Tuesday, September 30, 2008

Pot does NOT make young people depressed

The study does appear to cover heavy users of marijuana so the finding is a bit surprising. Heavy use does seem to promote paranoid psychosis to some degree but depression is apparently different. The possibility of long-term effects manifesting in later life remains, however. Abstract follows:

Adolescent Cannabis Problems and Young Adult Depression: Male-Female Stratified Propensity Score Analyses

By Valerie S. Harder et al.

Cannabis use and depression are two of the most prevalent conditions worldwide. Adolescent cannabis use is linked to depression in many studies, but the effects of adolescent cannabis involvement on young adult depression remain unclear and may differ for males versus females. In this cohort study of youth from a mid-Atlantic metropolitan area of the United States, repeated assessments from 1985 (at age 6 years) through 2002 (at age 21 years) were made for 1,494 individuals (55% female). Measured covariate differences between individuals with and without cannabis problems were controlled via propensity score techniques. The estimated risk of young adult depression for adolescents with cannabis problems was not significantly different from that for comparison adolescents for either females (odds ratio = 0.7, 95% confidence interval: 0.2, 2.3) or males (odds ratio = 1.7, 95% confidence interval: 0.8, 3.6). The evidence does not support a causal association linking adolescent-onset cannabis problems with young adult depression.

American Journal of Epidemiology 2008 168(6):592-601

The moralistic myth of the `demon drink'

The UK government's list of nine types of heavy drinker is based less on scientific research than puritan zeal. It's part of a campaign that is both absurd and insulting

Do you drink to `unwind and calm down and to gain a sense of control when switching between work and personal life'? Perhaps your preferred way to `reconnect with old friends' is to meet up in a pub. Maybe you drink in `fairly large social friendship groups' and find a `sense of community' in your local pub, or perhaps you don't go out, and just drink at the end of the day when all your chores are done.

If any of this applies to you, and if you're over 35, you'll soon be targeted by a UK government health campaign, which, according to public health minister Dawn Primarolo, will help people `understand the effects of their drinking habits and help them make changes for the better'.

Underlying this forthcoming campaign is new research by the Department of Health (DoH) which has defined nine personality types of `heavy drinkers', that is, men who drink over 50 units of alcohol a week, and women who drink over 35 units a week. These types not only include `depressed drinkers' and `border dependents', which might well indicate potentially serious alcohol-related psychological problems, but `de-stress drinkers', `re-bonding drinkers', `community drinkers', `conformist drinkers', `macho drinkers', `boredom drinkers' and `hedonistic drinkers'. The DoH hopes to use this segmentation to, in the words of one report, `tailor its propaganda to suit all the target personalities' (1).

According to the report, alcohol serves many functions: it's the `shared connector' that helps people to get along with old friends; it's the means to `feel a strong sense of belonging and acceptance' or a `sense of community' at the local pub; it's the tipple of an evening born of boredom; or it's a way to express `independence, freedom and "youthfulness"'. The net effect of the research is to transform normal behaviour like relaxing after work, socialising with your friends, or just relieving your inhibitions and having a good time, into pathological conditions dangerous to your health (2).

Yet, as with all governmental lifestyle regulation, the basis for the DoH campaign is moral and political, not scientific or medical (3). The cod-psychologising about `drinking types' aside, even the notion of a `heavy drinker' is suspect, based as it is on government-defined unit limits that have no scientific basis. A former editor of the British Medical Journal involved in the process of setting the government's recommended drinking limits, which were first introduced in 1987, recently revealed that reports advising that moderate drinking above these limits was beneficial to health were simply suppressed in favour of `useless' limits that were `plucked out of the air' (4).

Instead, the government seems intent on commissioning scientists to try to produce evidence to back up its essentially moralistic obsession with how much we drink. This July, for instance, research at the North West Public Health Observatory (NWPHO) fuelled suitably scary headlines, warning that 15,000 people die from alcohol-related deaths annually, a leap of 80 per cent on previous estimates. Alarmingly, over a quarter of all deaths among 16- to 24-year-olds were attributed to alcohol. On this basis the DoH stated alcohol-related hospital admissions totaled 810,000, costing $5bn a year (5). But on closer examination of the facts, the continued politicisation of science becomes obvious:

* The NWPHO research identifies 47 conditions caused by alcohol - 34 of them `partially', like cancer, and accidents like falls. This is actually a reduction from the previous total of 53, which was determined by the Cabinet Office in 2003, and included various scientifically unsubstantiated conditions (6). Despite this, the government continues to use its own dodgy figures to estimate alcohol-related National Health Service (NHS) costs, thereby claiming an increase from o1.7billion to o2.7billion between 2003 and 2006/7 (7). Moreover, the government continues to peddle its preferred figures of 810,000 hospital admissions and `15-20,000 premature deaths' when the NWPHO report identified significantly lower figures: 459,982 admissions and under 15,000 deaths (8). When the facts don't fit, just use your own.

* The massive leap in alcohol-related deaths is almost entirely related to the inclusion of these `partially' caused conditions (10,283 deaths out of 14,982), for which the evidence is weak. Associated risk factors are drawn from two decade-old pieces of research and have no `confidence intervals' associated with them. In other words, we don't know how reliable these numbers are. Given that we are talking about a few dozen or hundred cases of some conditions, the risk could be statistically insignificant. Furthermore, these `partially' caused conditions are largely accounted for by `mental and behavioural disorders caused by alcohol'. While it is true that many mentally ill people have alcohol problems, it is far from obvious that they are mentally ill because they drink. However, the uncertainties and qualifications scientists are compelled to indicate tend to be ignored in media commentaries and government statements. When in doubt, obliterate doubt.

