Wednesday, September 23, 2009

Lies and deceit below

The original journal article is here. The article below glides over the fact that the effect of HRT on incidence of cancer was NON-SIGNIFICANT statistically. And given the large numbers involved, the effect had to be pretty tiny in absolute terms for that to be so. The marginally significant difference in mortality among HRT users who DO get cancer is more a puzzle than a threat. In absolute terms, women on HRT are most UNLIKELY to die of lung cancer -- unless they smoke. Smoking is the real risk factor

The constant reliance on relative risk ratios is very annoying and uninformative. It may be good for getting journal articles published but it is useless to the average person trying to work out a reasonable policy for themselves. What they need to know is the ABSOLUTE risk -- and in all the reports about the evils of HRT it is negligible

If taking HRT raises your risk of some illness from 1 in 4000 to 1 in 3000, that gives a relative risk ratio big enough to generate a scary academic journal article but in absolute terms the risk is still negligible

Hormone replacement therapy, already linked to [minute] increases in breast cancer, heart disease and stroke, nearly doubles a woman's risk of dying from lung cancer, researchers reported Saturday in a finding that may be the final nail in the coffin for a therapy that is already in rapidly declining use. The findings "seriously question whether hormone-replacement therapy has any role in medicine today," wrote Dr. Apar Kishor Ganti of the University of Nebraska Medical Center in an editorial accompanying the online publication of the report in the medical journal Lancet.

The link to lung cancer "is yet another reason to not use hormone replacement therapy if it can be avoided," said Dr. Mark Faries, director of translational tumor immunology at the John Wayne Cancer Institute in Santa Monica, Calif., who was not involved in the research. "It raises the bar for deciding to do HRT."

The findings come from the Women's Health Initiative, a large study originally begun in 1991 to demonstrate, in part, that administration of a combination of estrogen and progestin could relieve debilitating symptoms of menopause and reduce the risk of heart attack and stroke. The hormone replacement arm, which enrolled more than 16,000 women, was halted prematurely after about 51/2 years when it was observed that the risks far outweighed any potential benefits.

The therapy not only did not protect against heart disease and stroke, but it yielded only questionable improvements in quality of life and produced a small but statistically significant increase in the risk of heart disease, stroke and breast cancer. Several subsequent reports have shown that the rate of breast cancer rose by at least 15 percent during the 1990s when HRT was blooming, then dropped sharply when many women abandoned the treatment after a 2002 report on the subject.

Treatment with estrogen has a deleterious effect on breast cancer patients because the hormone binds to estrogen receptors on tumor tissue, accelerating its growth. Recent laboratory studies have shown that lung tissue also has estrogen receptors and that the accelerated growth is even more dramatic in lung tumor cells, according to Dr. Richard J. Pietras, who directs the Stiles program on oncology at the University of California, Los Angeles' Jonsson Comprehensive Cancer Center. Among other effects, the hormone promotes the growth of blood vessels that nourish growing tumors.

"We've been suspecting for a long time that this is an area we need to investigate," Pietras said. The need is especially dramatic because the incidence of lung cancer in women has been growing and more women now die from it than from breast, ovarian and colon cancers combined. About 99,000 women are diagnosed with lung cancer each year, and 71,000 die from it.

The first results from the Women's Health Initiative suggested that the hormones might have an effect on lung cancer. To further explore a link, Dr. Rowan Chlebowski of the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center and his colleagues studied the women in the Women's Health Initiative for an additional 2 1/2 years.

At the end of the eight-year period, they found that 109 women who received the estrogen and progestin treatments had been diagnosed with lung cancer, compared with 85 in the group that received a placebo — a modest 23 percent increase in incidence.

The difference was more dramatic when they considered deaths. In the group receiving hormone therapy, 73 women died, compared with 40 in the placebo group, a 71 percent increase. The increase in lung cancer deaths accounted for half of the overall increase in deaths in the women receiving hormone therapy, Chlebowski said. The effect was most pronounced for so-called non-small-cell lung cancer, the most common form in women. There were 62 deaths from this type of tumor in women receiving hormones, compared with 31 deaths in the placebo group.

