Saturday, May 31, 2008

We must kick our methadone habit

Drug addicts often do not really need the heroin substitute that they are prescribed

By Theodore Dalrymple

It is unusual for politicians to face up to the obvious, but the Scottish Executive seems for once to have done so: it has recognised what has long stared it in the face, namely that dishing out methadone to drug addicts is not the answer to their problems or to the problems that they cause society. A different approach is needed.

Perhaps in 100 years historians will wonder why so many of the governing elite, from senior doctors to Cabinet ministers, persisted for so long in the belief that doling out methadone was the answer. The explanation, I think, will be that they wilfully misunderstood the nature of the problem.

Many years ago I used to dole out methadone like the best (or the worst) of them. This was before I thought at all deeply about the question of drug addiction and accepted uncritically all that I had been taught about it by doctors senior to me. I began to change my opinion when I worked in prison where it was the clinical policy to give addicts methadone. I noticed that, far from creating an atmosphere of contentment and satisfaction, it created one of perpetual tension and irritation. Shortly after having been prescribed a dose, the prisoner would return and say, in an intimidating fashion: "It's not holding me, doc, it's just not holding me," and sometimes announce that, unless he was prescribed more, he would end up attacking other prisoners, and then it would be the doctor's fault.

In Scotland the great majority of addicts prescribed methadone by their doctors never stop taking it, and most of them take other drugs as well. A particularly dangerous combination of drugs is methadone and benzodiazepines (drugs such as Valium), and yet drug clinics and other doctors persist in prescribing this often fatal combination - largely, I suspect, because they are too frightened of their patients to refuse them anything.

The number of people admitted to hospital having taken a dangerous overdose of methadone (556 in 2006-07) is greater, proportionately, than the number of people admitted to hospital having taken a dangerous overdose of heroin (1,530 cases). In Dublin recently, more people have died of methadone poisoning than of heroin overdose. The supposed cure causes as many problems as the supposed disease. If addicts prescribed methadone are given the opportunity to divert it on to the black market, they will: which suggests that they do not really need it in the first place.

In France, addicts are often prescribed a different drug, buprenorphine, which soon became the street drug of preference in Finland, to which it was illegally re-exported by the addicts. More recently, a huge epidemic of buprenorphine addiction has occurred in Georgia (the ex-Soviet republic), numbering scores of thousands of addicts, who take buprenorphine diverted from France. If the addicts really needed the drugs, they would take them rather than divert them on to a black market.

In the prison in which I used to work, a buprenorphine tablet that had been prescribed for an addict to alleviate the symptoms of withdrawal from heroin on arrival in the prison, and which an addict had put in his mouth and spat out for sale to another prisoner, was known as a "furry" because of its rough surface. Again, this suggests that addicts did not really need what they were prescribed, and that the whole basis of prescription was flawed.

The fundamental error that the Scottish Executive has now admitted is in having regarded addiction to heroin as a technical medical problem, to be solved by technical medical means. But that old approach amounts to a surrender to blackmail: give me what I want or I will continue to behave badly and to hold you responsible for the ill-effects of my own behaviour.

Suppose we gave money to burglars to induce them to stop burgling. No doubt most of them would stop for a length of time depending upon how much we gave them. But this does not mean that money is the treatment of the dreadful disease of burglary, or because we prevented certain individuals from continuing to burgle it means that we had reduced the disease of burglary in society as a whole. Rather, we would have encouraged its spread.

This is precisely the logic that has been applied to drug addiction. Just how precisely is evident from the Government's recent declared policy that clinics should now give drug addicts money or other rewards for not taking drugs (as least as proved by drug-free urine samples, something experienced drug addicts have long learnt to provide). This is the first time in the history of medicine, so far as I know, that bribery has been considered a medical treatment.

Contrary to what everyone supposes, withdrawal from heroin is not a serious medical condition - unlike, say, withdrawal from alcohol when it results in delirium tremens (the DTs). The suffering is grossly exaggerated and, in so far as it is genuine, is largely produced by anticipatory anxiety that is itself the consequence of years of mythologising the fearsomeness of withdrawal.

Addiction to heroin is a medical problem only to a minor extent, which is why predominantly medical means will never solve the problem. Most of Britain's 300,000 addicts are drawn from broken families, have a poor education, are without much hope for (or for that matter fear of) the future and have no cultural life, intellectual interests or religious belief. Delusory euphoria - the paradise at three pence a bottle that De Quincey described in his Confessions of an English Opium Eater - is the best that they think that they can hope for in life. This is not a medical problem. Where addiction is concerned, it is time to throw physic to the dogs.


Appalling: Australian toddlers prescribed ADHD drugs

TODDLERS as young as two are being diagnosed with ADHD and prescribed drugs including Ritalin. Figures obtained by The Daily Telegraph reveal 311 children in NSW aged five and under depend on controversial medication, including 58 four-year-olds and 13 three-year-olds. Health Department figures show that, nationally, doctors have prescribed ADHD drugs to five toddlers aged only two, despite possible side effects.

The mother of one four-year-old who has been on Ritalin since the age of three said she knew there could be long-term effects but the change in her son's behaviour was worth the risk. "At first I was hoping he didn't have ADHD and I didn't want to put him on medication but I thought I should give it a go and there has been a big improvement," the single mother of two told The Daily Telegraph.

But the disturbing figures tell only part of the story. They cover scripts subsidised under the Pharmaceutical Benefits Scheme - only a proportion of the young children on ADHD drugs. With Australia's ADHD rates among the highest in the world, the federal Department of Health said prescriptions paid for without PBS subsidies "are a significant portion of the total scripts". It has no corresponding data for them.

The most widely prescribed drugs for the youngest children, according to the figures to March this year, continue to be Ritalin and the longer-lasting associated drug, Concerta, which was added to the PBS last year. Dexamphetamine is the next most popular while Strattera, a longer-lasting non-stimulant, is less popular and prescribed mainly for children aged six and older.

As well as the three and four-year-olds, there are 240 five-year-olds on subsidised ADHD drugs in NSW. There are 6692 6- to 10-year-olds, 9006 11- to 15-year-old and 2584 16- to 18-year-olds. The figures follow the State Government's ADHD review which found there was no overprescribing of drugs. But child psychiatrist Jon Jureidini said he was disappointed at the number of preschoolers on the list. "I would be confident that they (the drugs) are being inappropriately used in most cases of preschool children," Dr Jureidini said. "ADHD is not a good explanation for putting these children on drugs. "I have seen children of that age displaying very disturbed behaviour but it is usually a medical problem or significant family circumstances that are undermining their well-being."

However paediatrician Dr Michael Kohn, the treating doctor for the four-year-old, said he was not surprised at the number of children on ADHD medication. Dr Kohn, a senior staff specialist in paediatrics at The Children's Hospital at Westmead, said the prescribing of ADHD drugs to children aged four and less was strictly controlled in NSW. Specialists needed the permission of the state's Stimulant's Committee with the committee having to meet on each individual case.

Source. Commentary here

Friday, May 30, 2008

Can aspirin help to prevent breast cancer?

Don't rely on it. The popular article below does not say where they got their info from but I presume this study from some years back has now reached journal publication somewhere. And it is just the usual epidemiological muck. A weak correlation is found -- in this case, taking aspirin reduced your risk from 1.7% to 1.5% or thereabouts -- and a simple causal inference is immediately declared "ex cathedra". The fact that women who regularly take aspirin might differ from women who do not in all sorts of ways is completely ignored. If there is any meaning in the findings at all, they probably mean that middle class women take more aspirin

Lurking in bathroom cabinets and medicine chests across the land is a wonder drug: aspirin. Over the past two decades, the mild painkiller has been used against rheumatoid arthritis, strokes and heart attacks, and has been shown to protect nerves, fight a virus linked with birth defects, inhibit a protein that enables the Aids virus to multiply, and help treat adult-onset diabetes.

Researchers have also suggested the drug may help prevent bowel, pancreatic and lung cancer, and a team in Italy has reported that taking regular doses for five years or more can cut the risk of cancers of the mouth, throat and oesophagus by two thirds.

This week, the drug's superstar status was confirmed by an American study of more than 80,000 women which concluded that regular use of aspirin and ibuprofen can hinder the formation and growth of breast cancer, cutting the risk by up to half. Aspirin must now count as one of the greatest finds in medical history.

The history of its use stretches back thousands of years. A collection of medicinal recipes from the second millennium BC recommended treating rheumatic and back pain with an infusion of dried myrtle leaves, which contain salicylic acid, a close chemical relative of aspirin. In the fifth century BC, Hippocrates prescribed extract of willow-tree bark for fever and labour pains. Again, the active substance is salicylic acid. By the late 1800s, salicylates had become the standard drug for treating arthritis, but they irritated the stomach. Enter Felix Hoffman who, working for the German company Bayer & Co, set out to find a less irritating medicine for his father's arthritic pain. In 1897, he created acetylsalicylic acid. Aspirin was born.

By 1950, aspirin was the best-selling painkiller, but it was not until 1971 that doctors discovered the drug's secret. British pharmacologist Sir John Vane found that aspirin worked by inhibiting hormone-like chemicals that play a role in pain and inflammation and regulate blood flow.