* Even if we accept the figures as given, when put into context, they look far less scary. While 14,982 deaths sounds a lot, it constitutes just 3.1 per cent of deaths in the UK. Booze accounts for over a quarter of deaths among 16- to 24-year-olds, but in absolute terms this meant just 446 people in 2005; the percentage is high for the simple reason that very few people die young. Again, 459,842 hospital admissions sounds a lot, but it constitutes just 2.3 per cent of all hospital inpatient and outpatient admissions (9). Given that 70 per cent of Britons drink, these figures suggest a generally low health risk, with serious problems being confined to a hard-core minority. Despite popular belief that Britain has a serious drinking problem, the international figure for alcohol-related diseases is four per cent.

* The NWPHO report even admits that drinking seems to help prevent some conditions like heart disease, and initially its authors found drinking even saved 8,838 lives in 2005 - though they subsequently try to scale this figure back, selectively using research that found little preventive benefit, rather than the opposite (10). Still, if the context dilutes the message, dilute the context.

* The NWPHO research actually finds little evidence to substantiate the government's obsession with `heavy drinkers' beyond re-telling the already-obvious: that sustained alcohol abuse increases the risk of diseases directly caused by alcohol, like cirrhosis of the liver, alcohol poisoning and throat diseases. For some `partially' caused conditions, the evidence is very weak. The research actually finds that the incidence of cancer, hypertension and pancreatitis do not vary with alcohol consumption among men, and are in fact `attributable more to lower levels of alcohol consumption' among women. Instead of therefore questioning the link between boozing and such diseases, the report `suggest[s] that there is a requirement for harm reduction strategies to target the general population, and not just high-risk drinkers'. A failure to find the link is thus transformed into regulation for the entire population, on the basis of three diseases that account for a mere 0.07 per cent of annual hospital admissions (11).

Such contortions illustrate that scientific research is being harnessed to a pre-existing policy agenda that is rooted not in hard medical fact but in moral concerns. Put simply, elites have a moral problem with people who enjoy drinking. They describe town centres as `no-go areas', express amazement and disgust at the revelation that 5.9million of us `drink to get drunk', and hope 24-hour licensing laws will moderate our barbaric customs in the direction of `European caf, culture'. This contempt for the masses, coupled with the vacuousness of their own visions for how to take society forward, produces moralising and therapeutic interventions designed to wean us from the bottle.

The DoH suggests heavy drinkers booze because of a `general sense of malaise in their lives' and to `give their lives meaning'. Perhaps they do. But is it really the state's place to psychoanalyse us, pathologise our normal social interactions, and scare us into `making changes for the better'? After the smoking ban left them without a focus for public health policy, it's actually health ministers who experienced a `general sense of malaise' and now resort to hectoring drinkers to `give their lives meaning'.

So if you receive one of the 900,000 leaflets and self-help booklets being targeted at heavy drinkers in the next few weeks, do the rational thing: bin it, and tell the `health promotion' lobby that really should get out more.


Monday, September 29, 2008

Does early alcohol consumption make for more drinking in later life?

Some apparently epidemiological research found that children introduced to drink under the age of 15, even in supervised conditions, were more likely to become alcoholics. Once again which is cause and which is effect is assumed. Did anybody consider that parents who give alcohol to younger kids might be themselves big drinkers and that tendency to drink might be hereditary? Thus it could be the parentage that makes someone a big drinker, not how early they began drinking. The study proves NOTHING about the effect of giving kids alcohol while young

For parents it is one of the great dilemmas of child-rearing. How should you teach your children to deal with alcohol? Should you ban it altogether - and risk making it seem more attractive - or let your youngsters try a little wine at family meals in the hope that they will learn to drink responsibly? A new study from America's respected National Institute on Alcohol Abuse and Alcoholism (NIAAA) suggests the liberals may have got it badly wrong. It found that if young people have their first taste of alcohol before the age of 15 it sharply raises their risk of becoming alcohol dependent in later life. "We can see for the first time the association between an early `age of first drink' and an increased risk of alcohol use disorders that persists into adulthood," said Deborah Dawson, a research scientist at the NIAAA.

The findings come amid rising concern over teenage drinking habits in Britain, where 54% of teenagers admit to binge-drinking within the previous month. America has tougher restrictions - all states ban alcohol sales to under21s - but teen drinking still flourishes. A study found that under21s drank 20% of all alcohol consumed in the United States and that one-third of high school pupils were binge-drinking once a month or more.

Until now it had been argued that early drinking and subsequent alcohol dependency reflected underlying factors such as social deprivation, poor education or childhood abuse. Although such factors may play an important role for some people, the NIAAA study shows that early exposure to alcohol is a risk in itself. It means that giving youngsters small amounts of alcohol in the hope of teaching them restraint may have the opposite effect.

One theory is that teenagers' brains are changing so fast that exposure to intoxicants can affect long-term development, creating a link between alcohol consumption and pleasure. The NIAAA's study seems to confirm this. The researchers looked at data gathered over three years from more than 22,000 young Americans. These were divided into three groups: those who first drank under the age of 15, between 15 and 17, and 18 or over. The researchers then looked at the drinking patterns that evolved in each of the three groups and at the first incidence of alcohol abuse or dependence.

Howard Moss, associate director for clinical and translational research at the NIAAA, said the study showed that it was important to delay the onset of drinking behaviour as late as possible. "Early alcohol consumption itself, as a misguided choice, is driving the relationship between early drinking and risk for development of later alcohol problems," he said.

The findings will undermine the belief, widespread in France and southern Europe, that children should be given watered wine at meals to learn how to drink responsibly. Frederick Rousseau, a music producer who lives in Paris with his two daughters, aged 18 and 15, said such attitudes were increasingly seen as irrelevant because France was experiencing a surge in teenage drinking similar to that in Britain. "My own younger daughter got drunk at a recent party even though she is so young," he said. "Teenagers here prefer hard drink like vodka now and they drink like mad."

Sarah-Jayne Blakemore, who leads a research group at the University College London Institute of Cognitive Neuroscience, said: "The young brain is very malleable and changes fast in response to new influences, although a lot might depend on the amounts drunk as well as the exposure itself."


