Friday, February 29, 2008

"Diversity" is bad for your heart

Oh dear! What a nasty finding for the Left we have below. As we know from Putnam's work (See also here), community involvement is lowest where a community is ethnically diverse. Yet this study shows that people living in low community involvement areas have more heart problems. The authors don't put it that way, of course but that is what their study shows. And it makes sense. Being afraid to go outside your front door is stressful and stress is certainly bad for your heart

Home may be where the heart is, but it could be one's surrounding community that helps keep the ticker healthy, according to a new study led by researchers at the University of California, Berkeley's School of Public Health. "This analysis points to a real effect on real people," said study lead author Richard Scheffler, UC Berkeley professor of health economics and public policy. "It speaks to the value of clubs and social organizations in providing health information and reducing stress, both of which are known to reduce heart disease." The full study is to be published online in the Feb. 28 issue of the journal Social Science & Medicine.

"This is the first study to demonstrate a link between community social capital and prognosis following heart disease," said study co-author Dr. Ichiro Kawachi, professor of social epidemiology in the Department of Society, Development and Human Health at the Harvard School of Public Health. "Other research has linked social capital to health outcomes, but most of these studies have been cross-sectional, and therefore difficult to draw conclusions about cause-and-effect relationships. The findings of this study take us in the right direction."

The researchers based the degree of social capital in any given county upon the number of people employed in various organizations, including religious, civic, political, social and alumni groups.

There is growing evidence that cardiovascular health is linked to where a person lives, but it had been unclear whether location served as a proxy for other unmeasured factors, including the type of medical treatment or health care available there. To address this gap, UC Berkeley researchers partnered with Kaiser Permanente Northern California, a non-profit integrated health care delivery system. Data was obtained from actual clinical records of nearly 35,000 Kaiser Permanente patients who had been hospitalized for acute coronary syndrome - a term describing symptoms of decreased blood flow to the heart - in Northern California between 1998 and 2002. Patients were tracked for symptoms of recurring heart problems. To protect patient privacy, only authorized Kaiser Permanente personnel had direct access to the clinical records for this study.

"Because we're using actual clinical records instead of self-reported medical information, we have a clearer picture of a person's health status and medical treatment," said Scheffler, who is also director of the Nicholas C. Petris Center on Health Care Markets & Consumer Welfare at UC Berkeley's School of Public Health. "And because all the patients are in the same health care system, we avoid the problem of comparing people with different kinds of health plans or who don't have insurance at all. We also were able to follow patients over time to track any recurrence of heart problems, which is very unique."

The authors noted that patients in low-income areas have the most to gain from higher social capital. "Our findings are consistent with the hypothesis that social capital helps more those in the lower socioeconomic spectrum," said study co-author Dr. Carlos Iribarren, research scientist at Kaiser Permanente Northern California. "Those with greater economic advantage don't seem to benefit, or benefit less, because they have other resources available to them."

The researchers pointed out that patients did not need to be members of any of the community organizations measured in order to benefit. "An area with a high density of social networks and resources changes the character of a community, regardless of whether any one particular individual joins or not," said Scheffler. "It's the opposite of having a liquor store on every corner. You don't have to shop at the liquor stores to be impacted by the type of environment they create."

Thirty-five of California's 58 counties were included in the study. The eight counties found to have the highest levels of community social capital are, in descending order, San Francisco, Lake, Sacramento, Santa Cruz, Marin, Tuolumne, Nevada and Alameda. "The majority of information available about the determinants of health is based upon individual behavior," said Leonard Syme, UC Berkeley professor emeritus of epidemiology and study co-author. "This study clearly shows that the world within which people live also has an important impact on health."


Breast Cancer Reprieve

The arrogant and narrowminded FDA eases up a little

In a surprise decision, the Food and Drug Administration played against type and gave approval for Avastin as a treatment for metastatic breast cancer. It was the right option for terminally ill women, who will gain another weapon against a disease that kills about 40,000 every year. In clinical trials, Genentech's biologic drug was shown to control the growth and spread of tumors, doubling the amount of time before illness worsened. That translates into an improvement in quality of life, and the results were corroborated by further studies.

Avastin shouldn't have been controversial. But an FDA panel ruled that "progression-free survival" was not sufficient, because the agency's usual acid test for anticancer agents is extending life overall. Such an analysis overlooks the real benefits to women in the months they have left. But as late as last week, it looked as though approval would be delayed or rejected outright.

The "accelerated approval" granted to Avastin is contingent on follow-up trials, and Avastin could be pulled from the market if future research fails to demonstrate that treatment prolongs life. In an interview with us on Monday, oncology drugs chief Richard Padzur said that the FDA was "not demanding" a survival advantage but would consider it a factor. In 2005, the lung cancer drug Iressa was approved and then withdrawn under similar conditions, and the danger is that history will repeat itself.

As for the notion that the decision portends a shift in the way the FDA evaluates cancer drugs, Dr. Padzur assured us that it "not a new step in our regulatory decision making." He emphasized that prolonging life was still the FDA's primary criterion, and noted that Avastin was green-lighted because its quality-of-life benefits were "statistically robust." Yet the narrowness with which the FDA balances risk and reward was the reason Avastin was contentious -- especially Dr. Padzur's statistical models.

FDA evaluation methods insist on large average effects and simplistic mortality rates. Only about 10% of patients responded to Iressa, for instance, and could be identified by genetic tests; but these targeted results didn't mesh with the arbitrary FDA approach. Other innovative medicines like Provenge (for prostrate cancer) and Junovan (for pediatric bone cancer) are pointlessly blocked by Dr. Padzur's division, and the risk is that Avastin still could be too, whatever its current reprieve.

The finality of life-and-death decisions makes the approval of such drugs fundamentally a moral issue. Avastin may have slid beneath the wire, but the FDA hasn't changed its morally indefensible standard, and further drug approvals are still subject to the whims of a bureaucracy that puts statistical models above the choices of dying patients.



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.

"What we should be doing is monitoring children from birth so we can detect any deviations from the norm at an early stage and action can be taken". Who said that? Joe Stalin? Adolf Hitler? Orwell's "Big Brother"? The Spanish Inquisition? Generalissimo Francisco Franco Bahamonde? None of those. It was Dr Colin Waine, chairman of Britain's National Obesity Forum. What a fine fellow!


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