) with HRT. They caution, in other words that it may do harm as well as good. The evidence for the "other risks" is, however, as far as I can tell, almost wholly epidemiological -- which translates as "speculative". So I think that the direct evidence of improvement in the heart's circulatory system recorded below DOES warrant use of estrogen in women with circulatory or cardiac problems

Estrogen Therapy and Coronary-Artery Calcification

By JoAnn E. Manson et al.

ABSTRACT

Background: Calcified plaque in the coronary arteries is a marker for atheromatous-plaque burden and is predictive of future risk of cardiovascular events. We examined the relationship between estrogen therapy and coronary-artery calcium in the context of a randomized clinical trial.

Methods: In our ancillary substudy of the Women's Health Initiative trial of conjugated equine estrogens (0.625 mg per day) as compared with placebo in women who had undergone hysterectomy, we performed computed tomography of the heart in 1064 women aged 50 to 59 years at randomization. Imaging was conducted at 28 of 40 centers after a mean of 7.4 years of treatment and 1.3 years after the trial was completed (8.7 years after randomization). Coronary-artery calcium (or Agatston) scores were measured at a central reading center without knowledge of randomization status.

Results: The mean coronary-artery calcium score after trial completion was lower among women receiving estrogen (83.1) than among those receiving placebo (123.1) (P=0.02 by rank test). After adjustment for coronary risk factors, the multivariate odds ratios for coronary-artery calcium scores of more than 0, 10 or more, and 100 or more in the group receiving estrogen as compared with placebo were 0.78 (95% confidence interval, 0.58 to 1.04), 0.74 (0.55 to 0.99), and 0.69 (0.48 to 0.98), respectively. The corresponding odds ratios among women with at least 80% adherence to the study estrogen or placebo were 0.64 (P=0.01), 0.55 (P<0.001), and 0.46 (P=0.001). For coronary-artery calcium scores of more than 300 (vs. <10), the multivariate odds ratio was 0.58 (P=0.03) in an intention-to-treat analysis and 0.39 (P=0.004) among women with at least 80% adherence.

Conclusions: Among women 50 to 59 years old at enrollment, the calcified-plaque burden in the coronary arteries after trial completion was lower in women assigned to estrogen than in those assigned to placebo. However, estrogen has complex biologic effects and may influence the risk of cardiovascular events and other outcomes through multiple pathways.

NEJM, 2007, Volume 356:2591-2602





IQ AND BIRTH ORDER

The article Explaining the Relation Between Birth Order and Intelligence by Petter Kristensen and Tor Bjerkedal (appearing in the journal "Science") seems to have got quite an amazing amount of press so I thought I should say a few words about it. I did not make any comment initially because I thought that it raised no new issues and was not in any way surprising.

To recap briefly, the authors did some very clever statistics on data from Norwegian army recruits which show pretty clearly that being a firstborn raises your IQ by a few points.

I think the reason the article has got such a lot of attention is that the political Left seizes on environmental causes of intelligence like a thirsty man in a desert. All the evidence is of an overwhelming genetic influence on IQ so anything that appears to "undermine" that will be highlighted -- given the traditional but vastly counterfactual Leftist belief in the infinite plasticity of human characteristics.

But the Norwegian findings don't in fact undermine anything. Although IQ is one of the human attributes that is most strongly influenced by genes, nobody has ever claimed that genes alone do the trick. It has always been known and asserted that environmental factors have a subsidiary role -- and stimulation in early childhood has long been agreed to be one of those subsidiary factors.

And firstborns get more attention and hence most stimulation. So a small advantage from being a firstborn was always to be expected.

Perhaps the most amusing part of the coverage given to the findings is the way that old scientific fraud, Frank Sulloway, has managed to insert himself into the discussion. Sulloway is a great advocate of birth order as an influence on human behaviour so I suppose it had to happen but Sulloway's own theory is that birth order determines your politics and, among social scientists, I think it is only the credulous who believe that these days. Sulloway's sustained attempts to block publication of evidence contradicting his theory probably tell you all you need to know about that.

Just a footnote: Did you know that your politics are even more heavily determined by your genetics than is how tall you are? Some people (Leftists) are just born crybabies. See Eaves, L.J., Martin, N.G., Meyer, J.M. & Corey, L.A. (1999) Biological and cultural inheritance of stature and attitudes. In: Cloninger, C.R., Personality and psychopathology. Washington, D.C.: American Psychiatric Press. Pesky things, those genes!

****************

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.

*********************

DO MILD DIABETIC SYMPTOMS GIVE YOU HEART ATTACKS?

Since diabetes is a seriously life threatening disorder, it is reasonable enough to expect that those who have only a mild form of it might die sooner too -- but I am not convinced that the study below shows that. We are informed that 65% of the deaths from heart attacks in their sample (218 out of 298 people) were diabetics of all sorts -- including those with only some symptoms of diabetes. But the major group within those deaths would have been those with fully-blown diabetes, leaving very small numbers for those with only some symptoms of diabetes -- numbers that seem too small to permit much in the way of generalizations.

And the results found were rather contradictory anyway. It was found that those with "impaired fasting glucose" were more likely to die of heart disease but those with "impaired glucose tolerance" were not. So pick whichever one of those you like to conclude that pre-diabetic symptoms are or are not likely to lead to a heart attack! The conclusions of the paper are certainly more sweeeping and confident than the small numbers plus that inconsistency in results would warrant. Just another silly epidemiological study, I am afraid. If I had any pre-diabetic symptoms, I would certainly not let that study add to my worries. Fortunately, when I did have a glucose tolerance test a few years ago, my body was very well-behaved about it

Risk of Cardiovascular and All-Cause Mortality in Individuals With Diabetes Mellitus, Impaired Fasting Glucose, and Impaired Glucose Tolerance. The Australian Diabetes, Obesity, and Lifestyle Study (AusDiab)

Elizabeth L.M. Barr et al.

Background--Diabetes mellitus increases the risk of cardiovascular disease (CVD) and all-cause mortality. The relationship between milder elevations of blood glucose and mortality is less clear. This study investigated whether impaired fasting glucose and impaired glucose tolerance, as well as diabetes mellitus, increase the risk of all-cause and CVD mortality.

Methods and Results--In 1999 to 2000, glucose tolerance status was determined in 10 428 participants of the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). After a median follow-up of 5.2 years, 298 deaths occurred (88 CVD deaths). Compared with those with normal glucose tolerance, the adjusted all-cause mortality hazard ratios (HRs) and 95% confidence intervals (CIs) for known diabetes mellitus and newly diagnosed diabetes mellitus were 2.3 (1.6 to 3.2) and 1.3 (0.9 to 2.0), respectively. The risk of death was also increased in those with impaired fasting glucose (HR 1.6, 95% CI 1.0 to 2.4) and impaired glucose tolerance (HR 1.5, 95% CI 1.1 to 2.0). Sixty-five percent of all those who died of CVD had known diabetes mellitus, newly diagnosed diabetes mellitus, impaired fasting glucose, or impaired glucose tolerance at baseline. Known diabetes mellitus (HR 2.6, 95% CI 1.4 to 4.7) and impaired fasting glucose (HR 2.5, 95% CI 1.2 to 5.1) were independent predictors for CVD mortality after adjustment for age, sex, and other traditional CVD risk factors, but impaired glucose tolerance was not (HR 1.2, 95% CI 0.7 to 2.2).

Conclusions--This study emphasizes the strong association between abnormal glucose metabolism and mortality, and it suggests that this condition contributes to a large number of CVD deaths in the general population. CVD prevention may be warranted in people with all categories of abnormal glucose metabolism.

Circulation 2007, June 18, 2007




The perks and pitfalls of pride

Pride has perplexed philosophers and theologians for centuries, and it is a paradoxical emotion. Pride based on personal excellence is encouraged, but too much pride can easily tip the balance toward vanity, haughtiness and selflove. Scientists have also been perplexed by this complex emotion, because it is so unlike socalled primary emotions, those felt as a first response to a situation, like fear and disgust.