Ho hum! The attention-seekers will never let this one go

If you have 100 people trying to prove that cellphones are bad, you will get 5 false-positives by chance alone

CANCER experts have backed mobile phone manufacturers' rejection of the latest claims of links between mobiles and brain tumours. Researchers in Sweden said last week they had found evidence of links between mobile and cordless phones and one of the most common brain tumours. Lennart Hardell, of the University Hospital in Orebro also told a conference in London that young mobile users had a fivefold risk of getting a benign tumour called acoustic neuroma, which causes deafness. Neurosurgeon Charlie Teo said on ABC TV the association between tumours and phones was "quite compelling".

However, the Australian Mobile Telecommunications Association rejected Professor Hardell's assertions, calling it "alarmist" research that "had not undergone a proper process of review by scientific peers". "People can be confident there is no biological, medical or statistical basis to assert a link between mobile phone use and brain cancer," the association's chief executive Chris Althaus said. "The World Health Organisation's most recent health advice says none of the recent reviews have concluded that exposure to the radio frequency fields from mobile phones and their base stations cause any adverse health consequences." More than 600 studies supported these conclusions, Mr Althaus said.

Patricia McKinney, professor of pediatric epidemiology at Leeds University, agreed that there was no threat: "Overall, we found no raised risk of glioma [brain cancer] associated with regular mobile use and no association with time since first use, lifetime years of use, cumulative hours of use, or number of calls."

University of Sydney cancer specialist Bruce Armstrong said: "It's highly unlikely that that statement [fivefold risk] is true. There's no evidence of any substantial trend to an increase in risk of brain tumours in younger people in Australia."


Sunday, September 28, 2008

Tackling the epidemic of `bad science'

In his new book, Ben Goldacre takes a welcome swipe at quackery, but misses the wider abuse of science for political ends.

Ben Goldacre's weekly column in the Guardian has been a breath of fresh air through the world of science journalism. A junior hospital doctor, Goldacre has done more to challenge the junk science promoted by quacks and charlatans than most elite scientists and science writers. He has exposed health gurus, such as Gillian McKeith and Patrick Holford, who claim prestigious academic qualifications and titles and enjoy the endorsement of major media organisations (newspapers, television, publishers) as well as the commercial benefits of the $10billion food supplement industry.

A book based on his column, Bad Science, offers a more comprehensive critique of some of these familiar targets while providing a primer in evidence-based medicine for the general reader. Like Goldacre's column, his book is enlightening, shocking and often hilarious.

Bad Science offers an entertaining romp through the wacky world of the once alternative, but now sadly mainstream, homeopaths and nutrititionists. Goldacre ridicules their sugar pills, their homeopathic solutions with `memories' of dissolved molecules, their detox regimes, vitamins, anti-oxidants and supplements. This is a market in which McKeith's `Fast Formula Horny Goat Weed Complex' for enhanced sexual satisfaction (now withdrawn after complaints from the medicines regulatory authorities) once competed with Holford's `Q-Link' pendant offering protection against electromagnetic radiation (constituents worth 0.5 pence, retail price 69.99 pounds). Goldacre also exposes the preposterous claims of the promoters of `Brain Gym' techniques, now apparently widely used in UK schools, and the bogus research claiming that omega-3 fish oils can improve exam performance.

Yet other examples of pseudoscience that have, arguably, greater influence on the life and health of the nation remain curiously neglected in Goldacre's account. For example, as recent contributions to spiked have argued, controversies over population, passive smoking, the HIV/Aids epidemic and the links between diet and health are characterised by the subordination of science to propaganda. Indeed, all these issues provide examples of the sort of statistical scams and scientific sharp practice (such as extrapolation from inadequate data, confusion of observational and intervention studies, over-interpretation of laboratory studies, cherry picking and data dredging) that Goldacre describes.

While Bad Science savages the nutritionists' dogmatic dietary advice, Goldacre repeatedly endorses the benefits of what he characterises as a `healthy lifestyle'. With uncharacteristic adherence to dull convention, Goldacre repeats the litany that people should be advised to stop smoking, to follow a `healthy diet' of fruit, vegetables and natural fibre and take regular exercise. But, whereas there is strong evidence against smoking, the same cannot be said for recommending any particular diet - and even less for the virtues of exercise. It is striking that, though Goldacre subsequently acknowledges that two major intervention studies - the Multiple Risk Factor Intervention Trial (MRFIT) and the Women's Health Initiative - failed to show any benefit from dietary change, in defiance of his own strictures about evidence-based medicine, he continues to preach the healthy-living gospel.

`Why do clever people believe stupid things?', asks Goldacre. Part of his explanation for the popular impact of pseudoscience goes some way towards explaining the inconsistency of his own approach: `Our values are socially reinforced by conformity, by the company we keep', he writes, emphasising the `phenomenal impact of conformity'. It appears that while Goldacre is prepared to challenge some of the anti-scientific prejudices of his Guardian readers, he shares some of the wider values that have acquired a pervasive influence in modern society.

These include a pessimistic outlook towards the prospects for nature and society, reflected in the popularity of apocalyptic and doomsday scenarios of all kinds, and notably in a willingness to embrace the likelihood of catastrophe from epidemic disease (whether in the form of AIDS, mad cow disease, SARS, bird flu or mere obesity). They also include a misanthropic outlook towards humanity, expressed in contemptuous attitudes towards the masses, notably towards people who vote for George Bush or against the EU, those who smoke or are overweight. A third theme is a growing sympathy for authoritarian interventions to deal with social problems, whether the issue is AIDS, banning smoking, banning trans fats, or banning advertising for `junk food'.

A combination of these attitudes - among scientists and politicians as much as in the general public - leads to an inclination to turn a blind eye towards pseudoscience if it furthers the wider social agenda that follows from them.