Around 50,000 tons of aspirin are now made annually. In the wake of this week's headlines, that amount looks likely to grow further. The new findings emerge from the Women's Health Initiative, a US government study started more than a decade ago to track diseases such as cancer. The data reveals that taking two or more tablets of aspirin and other so-called non-steroidal anti-inflammatory drugs - NSAIDs - a week has a significant effect in reducing the risk of developing breast cancer.

Most of the women were taking aspirin and ibuprofen for arthritis, muscle pain or headaches. Regular use of the drugs for five to nine years reduced the participants' risk of developing breast cancer by 21 per cent, according to Prof Randall Harris of Ohio State University and his team. He was "amazed" by these results, which held good when confounding factors, such as age, weight and exercise, were taken into account. Extending the use of NSAIDs to 10 or more years resulted in an even greater reduction of 28 per cent. The researchers observed that ibuprofen was more effective than aspirin in preventing breast cancer (49 per cent versus 21 per cent reduction in risk). Small doses did not have any significant effect. "There is compelling and converging evidence to indicate that NSAIDs may have protective effects against breast cancer and other forms of cancer," says Prof Harris.

Aspirin is what pharmacologists call a "dirty" drug - it has many different actions because it binds to many molecular targets in the human body. In the case of cancer prevention, the key target is the cyclo-oxygenase enzyme COX-2, the trigger of pain and inflammation, which is made in abnormally high amounts in most human breast cancers. Recent studies indicate that COX-2 may be implicated in several events in tumour development.

Given that breast cancer is the most common form of cancer, affecting about one in 10 women in Britain, should all women now start taking aspirin? Certainly not in the case of very young women: last year, the then Medicines Control Agency warned that children under the age of 16 should not take the drug because of links with Reye's syndrome, a very rare but potentially fatal condition that affects the brain and liver in children and adolescents.

However, Prof Harris believes the new evidence is "so compelling" that women over 40 might consider taking aspirin or ibuprofen regularly - but only after consulting their GP, because there is a risk of side effects, such as indigestion, ulcers and gastrointestinal bleeding.

The drug could become an important part of cancer prevention, agrees Dr Richard Sullivan, head of clinical programmes for Cancer Research UK. However, he stresses that scientists now need to weigh up how many women could be prevented from getting breast cancer and how many could suffer fatal side effects from taking these drugs. "Aspirin has to count as one of the greatest finds in the history of drug discovery," he says. "However, we're not yet at the stage where we can recommend that everyone starts taking aspirin on a daily basis to protect against breast cancer, as we'll need to further investigate its effectiveness and the possible side effects of long-term use."


Energy drinks linked to risky behavior among teenagers

That stimulants stimulate all sorts of behaviour -- both good and bad -- should not be a big surprise

Health researchers have identified a surprising new predictor for risky behavior among teenagers and young adults: the energy drink. Super-caffeinated energy drinks, with names like Red Bull, Monster, Full Throttle and Amp, have surged in popularity in the past decade. About a third of 12- to 24-year-olds say they regularly down energy drinks, which account for more than $3 billion in annual sales in the United States.

The trend has been the source of growing concern among health researchers and school officials. Around the country, the drinks have been linked with reports of nausea, abnormal heart rhythms and emergency room visits.

In Colorado Springs, several high school students last year became ill after drinking Spike Shooter, a high caffeine drink, prompting the principal to ban the beverages. In March, four middle school students in Broward County, Florida, went to the emergency room with heart palpitations and sweating after drinking the energy beverage Redline. In Tigard, Oregon, teachers this month sent parents e-mail alerting them that students who brought energy drinks to school were "literally drunk on a caffeine buzz or falling off a caffeine crash."

New research suggests the drinks are associated with a health issue far more worrisome than the jittery effects of caffeine risk taking. In March, The Journal of American College Health published a report on the link between energy drinks, athletics and risky behavior. The study's author, Kathleen Miller, an addiction researcher at the University of Buffalo, says it suggests that high consumption of energy drinks is associated with "toxic jock" behavior, a constellation of risky and aggressive behaviors including unprotected sex, substance abuse and violence.

The finding doesn't mean the drinks cause bad behavior. But the data suggest that regular consumption of energy drinks may be a red flag for parents that their children are more likely to take risks with their health and safety. "It appears the kids who are heavily into drinking energy drinks are more likely to be the ones who are inclined toward taking risks," Miller said.

The American Beverage Association says its members don't market energy drinks to teenagers. "The intended audience is adults," said Craig Stevens, a spokesman. He says the marketing is meant for "people who can actually afford the two or three bucks to buy the products."

The drinks include a variety of ingredients in different combinations: plant-based stimulants like guarana, herbs like ginkgo and ginseng, sugar, amino acids including taurine as well as vitamins. But the main active ingredient is caffeine. Caffeine content varies. A 12-ounce serving of Amp contains 107 milligrams of caffeine, compared with 34 to 38 milligrams for the same amount of Coca-Cola or Pepsi. Monster has 120 milligrams and Red Bull has 116. Higher on the spectrum, Spike Shooter contains 428 milligrams of caffeine in 12 ounces, and Wired X344 contains 258.

Stevens points out that "mainstream" energy drinks often have less caffeine than a cup of coffee. At Starbucks, the caffeine content varies depending on the drink, from 75 milligrams in a 12-ounce cappuccino or latte to as much as 250 milligrams in a 12-ounce brewed coffee.

One concern about the drinks is that because they are served cold, they may be consumed in larger amounts and more quickly than hot coffee drinks, which are sipped. Another worry is the increasing popularity of mixing energy drinks with alcohol. The addition of caffeine can make alcohol users feel less drunk, but motor coordination and visual reaction time are just as impaired as when they drink alcohol by itself, according to an April 2006 study in the medical journal Alcoholism: Clinical and Experimental Research.

"You're every bit as drunk, you're just an awake drunk," said Mary Claire O'Brien, associate professor in the departments of emergency medicine and public health services at Wake Forest University Baptist Medical Center in Winston-Salem, North Carolina

O'Brien surveyed energy drink and alcohol use among college students at 10 universities in North Carolina. The study, published this month in Academic Emergency Medicine, showed that students who mixed energy drinks with alcohol got drunk twice as often as those who consumed alcohol by itself and were far more likely to be injured or require medical treatment while drinking. Energy drink mixers were more likely to be victims or perpetrators of aggressive sexual behavior. The effect remained even after researchers controlled for the amount of alcohol consumed.

Energy drink marketers say they don't encourage consumers to mix the drinks with alcohol. Michelle Naughton, a spokeswoman for PepsiCo, which markets Amp, said, "We expect consumers to enjoy our products responsibly."


Thursday, May 29, 2008

Moderate wine drinking promotes a healthier liver

Or does it? Maybe it does but the study below does not prove it. The study is better than many in that it did control for social class variables but there are many things not controlled for -- such as personality, diet and lifestyle. Are we to assume that non-drinkers and moderate drinkers are the same on average? Surely not. Yet we would have to assume that to make the causal inferences below.

Amusing that wine is found to be good for you but beer is bad. All of the results below were quite predictable from the probable habits of the researchers. Wine has been getting a good rap for some years now. Anybody would think that wine-drinking had become popular among the bourgeoisie in recent years! Oh dear!

I am sure that the researchers would be quite huffy about the suggestion I have just made but they should read up on the Rosenthal effect

Popular summary below followed by journal abstract

In Hepatology this week, researchers have shown that moderate wine consumption decreases the risk of developing fatty liver disease. A total of 11,754 adults aged 21 and over were involved in the study -- 7211 non-drinkers and 4543 moderate drinkers. "Moderate" was defined as having up to an average of one drink per day of either 120 millilitres (ml) of wine, 350ml of beer or 30ml of spirits. Compared to non-drinkers, those who drank one glass of wine a day had half the risk of developing fatty liver disease. But those who drank moderate amounts of beer or spirits had more than four times the risk of liver disease as non-drinkers.


Modest wine drinking and decreased prevalence of suspected nonalcoholic fatty liver disease

By Winston Dunn et al.


People at risk for coronary heart disease are often at risk for nonalcoholic fatty liver disease (NAFLD). The association of modest wine consumption with NAFLD has not been studied and the recommendation of wine for patients at risk for both diseases is controversial. The aim is to test the hypothesis that modest wine consumption is associated with decreased prevalence of NAFLD. We included Third National Health and Nutrition Examination Survey participants who either reported no alcohol consumption or preferentially drinking wine with total alcohol consumption up to 10 g per day. Suspected NAFLD was based on unexplained serum alanine aminotransferase (ALT) elevation over the cut point of the reference laboratory (ALT > 43) and the cut point based on the 95th percentile of healthy subjects (ALT > 30 for men; ALT > 19 for women).

Multivariate analysis was adjusted for age, gender, race, neighborhood, income, education, caffeine intake, and physical activity. A total of 7,211 nondrinkers and 945 modest wine drinkers comprised the study sample. Based on the reference laboratory cut point, suspected NAFLD was observed in 3.2% of nondrinkers and 0.4% of modest wine drinkers. The adjusted odds ratio was 0.15 (95% confidence interval, 0.05-0.49). Using the healthy subject cut point, suspected NAFLD was observed in 14.3% of nondrinkers and 8.6% of wine drinkers. The adjusted odds ratio was 0.51 (95% confidence interval, 0.33-0.79). Conclusion: Modest wine consumption is associated with reduced prevalence of suspected NAFLD. The current study supports the safety of one glass of wine per day for cardioprotection in patients at risk for both coronary heart disease and NAFLD.