Psychologists have been exploring pride's origins and purpose, and whether pride is as universal as, say, joy or anger.

In the June issue of the research journal Current Directions in Psychological Science, Jessica Tracy of the University of British Columbia in Vancouver and Richard Robins of the University of California, Davis review several recent studies on the nature and function of pride.

In one experiment, researchers used photographs of models with varying facial expressions and body language, asking subjects to identify the nonverbal signs of pride.

They found what they called a prototypic prideful look, which was recognized by children as young as four and people of many different cultures, including members of an isolated, preliterate tribe in Burkina Faso, West Africa.

So pride seems to be universal, they said, but that still leaves the questions: What is it? What is its purpose? To explore this, Tracy and Robins first asked people to come up with words that they associated with pride. They found that either people link pride to such achievementoriented ideas as accomplishment and confidence"authentic" pride -- or to self-aggrandizement, arrogance and conceit -- "hubristic" pride.

People who tend to feel authentic pride were more likely to score high on tests of extroversion, agreeablen, genuine selfesteem and conscientiousness, the pair found; but people who tend to feel hubristic pride were narcissistic and prone to shame. Further, they found that people who felt positive, achievementoriented feelings of pride viewed hard work as the key to success in life, whereas hubristic people tended to view success as predetermined, due to their stable abilities.

Tracy and Robins argue that the primitive precursors of pride probably motivated our ancestors to act in altruistic and communitarian ways, for the good of the tribe. The physical display of pride both reinforced such behavior and signaled to the group that this person was worthy of respect. So individual pride, at least the good kind, contributed in important ways to the survival of the community.

But what about pride's dark side? Tracy and Robins speculate that hubris might have been a social "short cut," a way of tricking others into paying respect when it was not warranted. Those who could not earn respect the oldfashioned way figured out how to look and act accomplished in order to gain status. Social cheaters puffed themselves up because deep down they did not have what it took to succeed. Whatever respect they got would have been fleeting, of course, as it is today.

Source

****************

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.

*********************

PESTICIDES AND PARKINSON'S

Those wicked pesticides again! In yet another absurd epidemiological "study". Note that this study did NOT measure actual exposure to pesticides. It just recorded recollections that people had of their pesticide use. They found a slight tendency for people with Parkinson's disease to remember having used more pesticides in their lifetimes. That could be accounted for SOLELY as an outcome of the bad press that pesticides get. Some people with Parkinsons could well have thought: "It must be due to pesticides" -- and so have spent more time thinking about their pesticide use and magnifying in their minds how much they used.

The main effect that the authors noted was in fact that people who had been knocked on the head got more Parkinsons! So pesticides are less risky than knocks on the head! That finding too, however, may simply reflect hypotheses that sufferers had about their illness

Environmental risk factors for Parkinson's disease and parkinsonism: the Geoparkinson study

By Finlay D. Dick et al.

Objective

We investigated associations between Parkinson's disease and other degenerative parkinsonian syndromes and environmental factors in five European countries.

Methods

We undertook a case-control study of 959 prevalent cases of parkinsonism (767 with Parkinson's disease) and 1989 controls in Scotland, Italy, Sweden, Romania and Malta. We defined cases using the United Kingdom Parkinson's Disease Society Brain Bank criteria and excluded those with drug-induced or vascular parkinsonism or dementia. Subjects completed an interviewer-administered questionnaire regarding lifetime occupational and hobby exposure to solvents, pesticides, iron, copper and manganese. Lifetime and average annual exposures were estimated blind to disease status using a job-exposure matrix modified by subjective exposure modelling. Results were analysed using multiple logistic regression adjusting for age, sex, tobacco use, ever knocked unconscious and family history of Parkinson's disease.

Results

Adjusted logistic regression analyses showed significantly increased odds ratios for Parkinson's disease/parkinsonism with an exposure-response relationship for pesticides (low v no exposure, OR 1.13, 95% CI 0.82-1.57, high v no exposure, OR 1.41, 95% CI 1.06-1.88) and ever knocked unconscious (once v never, OR 1.35, 95% CI 1.09-1.68, more than once v never, OR 2.53, 95% CI 1.78-3.59). Hypnotic, anxiolytic or anti-depressant use for more than one year and a family history of Parkinson's disease showed significantly increased odds ratios. Tobacco use was protective (OR 0.50, 95%CI 0.42-0.60). Analyses confined to subjects with Parkinson's disease gave similar results.

Conclusions

The association of pesticide exposure with Parkinson's disease suggests a causative role. Repeated traumatic loss of consciousness is associated with increased risk.

Occup Environ Med., 1 March 2007





Diabetes drug in the gun

A safety row about a valuable diabetes drug (Avandia) based on tiny inter-group differences of only marginal statistical significance. Just attention-seeking behaviour on the part of one or two researchers. Just to put sensationalist medical statistics into perpective, let me look at the "43 per cent increase" reported below. An even greater 50% increase could have been arrived at if 3 out of a thousand Avandia uses got heart attacks versus 2 of of a thousand non-users getting heart attacks. In both cases the risk involved would be minor -- certainly no greater than crossing some streets. All findings reported in terms of "% increase" or other ratio statistics should be treated with grave suspicion -- but that accounts for most medical research reports. There are hordes of publication-hungry researchers and just not enough real findings to go around so mountains have to be made out of pimples

When he first saw the results of his study about the cardiovascular risks of the diabetes drug rosiglitazone - sold under the trade name Avandia - several weeks ago, Steven Nissen said that he felt sick and was unable to sleep. "It was very striking,'' he said after the publication of his report on the medicine that is GlaxoSmithKline's second best-selling drug. "When you see a signal this strong, I was truly frightened on behalf of our patients.''

The outcome of his meta-analysis of 42 previous clinicial trials was, indeed, troubling. It indicated a 43 per cent increase in the risk of heart attacks. It also showed a 64 per cent increase in the risk of death from cardiovascular causes, although this finding was said to be of borderline statistical significance, which means it may not be reliable. "I moved as quickly as humanly possible to publish the data,'' Nissen said.

Six days later, on May 22, the publication online of his report in the New England Journal of Medicine proved explosive. Within hours, shares in GlaxoSmithKline (GSK) had dropped 8 per cent amid fears that the drug, which generated $US3 billion in sales last year and is used by millions, could be pulled or could result in an expensive legal battle.

In Australia too the drug has proved a hit, reaching number 66 on the list of drugs that cost taxpayers the most money in 2005-06. In that year nearly 300,000 prescriptions for rosiglitazone were written, each of which cost just over $75 to fill - costing the federal Government's Pharmaceutical Benefits Scheme nearly $20 million.

The publication of Nissen's findings sparked a furore in both the medical profession and the media, a furore that was further stoked by the online publication of more data by the New England Journal of Medicine recently. The new data were interim findings from an ongoing trial that was set up with the aim of showing that Avandia was no worse than existing treatments in terms of its effect of cardiovascular events, including heart attack. Unfortunately for GSK, the new findings failed to deliver the longed-for exoneration.

Nor do they condemn the drug, and like Nissen's original meta-analysis, the latest findings have divided experts - with some still strongly attacking suggestions the drug is unsafe. Nissen, cardiology chief of the Cleveland Clinic, Ohio, is not to be dismissed lightly. One of the most respected medical researchers in the US, he was among the first to find a link between Vioxx, the anti-inflammatory drug, and an increased risk of heart attacks. The scandal that followed forced the drug's withdrawal in 2004 and thrust Merck, Vioxx's manufacturer and one of the world's biggest pharmaceutical companies, into a bruising legal battle that is still continuing.