Goldacre is ambivalent in his attitude towards the public. On the one hand, he proclaims - almost as an afterthought in his epilogue - that `people aren't stupid'. On the other, in the course of a familiar radical tirade against the evils of direct advertising in the USA by Big Pharma, he writes that `patients are so much more easily led than doctors by drug company advertising'. Again forsaking his scientific principles, he provides no evidence for a proposition that is no more than a personal prejudice, though no doubt one shared by most of his medical colleagues and his Guardian readers. In fact, Goldacre's account provides numerous examples of how doctors have been misled by drug companies. I see no reason why patients, provided they have access to the appropriate information, should not be capable of making rational decisions in these matters.

`The greatest problem of all is dumbing down', concludes Goldacre. But this problem starts at the top, among scientists who share the loss of confidence and authority that afflicts the elite of contemporary society. The very fact that it has been left to a junior hospital doctor to take the lead in challenging important areas of pseudoscience in modern society reflects the abdication of responsibility by the scientific establishment. This - rather than the role of the media, abject though that has been - is the real lesson of the imbroglio over the MMR vaccine, itself the subject of an excellent chapter in Bad Science.

Senior scientists must take up their responsibility to explain and defend science in public, and to set their own house in order by tackling fraud, exposing junk science and calling a halt to the abuse of university titles and academic qualifications. Then, even the arts graduates who (to Goldacre's distaste) dominate the media will soon learn to read a paper critically and provide an informed account to their readers.

As the autism expert Laura Schreibman puts it in her book The Science and Fiction of Autism: `One need not be a scientist in order to know how to evaluate information critically; one just needs to be appropriately critical.'


Britain: An endless diet of government intervention

Health authorities and food campaigners have pursued their pet projects by promoting scare stories about children's health.

Next week sees the start of celebrity chef Jamie Oliver's campaign to change the way children are fed. But while providing children with better meals and facilities at school is a worthy enough aim, lecturing the nation's parents about how they are setting up their kids for a (short) lifetime of ill-health is simply nauseating.

While campaigners call for more government intervention into our eating habits, it is surely time to call a halt. The last thing we need is a further expansion of schemes and initiatives.

We have been led to believe that we are facing a timebomb of ill-health that can only be defused by changing the way our children eat. That might be justified if children were dropping like flies from disease. In fact, the opposite is true. According to figures for England and Wales, in 1981 there were 30 deaths for every 100,000 children aged between one and 14 years. In 2006, that had more than halved to 14 deaths per 100,000. Death in childhood was rare and has become even rarer in the last 25 years or so.

Are children becoming sicker? Clearly, serious infectious disease is largely a thing of the past. Obesity may be increasing, but obesity is not a disease; at most, it is associated with a number of chronic conditions. The most obvious of these in relation to children is the apparent emergence of type-2 diabetes among children, something previously considered to be a condition of middle age. Yet research published in Diabetes Care in 2007 suggests that type-2 diabetes remains unusual in children under the age of 17. The researchers undertook a year-long survey of 2,665 consultant paediatricians in the UK and Ireland. During this period, 67 cases of type-2 diabetes were reported, all of them in the UK, suggesting an overall incidence of 5.3 cases per million children.

So, type-2 diabetes in children would seem to be, if not a one-in-a-million occurrence, not far off. Furthermore, while there is a strong association between being overweight and type-2 diabetes, the association with ethnic status is worrying. As the authors note: `The incidence rates for South Asians and blacks are an alarming 3.5 times and 11 times higher, respectively, than in whites.' This ethnic differential continues into adulthood. If the government were really serious about tackling type-2 diabetes, it would do better to devote a substantial research effort to understanding this differential rather than lecturing the whole population about our personal habits.

Nor is it the case that there is mass malnutrition among children. According to Family Food 2006, the average UK family is getting all the protein and energy required, plus plenty of vitamins and minerals. The average household now spends just 10 per cent of its income on food and non-alcoholic drinks. Food has never been so readily available and in such variety. Even where children do have rather limited tastes, we should chill out. While nutritionists may be sniffy about about children eating cheeseburger, chips and fish fingers all the time, such foods do actually provide a fair proportion of a child's nutritional needs. They may not be perfect, but such eating habits are highly unlikely to result in an epidemic of disease, either.

But there is a more fundamental principle at stake: it is not the government's business to interfere in our personal lives except in the most exceptional circumstances. Yet we are subject to endless health advice both from official sources and through the popular media, from shows like Honey, We're Killing the Kids to the much-praised but frankly hectoring series by Jamie Oliver on school meals. If that were not enough, that intervention is increasingly direct, with parents receiving letters home about their children's supposed weight problems and being given strict instructions about what to put in their lunchboxes.

It seems that the government, the health authorities and a variety of different campaigners see it as their job to overrule parents about how their children should eat. In reality, the vast majority of parents endeavour to get their children to eat well, but in the absence of eating well, they make pragmatic, personal decisions about how to ensure they eat something. Current levels of intervention are unlikely to help matters and are an insult to the decision-making abilities of parents.

If children's food is a top priority, then make school meals free, or at least cheap, at the point of delivery and give them the time and surroundings to eat them comfortably. That's not a health strategy, that's just common decency. If adults would not tolerate being forced to queue up for ages to receive mediocre food in a hall so crowded that there is often nowhere to sit, why should we assume our children should put up with it? And let those meals taste of something; salt in recent years has been treated in school canteens like it is a chemical weapon rather than a fundamental requirement of good cooking. It is noticeable that the new cookbook produced by the government to teach kids how to prepare their own meals avoids salt or sneaks it into recipes in stock. No wonder children are rejecting such bland offerings.

But before the first school bell of the day sounds, and after hometime, it would be far better if the government, the health authorities and the self-appointed guardians of our diets did what children up and down the country do at lunchtime: bugger off.