HEPATOLOGY 2008, Volume 47, Issue 6 , Pages 1947 - 1954

What happened to the obesity "epidemic"?

The percentage of children who are obese has been roughly stable since 1999, but no one knows why. But why not?

The stunning three-decade rise in childhood obesity that prompted the government to declare an "epidemic" of fat appears to have leveled off, although the rate is still more than three times higher than in the 1970s, researchers reported today. The analysis was based on data from tens of thousands of children showing that the percentage of obese youngsters has been roughly stable since 1999 in every age and racial group they surveyed.

The level of obesity "is still too high," said lead author Cynthia Ogden, an epidemiologist with the federal Centers for Disease Control and Prevention. But she added: "Maybe there is some cause for optimism."

The mystery is what caused the plateau. The leading possibility is that educational and regulatory campaigns to get children to eat less junk food and exercise more have begun to pay off.

The findings "may signal that this national epidemic is not an unstoppable force," said Dr. Risa Lavizzo-Mourey, president of the Robert Wood Johnson Foundation, which has committed $500 million to promoting physical activity in communities and improving nutrition in schools. "When parents, government, schools, the food and beverage industries, other businesses, and the nonprofit and philanthropic sectors work together, we can make progress, and we can reverse this epidemic," she said in a statement.

Some researchers, however, said the answer could be that the epidemic has simply reached a saturation point -- kids just can't get any fatter. "Eventually it had to level off," said S. Jay Olshansky, an epidemiologist at the University of Illinois at Chicago who was not involved in the study. "The question was when. Maybe this is it."

The rise in obesity among children and adults has been one of the biggest public health issues of the last few years, both in this country and around the world. It was first noticed by researchers in the 1980s as a relentless upward slope that threatened to undo progress on heart disease and exacerbate other killer illnesses influenced by weight, including diabetes, high blood pressure and some types of cancer.

The CDC issued an unsettling report in 2004 [later discredited] that concluded obesity caused 400,000 deaths a year in the United States, just slightly below the death toll from smoking. About a third of U.S. adults are obese, based on a measurement known as body mass index, a ratio of height and weight.

Of particular concern has been obesity in children because their eating patterns set them on course for lifelong health problems. One study in 2005 found that as a result of obesity, children today could be the first generation of the modern era to live shorter lives than their parents.

The latest study, published in the Journal of the American Medical Assn., showed that 16.3% of children ages 2 to 19 are obese and an additional 15.6% are overweight.

The government has been tracking the heights and weights of children since the 1970s as part of an ongoing health and nutrition survey. By today's definition, 5% of children at that time were obese and 10% were overweight.

The latest analysis, which looked at 4,207 children surveyed in 2005 and 2006, found their BMIs did not differ significantly from children surveyed in 2003 and 2004.

When the researchers incorporated the new numbers into their analysis, their statistical model showed that 1999 marked the beginning of the leveling off. The finding tracks with a study last year showing a stabilization of obesity rates among adults.

More here

Wednesday, May 28, 2008

Pay more for modern drugs and live longer?

Oh dear! I would have expected better than this of economists. The finding that people who use expensive modern drugs live longer is entirely to be expected from the fact that such people are undoubtedly richer. High social class people live longer generally

AUSTRALIANS can add almost 15 months to their lifespan by using the latest drugs - if they can afford it. A study has confirmed the benefits of new-generation medicines, but finds they come at a cost of $10,585 for every extra year of life. The study, published this month by the US National Bureau of Economic Research, compared the average age at death from 1995 to 2008 with dates of registration of 113 drugs being sold in Australia. It found a link, with later-version drugs, rather than older ones, associated with longer lifespans.

"This implies that using newer drugs has reduced premature mortality - especially mortality before age 65 - in the Australian population," it says. The study suggested older medicines still offered benefits, noting that even in the absence of the most recent pharmaceuticals, average age at death would still have increased by about eight months.

Health economists have paid increasing attention to the cost of drugs as spending on Australia's Pharmaceutical Benefits Scheme has risen. The PBS, which costs taxpayers about $6 billion a year, subsidised 80 per cent of the 170 million prescriptions that were filled in 2004-05. The agency's budget grew by 12.9 per cent a year from 1997-98 to 2002-03, before growth rates slowed due to pricing reforms.


Coke safer than water!

But still not safe enough for the attention-seeking fanatics. Given the vast amount of Sodium benzoate that has already gone down throats worldwide with no demonstrable harm resulting, the whole thing is a crock, anyway

Coca-Cola Australia has no plans to phase out a controversial additive in its drinks, despite moves in Britain to remove it. Sodium benzoate has been linked to damage to DNA and hyperactivity in children [For the crap that passes for reseach on the connection between food additives and hyperactivity see my post of 25th], and is used as a preservative in Diet Coke in Australia. Coca-Cola in Britain said it had begun withdrawing the additive from Diet Coke in January in response to consumer demand for more natural products.

Sodium benzoate is used to stop fizzy drinks going mouldy. It is found naturally in some fruits, including bananas, but is used in greater strengths in the soft drink industry. A statement from Coca-Cola revealed there were no plans to change the formulation of the popular drink in Australia. "The use of food additives is strictly regulated under Australian law," it stated. "All of the ingredients used in products of The Coca-Cola Company are safe and approved for use by the Food Standards Australia New Zealand."

A survey by FSANZ in 2006 found levels of benzene and sodium benzoate in soft drinks were well below World Health Organisation guidelines for levels in drinking water. Even so, they have been working with the food industry to reduce the level of benzene in drinks.


Tuesday, May 27, 2008

DNA again: Low cancer risk for big drinkers

Another entry in the old alternating good for you, bad for you, good for you farce

The genes that regulate how quickly people get drunk also influence their risks of developing cancer of the mouth, larynx or gullet, a new study has found. People with a fast-acting variant of the gene for alcohol dehydrogenase - the enzyme that breaks down alcohol - were at much lower risk of these cancers, according to scientists collaborating in the international study. The reason, they conclude in Nature Genetics, is that these hyper-active enzymes break down alcohol, which is a toxin, more quickly.

This means that the mouth and throat are exposed to the damaging effects of alcohol for a shorter period, with a lower chance that cancer will be initiated. The study was led by Paul Brennan of the University of Aberdeen and incorporated data from almost 4,000 cases of cancer and more than 5,000 healthy people from Europe and Latin America.

There are known to be many variants of the alcohol dehydrogenase gene, which determine in part how susceptible people are to drinking. Its true purpose is to convert the alcohol created by bacteria in the gut into aldehydes, and then, via another enzyme, into harmless substances. Since the invention of brewing thousands of years ago, however, the alcohol and aldehyde enzymes have found themselves a much bigger task - detoxifying alcohol drunk for pleasure. Some people who lack the enzyme cannot drink even small amounts without becoming drunk.

The new study looked at the frequency of six variants of the alcohol dehydrogenase gene in the cancer cases and compared it with the frequency of the same six variants in people who had not developed cancer. It identified two variants that are particularly powerfully protective, called rs1229984 and rs1573496. People with the rs1229984 gene are known to break down alcohol 100 times faster than those without it. The results showed that both these genes protect against cancer, and are particularly powerful in combination. Those who carry both genes were 55 per cent less likely to develop any of the cancers studied.

Dr Tatiana Macfarlane, senior lecturer at the University of Aberdeen's department of general practice and primary care, and one of the authors, said: "The study showed that your risk of getting oral cancers is linked to genetics as well as lifestyle. "We found that, in particular, the risk depends on how fast your body metabolises alcohol. "The results suggest that the faster you metabolise it, the lower your risk. "These results provided the strongest evidence yet that alcohol consumption is strongly linked to oral cancers. "The risk is particularly high if you also smoke or rarely eat fruit and vegetables."

Professor Gary Macfarlane, chair in epidemiology at the University, said: "At a time when we are concerned about the levels of alcohol consumption in the United Kingdom, these results demonstrate the public health importance of measures to reduce consumption and prevent deaths at young ages from diseases, including oral cancers."

In healthy people, neither of these gene variants seems to be linked to the amount of alcohol consumed. If possessing these protective genes encouraged people to drink more - because they metabolised alcohol more quickly - then any benefit would be eroded. But in fact there is no link between the genes and drinking habits. Equally, the genes do not have any effect on cancer risk among non-drinkers.

The only possible conclusion, say the authors, is that the protective effect comes from the greater ability of the carriers of these genes to break down alcohol before it can do so much harm


Rogue DNA can lead to nutritional deficincies

That some people can have nutritional deficiences because of their genes clearly detonates a lot of simplistic thinking. All men are NOT equal, once again

WHEN Michael Fenech sits down to dinner, he looks at the food on his plate rather differently to the rest of us. For Fenech, a principal researcher with the CSIRO's Human Nutrition centre in Adelaide, tasty morsels of meat and vegetables are more than just fuel to keep his body running. They also contain nutrients that have the potential to protect his DNA from serious damage, and affect his chances of falling ill.

Fenech has spent the past 20 years studying the nutrients we need to keep our genes healthy, and how our genetic make-up influences the way we respond to food. That work has put him at the forefront of a new scientific discipline known as "nutrigenomics", which brings to bear a detailed understanding of how humans differ from one another in genetic terms and applies it to the traditional science of nutrition.