Speaking before the latest interim results were released, Nissen made no effort to avoid comparison between Avandia and Vioxx - a parallel that Glaxo has been keen to downplay. "I hope that GSK does not go the same way as Merck did,'' he said. "They (GSK) have been marketing a drug with very serious problems. In my view, a lot of people have been harmed.''

When asked for his views on just how many, Nissen pointed to comments made by US Senator Charles Grassley, an Iowa Republican. He claimed that an evaluation by the US Food and Drug Administration (FDA) had suggested that between 60,000 and 100,000 heart attacks could be linked to the drug since its launch in 1999 - more than 20 per day. "I feel pretty strongly that our findings are conclusive,'' Nissen said. "There is something odd about this drug that increases the risk of cardiovascular problems and death.''

However, GSK is not the only party that disagrees with Nissen. While Nissen's analysis conceded it had flaws, many independent experts say these are so fundamental that its hypothesis, that Avandia causes heart attacks, has little weight. The flaws they point out include the fact that many of the 42 studies Nissen reviewed to reach his conclusions were small and short-term, and dealt with such small numbers of heart attacks that the findings were open to statistical doubt. Another was that few of the studies were designed to assess effect on heart attacks, and so did not establish that the events recorded as heart attacks were not in fact something less serious, such as acute angina.

Within days of the release of Nissen's work The Lancet, the British medical journal, urged caution about the findings. In an editorial published online, it gave warning of the dangers of "alarmist headlines and confident declarations that help nobody''. In Australia, many experts have also been sceptical. Associate Professor Shane Hamblin, director of diabetes at Melbourne's Western Health, told a recent edition of the GP weekly Medical Observer there were "a lot of holes in this (Nissen's) meta-analysis'', while Professor Nikolai Petrovsky, director of the diabetes and endocrinology department at Flinders Medical Centre in Adelaide, was reported in Australian Doctor as saying he was "amazed'' the NEJM had published Nissen's study. All the Australian experts asked for their views said patients already taking Avandia should not stop, although some said doctors should not prescribe it to new patients who had "major cardiovascular conditions''.

But the picture was complicated further by the NEJM's publication of the second study - an interim analysis of data from a long-term trial involving over 4400 patients that has been specifically designed to demonstrate Avandia's cardiovascular safety. These interim findings found that patients treated with rosiglitazone had double the risk of heart failure - in which the heart beats too weakly. While this is a previously recognised side-effect, the study sheds light on how commonly treated patients will experience it.

The interim results also found a trend towards more heart attacks among patients treated with rosiglitazone as opposed to patients on alternative drugs. But these results were not so stark that the study's authors could confidently say they were not the play of chance. This lack of statistical significance has been interpreted by GSK and some experts as evidence that Avandia is safe, and by others - including the authors of three NEJM editorials - that serious safety questions remain.

But as in the US - where the Food and Drug Administration is coming under pressure over a growing perception that it has been too slow to act over safety fears - some experts say the Avandia case raises questions about how effectively in Australia we regulate medicines. David Henry, professor of clinical pharmacology at the University of Newcastle, said following the latest interim trial results, it "doesn't look good for rosiglitazone'' in terms of the drug's safety. "You can be fairly confident from the latest results that rosiglitazone is no better - and it may be worse than existing therapies,'' Professor Henry said.

"The whole purpose of the drug is to improve diabetic control and reduce complications - and here we are several years down the track since the drug's launch, beginning to question whether the drug is safe. "We shouldn't be asking these questions so long after these drugs have been introduced. It's a failure of drug development, and a failure of drug regulatory processes.'' Henry says that just as critics are using the Avandia controversy to argue for more power for the FDA, the Therapeutic Goods Administration should have power to force drug companies to conduct properly designed studies to answer safety questions much earlier.

Previous studies on Avandia established that it was effective at controlling blood sugar levels - but the longstanding assumption that patients would automatically be healthier as a result has been rocked by the findings about increased cardiovascular risk. However, Henry is not hopeful of this being workable under current funding arrangements. "It's hard when these agencies rely on fees raised from the drug companies to pay their staff, and it's hard when they don't have strong support from politicians,'' he says.

Source

****************

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.

*********************

Fat Diabetics get less heart disease

Researchers at the University of Pittsburgh Schools of the Health Sciences studying links between an early sign of heart disease called coronary artery calcification and body fat have found that, paradoxically, more fat may have some advantages, at least for people -- particularly women -- who have type 1 diabetes. Cardiovascular complications, including heart disease, are a leading cause of death for people with diabetes, who tend to suffer cardiovascular disease decades earlier than non-diabetics.

"Gaining weight may reflect good or better treatment with insulin therapy, which may partly explain why participants who gained weight over time had lower mortality rates," said Trevor Orchard, M.D., professor of epidemiology at the University of Pittsburgh Graduate School of Public Health (GSPH), who is presenting the findings during the 67th annual meeting of the American Diabetes Association.

For this particular report, Dr. Orchard and his colleagues focused on 315 patients with type 1 diabetes participating in the Pittsburgh Epidemiology of Diabetes Complications Study, an 18-year prospective study of childhood onset type 1 diabetes, which began in 1986. As part of the study, the patients recently received a special computed tomography scan (CT) to assess coronary artery calcification.

The participants' mean age was 42, and mean duration of diabetes was 34 years. In addition to the CT scan, patients were evaluated for fat underneath the skin and in the abdominal region, body mass index (BMI) and waist circumference. Although investigators noted a positive association for all measures of fatness and having any coronary artery calcification, in the two-thirds of patients who had calcification, the relationship reversed so that people with more fat had less severe calcification.

This association also varied by gender. Women with less fat under the skin had more evidence of coronary artery calcification than those with more fat. Thinner men also had more evidence of coronary artery calcification than men with a higher BMI.

"What it comes down to is a kind of double-edged relationship," said Baqiyyah Conway, M.P.H., lead author of the abstract, adding that these associations of less severe artery calcification with greater fat persisted even when controlling for standard cardiovascular disease risk factors such as increased levels of LDL, or bad cholesterol, triglycerides, high blood pressure and lower levels of HDL, or good cholesterol. Controlling for kidney disease, another common complication of diabetes, weakened the association in men but not in women.

"This is not a firm recommendation to people with type 1 diabetes to put on weight, but it does raise the possibility that weight recommendations in type 1 diabetes may be somewhat different than those for the general population, and emphasizes the complex relationship between body fat and cardiovascular risk in diabetes," said Dr. Orchard, who also is professor of medicine and pediatrics at the University of Pittsburgh School of Medicine.

Source





ADHD: Amazing government decision in Australia

The drug may harm more than help. And there is a growing consensus that drug solutions for ADHD are much overdone anyway. Such drugs are very often just a substitute for school discipline

A CONTROVERSIAL treatment for attention deficit hyperactivity disorder will be added to the Pharmaceutical Benefits Scheme, despite its potential to cause suicidal thoughts and stunt growth. Health Minister Tony Abbott announced in April that Strattera would be added to the scheme from July 1 for the treatment of ADHD in children aged six to 18 who could not take stimulant treatments such as methylphenidate, known as Ritalin, or dexamphetamine.

Under the PBS, the drug's price will drop from more than $100 for a month's supply to just $30.70, or $4.90 for concession-card holders. Mr Abbott said about 18,000 people would take Strattera during its first full financial year of listing, adding about $101.2million to PBS expenditure between 2007-08 and 2010-11.

The move comes after a Therapeutic Goods Administration assessment of Strattera last year, which identified suicidal thoughts, agitation, weight loss, chest pain and swollen testicles as potential side effects of the drug.

A spokeswoman for Strattera manufacturer Eli Lilly said drug regulation agencies in the US, Europe, Britain and Australia had all recently reviewed the safety of the drug and had reaffirmed the drug's benefits justified the risks. "There are benefits and risks associated with every medication," she said. "Strattera is the most extensively studied psychiatric drug in children with the most comprehensive clinical-trials database compared to any other ADHD medication."