"The important thing is this is the identification of a new, lethal side effect of estrogen plus progestin use," he said. The findings "have special significance" for women who are now or have been heavy smokers, he said.

Women who were current smokers and who took hormone therapy had a 1 percent chance of dying from lung cancer in five years. Women who had smoked had about half that risk. "About half the post-menopausal women in the United States would fall into either category," he said.

The findings suggest that the hormones do not themselves cause lung cancer, but that they accelerate the growth of existing tumors, making them more aggressive and more likely to metastasize, Chlebowski said.

Lung cancer is "a very potent, brutal disease," said Dr. Glen Justice, director of the MemorialCare Cancer Center at Orange Coast Memorial Medical Center in Fountain Valley, Calif. "The real take-home message here is that you have got to have a very good reason for going on hormones because we now know that there are so many negative effects."


Eating junk food could fatten your tax bill

And a tax is likely to be counterproductive anyway

Alarmed by a tripling of obesity rates among U.S. children over the past 30 years—nearly one in five of today’s adolescents is claimed to be obese—the Institute of Medicine and the National Research Council issued a report just before Labor Day recommending a series of policy initiatives aimed at trimming the flab from America’s youth.

Saying the child obesity problem cannot be solved at the federal level, the two groups counsel state and local officials to impose their own soft drink taxes, tax “junk food,” limit access to television and video games in after-school programs, replace public school vending machines with water fountains, open school playgrounds to the general public, build more sidewalks and bicycle paths, make shopping at stores that sell fresh food more convenient for people living in low-income neighborhoods, and require restaurants to list calorie counts on their menus.

The report takes another step down the road to government control of lifestyle choices. The more successful the current administration is in displacing private health insurance with a taxpayer-financed public option, the more coercion to adopt healthy ways of living one can expect—stop smoking, exercise regularly and eat only the foods recommended by those who know what’s good for you.

A public health insurance program will deny coverage to no one and will charge everyone (probably within certain age groups) the same premium, including those with pre-existing conditions, such as diabetes or merely being overweight. Under the circumstances, there are only a few ways of keeping the program’s costs from careening completely out of control. Government can regulate the types of medical procedures for which health care providers can apply for reimbursement; limit the amounts of those reimbursements; and use selective taxes and other government powers to “encourage” individuals covered by the public option to avoid behaviors the so-called experts link to illness and injury.

With private health insurance, by contrast, insurers have incentives to charge premiums that reflect the actuarially determined probability that individual policyholders will submit claims. Smokers pay more for health and life insurance than nonsmokers, and overweight people, especially those with histories of adult-onset (Type 2) diabetes, high blood pressure or elevated cholesterol levels, pay more than those with a clean bill of health.

With risk-based insurance premiums, the consequences of smoking and overeating are not social costs, borne by everyone, but private costs borne largely by those who overindulge. Private health insurers do not charge higher premiums to people who enjoy soft drinks or junk food on occasion, but to those who regularly pig out and put on the pounds.

Selective excise taxes are blunt instruments for controlling behavior. Taxing soft drinks may cause people to drink less soda, but some will substitute other high-calorie drinks. Taxing Big Macs may reduce cash register sales, but some will simply eat more loaded pizza, or make cheeseburgers at home.

Maine already tried this. During the 10 years the so-called snack tax was in effect, the state’s adult obesity rate doubled, from 10 percent to 20 percent.

What Nobel laureate James Buchanan calls the “meddlesome preferences” of those who want you to behave as they do now threaten our personal freedoms. Lifestyle choices should not be ceded to government.


1 comment:

John A said...

Re childhood obesity, I think anyone who claims kids are fatter in the past two decades than ever before should be forced to watch old movies. Shirley Temple would today be ostracised and her parents taken to task for all that obvious fat. And "Our Gang" - "Little Rascals" even worse, Yeah, "Spanky" is obviously obese. But look at Darla - perhaps heavier than Temple. Even "Buckwheat" had chubby cheeks. Off-hand, I think only "Froggie" might be acceptable to the doomsayers in appearance - and I'd lay odds a BMI [*spit*] assessment would put him over the top.