It's also a field that's poised to take on growing importance given the recent political emphasis on "preventive" health care, as highlighted in this week's federal budget. Advocates say nutrigenomics could allow us to tailor our diets to our individual genetic characteristics -- potentially helping us lose weight more effectively, avoid cancer, say goodbye to binge drinking and live to a ripe old age.

Folate -- a vitamin found in leafy vegetables, fortified grain products and other foods -- is a good example of how nutrients can affect our genes, Fenech says. "When one has inadequate intake of folate, the DNA in the cells can be damaged, or fragmented, or the expression of the genes can be altered," he says. This can have a dramatic effect on our chromosomes, causing as much damage as carcinogenic doses of radiation. Similar damage may result from deficiencies in other nutrients such as calcium, magnesium, retinol, nicotinic acid, vitamin E and vitamin B12, adds Fenech. And as our cells grow and divide the damage can accumulate, a problem associated with infertility, developmental defects in the foetus, cancer, Alzheimer's disease and other conditions.

But avoiding these unhealthy outcomes is not a simple matter of everyone boosting their nutrient intake a certain amount, Fenech says. Each of us carries within our cells different forms of genes that affect how our bodies absorb and use the nutrients we need, such as folate and vitamin B12. "At this point in time, we're assuming that the nutritional requirements are the same for everyone and that everyone absorbs the nutrients in the same way -- well, that's not the case."

Fenech's work is giving us an important insight into the detailed mechanics of how good dietary choices keep us healthy, says nutritionist Rosemary Stanton. "Michael Fenech is a genuinely good researcher," she says. "The sort of work he does may offer some really important solutions for some people."

In 2005, Fenech and his CSIRO colleagues developed a test that specifically measures the amount of damage present in human DNA, dubbed the "cytokenesis-block micronucleus cytome (CBMN Cyt) assay." Since last year, the test has been used by an Adelaide health clinic called Reach 100. For a fee of roughly $600 per test, the clinic offers patients a chance to have their level of DNA damage measured by CSIRO scientists, and then provides tailored suggestions on how to improve it through dietary supplements and lifestyle changes.

Beyond preventing DNA damage, nutrigenomics suggests there might be other ways to personalise our diet according to our genetic make-up. One particular gene, called apolipoprotein E (APOE), for example, can have a dramatic impact on your risk of heart disease and diabetes, depending on which variant you carry. About one in five people carries a specific variant of the gene that raises cholesterol, increases diabetes and Alzheimer's risk and reverses the protective effects of moderate alcohol drinking.

Individuals with that genotype should be careful about their diet and exercise, and in particular should give up or avoid smoking and alcohol, Lynn Ferguson from Nutrigenomics New Zealand wrote in the journal Molecular Diagnosis & Therapy in 2006. "However, very few of the population are aware of their APOE genotype at present."

Fenech adds that genes can also partly determine how well you do on particular diets. "We know that there is variation in people's response to weight-loss diets and the genetic basis of that response is being unravelled," he says. "That is actually being worked out now."


Monday, May 26, 2008


It well might. Wartime is a time for some very stressful experiences. It is also, however, a time of great comradeship and that could have a positive effect. So where does the balance lie? The study below is more rigorous than most in that it makes defensible comparisons. And its conclusion is that war deployment has a POSITIVE effect.

But that conclusion is too "incorrect" so the authors descend into illogic. They say that nutcases are weeded out during recruit training and that is why veterans come back OK.

But that seems to ignore their own findings. They compared marines who had been deployed to a war zone with marines who had not. But BOTH groups had passed through recruit training -- so both should have been equally "weeded out". Yet despite the high comparability of the two groups, those who had seen war did better in terms of mental health.

Journal abstract follows:

Psychiatric Diagnoses in Historic and Contemporary Military Cohorts: Combat Deployment and the Healthy Warrior Effect

By Gerald E. Larson et al.

Research studies have identified heightened psychiatric problems among veterans of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). However, these studies have not compared incidence rates of psychiatric disorders across robust cohorts, nor have they documented psychiatric problems prior to combat exposure. The authors' objectives in this study were to determine incidence rates of diagnosed mental disorders in a cohort of Marines deployed to combat during OIF or OEF in 2001-2005 and to compare these with mental disorder rates in two historical and two contemporary military control groups. After exclusion of persons who had been deployed to a combat zone with a preexisting psychiatric diagnosis, the cumulative rate of post-OIF/-OEF mental disorders was 6.4%. All psychiatric conditions except post-traumatic stress disorder occurred at a lower rate in combat-deployed personnel than in personnel who were not deployed to a combat zone. The findings suggest that psychiatric disorders in Marines are diagnosed most frequently during the initial months of recruit training rather than after combat deployment. The disproportionate loss of psychologically unfit personnel early in training creates a "healthy warrior effect," because only those persons who have proven their resilience during training remain eligible for combat.

American Journal of Epidemiology, 1988, Volume 167, Number 11 Pp. 1269-1276

Melanomas gone in just seven days

Melanomas are a very deadly form of skin cancer and the normal treatment is radical surgery

AUSTRALIAN researchers have discovered a range of new treatments for melanoma which could save up to 1500 lives a year. The Sydney Melanoma Unit at Royal Prince Alfred Hospital is conducting a clinical trial in which individual tumours are injected with a red dye called rose bengal.

Unit director John Thompson said within seven days the tumours become necrotic and die, and within 14 days they simply lift off the skin. Professor Thompson said an earlier trial of 20 patients showed between 60 and 80percent of tumours were successfully treated with one injection. The trial also found that rose bengal didn't affect healthy tissue and seemed to induce a beneficial immune system response that killed off other tumours that hadn't been injected.

"It has been interesting to observe that not only injected tumour deposits undergo involution [reduction] and necrosis but non-injected 'bystander' lesions sometimes undergo involution as well," he told the Australasian College of Dermatologists annual meeting last week. Rose bengal has been used for 50 years to diagnose liver and eye cancer. It has also been used as an insecticide.

Professor Thompson said phase one of the trial had proved the treatment was safe, although one woman ended up in intensive care with a serious reaction after driving for 1 hours in the summer sun after having her injection. For another study, Professor Thompson is hoping to recruit 65 patients who have melanomas that can't be treated with surgery.

Australia has the highest rate of melanoma in the world, with 9500 cases diagnosed annually. One in 19 Australians can expect to be diagnosed with a melanoma in their lifetime. If detected early, there is an excellent chance of survival. However, standard chemotherapy is not highly effective once the melanoma has spread.

The development of a vaccine has been elusive but researchers at the Newcastle Melanoma Unit have made a surprising breakthrough. Professor Thompson said about 120 patients were given an injection made from materials from their own tumour. The procedure was designed to stimulate the body's immune system to reject the tumour. The patients had metastatic (widespread) stage IV disease and an average life expectancy of six to nine months. The trial showed those who got the vaccine had a 40percent chance of surviving for five years, compared to 22 per cent for those who weren't vaccinated. "It surprised us greatly - there was a fairly substantial benefit in the patients who received the vaccine," Professor Thompson said.

At Royal Prince Alfred Hospital, Diona Damian has treated three patients with extensive widespread melanoma with diphencyprone (DPCP), a chemical used to treat warts and hair loss. Associate Professor Damian said two patients are disease-free three years and one year later respectively, while in a third patient, the application of DPCP appeared to slow the progression of the disease but he died 18 months later.


Sunday, May 25, 2008

Another medical ignoramus

When the specialists are talking garbage, what hope is there for the average person with a problem? News report below followed by an extended comment

REMOVING artificial colours and preservatives from the diets of children with ADHD should be considered a first-line treatment to reduce hyperactivity, a child allergy specialist says. Professor Andrew Kemp from the Children's Hospital at Westmead, in Sydney, said there was good scientific evidence that preservatives and colourings increased hyperactive behaviour. However, parents of children with attention deficit hyperactivity disorder (ADHD) were rarely encouraged to make dietary changes.

"Three main treatments are available for hyperactivity in children - drugs, behavioural therapy and dietary modification," Professor Kemp wrote in the British Medical Journal. "Interestingly, the use of drugs and dietary modification is supported by several trials, whereas behavioural therapy - which is presumably thought necessary for adequate treatment - has little or no scientifically based support."

He said eliminating colourings and preservatives was wrongly regarded by some as an "alternative treatment" rather than a standard treatment, like drugs, for ADHD. By contrast, Professor Kemp said, alternative medicines that were regarded with suspicion by many medical practitioners were used widely by up to half of ADHD families.

A recent trial in almost 300 British children without ADHD showed that eating a mixture of food additives, equivalent to that found in two 56g bags of lollies, significantly increased hyperactivity.

Professor Kemp said there was a strong case for trialling elimination in ADHD children given the evidence, the harmless nature of such intervention and the large numbers of children taking drugs for hyperactivity. Recent statistics from Western Australia show 2.4 per cent of that state's children had been prescribed stimulant drugs.


The fool seems to be hanging his hat on just a few studies -- ignoring the many studies that failed to find any effect. If a theory is popular and lots of studies are done, some will show an effect by chance alone. And even the "confirmatory" studies leave a lot to be desired. Let's look at one example of the amazing reasoning in such studies. I reproduce just 4 paragraphs:

Food additives are associated with symptoms of attention deficit hyperactivity disorder (ADHD), according to the results of a randomized trial published in the June issue of the Archives of Diseases in Childhood. The investigators suggest removing these from the diet of all children.