The head of psychological medicine at Adelaide's Women's and Children's Hospital, Jon Jureidini, said he was concerned that doctors would not exhaust other treatment options before using Strattera. "Although it's not supported to be a first-line drug, I think we'll find that it will be used as a first-line drug, which is not what the PBAC (Pharmaceutical Benefits Advisory Committee) intended," Dr Jureidini said. "The concerns about this drug are that it's very expensive and it's not proven to be any better than the cheaper drugs that are around and that's reflected in the determination by the PBAC, who will only financially support its use if other stimulant drugs have been tried."

University of NSW ADHD specialist Florence Levy said stimulant drugs such as Ritalin were not suitable for about 10 to 20 per cent of children with the disorder because of side effects. Professor Levy said she had not seen any of the serious psychiatric side effects reported in the US. "They apply more to adolescents and at higher dosage levels. The children I see are younger children and I haven't experienced those sorts of problems," she said. Australian Medical Association vice-president Choong-Siew Yong, who specialises in child and adolescent mental health issues, said Strattera's side effects were "fairly rare" but recommended doctors and families discuss ways to monitor potential reactions in children taking the drug.

Source

****************

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 OMEGA 3 PHOENIX RISES FROM THE ASHES ONCE AGAIN

Despite many big studies showing it to have no beneficial effects on cancer etc., there still seems to be a compulsion to find that fish oil is good for you. A recent abstract below:

Modulation of prostate cancer genetic risk by omega-3 and omega-6 fatty acids

By Isabelle M. Berquin et al.

Although a causal role of genetic alterations in human cancer is well established, it is still unclear whether dietary fat can modulate cancer risk in a predisposed population. Epidemiological studies suggest that diets rich in omega-3 polyunsaturated fatty acids reduce cancer incidence. To determine the influence of fatty acids on prostate cancer risk in animals with a defined genetic lesion, we used prostate-specific Pten-knockout mice, an immune-competent, orthotopic prostate cancer model, and diets with defined polyunsaturated fatty acid levels. We found that omega-3 fatty acids reduced prostate tumor growth, slowed histopathological progression, and increased survival, whereas omega-6 fatty acids had opposite effects. Introducing an omega-3 desaturase, which converts omega-6 to omega-3 fatty acids, into the Pten-knockout mice reduced tumor growth similarly to the omega-3 diet. Tumors from mice on the omega-3 diet had lower proportions of phosphorylated Bad and higher apoptotic indexes compared with those from mice on omega-6 diet. Knockdown of Bad eliminated omega-3-induced cell death, and introduction of exogenous Bad restored the sensitivity to omega-3 fatty acids. Our data suggest that modulation of prostate cancer development by polyunsaturated fatty acids is mediated in part through Bad-dependent apoptosis. This study highlights the importance of gene-diet interactions in prostate cancer.

J. Clin. Investigations, June 21, 2007. So it works in speciallly prepared mice. Ho Hum!






A jab to halt Alzheimer's could be available within a few years

Vaccine will save patients from worst symptoms of illness



A revolutionary drug that stops Alzheimer's disease in its tracks could be available within a few years. It could prevent people from reaching the devastating final stages of the illness, in which sufferers lose the ability to walk, talk and even swallow, and end up totally dependent on others. The jab, which is now being tested on patients, could be in widespread use in as little as six years. The most common cause of dementia, Alzheimer's affects around 500,000 Britons, with about 500 new cases diagnosed every day as people live longer.

Treatment costs the NHS up to 14billion a year - more than it spends on strokes, heart disease and cancer combined. Existing drugs can delay the progress of the symptoms, but their effect wears off relatively quickly, allowing the disease to take its devastating course. In contrast, the new vaccine may be able to hold the disease at bay indefinitely. Professor Clive Ballard, of the Alzheimer's Society, said: "A successful vaccine would be a groundbreaking treatment advance for the 25million people with Alzheimer's disease worldwide."

Vaccines are typically used to provide immunity to a disease as a preventive measure before it can develop, but this is an example of a therapeutic vaccine, used to treat a disease which has already developed. Known as CAD106, it is the brainchild of scientists at Zurich-based biotechnology firm Cytos, which is also developing anti-smoking, obesity and flu vaccines. Cytos chief executive Dr Wolfgang Renner said: "If it could prevent the progression of Alzheimer's, it would be fantastic."

Early tests showed the vaccine is highly effective at breaking up the sticky protein that clogs the brain in Alzheimer's, destroying vital connections between brain cells. When the jab was given to mice suffering from a disease similar to Alzheimer's, 80 per cent of the patches of amyloid protein were broken up. The vaccine is now being tried out on 60 elderly Swedish patients in the early and middle stages of Alzheimer's. Half of the men and women are being given the vaccine while half are being given dummy jabs. Although the year-long trial is designed to show that the treatment is safe, the researchers will also look at its effect on the patients' symptoms.

While the results are not due until early next year, the initial findings are promising. Dr Renner told a Zurich conference earlier this week: "I am glad to report that the vaccine is very well tolerated." If the trial is successful, larger-scale trials will follow, in which researchers will work out the best dose to give and how often it should be given. The finished product is six to eight years from the market. The vaccine uses a tiny section of the amyloid protein attached to an empty virus shell to trick the immune system into attacking and breaking up deposits of protein clogging the brain.

Scientists at Cytos, who have sold the rights to the vaccine to Swiss pharmaceutical giant Novartis, say the vaccine is likely to be given to those in the early stages of Alzheimer's, to stop the disease from progressing. The development of tests capable of detecting the disease in its earliest stages would allow the jab to be given at the first possible opportunity. It could also be used to keep the disease at bay in those with a strong family history of the illness, and even for the mass vaccination of people in late middle age. However, while the jab may stop the disease in its tracks, it is not expected to repair dead tissue, and so will not be a cure. Nevertheless, preventing the disease's progression would have an enormous impact on sufferers' lives.

Source

****************

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.

*********************

Warning on drugs to cut post-surgical heart attacks

The journal article is here

DOCTORS are routinely giving drugs to patients in the belief they reduce post-surgical heart attacks when there is little or no evidence that they do any good - and in fact can cause significant harm. Tens of thousands of surgery patients every year in Australia alone are given beta-blockers, which slow the heartbeat, and cholesterol-lowering drugs called statins, just before or after non-cardiac surgery.

About 100 million patients are given the drugs each year worldwide, in the belief they reduce cardiac complications such as heart attack that affect between 0.5 and 1 per cent of patients. But an editorial by Australian experts published in the British Medical Journal says the basis for this practice is flawed and no patient should be given the drugs for this purpose.

Co-author Stephen Bolsin, director of anaesthesia at Victoria's Geelong Hospital and associate professor of patient safety, said the most recent and reliable studies suggested that contrary to earlier beliefs, the drugs had no effect on reducing complications. But patients were still exposed to their side-effects, which in the case of beta-blockers could include causing blood pressure to plunge dangerously, or the heartbeat to slow too much.

Statins are associated with liver and muscle toxicity. While Associate Professor Bolsin said these effects were rare when used after surgery, these drugs were more expensive than beta-blockers and cost health systems vast amounts for no patient benefit. "We suggest that patients already receiving beta-blockers or statins before surgery should continue with treatment," Associate Professor Bolsin wrote in the editorial.

Source






Military suicide hoax

By Steven Milloy

Researchers and the media did their best this week to scare military personnel and their families with the widely reported headline, "Military Service Doubles Suicide risk". "Male veterans are twice as likely as their civilian counterparts to die by suicide," Portland State University professor Mark Kaplan told the Atlanta Journal Constitution. "We don't know why. But this finding may foreshadow what is going to come with the current cohort of military personnel who have served in Afghanistan and Iraq," he added.