Saturday, September 27, 2008


Deaths from illness are generally greatest in winter so the fact that people in tropical countries have shorter lifespans obviously reflects factors other than their warmer climate: The greater prevalence of uncontrolled insect pests, for instance, and the fact (confirmed in the study below) that blacks have greater health problems. The article below however restricts itself to different areas in California so public health measures there should be fairly uniform statewide.

It would appear however that it was only heart disease that was found to be slightly more common in warmer parts of the State. Since the authors apparently examined a large range of causes of death, this single difference almost certainly is just the result of data dredging -- random, in other words: Not to be taken seriously. I was born and bred in a very hot climate (but in an area populated by people of mainly British extraction) so if the contentions of these authors had any merit, people should have been dying like flies from heart attacks. They didn't. Abstract follows

A Multicounty Analysis Identifying the Populations Vulnerable to Mortality Associated with High Ambient Temperature in California

By Rupa Basu and Bart D. Ostro

The association between ambient temperature and mortality has been established worldwide, including the authors' prior study in California. Here, they examined cause-specific mortality, age, race/ethnicity, gender, and educational level to identify subgroups vulnerable to high ambient temperature. They obtained data on nine California counties from May through September of 1999-2003 from the National Climatic Data Center (countywide weather) and the California Department of Health Services (individual mortality). Using a time-stratified case-crossover approach, they obtained county-specific estimates of mortality, which were combined in meta-analyses. A total of 231,676 nonaccidental deaths were included. Each 10øF (c.4.7øC) increase in mean daily apparent temperature corresponded to a 2.6% (95% confidence interval (CI): 1.3, 3.9) increase for cardiovascular mortality, with the most significant risk found for ischemic heart disease. Elevated risks were also found for persons at least 65 years of age (2.2%, 95% CI: 0.04, 4.0), infants 1 year of age or less (4.9%, 95% CI: -1.8, 11.6), and the Black racial/ethnic group (4.9%, 95% CI: 2.0, 7.9). No differences were found by gender or educational level. To prevent the mortality associated with ambient temperature, persons with cardiovascular disease, the elderly, infants, and Blacks among others should be targeted.

American Journal of Epidemiology 2008 168(6):632-637

Honey could be a wonder drug

Time for a double-blind trial. I have a bottle of Manuka honey in my medicine cabinet but have never used it for anything. Being an old guy, I mostly uses iodine for asepsis. It stings but that way you know it is doing you good! (just joking)

HONEY, used for generations to soothe sore throats, could soon be substituted for antibiotics in fighting stubborn ear, nose and throat infections, according to a new study. Ottawa University doctors found in tests that ordinary honey kills bacteria that cause sinus infections, and does it better in most cases than antibiotics. The researchers have so far tested manuka honey from New Zealand, and sidr honey from Yemen. "It's astonishing," researcher Joseph Marson said of bees' unexplained ability to combine the nectar of flowers into a seemingly potent medicine.

The preliminary tests were conducted in laboratory dishes, not in live patients, but included the "superbug" methicillin-resistant Staphylococcus aureus or MRSA, which is highly resistant to antibiotics. In upcoming human trials, a "honey rinse" would be used to "flush out the goo from sinus cavities," said Marson.

The two killed all floating bacteria in liquid, and 63-91 per cent of biofilms - micro-organisms that sometimes form a protective layer in sinus cavities, urinary tracts, catheters, and heart valves, protecting bacteria from normal drug treatments and often leading to chronic infections. The most effective antibiotic, rifampin, killed just 18 percent of the biofilm samples in the tests.

"As of today, nobody is sure what in the honey kills the bacteria," Marson said, noting that "not all honeys have the same potency" and calling for more research to determine the mechanism behind the healing. Canada's clover and buckwheat honey did not work at all. Previous studies have shown honey's healing properties on infected wounds.

The results of the study were presented this week at the annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery, in Chicago.


Friday, September 26, 2008

Charming food freaks in Berkeley

All ego

As most veteran customers know, it takes a pretty thick skin to successfully navigate the Berkeley Bowl, this strident city's most popular grocery store. Outside, petitioners seeking signatures for ballot measures have come to blows with opinionated residents. In the tiny parking lot, nicknamed the Berkeley Brawl, frustrated motorists have been known to ram one another's cars. At the checkout, people have thrown punches and unripened avocados at suspected line-cutters.

When one shopper was told she couldn't return a bag of granola, she showily dumped its contents on the floor. Culyon Garrison, who works at the customer-service desk, recently had a loaf of bread thrown at him.

The produce emporium -- one of the nation's most renowned retailers of exotic fruits and vegetables -- creates its own bad behavior. Kamikaze shoppers crash down crowded aisles without eye contact or apology for fender-benders. So many customers weren't waiting to pay before digging in that management imposed the ultimate deterrent: Those caught sampling without buying will be banned for life -- no reprieves, no excuses. (Not even "I forgot to take my medication.")

Raphael Breines, who was ejected last year for eating on the premises, said he couldn't decide between two types of apricots, so he sampled both. Security stopped him in the parking lot. "They treated me like a thief," said the 37-year-old park planner, who was photographed and required to sign a no-trespass agreement. "Technically I was stealing, but I wasn't trying to hide anything. I was just deciding which type of apricot to buy." Breines, a longtime customer, sent an apology letter, asking to be reinstated. His request was denied.

Store manager Larry Evans says the policy is a fair response to doctors, lawyers and college professors who help themselves to bags of cookies, nuts and vitamins, stick their fingers in pies and guzzle from bottles of sake, assuming the rules don't apply to them. "There's a sense of entitlement to this town," Evans said. "People think, 'If I want to do it, I'll do it, just try and stop me.' "

Seven years on the job, he said, has given him insight into the city's sometimes sharp social elbows. "Berkeley residents are angry -- they're mad at the president, the economy, all kinds of stuff. And this is the place where it seems to get released, the local supermarket."