"There have been no population based studies examining the prevalence of hyperactivity related to intolerance to food additives following the initial claims of the detrimental effect of artificial additives on children's behaviour," write B. Bateman, from the University of Southampton in the U.K., and colleagues. "Subsequent studies, despite improved methodology, have failed to substantiate this claim or have only shown a small effect."

So they did a new study. The theory HAD to be proved. And they found?

During the withdrawal phase, there were significant reductions in hyperactive behavior. Based on parental reports, there were significantly greater increases in hyperactive behavior when children were given the drink containing additives than when given the placebo drink. The presence or absence of hyperactivity or of atopy did not influence these effects. There were no significant differences detected based on objective behavioral testing in the clinic by a tester blind to dietary status.

Study limitations include possible self-selection of families to take part in the food challenge, completion of all phases of the study by only 70% (277of 397) of those invited, and inability to demonstrate changes in hyperactivity on the basis of psychologist-administered tests. The authors recommend attempts at replication in other general population samples and extension of this study to older age groups.

They admitted the large limitations of their research and, on the most objective bit of evidence (in red above) that they had, they found (as did many studies before them) that there was NO EFFECT of the additives! Yet they still go on to make recommendations as if there had been an effect!

And note another revealing detail in the report: Kids with atopy (allergic tendencies) were NOT more likely to be affected by the additives! If anybody should have been, they should have been. But they were not.

An awful lot of medical research is just one big steaming heap of crap.

Saturday, May 24, 2008

Pap smears 'are a waste of time'

A CERVICAL cancer specialist has welcomed a drop in screening among young women, saying Australians had finally realised they are "wasting their time" getting pap smears every two years. New statistics from the Australian Institute of Health and Welfare (AIHW) show cervical cancer cases and death rates have dropped, but testing rates among younger women were slipping. Health officials say the drop, by as much as 15 per cent in the past decade, was a concern and called for women to be vigilant about biennial screening even if they have been immunised with the new cervical cancer vaccine.

But Dr Gerry Wain, former director of the NSW cervical cancer screening program, said the results showed women and doctors were understanding cervical cancer prevention better than the policy makers. "They know from going back time and time again for smears that it's just not necessary to get them that often," said Dr Wain, a gynaecological oncologist at Westmead Hospital in Sydney. "It's wasting their time and it's putting pressure on the screening program that it just doesn't need."

Dr Wain said he supported changing guidelines to three-yearly screening as recommended by the World Health Organisation, and called for women aged 20 to 24 to be removed from the program all together. "They have the vaccine, and statistics show their infections invariably go away on their own anyway," he said.

The new report, Cervical Screening in Australia 2005-2006, showed that in the two years to 2006, about 56 per cent of women in their late 20s got a pap smear compared to 65 per cent a decade earlier. A similar drop was seen among women in their early 20s and 30s.

The statistics were gathered before the introduction of Gardasil and Cervarix, Australian-developed vaccines which protect against two types of human papillomavirus that cause 70 per cent of all cervical cancer cases. Universal vaccination is expected to dramatically decrease rates of disease for the under 26-year olds who get it, but AIHW officials say all women still need to get screened.

"The need for women to have regular pap tests remains as important as ever, despite the significant advance of the new cervical cancer vaccination," said the institute's medical adviser Dr Paul Magnus.

The report showed Australia had one of the highest screening rates in the world. Both the number of new cases and the death rate had more than halved in the past decade.


Patch form of HRT may pose less clotting risks than pill does

Good to see that proper caution about the results is included and that the very low probablity of harm is mentioned. The small number of studies chosen for inclusion in the survey seems rather surprising, however. Are we seeing biased data selection here?

Previous studies have found an increased risk not only of blood clots, but also coronary heart disease and breast cancer among postmenopausal women who take hormone replacement therapy (HRT). But, according to background information in the paper, no one has assessed how high the increased risk is, or whether the risk varies with the type of therapy.

Scarabin and his colleagues reviewed data from eight observational studies and nine randomized controlled trials on HRT and venous thromboembolism (VTE), a potentially fatal blood clot in the vein. Pool results indicated that the risk of VTE was 2.5 times higher in women taking oral estrogen compared to women taking no estrogen. The risk was most pronounced during the first year of treatment and in women who were overweight or predisposed toward developing blood clots. By contrast, women currently using the patch had only a slightly elevated risk compared to women taking no estrogen. Women who had stopped taking HRT saw their risk return to normal.

According to the authors, the increased risk translates into an additional 1.5 events per 1,000 women per year. Most of the data came from existing observational trials, however, not the gold-standard randomized trials, so the findings should be interpreted with caution, the authors warned.

Other experts agreed. "It's observational and very interesting, but clearly more studies need to be done," said Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York City. "Maybe this opens the door for a way to give hormones more safely to those who need it."


Friday, May 23, 2008

Raw Milk Rebellion: How much business does the government have in the barnyard?

See also a previous post here on May 5th

On May 1, Pennsylvania state troopers arrived at the home of Mennonite farmer Mark Nolt, seizing a reported $20,000 to 25,000 worth of farm equipment and placing Nolt under arrest. His crime? The illegal sale of unpasteurized milk and other dairy products. And Nolt isn't alone. In February, federal investigators subpoenaed two employees of Mark McAfee's Organic Pastures Dairy in California. Though the subpoenas do not indicate the purpose of the investigation, McAfee told me the feds were seeking evidence that his dairy was selling unpasteurized milk for human consumption across state lines.

These are just the latest skirmishes in the growing conflict over the right to sell unpasteurized, or "raw" milk. On one side of the fight is an odd coalition of whole foodists, dairy farmers, and libertarians who want the government to butt out of their milk-drinking decisions. On the other side are public health officials and assorted busybodies determined to tighten regulations.

Fittingly, the debate has come to a head in California, a state equally known for its organic foods and its nanny state meddling. Late last year, the legislature quietly enacted strict new bacteria limits on raw milk, holding the product to the same standard of sterility as its pasteurized counterpart. Proponents contend the rule is necessary to protect consumers from dangerous diseases. Opponents, including McAfee and state Senator Dean Florez, say the standard is unfeasible and will put dairymen out of business. They've secured a temporary restraining order against the law, but losing in court could bring about what Florez calls "the end of raw milk in California."

While the fight to produce and consume unpasteurized milk might seem like a step back in time, raw milk advocates have good reason to lament the state of the modern dairy. Today's agricultural processes sacrifice flavor for safety. In the 2004 edition of his classic book, On Food and Cooking, food science writer Harold McGee explains how milk used to change with the seasons. When it wasn't preserved in cheese, butter, or other products, it was enjoyed fresh on the farm and tasted of the pasture. The growth of cities in the 18th and 19th centuries changed this. Without access to grass, cows were often fed on less nutritious fare, like the spent grains from beer brewing. The resulting milk was less flavorful and frequently unsafe. Expanding railroads and the invention of the refrigerated rail car brought fresher milk to the cities, but these required producers to pool their output, increasing the risk of contamination. Milk-borne illness quickly became a major cause of infant mortality.

Thus pasteurization came as a tremendous boon. By heating milk below the boiling point, producers killed off potentially harmful bacteria and increased their product's shelf life. As pasteurization became the norm, both the federal government and many states prohibited the sale of unpasteurized milk. Though these regulations made milk safer, today's burgeoning growth in natural foods requires a looser regulatory approach.

In short, safer milk resulted in the loss of seasonality and taste. Cooking milk introduces new flavors, some of them unpleasant. And since pasteurization kills bacteria indiscriminately, many raw milk devotees argue that the process robs them of probiotics, bacteria that they say build their immune systems and aid digestion. As McAfee put it to me, "kids are germ magnets." Exposing them to raw milk, he argues, is good for them. Similarly, the testimonials section on the website of the Campaign for Real Milk, a project of the Weston A. Price Foundation that aims to overturn legal barriers to unpasteurized milk, is full of quotes from people writing that the product has cured them of everything from indigestion to autism. While some of these claims are obviously far-fetched, it's clear that many raw milk drinkers believe they benefit from introducing a thriving population of bacteria into their bodies.

And therein lies the problem. If a batch of unpasteurized milk happens to be tainted with E. coli or Listeria, feeding it to a "germ magnet" will lead to potentially serious illness. In his testimony at Florez' senate hearing, University of California-Davis professor Michael Payne testified that although raw milk accounts for just a tiny percentage of milk consumption in the U.S., it is responsible for twice the number of disease outbreaks as pasteurized milk. John Sheehan, director of the FDA's Division of Dairy and Egg Safety, takes things further and compares drinking raw milk to "playing Russian roulette with your health."

Alarmist statements like Sheehan's make it hard to believe the government's more reasonable warnings, and the FDA's ban is arguably part of what gives raw milk its allure. Payne does not advocate banning the sale of raw milk, but he does suggest that tighter regulations could help ensure safety. At greatest issue is California's new requirement that raw milk contain no more than 10 coliform bacteria per milliliter, the same standard that pasteurized milk must meet. The state argues that even though these bacteria are not inherently harmful, their presence is suggestive of fecal contamination; McAfee contends that such a low measure will be impossible to satisfy in California. Although Maine and Washington have instituted the 10 coliform limit without killing their raw milk industries, he is right to worry. Nearly a quarter of samples tested in Washington and Maine didn't pass the test, and even California's own Department of Food and Agriculture reports that only 25% of bulk milk samples collected in the state pass the test before being pasteurized.