Published in the Journal of Epidemiology and Community Health (July 2007), Kaplan's study consisted of 320,890 men who were followed for 12 years. As it is a statistical correlation study - rather than an investigation into whether an actual cause-and-effect relationship exists between military service and suicide - I naturally was skeptical. From the very beginning, the study didn't disappoint me.

The study summary stated that the veterans' suicide rate was 2.04 times that of non-veterans. When I read the study to see how the 2.04 figure was derived, I found no explanation. Mysteriously, the 2.04 figure did not even appear in the study itself - that's pretty unusual. I did, however, find a bar graph in the study that presented 2.13 as the difference in suicide rate between veterans and non-veterans.

You might think that this solved the mystery. A typographical or editorial foul-up must have inadvertently led to the 2.04-figure, rather than the 2.13 figure, being spotlighted in the study summary, right? We'll get to that later. In the meantime, my discovery of the 2.13-figure only deepened the mystery. Kaplan wrote in his study that the 2.13-figure represented the difference in suicide rates between veterans and non-veterans after statistical adjustment to account for other potential risk factors for suicide, including age, marital status, living arrangement, race, education, family income, employment status, geographic region, interval since last visit to a doctor, self-rated health and body mass index.

This list seemed impressively comprehensive and ostensibly strengthened the case for his claimed result - until, that is, I discovered that a key potential suicide risk factor apparently was omitted from his statistical adjustment. There's a table in Kaplan's study in which he presents the difference in veteran suicide rates by individual risk factors, including age, race, marital status, living arrangement, education, employment status, region of residence, urban/rural locality, self-rated health, body mass index, psychiatric conditions and activity limitation.

With the exception of race, education and activity limitation, none of these risk factors were statistically significantly associated with increased suicide rates. But since race, education and activity limitation were associated with increased suicide risk, all three should have been among the potential risk factors Kaplan considered when he did his statistical adjustments to produce the 2.13-figure. If you compare the above-mentioned lists of suicide risk factors, however, you'll note that while activity limitation was identified as a significant risk factor for suicide, it apparently was not included in the statistical adjustment that produced the 2.13-figure. And of the three statistically significant risk factors for suicide, activity limitation was by far the greatest - veterans with activity limitations had a 4.44 times greater rate of suicide than veterans with no activity limitations, as compared to race (3.23) and education (2.67).

Is the omission of the activity limitation factor another study typo? Was it inadvertently omitted from the statistical adjustment? Or was it omitted from the analysis because it would produce a non-result that rendered the study non-publishable and non-newsworthy? It certainly cannot be said that Kaplan was ignorant of the significance of the activity limitation risk factor. "According to Kaplan, the risk of suicide was highest among men whose activities were limited by health problems," reported the Atlanta Journal-Constitution.

Kaplan also published a study earlier this year entitled, "Physical illness, functional limitations and suicide risk: A population-based study" in the American Journal of Orthopsychiatry (Jan. 2007) in which he stated, "After controlling for potential [confounding risk factors], functional limitations were shown to be a significant predictor of suicide."

When I contacted Kaplan about these issues, he immediately acknowledged that the 2.04-figure was a typo and that the 2.13-figure was correct. Interestingly, he also provided me with a dubious error bar for the 2.13 figure. When I asked him about that, another acknowledgment of error was made. These may seem like small errors, but they certainly build no confidence.

As to the crucial omission of activity limitation as a risk factor, Kaplan deferred responding, writing that he needed to consult with one of his statistician co-authors. As of the time of this column, I had not heard back from Kaplan on that point. But you might think that a lead study author who gave many media interviews this week would be readily familiar with such a key component of his analysis. Of all the researchers I've interviewed over the years about their results, none has ever failed to immediately provide an answer to such a basic question.

I don't know whether Kaplan ultimately will produce a satisfactory explanation for the activity limitation omission - the study's remaining mystery. In some ways it doesn't matter. The study's other shortcomings - particularly that veteran suicide rates weren't higher across the vast majority of demographic groups examined, which indicates that military service itself isn't a causative factor in suicide - are alone enough to debunk it and the scary headlines it spawned.

But the wide reporting of a paper with such major and easily discoverable problems - as well as Kaplan's questionable effort to foment concern about suicide risk among veterans of Afghanistan and Iraq - reflects poorly on him and his co-authors, the publishing journal and the media.

Source

****************

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.

*********************

'Golden bullet' may be cancer hunter and killer

A "GOLDEN bullet" treatment for cancer which tracks down tumours before wiping them out with a blast of heat is to be tested on patients within weeks, it was revealed yesterday. The "seek and destroy" technique uses an injection of microscopic glass spheres, coated in gold, which seek out potentially deadly cancers in the body. Once enough spheres have flocked to the tumour, doctors "activate" them using a low energy beam of light. In tests, tumours have been totally destroyed.

Unlike conventional cancer treatments, the golden bullet approach uses no toxic chemicals and no radiation, reducing the risk of unpleasant side effects. It could also be far cheaper than existing treatments. Cancer scientists have predicted that it could help tackle a range of potentially deadly diseases, from skin cancers to cancers of the cervix, breast, brain and neck.

Tests on mice found that the treatment worked exceptionally well, New Scientist magazine reported yesterday. When it was tried on nine mice with colon cancer, the tumours were destroyed. Rice University (Texas) professor Jennifer West, who helped develop the treatment, said clinical trials on cancer patients were expected to begin in the US within weeks.

The first phase will find out whether the treatment successfully kills off tumours. A second stage, due to start in a couple of years, will test the particles' ability to identify tumours. "From the work we have done so far, we believe that this therapy will work on any soft-tissue tumours, such as the breast, prostate, brain, skin, head, neck and cervix," Professor West said.

Cancer Council Queensland director of community services and research programs Associate Professor Suzanne Steginga said the emergence of nanotechnology as a potential area for cancer treatment emphasised the critical importance of research. "The question, of course, will be how this work transfers from animal to human models, and this will take some years to answer," she said. "We wait with great interest for the outcomes of these trials."

The golden bullet treatment is not the first to use "nanoparticles" . Past studies have shown that microscopic capsules injected into the bloodstream can deliver drugs directly to tumours.

Source





In Defense of Andrew Speaker

Now that the initial shock and outrage over the case of Andrew Speaker - who flew to Europe and back despite having a drug-resistant strain of TB - have died down, we're hearing the predictable cries for more government power and money. Dr. Julie Gerberding, head of the CDC, told lawmakers in early June, "If we believe the patient has a strong intent to put others at risk, we need to have confidence we can take action absent documentation of intent to cause harm." And just this Sunday, a typical editorial in The Republican concludes:

Speaker is now in medical isolation in Denver. His close call must serve as a wake-up call. Specialists have been sounding the alarm. They want more federal money for research, education and outreach. And they want the authority to forcibly quarantine someone with a drug-resistant form of tuberculosis. They should get all of that - and soon.

Cases of medical quarantine are classic examples of situations where the rights of the individual are supposedly trumped by the safety of the community. After all, when people's decisions have consequences beyond their private lives, the government should and must intervene.

In contrast to this conventional wisdom, permit me to make a case for the exact opposite conclusion. I claim that the Andrew Speaker case beautifully illustrates the incompetence of government programs, and proves that the free market is the best system to referee complicated situations like this.

First some background that may change your opinion of Speaker: Based on what you've heard, he must be a very selfish guy, right? Well maybe, but one theory is that Speaker might have contracted TB when he was doing charity work for sick people in Vietnam.

Speaker has said time and again that health officials told him he wasn't a threat to anybody. Before he left for Europe, he was walking around freely, practicing law, interacting with his fianc‚e and her young daughter, and so forth. Anyone who's planned a wedding knows it's a logistical nightmare. Is it so shocking that Speaker decided to go ahead with his travel plans, rather than canceling his international tickets and other arrangements, so that he could stay in the US and continue to walk around freely with his TB that wasn't contagious?