Longtime Berkeley residents also think they have a grip on the good life, so being banned from the Bowl is no small matter. On a typical summer day, a shopper at the Bowl is likely to find 20 kinds of apples, eight types of mangoes, half a dozen varieties of papaya, six kinds of garlic, five types of ginger and 40 different tomatoes.


British Doctors told to curb use of Ritalin in hyperactive children

Children with attention deficit hyperactivity disorder (ADHD) should be treated with drugs such as Ritalin only in severe cases and never when they are younger than 5, under official health guidelines issued today. Widespread concerns that medication is used too freely to calm hyperactive children have been recognised by two clinical practice watchdogs, which are now advising doctors not to prescribe drugs whenever possible.

Most children with ADHD should instead be offered psychological therapy to improve their behaviour, backed up by training to support their parents and teachers, the National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Mental Health (NCCMH) recommend. Drugs such as Ritalin and Concerta (brand names for methylphenidate) and Strattera (atomoxetine) should be used as frontline treatments only when severe ADHD is diagnosed, or when other options have failed.

While up to 3 per cent of school-age children in Britain are affected by ADHD, only about a third to a quarter of these would qualify as severe cases. In a typical school of 1,400 children, between 30 and 40 would have a diagnosis of ADHD, and about 10 would be classed as severely affected.

The symptoms of ADHD include an inability to concentrate for long periods, hyperactive and restless behaviour, and impulsive actions, such as speaking without thinking of the consequences or failing to wait and take turns. It also affects about 2 per cent of adults.

ADHD support groups welcomed the guidelines, but said that they would have to be backed by increased resources for behavioural therapy if they are to have the desired effect. Andrea Benbow, chief executive of the Attention Deficit Disorder Information and Support Service, said that many parents had to wait months or even years to be given psychological therapy and training, and that many programmes were not designed for ADHD or effective for it. "There are huge waiting lists, and many training programmes are not ADHD-specific and they're useless," she said. "We need these interventions - drugs are not the be all and end all - and parents would welcome them if they were there. "This needs to be backed by better resources. Lots of the good programmes are delivered by the voluntary sector, but the problem is, who funds them?"

The new guidance follows growing disquiet among some parents, teachers and doctors about the number of children taking medication for ADHD, who often remain on drugs for years. More than 600,000 prescriptions for the three drugs were filled in 2007 in England, though the number of children who received them is estimated at between 50,000 and 100,000 because only a month's supply is generally prescribed at once.

Ritalin is the most common ADHD drug, with 461,000 prescriptions filled in England in 2007. This compares with 199,000 in 2003, 26,500 in 1998 and 3,500 in 1993. The growth has alarmed some observers, concerned that some doctors are turning to medication too quickly to control a disorder that often responds well to other treatment strategies. Ritalin and Concerta can have side-effects that include nervousness, insomnia, appetite loss and weight loss. Strattera can cause nausea, dizziness, fatigue and mood swings. There has also been little research into the implications of taking them as long-term treatments.

Prescription rates vary widely. In July a study by the Health Service Journal found that some primary care trusts offer Ritalin up to 23 times more than others: in Wirral, pharmacists dispensed one prescription for every seven children under 16, compared with one for every 159 children in Stoke-on-Trent.

Other treatment options include sending children on courses of cognitive behavioural therapy or social skills training, and training parents in how to cope with the condition and improve their children's behaviour. Teachers can also be trained to manage children with ADHD. These can be highly effective, but drugs are often used instead because they offer a quicker solution and are not subject to long waiting lists.

The guidelines recommend a sparing approach to drug use when possible. Tim Kendall, a consultant psychiatrist in Sheffield and joint director of the NCCMH, who sat on the expert panel, said: "Quite commonly, people tend to revert to offering methylphenidate or atomoxetine. "When they do that, it's not always because there's a good balance of risk and benefits. It's because the child has got what appears to be ADHD and that's what's available. It's easier to prescribe a drug when other options like parent-training programmes are not available."

Gillian Leng, deputy chief executive of NICE, said: "Today's guideline, which is published during ADHD Awareness Week, is the first guideline to address the diagnosis and management of ADHD within both clinical and education settings. At its heart is the recognition of the importance of establishing a multidisciplinary team, including the person with ADHD, their family and their teachers in order to help support the person with ADHD achieve their full potential."

Professor Eric Taylor, of the Institute of Psychiatry in London and chairman of the guideline development group, said: "I believe these guidelines will make people with ADHD, and their families, more confident that their problems will be recognised and can often be helped, and that they will provide professionals with a framework for good practice nationally."


Thursday, September 25, 2008


The study below is monumental in its stupidity. Some poor mother gives birth to a kid with a hare lip and is of course riven with guilt and self-doubt. Some earnest researchers come around with a questionnaire three month later and ask her if she boozed a lot during her early pregnancy. Tearfully, she says: "That's it! Those few drinks I had must have been too much!" So she reports to the researcher that she was indeed a boozer. And the idiotic researcher takes that as evidence that she really was a heavy drinker. So we get the report below. Self-report studies in general are notoriously unreliable but this one takes the cake. If the researchers had administered their questions BEFORE all births, they might have had something worth reporting

First-Trimester Maternal Alcohol Consumption and the Risk of Infant Oral Clefts in Norway: A Population-based Case-Control Study

By Lisa A. DeRoo et al.