Florez is considering legislation that would substantially raise the coliform limit for raw milk and increase testing for pathogens, along with other safety improvements. Given that so many raw milk consumers demand live bacteria in their milk, it's a reasonable compromise, and one that McAfee says his dairy could live with.

And yet, while certain regulations make sense for broad retail sales, there's something heroic in the civil disobedience of men like Mark Nolt. After all, if a consenting adult wants to buy milk taken straight from the cow, is it any business of the law to interfere?

When I recently visited dairywoman Kitty Hockman-Nicholas at Hedgebrook Farms in Winchester, Virginia, I saw nothing dangerous or diabolical. Kitty showed me around the farm, introduced her cows by name, and demonstrated her milking process. It would have been illegal for Kitty to sell me raw milk-she provides it for people who buy into "cow shares" and thus technically own the cows from which they get their dairy-but she kindly sent me home with some as a gift.

My trip to the farm provided delightful insight into the origins of one of our most essential foods. I didn't enjoy any miraculous health effects after drinking it, but the taste was smooth and creamy, with none of the processed aftertaste I now can't help noticing in store-bought milk. As I sipped my unpasteurized beverage, I reflected on the absurdity of the situation: If Kitty were to offer the same experience to others for a profit, the government could forcibly put her out of business.

Though Mark Nolt, Mark McAfee, and their loyal customers' devotion to raw milk may seem eccentric to some, the consumption of raw fish in sushi or uncooked meat in beef carpaccio is equally strange to others. And with consumer freedom increasingly under attack from busybodies on the left and right, it's hard not to admire their rebelliousness and their resolution to drink milk in its freshest form. Though there is certainly a place for reasonable food safety laws, any regulation that leads to otherwise law-abiding farmers being shutdown or arrested has gone too far. With a growing movement of consumers demanding raw milk, the time has come for the government to get out of their way.


The A2 milk theory

Three years ago Victorian dairy farmers Wayne, Peter and David Mulcahy made what could certainly be viewed as a risky business decision. They spent hundreds of thousands of dollars to start the labor-intensive process of converting their entire herd of cows. In a few years, the only milk produced on their Kyabram farm will be a variety known as A2, named for an ancient version of an ordinary cow gene.

Because the Mulcahys wanted to continue selling regular milk - and earn a premium from the A2 milk they were already producing - they've gone to considerable lengths. The process has involved genetically testing their cows, and then segregating them from the rest of the herd. They have to be milked separately, and the milk has to be stored and processed separately. The family purchased additional storage vats and equipment, and had to be particularly diligent to ensure that none of the cows strayed into the other herd.

So why the extra efforts? It has to do with a protein, a compound that's important to building and regulating the body. A tiny protein found in ordinary milk might not seem a likely villain, but some experts warn that under certain circumstances, it can be. More than 100 scientific papers have drawn links between A1 beta-casein, a protein found in cow's milk, and serious illnesses including type 1 or juvenile diabetes and heart disease, and to a lesser extent, autism and schizophrenia. But just how strong the evidence is - and what should be done as a result from a public health perspective - has been the subject of debate.

In 2002 the Mulcahys happened upon a stock agent connected with A2 Corporation, the company that holds the patents for genetic testing of cattle and owns the A2 Milk trademark, a guarantee that the cow does not produce A1 beta-casein. They researched the claims the group made, and found them compelling. And they had some experience of their own. Peter's young daughter, Alexandra, would become violently ill within 20 minutes of consuming any dairy product, leading her doctor to conclude she was "lactose intolerant". But after hearing anecdotes of people who couldn't tolerate "normal milk" but didn't seem to have problems with A2, her parents decided to give it a shot. Sure enough, Alexandra could drink A2 milk without getting sick. "Our experience with Alexandra not only convinced us to convert to A2 cows, we believe the whole Australian dairy industry will eventually move that way too," Peter says.

Every litre of milk contains about two teaspoons of beta-casein, usually a mix between A1 and A2. A2 is the original type, found in herds of cattle thousands of years ago, but over time a natural mutation occurred in some European cattle, and A1 beta-casein developed, says Keith Woodford, professor of farm management and agribusiness at Lincoln University in New Zealand, and the author of a book on the subject, Devil in the Milk. According to Woodford, the genetic difference between the two beta-caseins is tiny, but the difference in outcome is enormous. "The beta-casein has 209 amino acids (the building blocks of proteins) and the difference between A1 and A2 is just one of these," he says.

That is, the amino acids appear in a fixed sequence, and while A1 milk has an amino acid called histidine at one position, A2 milk has a proline. Woodford says that histidine changes the way the protein is digested, releasing a protein fragment called beta-casomorphin 7, or BMC7 for short. BMC7, he says, is a powerful opioid-a narcotic. It's also an oxidant. In laboratory tests BMC7 modifies cholesterol to a form that creates dangerous fatty plaques that line artery walls.

There have been no studies confirming a link between A1 and milk intolerance, but Woodford says anecdotal and observational evidence shows that a number of people who are intolerant to milk and automatically assume it's the lactose causing the problem, may in fact be intolerant to the BCM7. Alexandra Mulcahy may well be a case in point. Woodford ticks off the evidence against A1. For example, he says, experiments with mice found that 47 per cent of those fed A1 beta-casein developed diabetes after 250 days. None of the mice fed A2 beta-casein developed the disease.

But it's not all black-and-white, like the Mulcahy's Holsteins. For most people, BCM7 passes through their system without further ado because it's just too big to get through their gut wall into the blood stream. Still, for about 20 per cent of people BCM7 could be a problem. These include people who have a "leaky gut" that allows molecules called peptides to pass through. Groups who could be at risk of leaky guts include newborn babies, people with untreated celiac disease, stomach ulcers and Crohn's disease.

Public health expert Boyd Swinburn knows how heated the topic can be. He wrote a literature review of A1 and A2 beta-caseins for the New Zealand Food Safety Authority which was released in 2004. That report didn't take a hard-line stance, but didn't say the A2 coast was clear, either, though that's how the New Zealand Food Safety Authority interpreted the findings in its media hype: "all milk was safe", it spruiked, using a phrase Swinburn explicitly avoided. "The research that's there at the moment is very suggestive, but it's certainly not conclusive," says Swinburn, who now chairs Deakin University's population health program in the school of exercise and nutrition sciences. "There's good rationale for dairy farmers to consider changing their herds, but there's not empirical evidence that's strong enough for government warnings." Likewise, Food Standards Australia New Zealand spokersperson Lydia Buchtmann says FSANZ has examined the "very limited scientific evidence available on comparative health effects of the two milks" and does not believe the available information warrants a change to the Food Standards Code.

"FSANZ has noted that further research is in progress and concluded that, while there are some interesting hypotheses being examined, it could not proceed with regulatory action on the basis of the available evidence. FSANZ has not received any applications to amend the milk provisions of the Food Standards Code to consider A1 or A2 milk," she says. Still, Swinburn says there's now enough evidence to begin encouraging dairy farmers to switch their herds, if only as a precautionary measure. It takes about a decade to make a gradual transition to an A2-exclusive herd by breeding on A2 bulls. If the farmers keep selling regular milk with both A1 and A2 in the meantime, there's virtually nothing to lose. "There's no added cost, no detrimental effects and very little risk, and in fact there's quite a bit to gain," Swinburn says. "In 10 years either there'll be much stronger proof of these links and the farmer will be in a better position, or if not they won't have lost anything."

Meanwhile, Swinburn says people who have a strong family history of type 1 diabetes, who are at high risk of heart disease, or who have an autistic child, may want to consider drinking A2 milk. If they can find it, that is. So far, A2 milk is available in about 1500 supermarkets-costing about twice as much as the home brands - but shoppers in Tasmania and Western Australia are out of luck as the milk is still not available there.

Woodford agrees that it's probably too early to push for changes to regulation. He says the most important thing at this stage is to make sure people are aware of all the available evidence. But that's easier said than done. He argues that the dairy industry has downplayed the evidence amidst concerns that changing to A2 cows will create a communications and marketing nightmare and confuse consumers during the 10-year gap while the milk still contains a blend of the two beta-caseins. "There should be clear information so that farmers and consumers can make informed decisions," Woodford says. It's a decision the Mulcahy brothers have already made.


Thursday, May 22, 2008

Quackery at Yale

Post below excerpted from DC's Improbable Science. See the original for links and more

Remember that the terms `integrative' and `complementary' are euphemisms coined by quacks to make their wares sound more respectable, There is no point integrating treatments that don't work with treatments that do work.

`Integrative Medicine' at Yale says, like all the others on the roll of shame, says "we aim to improve awareness and access to the best in evidence-based, comprehensive medical care available worldwide". They all pay lip service to being "evidence based", but there is just one snag. It is untrue. In almost all cases, the evidence is either negative or absent. But this does not put them off for a moment. The whole process is simply dishonest.