When the scandal first broke, various health officials pooh-poohed Speaker's claims that he had been repeatedly told that he posed no threat to anyone. Yet Speaker's father surreptitiously taped one of the conversations, in which Dr. Eric Benning, medical director of the Fulton County health department, clearly tells Speaker "because of the fact that you actually are not contagious, there's no reason for you to be sequestered," and "As far as we can tell, you are not a threat to anybody right now."

Further proof that Speaker honestly believed he wasn't putting anyone in danger: Both sets of parents were present at the wedding, and he kissed his new bride on the mouth! And it's not just that these were six woefully ignorant people. In an ironic twist, Speaker's new father-in-law has a Ph.D. in microbiology and is a CDC expert in.drumroll please.tuberculosis! (You couldn't have made this stuff up.)

Now at this point in the saga, the CDC got a hold of Speaker and told him his strain of TB was more drug resistant than previously thought, and that he needed to either book a $100,000 private jet home (at his expense) or check himself into an Italian facility "indefinitely." Again, he wasn't told he was contagious; they advised him to take a walk and go to dinner before turning himself in.

Yes, at this point Speaker and his new bride definitely flouted their orders, and booked a flight to Canada (to avoid the US "no-fly" list), and then drove a rental car through border security without (they claim) lying about their identities. Before his trip, Speaker had been told that treatment in Denver was his one shot for survival, and he was afraid being detained in Italy would be a death sentence.

Now I ask, how in the world does this sordid tale justify more money and power for the CDC and other health officials? Suppose things had gone the opposite way, and that the feds had successfully coordinated with the airlines to prevent Speaker from flying to or from Europe. Surely newspaper editorialists would've congratulated the government on a job well done, and thanked their lucky stars that our society places limits on people's individual liberties.

So then why is it that when the government botches the job, again the conclusion is the same - to wit, we need the government to take away more liberties? If the government is so incompetent that it didn't even catch the newlyweds as they crossed the border from Canada through a regular checkpoint, why should we trust it to protect us from future outbreaks of contagious diseases?

Make no mistake, if the government didn't arrogate to itself the right to handle these life-or-death issues, the free market would fill the void. In a purely capitalist setup, it would be horrible for business if an airline allowed infectious passengers to fly internationally. Yet in today's world, airlines won't be punished for this carelessness, since travelers will assume "the government takes care of that type of thing." How many readers even know which airline Andrew Speaker used?

Some readers might object and say, "Wait a minute! Yes, the government fumbled the ball on this one, but so did the private airline. Neither agency prevented Speaker from putting people in danger."

But this isn't true. Suppose airline carriers instituted their own passenger rating system, and declined service to those it deemed infectious (or terrorist risks, for that matter). If these people were A-OK according to the government's list, then they could easily sue for baseless discrimination. So we see, the way the system works right now, if the government gets involved in something, it doesn't just supplement - it takes over.

The government botches just about everything it touches, whether it's schools, housing projects, reconstructing Iraq, or keeping the public safe from TB. Maybe it's time we quarantined the CDC and let the free market take a shot.

Source

****************

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.

*********************

HRT: On again, off again, on again

I condemned the scare stories from the beginning. Most of the health claims both for and against HRT are very flimsily based. Its usefulness in alleviating menopausal symptoms and limiting osteoporosis are the only considerations that should matter in decisions to use it or not. I said more about HRT on this blog on April 21

DOCTORS who alarmed millions of menopausal women by linking hormone replacement therapy with increased risk of heart attack or stroke, now say the drugs can lower the chance of heart disease. An American study published yesterday in The New England Journal of Medicine found that taking oestrogen for seven years or more soon after menopause can reduce calcification of the arteries, a major cause of heart attacks, by up to 60 per cent. Researchers say only older women who delay taking the drugs for at least 10 years are at risk.

The findings are a continuation of the Women's Health Initiative Study that caused a worldwide health scare in 2002 by controversially warning women that oestrogen replacement was potentially dangerous. This caused millions of women to stop using HRT. But the new research, which looked at 1100 women aged 50 to 59 who had undergone a surgically induced menopause through hysterectomy, could put many minds at rest. The lead author of the original study and the latest findings, Dr JoAnn Manson, of Boston's Brigham and Women's Hospital, said the new research would give women considering HRT reassurance that it was "unlikely to have an adverse effect on the risk of coronary events among women who have recently undergone menopause".

The results concur with a study published in the Journal of the American Medical Association in April that found the 2002 research fundamentally flawed. The JAMA study found there was a 30 per cent drop in deaths among women taking oestrogen.

But two international studies published about the same time showed hormone therapies could increase the risk of ovarian and breast cancer. Doctors at the time told Australian women the risks were low and to continue their hormone treatment. Melbourne's Baker Heart Research Institute director, Professor Garry Jennings, said yesterday that conflicting messages on HRT were confusing.

The latest research showed hormone treatment could be beneficial. "We like to think of something as black or white, good or bad, and it becomes a little complicated if it's good under this circumstance and not so good under others," he said. "What this study does is lend support to what has been the more recent practice, that is to still consider them (HRT) in younger women but to not really push them unless there are really disabling symptoms in older women."

Source






Crooked Chiropractors in California home free

When prominent chiropractors claim fake degrees, it does not need others to give chiropractic a bad name. But I guess that false health claims are endemic in California so nobody really cares

The board that oversees chiropractors now says it has no authority to discipline practitioners who claim advanced degrees from unaccredited universities, a reversal of an earlier policy that ensnared current board member Franco Columbu. The board has no regulation that spells out what kinds of claims about Ph.D.s might be misleading to consumers, said interim Executive Director Brian Stiger. As a result, the board can't send out letters to chiropractors who make those claims telling them to prove that the university is legitimate or stop advertising the degree, Stiger said. Some other professional licensing boards do restrict what licensees can claim about other degrees and credentials, Stiger and others say.

The board's new stance fails to protect consumers against misleading claims, said a legislator who has been investigating the Board of Chiropractic Examiners. "It's just another example of how out of control this board is ...," said Sen. Mark Ridley-Thomas, D-Los Angeles. "It goes directly to the issues of integrity and credibility. This drives me nuts."

For years, the board had been challenging chiropractors who claimed Ph.D.s from unaccredited institutions. The board investigates about five to 10 such cases each year, Stiger said. One was Columbu, a chiropractor appointed to the board by Gov. Arnold Schwarzenegger in February 2006. Columbu and Schwarzenegger are longtime friends from bodybuilding days, with Columbu, known as the Sardinian Strongman, standing as best man in Schwarzenegger's wedding. Two years before Columbu's appointment, the board sent him a "cease and desist" letter, telling him that he was in violation of a regulation on false and misleading advertising. The letter demanded that Columbu show proof that the issuer of his Ph.D., Donsbach University, was an accredited institution, or remove the Ph.D. claim from his advertising. The case was closed when Columbu furnished proof that he was no longer advertising the Ph.D.

But as of April of this year, Columbu still included a reference to a "Ph.D. in nutrition" on his Web site in a sales pitch for a $200 nutrition and training program. Columbu's Web site was not accessible Wednesday. After The Bee reported Columbu's situation in April, a lawyer wrote on Columbu's behalf that he had complied with the cease-and-desist letter but "due to an oversight" left one reference to the Ph.D. at the bottom of the Web page. The attorney, Wilkie Cheong, also questioned the board's authority to determine whether or not an institution conferring a Ph.D. was accredited. Columbu did not respond to a voice mail Wednesday.

Stiger said that he did not talk to Columbu about the change. He said it came up as part of his review of a number of board practices since taking over as interim director in March. Two lawyers agreed that the board doesn't have the authority to discipline chiropractors who claim Ph.D.s from unaccredited institutions, he said. Stiger sent out an e-mail Wednesday to the board staff so they would all be aware of the change.