Although alcohol is a recognized teratogen, evidence is limited on alcohol intake and oral cleft risk. The authors examined the association between maternal alcohol consumption and oral clefts in a national, population-based case-control study of infants born in 1996-2001 in Norway. Participants were 377 infants with cleft lip with or without cleft palate, 196 with cleft palate only, and 763 controls. Mothers reported first-trimester alcohol consumption in self-administered questionnaires completed within a few months after delivery. Logistic regression was used to calculate odds ratios and 95% confidence intervals, adjusting for confounders. Compared with nondrinkers, women who reported binge-level drinking ~5 drinks per sitting) were more likely to have an infant with cleft lip with or without cleft palate (odds ratio = 2.2, 95% confidence interval: 1.1, 4.2) and cleft palate only (odds ratio = 2.6, 95% confidence interval: 1.2, 5.6). Odds ratios were higher among women who binged on three or more occasions: odds ratio = 3.2 for cleft lip with or without cleft palate (95% confidence interval: 1.0, 10.2) and odds ratio = 3.0 for cleft palate only (95% confidence interval: 0.7, 13.0). Maternal binge-level drinking may increase the risk of infant clefts.

American Journal of Epidemiology, 2008 168(6):638-646

Autism: Charlatans to the Rescue

Comment on "Autism's False Prophets" By Paul A. Offit, M.D.

Ever since psychiatrist Leo Kanner identified a neurological condition he called autism in 1943, parents whose children have been diagnosed with the most severe form of the illness -- usually in the toddler stage, before age 3 -- have found themselves desperately searching for some way not to lose their children to autism's closed-off world. Unfortunately, such parents have often found misguided doctors, ill-informed psychologists and outright charlatans eager to proffer help.

Paul A. Offit, a pediatrician and the chief of infectious diseases at the Children's Hospital of Philadelphia, has gathered this sorry parade of self-styled samaritans for "Autism's False Prophets," an invaluable chronicle that relates some of the many ways in which the vulnerabilities of anxious parents have been exploited.

First, though, some basics about the disorder: According to the Autism Society of America, children and adults with autism "typically show difficulties in verbal and non-verbal communication, social interactions, and leisure or play activities." But there is a wide range of severity, hence the use of the umbrella term "autism spectrum disorder." At the less severe end of the spectrum, a diagnosis of Asperger's syndrome is sometimes applied to cases where there is no delay in children's acquisition of language. (The Austrian pediatrician Hans Asperger noted this milder form of autism in 1944, but it wasn't formalized as a diagnosis until the 1990s.)

For a disorder that has been noticed and described relatively recently, autism is quite common, affecting as many as one in 150 children. And the frequency of the diagnosis is increasing, according to the Centers for Disease Control and Prevention. The natural reaction to such an increase is: "Something must be causing it." The next step is: "Someone is to blame" -- followed by lawsuits, if only people can figure out whom to sue.

Dr. Offit notes two likely causes of the increase in autism diagnoses. One is that the definition of the disorder has broadened over time, so that children with mild symptoms are now being diagnosed when once they would have been regarded as merely quirky. That's certainly plausible. My son, now in his mid-30s, sought a formal evaluation a year ago, just to satisfy his curiosity about whether he's really an Aspy, as those with Asperger's sometimes call themselves. And indeed he is. But when he started school three decades ago, and his teachers worried about why he seemed to have trouble making friends, no one so much as mentioned a neurological problem as a possible explanation. Today they would, and they'd also have more useful guidance on what might help him (he seemed fine to us, his parents).

The second cause of the rise in autism diagnoses, according to Dr. Offit, is that in earlier times children with severe symptoms of what we now recognize as autism were more likely to be diagnosed, often incorrectly, as mentally retarded.

Just as autism is being found more often, so, it seems, are dubious explanations for the source of an illness that so far has defied medicine's attempts to find its origins. The parade of "false prophets" began lining up soon after the disorder was defined.

At mid-century, psychoanalyst Bruno Bettelheim set up a school in Chicago, and published a book, based on his theory that autism was precipitated by the "black milk" of mothers who treated children with a frosty emotional distance. His claims of successful treatment were widely disseminated; that the claims were fraudulent, not so much.

Next in Dr. Offit's parade are the advocates of "facilitated communication" from the 1970s and 1980s, who claimed that their approach enabled nonverbal children to express their true selves. Facilitated communication entailed having a "facilitator" support a child's hand or arm, helping the child type on a keyboard or use other devices. The method was easily debunked with a simple experiment: Don't allow the facilitator to see what the child is seeing and suddenly the child's communication skills evaporate. But facilitated communication flourished for years. Nobody thought to do the experiments until the children's true selves -- or at least their imaginative helpers -- began recounting false tales of sexual abuse.

In 1998, a British doctor named Andrew Wakefield joined the ranks of autism explainers, announcing in The Lancet that the disorder was caused by the triple vaccine for measles, mumps and rubella (MMR) given to young children. Only later did it emerge that the children he studied were clients of a lawyer who was searching for evidence he could use in a lawsuit. The disclosure prompted most of the co-authors of Dr. Wakefield's article to disavow it.

The MMR episode seems like just a prelude to the American manifestation of the childhood-vaccines panic of recent years. As Dr. Offit reports, the autism bogeyman is now the use of thimerosal, a preservative in vaccines. Thimerosal, as many studies in several countries have shown, is safe; whatever may be causing the increase in autism diagnoses, thimerosal isn't it. But in an excess of caution, federal agencies pushed to have thimerosal removed from almost all childhood vaccines.

The government's action was unnecessary but in itself not harmful. The problem was that removing the preservative seemed to confirm parents' fears: If thimerosal wasn't harmful, why get rid of it? The government's action did have the useful side effect of setting up a natural experiment. If thimerosal had been a cause of autism, the appearance of new cases should have begun to slow. In fact, autism diagnoses continued to climb.

Of course, the evidence rejecting thimerosal as a cause of autism had no effect on true believers, whose ranks include distraught parents and those beating the drums for their own patented remedies. Dr. Offit wonders why parents who distrust scientists and public health officials for refusing to admit that vaccines cause autism -- after all, they don't -- "haven't been similarly skeptical of the vast array of autism therapies, all of which are claimed to work and all of which are based on theories that are ill-founded, poorly conceived, contradictory, or disproved." Good question.