The evidence

The evidence has been summarised in several books recently, The following books are particularly interesting because they are all `views from the inside. Edzard Ernst is the UK's first Professor of Complementary Medicine. Barker Bausell was research director of an NIH funded Complementary and Alternative Medicine Specialized Research Center at the University of Maryland.

The first two books go through the evidence fairly and carefully. They show no bias against alternative treatments (if anything, I'd say they are rather generous in cases of doubt).

For a first class US account try Barker Bausell's Snake Oil Science. Bausell's book gives an excellent account of how to test treatments properly, and of all the ways you can be fooled into thinking something works when it doesn't. Bausell concludes
"There is no compelling, credible scientific evidence to suggest that any CAM therapy benefits any medical condition or reduces any medical symptom (pain or otherwise) better than a placebo".

For an excellent account of how to find the truth, try also Testing Treatments (Evans. Thornton and Chalmers)
It can now be said with some certainty that the number of alternative treatments that have been shown to work better than placebo is very small, and quite possibly zero

With that settled, what's going on at Yale (and many others on the roll of shame)? David L. Katz, MD, MPH, FACPM, FACP, is founder and director of the Integrative Medicine Center (IMC) at Griffin Hospital in Derby, Connecticut. He is also an associate professor, adjunct, of Public Health and director of the Prevention Research Center (PRC) at the Yale University School of Medicine in New Haven, Connecticut.

That sounds pretty respectable. But he is into not just good nutrition, exercise, relaxation and massage, but also utterly barmy and disproved things like homeopathy and `therapeutic touch'.

Watch the movie

It so happens that Yale recently held an "Integrative Medicine Scientific Symposium". Can we find the much vaunted evidence base there? That is easy to answer because three hours of this symposium have appeared on YouTube. So this is the public face of Yale medical school.

Dr Katz goes through several different trials, all of which come out negative. And what is his conclusion? You guessed. His conclusion is not that the treatments don't work but that we need a "more fluid concept of evidence" .

It's equally bizarre to hear Richard Belitsky, Dean of Medical Education at Yale saying he is "very proud" of this betrayal of enlightenment values. If this is what Yale now considers to be education, it might be better to go somewhere else.

This is not science. It isn't even common sense. It is a retreat to the dark ages of medicine when a physician felt free to guess the answer. In fact it's worse. In the old days there was no evidence to assess. Now there is a fair amount of evidence, but Dr Katz feels free to ignore it and guess anyway. He refers to teaching about evidence as `indoctrination', a pretty graphic illustration of his deeply anti-scientific approach to knowledge. And he makes a joke about having diverted a $1m grant from CDC, for much needed systematic reviews, into something that fits his aims better.

Katz asks, as one must, what should we do if there is no treatment that is known to help a patient. That is only too frequent a problem. The reasonable thing to say is "there is no treatment that is known to help". But Dr Katz thinks it's better to guess an answer. There is nothing wrong with placebo effects but there is everything wrong with trying to pretend that you are doing more than give placebos. Perhaps he should consider the dilemmas of alternative medicine.

No surprise that it is the Left who are big on food nuttiness

Facts and evidence generally matter little to them. Looking good is all

Fried shrimp on a bed of jasmine rice and a side of mango salad, all served on a styrofoam plate. Bottled water to wash it all down. These trendy catering treats are unlikely to appear on the menu at parties sponsored by the Denver 2008 Host Committee during the Democratic National Convention this summer.

Fried foods are forbidden at the committee's 22 or so events, as is liquid served in individual plastic containers. Plates must be reusable, like china, recyclable or compostable. The food should be local, organic or both.

And caterers must provide foods in "at least three of the following five colors: red, green, yellow, blue/purple, and white," garnishes not included, according to a Request for Proposals, or RFP, distributed last week. The shrimp-and-mango ensemble? All it's got is white, brown and orange, so it may not have the nutritional balance that generally comes from a multihued menu. "Blue could be a challenge," joked Ed Janos, owner of Cook's Fresh Market in Denver. "All I can think of are blueberries."

The national nominating convention Aug. 25-28 will bring about 50,000 people to Denver, and many will scarf loads of chow served at catered parties. The prospect of that business windfall has tantalized caterers since Denver was named host city for the convention more than a year ago. Caterers praise the committee and the city for their green ambitions, but some say they're baffled by parts of the RFP.

"I think it's a great idea for our community and our environment. The question is, how practical is it?" asks Nick Agro, the owner of Whirled Peas Catering in Commerce City. "We all want to source locally, but we're in Colorado. The growing season is short. It's dry here. And I question the feasibility of that." Agro's biggest worry is price. Using organic and local products hikes the costs. "There is going to be sticker shock when those bids start coming in," he says. "I'll cook anything, but I've had clients who have approached me about all-organic menus, and then they see the organic stuff pretty much doubles your price."

The document, which applies only to the host committee's parties, came after months of work that involved discussions with caterers and event planners along the Front Range, says Parry Burnap, Denver's "greening" director. Burnap is attached to the host committee full time for now; the committee works closely with the city but is a separate, nonprofit entity.

Thousands of other parties hosted by corporations, lobbying groups, individuals, nonprofits and more will happen in Denver during the convention, Burnap says. None of them is subject to the committee's green agenda. The committee's effort to host eco-friendly events, she says, hinges on its determination not just to put on a smart convention but to transform Denver into a top-shelf green city. "We are hoping that everything we are doing for greening (the convention) has some legacy value," she says. The RFP, for example, will likely live on after the convention in a brochure the city will distribute widely to help guide local businesses interested in improving their green practices.

Burnap says taking the organic and local route may be more costly, but the committee thinks caterers will find ways to comply and still make a profit. "It takes some creativity because some of these things are more expensive," she says. "But we're at the front end of a market shift."

Joanne Katz, owner of Three Tomatoes Catering in Denver, cheers the committee's environmental aspirations and is eager to get involved with the convention, but she wonders if some of the choices the committee is making are really green. Compostable products, such as forks and knives made from corn starch, are often imported from Asia, delivered to the U.S. in fuel-consuming ships. But some U.S. products are made from recyclable pressed paper. Which decision is more environmentally sound? "Customers are beginning to demand these things, and we don't have all of the information," she says. "And we are doing the best we can, one project at a time."

Burnap acknowledged that figuring out what is most green can be difficult. "Maybe in 20 years, there will be better analysis for us to make better choices," she says. "One we are talking about now is, is it better to compost or to recycle? If you are using a cup for a beverage, is it better to be (plastic) and back in the materials stream, or compostable, biodegradable waste and go into the waste stream or compost? There are no definitive answers."

Composting for the convention hasn't been entirely figured out yet, she says. Colorado has commercial composting companies, such as A1 Organics in Eaton, but the link between the composters and caterers hasn't been made.

The committee is working with other groups to develop a carbon-footprint "calculator" that will measure the environmental impact of each event and suggest an "offset" - a fee - that will go toward a fund helping to match carbon losses with carbon gains. "That's a fun one," Burnap says. "If these event planners will calculate and offset, it will start to get the money flowing into the Colorado Carbon Fund, a fund that will reinvest in renewable energy here in Colorado."


Wednesday, May 21, 2008

Using a mobile phone while pregnant can seriously damage your baby?

The endless hatred of anything popular again. If something is popular, the elitists never stop trying to prove that it is bad. They need to show that it is bad to prop up their own feelings of superiority. They have failed so far but, when they never stop trying, they must by chance alone come across some data somewhere that supports their prejudices. Sadly for them, however, what we have below is just epidemiological speculation again. What they REALLY found is probably that early adopters of technology are more self indulgent and that self-indulgent mothers have kids who are more disturbed.

A medical correspondent also asks: "Are women with cell phones also likely to give cell phones to their children -- who then will not be paying attention and doing their homework, but chatting mindlessly and sending friends text messages in class etc..?"

It's all speculation. Epidemiology cannot prove ANY causal link, any more than rodent studies can (except among rodents), and policy prescriptions should not be based on it.

Women who use mobile phones when pregnant are more likely to give birth to children with behavioural problems, according to authoritative research. A giant study, which surveyed more than 13,000 children, found that using the handsets just two or three times a day was enough to raise the risk of their babies developing hyperactivity and difficulties with conduct, emotions and relationships by the time they reached school age. And it adds that the likelihood is even greater if the children themselves used the phones before the age of seven.

The results of the study, the first of its kind, have taken the top scientists who conducted it by surprise. But they follow warnings against both pregnant women and children using mobiles by the official Russian radiation watchdog body, which believes that the peril they pose "is not much lower than the risk to children's health from tobacco or alcohol".

The research - at the universities of California, Los Angeles (UCLA) and Aarhus, Denmark - is to be published in the July issue of the journal Epidemiology and will carry particular weight because one of its authors has been sceptical that mobile phones pose a risk to health. UCLA's Professor Leeka Kheifets - who serves on a key committee of the International Commission on Non-Ionizing Radiation Protection, the body that sets the guidelines for exposure to mobile phones - wrote three and a half years ago that the results of studies on people who used them "to date give no consistent evidence of a causal relationship between exposure to radiofrequency fields and any adverse health effect".

The scientists questioned the mothers of 13,159 children born in Denmark in the late 1990s about their use of the phones in pregnancy, and their children's use of them and behaviour up to the age of seven. As they gave birth before mobiles became universal, about half of the mothers had used them infrequently or not at all, enabling comparisons to be made.

