MORE ON "EVIDENCE-BASED MEDICINE"

Following is an email I received from a specialist anesthetist

EBM has become a "buzzword" of the Health Care Administration, with several "agendas":

1. Somehow bureaucrats are playing "catch up", like THEY invented EBM to "purify" those dumb doctors. Much is a ploy to save money - somewhat like Leftists NEVER being satisfied with Bush's performance in war and economics, there is NEVER enough medical evidence to "prove beyond a doubt" that some treatment is valid. This saves money for the insurance company. Since NO therapy can be "absolutely proven", insurers LOVE EBM.

2. There is ANOTHER agenda - to take decision making away from the physician by publishing "guidelines" that any aide or nurse can perform - by reading the manual. This locks doctors out of the loop.

3. Much of this EBM in recent years comes from primary care - presented as NEW because it is NEW TO THEM. For many years, they have practiced based on "my experience", more often flawed than EBM. They think that application of science to medicine is something new.

In truth, anesthesiologists have known about this stuff for generations. It was an anesthesiologist (Virginia Apgar) who developed a scoring system for evaluation of newborns in the 50.s. This numerical score was the FIRST score for such, which in the past was simply descriptive. Since the 1930's, science has been a core value of anesthesiologists. We laugh at such arrogance among the primary care and health care bureaucracies.







IS TESTOSTERONE A FOUNTAIN OF YOUTH?

The study below showed that giving testosterone patches to old guys with low testosterone levels produced slimmer tummies and more muscle. What the inevitable downside might be is not yet known. Shorter lifespan is a possibility. And whether it helps normal men of that or other ages is not shown

Testosterone Therapy Prevents Gain in Visceral Adipose Tissue and Loss of Skeletal Muscle in Non-obese Aging Men

By C. A. Allan et al.

Background: Trials of testosterone therapy in aging men have demonstrated increases in fat free mass and skeletal muscle, and decreases in fat mass, but have not reported the impact of baseline body composition.

Objective: To determine the effect, in non-obese aging men with symptoms of androgen deficiency and low-normal serum testosterone levels, of testosterone therapy on total and regional body composition, and hormonal and metabolic indices.

Methods: 60 healthy but symptomatic, non-obese men aged ~ 55 years with TT levels <15nM were randomized to transdermal testosterone patches or placebo for 12 months. Body composition, by DEXA (fat mass, fat free mass, skeletal muscle) and MRI (abdominal subcutaneous and visceral adipose tissue, thigh skeletal muscle and intermuscular fat) and hormonal and metabolic parameters were measured at Weeks 0 and 52.

Results: Serum TT increased by 30% (P=0.01) LH decreased by 50% (P<0.001). Relative to placebo, total body fat free mass (P=0.03) and skeletal muscle (P=0.008) were increased and thigh skeletal muscle loss was prevented (P=0.045) with testosterone therapy while visceral fat accumulation decreased (P=0.001) without change in total body or abdominal subcutaneous fat mass; change in visceral fat was correlated with change in TT levels (r2=0.36; P=0.014). There was a trend to increasing total and LDL cholesterol with placebo.

Conclusion: Testosterone therapy, relative to placebo, selectively lessened visceral fat accumulation without change in total body fat mass, and increased total body fat free mass and total body and thigh skeletal muscle mass. Further studies are needed to determine the impact of these body compositional changes on markers of metabolic and cardiovascular risk.

Journal of Clinical Endocrinology & Metabolism, October 16, 2007

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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].

9). And how odd it is that we never hear of the huge American study which showed that women who eat lots of veggies have an INCREASED risk of stomach cancer? So the official recommendation to eat five lots of veggies every day might just be creating lots of cancer for the future! It's as plausible (i.e. not very) as all the other dietary "wisdom" we read about fat etc.

10). And will "this generation of Western children be the first in history to lead shorter lives than their parents did"? This is another anti-fat scare that emanates from a much-cited editorial in a prominent medical journal that said so. Yet this editorial offered no statistical basis for its opinion -- an opinion that flies directly in the face of the available evidence.

Even statistical correlations far stronger than anything found in medical research may disappear if more data is used. A remarkable example from Sociology:

"The modern literature on hate crimes began with a remarkable 1933 book by Arthur Raper titled The Tragedy of Lynching. Raper assembled data on the number of lynchings each year in the South and on the price of an acre's yield of cotton. He calculated the correlation coefficient between the two series at -0.532. In other words, when the economy was doing well, the number of lynchings was lower.... In 2001, Donald Green, Laurence McFalls, and Jennifer Smith published a paper that demolished the alleged connection between economic conditions and lynchings in Raper's data. Raper had the misfortune of stopping his analysis in 1929. After the Great Depression hit, the price of cotton plummeted and economic conditions deteriorated, yet lynchings continued to fall. The correlation disappeared altogether when more years of data were added."

So we must be sure to base our conclusions on ALL the data. But in medical research, data selectivity and the "overlooking" of discordant research findings is epidemic.

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