Julie D'Angelo Fellmeth, administrative director at the Center for Public Interest Law at the University of San Diego, said the Columbu situation puts the board staff in an awkward position. "I understand the board staff is between a rock and a hard place," she said. "How would you like to go after one of your own board members?" Another board member, Frederick Lerner, also claims a Ph.D., this one in electromedical sciences from City University Los Angeles. The university is unaccredited and is no longer approved by the state Bureau for Private Postsecondary and Vocational Education. But Lerner said that when he did course work and a dissertation in 1985, the school was legitimate.

Stiger said that in the absence of enforcement, the board would rely on public education, informing consumers about how to check out chiropractors' credentials. The board could also choose to pass a regulation to detail the kinds of claims that chiropractors are prohibited from making. But that option could be costly and time consuming.

Ridley-Thomas said the reversal is "Exhibit A" for why the Legislature should pass a bill asking voters to put the Board of Chiropractic Examiners under the control of the Department of Consumer Affairs. The board is more autonomous than other professional licensing bodies because it was set up by a 1922 initiative governing the chiropractic profession. With the board under tighter control, the Legislature would be able to review appointees like Columbu, he said, and would be more likely to pursue a regulation barring certain advertising claims. "The public deserves better, much better," he said.

Source

****************

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.

*********************

Ban all sand!

Given the do-gooder obsession with banning anything even remotely harmful (and sometimes not harmful at all), why not? Surely people should at least be kept away from beaches!

Waves and sharks aren't the only dangers at the beach. More than two dozen young people have been killed over the last decade when sand holes collapsed on them, report father-and-son doctors who have made warning of the risk their personal campaign. Since 1985, at least 20 children and young adults in the United States have died in beach or backyard sand submersions. And at least eight others died in Australia, New Zealand and the United Kingdom, according to a letter from the doctors published in this week's issue of The New England Journal of Medicine.

Among them was Matthew Gauruder, who died from a collapse at an after-prom beach party in Westerly, R.I., in May 2001. The 17-year-old was playing football with friends when he jumped for a pass and fell backward into an eight-foot-deep hole someone had dug earlier. Would-be rescuers made the problem worse by caving in more sand as they tried to approach him. People at the scene said he may have been buried 15 minutes, said his mother, Mavis. "People have no conception of how dangerous this is," she said, in an interview this week.

Sand hole collapses occur horrifyingly fast, said Dr. Bradley Maron of Harvard Medical School, the report's lead author. "Typically, victims became completely submerged in the sand when the walls of the hole unexpectedly collapsed, leaving virtually no evidence of the hole or location of the victim," wrote Maron, an internal medicine resident.

Maron, a former lifeguard, became interested in the topic in the summer of 1998. He was vacationing with his family on Martha's Vineyard when he and his father, Minnesota cardiologist Dr. Barry Maron, saw a lifeguard responding to a collapse that engulfed an 8-year-old girl. The girl survived, thanks to a dramatic rescue. But it left a big impression on Maron, who's spent years tracking - and writing about - similar incidents. "It's been almost like a vendetta for him," said Dennis Arnold, who runs the beach patrol in the Martha's Vineyard community of Edgartown and was Maron's boss that summer.

People naturally worry about splashier threats, like shark attacks. However, the Marons' research found there were 16 sand hole or tunnel deaths in the U.S. from 1990-2006 compared with 12 fatal shark for the same period, according to University of Florida statistics. And Bradley Maron thinks the sand-related deaths are less well-documented than shark attacks.....

On Martha's Vineyard, lifeguards are instructed to order children and adults out of any hole deeper than a child's waist, and to kick sand in to fill them, Arnold said. Occasionally, some parents protest. "They'll say 'You're ruining my kids day!' I say 'I don't care,'" Arnold said. Mavis Gauruder, who lives in Fort Mill, S.C., said she's tried to issue similar warnings, like the time she came upon a father digging a hole with a garden shovel for his young son. She went up to the pair and warned them of the dangers. The man seemed unmoved, so she finally told him she'd had a tragedy in her family involving a hole collapse. "I asked them to fill in the hole. They did, but they looked at me like I was interfering," she said.

Source





Stroke drug may also help with frostbite

An anti-clotting drug used to treat strokes and heart attacks can also restore blood flow to frostbitten fingers and limbs, greatly reducing the need for amputation, according to a new study. Doctors at the University of Utah who conducted the research on a small sample of patients hope it marks the start of a move beyond the traditional - and limited - treatment for frostbite. "What it does is help to rescue that tissue that is damaged but not yet dead," said Dr. Stephen Morris, one of the authors of the study, which was released Monday in the Archives of Surgery medical journal.

Patients who received the thrombolytic therapy at the university's burn center were more likely to keep their frostbitten fingers and toes than patients who went without the drug. All patients had similar degrees of frostbite.

Thrombolytic therapy is not new, but has been difficult to study because not every frostbite victim is a candidate. For instance, people already on blood thinners or someone who has suffered a head injury would be at risk for serious complications from the anti-clotting drug. Dr. John Twomey, burn director at the Hennepin County Medical Center in Minneapolis, first tried the therapy on a patient about 20 years ago and has treated 18 other patients with it since. Twomey, whose early findings are mentioned in the Utah study, said the treatment for frostbite has been limited to warming the affected tissue and waiting to see how much would survive.

"We saw all these frostbitten patients come in, and there was absolutely nothing we could do to alter their disease," Twomey said. "That was pretty discouraging and disheartening to see that happening, and it happened repeatedly."

In the Utah study, six patients who were treated with a drug called tissue plasminogen activator, or tPA, within 24 hours of injury were compared with 25 other patients who did not receive the drug, and one patient who got the anti-clotting drug later than the 24-hour window. Among the patients who received tPA within 24 hours, only six of 59 frostbitten fingers or toes were removed, or about 10 percent. In the other group, 97 of 234 affected digits were amputated, or about 41 percent.

The sample used for the study was small and taken only from one geographic area. The study was also based only on the one anti-clotting drug. Those are just a few of the variables that leave questions to be answered by future research. But for some, the findings may offer a chance at avoiding amputation. "For the injured tissue, there's still hope," said Dr. Amalia Cochran, another of the University of Utah authors.

Source

****************

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.

*********************

Fatty foods counter stress

And stress can lead to depression, which is a serious illness, with anxious depression sometimes leading to suicide. The study below was with rats only but it is a warning to look at both sides of the coin

GORGING on fatty comfort food really can make a stressed person feel better, tests on rats have shown. Stressed rodents were able to experience pleasure more easily if they ate high-fat foods, research from the University of NSW found.

This could explain why some people over-eat when under stress, and may even partially explain the obesity epidemic, said researcher Prof Margaret Morris. "If it's true that societal levels of stress are increasing, and if people are turning to food in response to that stress, then it may be a small component of why we're experiencing more obesity," she said.

Prof Morris tested the theory by separating baby rats from their mothers soon after birth. Tests using a sugar drink showed that these stressed rats were less able to sense pleasure than rats who hadn't been separated. These unhappy rats were then placed on either a regular rat diet or an unhealthy Western diet with 30 per cent fat. "It appears that the fatty diet almost counters the traumatic experience of the separation," Prof Morris said.

Source




Blood transfusions may do more harm than good

Contrary to their benign image, blood transfusions are overused and often harm patients, expert say. Jehovah's Witnesses have been laughing ever since blood-borne AIDS and Hepatitis problems surfaced but they have even more reason to laugh now. The Old Testament warnings (e.g. Leviticus 17:11-14) about the forbidden status of blood appear to have had some surprising wisdom in them. No doubt there were blood-borne diseases in ancient times too. It seems likely that on balance JWs have avoided more problems than they incurred by their stand against transfusions

REFUSE at your own risk: for years that's the message doctors have relayed to Jehovah's Witnesses and others who've declined blood transfusions. But transfusions are not the wonder procedure of popular, or even medical profession, imagination. Mounting evidence shows they significantly increase the risk of post-operative complications - including infections, kidney failure, lung injury and death.