They found that mothers who did use the handsets were 54 per cent more likely to have children with behavioural problems and that the likelihood increased with the amount of potential exposure to the radiation. And when the children also later used the phones they were, overall, 80 per cent more likely to suffer from difficulties with behaviour. They were 25 per cent more at risk from emotional problems, 34 per cent more likely to suffer from difficulties relating to their peers, 35 per cent more likely to be hyperactive, and 49 per cent more prone to problems with conduct.

The scientists say that the results were "unexpected", and that they knew of no biological mechanisms that could cause them. But when they tried to explain them by accounting for other possible causes - such as smoking during pregnancy, family psychiatric history or socio-economic status - they found that, far from disappearing, the association with mobile phone use got even stronger.

They add that there might be other possible explanations that they did not examine - such as that mothers who used the phones frequently might pay less attention to their children - and stress that the results "should be interpreted with caution" and checked by further studies. But they conclude that "if they are real they would have major public health implications".

Professor Sam Milham, of the blue-chip Mount Sinai School of Medicine in New York, and the University of Washington School of Public Health - one of the pioneers of research in the field - said last week that he had no doubt that the results were real. He pointed out that recent Canadian research on pregnant rats exposed to similar radiation had found structural changes in their offspring's brains.

The Russian National Committee on Non-Ionizing Radiation Protection says that use of the phones by both pregnant women and children should be "limited". It concludes that children who talk on the handsets are likely to suffer from "disruption of memory, decline of attention, diminishing learning and cognitive abilities, increased irritability" in the short term, and that longer-term hazards include "depressive syndrome" and "degeneration of the nervous structures of the brain".


Breast-feeding, but not oral contraceptives, is associated with a reduced risk of rheumatoid arthritis

The results below are again epidemiological so permit no firm inferences but, as rheumatoid arthritis is one of those intrinsically hard-to-explain autoimmune diseases, new lines of investigation are welcome. Since women who do not breastfeed are a biological aberration and since autoimmune diseases are too, there is some plausibility to the connection made below

New research at Malmo University Hospital has revealed that mothers who have more children and especially those who breastfeed their babies have a significantly lowered risk of arthritis later in life. Use of oral contraceptives, on the other hand, is of no benefit.

The study, which was funded by Lund University, The Craaford Foundation and the Swedish Rheumatism Association, wanted to determine whether breast-feeding or the use of oral contraceptives (OC) could affect the future risk of rheumatoid arthritis (RA) in a community-based prospective cohort.

Researcher Dr. Mitra Pikwer found that breastfeeding for more than a year reduced women's risk of rheumatoid arthritis 54% and breastfeeding for at least a month tended to reduce the risk 26 percent. Moreover, women who gave birth to more children tended to be at lower RA risk, with a 13% reduction for each child they had.

Female hormones are thought to play a role in rheumatoid arthritis because the incidence is twice as high for women than men, the researchers said. While arthritis often improves during pregnancy, there was no evidence of benefits in RA from the use of oral contraceptives, which contain some of the same hormones that are elevated during pregnancy.

From a community based health survey of 18,326 women, the analysis included 136 women with incident rheumatoid arthritis who were matched by age to 544 women (controls) in the study who did not have rheumatoid arthritis.

Women who had breastfed their children for 13 months or more had an odds ratio of 0.46 for incident RA and those who breastfed for one to 12 months had an odds ratio of 0.74 compared with those who had never breastfed.

See an abstract of the research here


Tuesday, May 20, 2008

New Zealand's Meningococcal Gold Rush

Another "Orchestrated litany of lies". New Zealand is good at those. For some other recent examples of how official New Zealand works, see here and here and here. For an update on New Zealand's original "orchestrated litany of lies", see here. To use an expression that would be understood in New Zealand: Everyone in government in New Zealand is "pissing in one another's pocket"


New Zealand's meningococcal disease story, as unravelled through analysis of previously secret documents obtained under the Official Information Act, reveals that the New Zealand government, media and public have been misled and manipulated by officials, advisors and scientists alike.

As a result of this manipulation, the government has committed an unprecedented 200 million taxpayer dollars to a mass vaccination experiment of 1.15 million New Zealand children with an untested and experimental vaccine. Despite being reassured by a bevy of pro-vaccine and vaccine manufacturer sponsored experts and none-less than the Minister of Health herself that the MeNZB(tm) vaccine is thoroughly tested and proven to be safe and effective, we reveal that Chiron's MeNZB(tm) vaccine was never used in the trials used to approve its license. We reveal that despite assurances, there is no evidence that the MeNZB(tm) vaccine will actually work as promised.

We believe that the magnitude of policy, regulatory and scientific misconduct is such that not only should vaccination with this vaccine be halted forthwith, but that the meningococcal vaccination program should be independently audited and the circumstances surrounding the development and implementation of the program subjected to a full Royal Commission of Inquiry.

In January 2002 the Minister of Health Annette King announced that "$100 million-plus" had been set aside to fund development and implementation of a vaccine to combat New Zealand's unique strain-specific meningococcal group B bacterium [1]

By May that year, following Ministry of Health negotiations with the preferred contract supplier, Chiron Corporation, that figure had become "a commitment of up to $200 million." [2] By September 2004 the sum of $250 million was being mentioned in parliament. [3]

In a July 7 2004 press release Ms King described the development and approval of the MeNZBT vaccine as `fantastic news.' She went on to explain that the MeNZBT vaccine had been "specifically developed with scientists from biotechnology company Chiron Corporation." Cabinet was told in 2001, immediately prior to approving the signing of the Chiron contract, that the deal included the "development of a unique or 'orphan' vaccine." [4]

Chiron's own press release declared they [Chiron] had specifically developed the vaccine. [5] The company quoted Ms King congratulating them "for their effort and dedication to this project."

But documents received under the Official Information Act reveal that the MeNZBT vaccine was not developed by Chiron Corporation. It was developed by the Norwegian Institute of Public Health. Chiron had bought the rights to mass manufacture and market the Norwegian meningococcal B vaccines in November 1999, nearly two years before the New Zealand government signed the initial contract with the company. [27]

Last March, in replying to a question in the House from National MP Dr Lynda Scott, the Minister of Health declared that $10.7 million has been spent on the development of the group B meningococcal vaccine. [49] While Cabinet papers, released under the Official Information Act, had most financial details censored as being commercially sensitive, it would appear that of the total $200 million cost, Chiron will net around a cool $140 million for developing and supplying the already developed vaccine. [28]

From the Norwegian perspective, the off-loading of their Norwegian specific vaccine to Chiron must have been a godsend given it had likely invested over a hundred million $US in double blind, placebo controlled studies involving 170,000 people and over 2,000 doctors and nurses for a vaccine that was never licensed for use in mass vaccination. (New Zealand's preliminary trials involved about 1,500 people and cost at least $7.8 million). In parliament on 19 October 2004 Ms King stated "[the Norwegian Government decision not to approve their vaccine for use] was ... based on the evidence they had, that it did not stack up in terms of cost-benefit, so they did not continue with it."

However The Lancet medical journal reported in 1991 that the Norwegian Institute of Public Health found that the large and robust clinical trials proved the vaccine to have insufficient efficacy to justify its use in a mass vaccination program. [6] The Lancet paper also contained data showing that the epidemic was waning naturally by the completion of the trials. The incidence had declined from peak levels by about 50%, similar to the natural decline that had occurred in New Zealand when the vaccine was approved.

More here

Hot humid weather causes aggression

Darwin heat has to be experienced to be believed

A NEW study has confirmed what people in the Top End [Northwestern Australia] have long known - soaring temperatures and overcast skies make tempers fray. Surgeons at Royal Darwin Hospital who analysed fracture rates found that so-called "mango madness", - a period of extreme weather tension that triggers violence as the wet season hits - is not just a myth.

An analysis presented at a medical conference in Hong Kong today showed fracture hospitalisations were 40 per cent higher in October and November when the Northern Territory had high temperatures with constant cloud cover and no rain. "It's also when the mango is harvested, so now it's official," said surgeon Mahiban Thomas. "When there are mangos in the markets there is madness in the streets."

The Northern Territory has one of the highest rates of alcohol consumption and violence in Australia. Almost 90 per cent of facial fractures admissions in the NT are caused by violence, the second highest rate after Greenland, which has extended periods of darkness.

Dr Thomas and his colleagues mapped monthly hospitalisations over 12 years to 2006 and compared them with historic weather data on temperature, humidity, rainfall, and sunshine. Most months had 15 to 20 admissions but there were consistently more than 30 in October and November when daily minimum temperatures at night were highest, humidity peaked and the rainfall and sunshine hours were lowest. "Hot nights spell trouble when there's all that warmth but no rain to relieve it and bring the tension down," Dr Thomas said. "We can't do anything about the weather but now we've proven the trend we can at least be prepared for it when October rolls around."

Psychologist Mathew Brambling, of Queensland University of Technology, said the findings added to growing international proof that weather, particularly heat and lack of sunshine, affected mood. Suicide rates were known to rise in heat waves, while shorter, dark days could affect the secretion of certain neurochemicals involved in mood, giving rise to a condition called seasonal affective disorder (SAD). "In tropical climates, there's a combination of these heat tensions that affect the way the brain works and influences irritability and impulsiveness for violence," Dr Brambling said.