Wednesday, March 04, 2009

Material success and social failure?

More junk epidemiology below. The authors find less social dysfunction in Nordic countries and in Japan and say that is because incomes are more equal there. So, like nearly all epidemiologists, they make causal inferences from correlational data -- which you cannot logically do. They allegedly spent 30 years arriving at their conclusions so I am sorry to say that it took me approximately two minutes to see an alternative explanation for their findings: ethnic diversity. Japan to this day has few immigrants and the Nordic countries have only recently begun to have a large immigrant population. And as Robert Putnam has famously shown, social homogeneity expands trust and co-operation. So there is less social dysfunction because people feel happier and safer and more co-operative in a country where most people are like them.

And, without looking at it in detail, I am guessing that the same applies to U.S. States. States with the largest minority populations (the South?) have the highest level of social dysfunction.

How nasty of me to undermine so quickly conclusions that so suit the prejudices of the Left! But even if all of the explanation that I have just given is wrong, the point still stands that "correlation is not causation". You learn that in Statistics 101 but if you are a grand epidemiologist, you are allowed to ignore that, apparently. And BOTH of us could be wrong. There could be some third process at work generating the numbers concerned. Assigning causes from epidemiological data is always mere speculation

It is common knowledge that in rich societies the poor have shorter lives and suffer more from almost every social problem. Likewise, large inequalities of income are often regarded as divisive and corrosive. In a groundbreaking book, based on 30 years' research, Richard Wilkinson, Emeritus Professor at The University of Nottingham together with co-author Kate Pickett from the University of York, go an important stage beyond either of these ideas to demonstrate that more unequal societies are bad for almost everyone within them - the well-off as well as the poor.

Richard Wilkinson and Kate Pickett forcefully demonstrate that nearly every modern social and environmental problem - ill-health, lack of community, life, violence, drugs, obesity, mental illness , long working hours, big prison populations - is more likely to occur in a less equal society, and adversely affects all of those within it.

The remarkable data the book presents and the measures it uses are like a spirit level which we can hold up to compare the conditions of different societies. It reveals that if Britain [Which has always received lots of immigrants and which as a consequence now has a large and troublesome minority population] became as equal as the average for the four most equal of the rich countries (Japan, Norway, Sweden and Finland), levels of trust might be expected to increase by two-thirds, homicide rates could fall by 75 per cent, everyone could get the equivalent of almost seven weeks extra holiday a year, and governments could be closing prisons all over the country.

The Spirit Level: Why More Equal Societies Almost Always Do Better, shows us how, after a point, additional income buys less and less additional health, happiness and wellbeing. The issue is now community and how we relate to each other. This important book explains how it is now possible to piece together a new, compelling and coherent picture of how we can release societies from the grip of pervasive and schismatic dysfunctional behaviour, a picture which will revitalise politics and provide a new way of thinking about how we organise human communities. It is a major new approach to how we can improve the real quality of life, not just for the poor, but for everyone.

More here

How that 'healthy' fruit juice could give you liver failure- or worse

When the cat allergy I suffered as a teenager seemed to have reappeared at the end of last year, I went to the GP for advice. I couldn't face the prospect of getting rid of my beloved moggy, so I wanted an allergy test to see if he really was the problem. While I waited for an appointment for the test, my GP prescribed the non-drowsy antihistamine Fexofenadine hydrochloride and told me, in a casual way, to avoid grapefruit juice.

I started taking the drug and my symptoms disappeared. A month later, I was craving my favourite juice and had forgotten the GP's warning. Within two days of drinking grapefruit juice, my heart was racing and, having previously suffered from arrhythmia (irregular heartbeat), I became anxious. My doctor diagnosed the problem immediately as a bad interaction between grapefruit juice and the drug.

Who could imagine something that seems so healthy could harm you? Bad reactions to all fruit juices - but grapefruit juice in particular - are seen as so serious that you're meant to report them to the Medicines and Healthcare Products Regulatory Agency (MHRA). The most serious case was when a healthy 29-year-old man was prescribed an antihistamine twice daily for a year to treat hay-fever. He drank two glasses of grapefruit juice, took his drugs, became ill shortly afterwards and dropped dead after the interaction between the juice and the drug interfered with his heart rhythm. Other bad reactions can be as serious as liver failure if grapefruit juice interacts badly with cholesterol drugs, or dangerously low blood pressure if you're on drugs for, ironically, high blood pressure. Sometimes, with antibiotics for example, the drug will simply cease to work. There can be bad interactions with statins and some cancer drugs, too.

I usually give up wine in January, but, alarmed by what I'd been told, I haven't had grapefruit juice this year. How can fruit juice have such an effect? It seems some contain higher levels of the chemical naringin, a natural flavour, which causes too much of certain drugs to be absorbed into the bloodstream. An enzyme in the gut that usually partially destroys the drug as it is absorbed is effectively knocked out by the naringin - transforming a safe medication into a potentially toxic overdose. It's not only naringin that's to blame; other chemicals called furanocoumarins which are found in juice can cause problems.

Grapefruit, with its high levels of both, is the main culprit, but orange and apple juices also contain damaging chemicals that can combine badly with drugs. These include anti-cancer drugs such as etoposide, the beta blockers atenolol, celiprolol and talinolol, and the antibiotics ciprofloxacin, levo-floxacin and itraconazole. The good news is that eating grapefruit segments is thought to be safe - it is the concentration of the chemicals in the juice that is responsible for adverse reactions.

The link between adverse drug reactions and fruit juice was made in 1991 by a Canadian pharmacologist, yet some drug manufacturersare still giving patients insufficient warning about the risks, say experts. 'Every medicine that carries a risk of interacting with fruit juice should carry a warning in the patient information leaflet of every prescription. But this just isn't happening,' says Munir Pirmohamed, professor of pharmacology at Liverpool University and a specialist in adverse reactions.

Kelly-Ann Prime, a cardiac nurse with the British Heart Foundation, says: 'We know grapefruit juice and some statins react badly. A trial of one called Sinva showed that even small amounts of grapefruit juice increased the likelihood of side-effects, including leg cramps and stomach problems. There aren't enough warnings about the possible effects of grapefruit juice and statins, so patients need to be careful and aware.'

However, Professor Pirmohamed stresses that you should not suddenly stop taking prescribed medicine. 'We wouldn't want patients to take themselves off beneficial medication without good cause just because there's no mention of fruit juice in the leaflet - they should always talk to their doctor.' So, if you are taking any medication, stay off the juice until you've seen your GP.


1 comment:

John A said...

Grapefruit: it is too bad the author had such a bad experience, good that she did some research. But, well, of the seven meds I take daily five PROMINENTLY warn about grapefruit - I have even given up soft drinks with it. ut while orange juice (for example) poses similar risk, it is to such a lesser (near non-existent) degree that I feel no compunction about consuming same.