Yet instead of being saved as a last resort, they are still being performed when other safer options could be used instead. In fact, more than 25 per cent of blood transfusions currently performed are unnecessary, according to a visiting US expert who spoke at the annual scientific meeting of the Australian and New Zealand College of Anaesthetists (ANZCA) two weeks ago. Internationally renowned emergency medicine and anaesthiology professor Bruce Spiess told the conference that while blood transfusions have long been "believed to be helpful and a pillar of modern medicine'', there was now relatively little evidence to support such claims.

"Drug options are carefully tested and regulated through prospective, randomised double-blind testing, but blood transfusion stands apart,'' Spiess says. "It has never been safety or efficacy tested.'' It's a point that has been echoed by several Australian experts, including anaesthesists associate professor Larry McNicol and doctor Peter McCall at Austin Health in Melbourne.

"From the point of view of the risk of transmitting infections, blood transfusions are safer than they have ever been,'' McCall says. "However, there is an ever-increasing body of research about adverse outcomes in association with them. Still there is a tendency to think that blood transfusions are mystical and lifesaving, and it is better to give them than to withhold them.'' The reasons not to make blood transfusion routine are becoming increasingly apparent: a person who has had a blood transfusion after surgery has up to four times the risk of wound infections. People who have blood transfusions during cancer surgery face up to twice the risk of the cancer recurring.

In his conference presentation, Spiess discussed Swedish research on cardiac patients that compared Jehovah's Witnesses who refused blood transfusions to patients with similar disease progression during open-heart surgery. The research found those who refused transfusions had noticeably better survival rates.

There are a few major reasons complications arise following transfusion. For one thing, immune response is impaired as the body responds to the blood as a foreign body, much in the same way it responds to a transplant, experts say. The properties of red blood cells also become altered when blood is stored, reducing their ability to distribute oxygen through the body. Yet at least 25 per cent of transfusions that are done could be avoided, Spiess says.

A 2005-2006 audit of the use of fresh frozen plasma in hospitals in Tasmania and Victoria found that one-third of the transfusions performed were inappropriate under underguidelines issued by the National Health and Medical Research Council, says associate professor Larry McNicol, who also chairs the Better Safer Transfusion program run by the Victorian Government. "Essentially these patients really perhaps didn't need it and there might not have been therapeutic benefits,'' McNicol says.

But there are still circumstances when blood transfusion is necessary, and the patient would probably die if they did not receive one, says University of Sydney professor James Isbister, a consultant on haemotology and blood transfusion who chairs the Red Cross advisory board. Isbister says blood transfusion can be vital for patients undergoing major surgery after experiencing major trauma or shock when there is major bleeding that is difficult to control quickly. It can also be instrumental in managing hemophilia, where blood does not clot, as well as acute hemorrhages. "A lot of major surgery would never have developed without the possibility for blood transfusion either - for instance, open heart surgery,'' Isbister says.

But many of the cases in the Better Safer Transfusion audit involved transfusions that could have been avoided. For example, it was once thought that blood transfusions should be performed any time a patient's hemoglobin level dipped below 10 grams of hemoglobin per decilitre of blood - but now guidelines in varying countries put that between 6 and 8g. "It used to be that 10g was the acceptable minimum, but now we know that patients are at no detriment by a running a lower count and we can avoid these additional risks,'' McCall says. "When the blood count is lower, the heart is able to beat more strongly - so it can actually pump more efficiently to distribute the blood better.''

The audit also uncovered a tendency for some doctors to use transfusions as a precaution in patients who were at risk of bleeding, but not yet bleeding - for example, they might have had abnormal test results. In those cases the guidelines recommend doctors wait until bleeding starts. Other studies have also shown that the likelihood of receiving a transfusion during elective orthopaedic surgery or cardiac surgery can vary enormously between hospitals, despite there being little difference between the patients, Isbister says. "There's huge variation between hospitals and surgeons depending on where you have your operation - in one hospital you can have an 80 per cent chance of being transfused, and in another hospital 10 per cent chance.'' "Most patients undergoing hip and knee surgery should only have a 10 to 20 per cent chance of needing a transfusion - but there's evidence it can be much higher.''

There are a number of ways to avoid transfusions, including drugs that minimise blood loss and others that stop clots from being dissolved, as well as anesthetic and surgical techniques to minimise blood loss. "You don't always have to bring a person's blood pressure up to normal - you can keep it low and that minimises bleeding,'' he says.

In surgery where there's a risk of major blood loss, doctors frequently use a technique called "red cells salvage'', which allows them to reuse the patient's own blood rather than transfusing someone else's. The patient's blood is collected in a machine where it is then washed in a saline solution before being given back to the patient.

But the battle to reduce unnecessary transfusions often begins before surgery. "One of the ways to minimise transfusions is to prepare patients better before surgery - for example you can give them supplements to get their blood count up before surgery,'' McCall says. To that end a 2005 South Australian audit found that 18 per cent of people who had been on waiting lists for elective surgery had anemia, which increases the chances of needing a transfusion. If the anemia had been better managed before surgery some of those patients could have avoided blood transfusions, according to Kathryn Robinson, medical adviser of South Australia's BloodSafe.

But for all the bad news, experts say that change is on the horizon. Various states are developing initiatives to help decrease unnecessary transfusions, and at a conference of federal and state health ministers in March the federal Government said it would fund two initiatives expected to improve the safety of the blood supply and improve outcomes for people who do ultimately need transfusions. One of those initiatives is the universal testing of platelets, which carry particularly high risks of complications. Unlike other blood products, platelets can't be refrigerated, so they are susceptible to contamination by bacteria. International guidelines recommend all platelets be universally tested for the bacteria, but currently only about 5 per cent of the supply is tested, McNicol says.

At the same meeting the government announced that by 2010 all blood will be processed to remove white blood cells, known as leuko-reduced blood, which has been shown to dramatically reduce complications and is already in widespread use in Canada, New Zealand, Western Europe and elsewhere. "There are three randomised controlled studies in heart surgery, where patients who were deemed appropriate to be transfused got either leuko-reduced blood or blood with white cells present,'' Spiess says. "The death rate in those with leuko-reduced blood was roughly half that in those with blood with white cells,'' Speiss says. "In the patients that got no blood, there were no deaths at all.'' [Quite amazing testimony to the fragile status of medical "wisdom". And it is this false "wisdom" that has been enforced by law in many places!]

Source




British Food Fascism Hits Egg Advertisement

We read:

"Fifty years after Britons were implored to "Go to work on an egg", an advertising watchdog has banned a revival of the campaign, saying that it breaches health guidelines. Plans to mark the anniversary by broadcasting the original television advertisements featuring Tony Hancock have had to be called off.

The ban by the Broadcast Advertising Clearance Centre, which vets television advertisements, was condemned as ridiculous yesterday by the novelist Fay Weldon, who used to work in advertising and helped to create the campaign. "I think the ruling is absurd," she said. "We seem to have been tainted by all the health and safety laws. If they are going to ban egg adverts then I think they should ban all car adverts, because cars really are dangerous, and bad for the environment.

The advertising clearance centre, a government-backed watchdog, says that it blocked the campaign because eating an egg for breakfast every day was not a "varied diet". ....

The egg information service offered to add a line to the adverts saying that eggs should be eaten as part of a varied diet. The compromise was rejected.

The egg information servicesaid it was shocked by the ruling. It said eggs were a healthy food recommended by nutritionists and many other advertisers promote their products to be eaten every day, "so we are very surprised eggs have been singled out.

Source

****************

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.

*********************