Wednesday, September 24, 2008


Latest abstract below. They found that the closer you stick to what they regard as a typical Mediterranean diet (oil not butter; More vegetables and less meat; plenty of garlic; red wine rather than beer etc.) the longer you live, though only by a small amount. For all we know, however, it could be that it is people who are careful of their health who are most likely to stick to such a heavily-hyped diet and that people who are more careful of their health live longer anyway. And the pesky facts about Australia are ignored too. Australia has exceptionally long life expectancies despite being as gastronomically different from Southern Europe as it is geographically distant. The usual Australian diet is about as "wrong" as you can get by Mediterranean standards.

And let me get REALLY pesky here. Have you ever seen Mediterranean people (particularly Southern Italians) in later life? They are mostly shaped like barrels. So how does that fit in with the obesity war?

Adherence to Mediterranean diet and health status: meta-analysis

By Sofi F et al.

OBJECTIVE: To systematically review all the prospective cohort studies that have analysed the relation between adherence to a Mediterranean diet, mortality, and incidence of chronic diseases in a primary prevention setting.

DESIGN: Meta-analysis of prospective cohort studies.

DATA SOURCES: English and non-English publications in PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials from 1966 to 30 June 2008. Studies reviewed Studies that analysed prospectively the association between adherence to a Mediterranean diet, mortality, and incidence of diseases; 12 studies, with a total of 1 574,299 subjects followed for a time ranging from three to 18 years were included.

RESULTS: The cumulative analysis among eight cohorts (514,816 subjects and 33,576 deaths) evaluating overall mortality in relation to adherence to a Mediterranean diet showed that a two point increase in the adherence score was significantly associated with a reduced risk of mortality (pooled relative risk 0.91, 95% confidence interval 0.89 to 0.94). Likewise, the analyses showed a beneficial role for greater adherence to a Mediterranean diet on cardiovascular mortality (pooled relative risk 0.91, 0.87 to 0.95), incidence of or mortality from cancer (0.94, 0.92 to 0.96), and incidence of Parkinson's disease and Alzheimer's disease (0.87, 0.80 to 0.96).

CONCLUSIONS: Greater adherence to a Mediterranean diet is associated with a significant improvement in health status, as seen by a significant reduction in overall mortality (9%), mortality from cardiovascular diseases (9%), incidence of or mortality from cancer (6%), and incidence of Parkinson's disease and Alzheimer's disease (13%). These results seem to be clinically relevant for public health, in particular for encouraging a Mediterranean-like dietary pattern for primary prevention of major chronic diseases.

BMJ. 2008 Sep 11;337:a1344


Arthritis surgery now found to be useless. Opening up an arthritic joint, cleaning out the junk and smoothing out the rough bits should so SOME good, right? 'Fraid not. Once again a proper controlled study detonates assumptions

A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee

By Alexandra Kirkley, M.D. et al.


Background: The efficacy of arthroscopic surgery for the treatment of osteoarthritis of the knee is unknown.

Methods: We conducted a single-center, randomized, controlled trial of arthroscopic surgery in patients with moderate-to-severe osteoarthritis of the knee. Patients were randomly assigned to surgical lavage and arthroscopic d‚bridement together with optimized physical and medical therapy or to treatment with physical and medical therapy alone. The primary outcome was the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (range, 0 to 2400; higher scores indicate more severe symptoms) at 2 years of follow-up. Secondary outcomes included the Short Form-36 (SF-36) Physical Component Summary score (range, 0 to 100; higher scores indicate better quality of life).

Results: Of the 92 patients assigned to surgery, 6 did not undergo surgery. Of the 86 patients assigned to control treatment, all received only physical and medical therapy. After 2 years, the mean (~SD) WOMAC score for the surgery group was 874~624, as compared with 897~583 for the control group (absolute difference [surgery-group score minus control-group score], -23ñ605; 95% confidence interval [CI], -208 to 161; P=0.22 after adjustment for baseline score and grade of severity). The SF-36 Physical Component Summary scores were 37.0~11.4 and 37.2~10.6, respectively (absolute difference, -0.2~11.1; 95% CI, -3.6 to 3.2; P=0.93). Analyses of WOMAC scores at interim visits and other secondary outcomes also failed to show superiority of surgery.

Conclusions: Arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.

NEJM, 2008, Volume 359:1097-1107 Number 11

Tuesday, September 23, 2008

Sexually active girls get depressed?

The journal abstract is here. Prepublication version here. The authors have made some attempts at control but I cannot see that they have ruled out the possibility that girls who have low self-esteem to start with might consent to sex at a younger age. We could have the cart before the horse here

YOUNG girls who are sexually active are far more likely to suffer from depression than those who remain virgins, according to a controversial study. Academics found that teenage sex leaves many girls with feelings of guilt and low self-esteem.

Following a study of more than 14,000 US teens aged between 14 and 17, researchers said the feelings could be directly ascribed to sexual activity, rather than outside influences. The study, published in the Journal of Health Economics, found that having sex doubled the chances of girls becoming depressed, with 19 per cent of those who had sex exhibiting symptoms of depression, compared with 9.2 per cent who had abstained. The study also found that the mental health of boys in the same age group did not correlate with sexually active.



This is an amusing one. Some more cart before the horse logic. The authors find that people are slimmer where there are more doctors. But, despite hailing from good old class-conscious England, they have missed the obvious. Middle class people are slimmer and live in nicer areas. And doctors like living in nicer areas and seeing middle class people. So it is nicer areas that cause both the slimness and the increased presence of doctors. The presence of more doctors is not causal. Abstract follows:

GP supply and obesity

By Stephen Morris and Hugh Gravelle


We investigate the relationship between area general practitioner (GP) supply and individual body mass index (BMI) in England. Individual level BMI is regressed against area whole time equivalent GPs per 1000 population plus a large number of individual and area level covariates. We use instrumental variables (area house prices and age weighted capitation) to allow for the endogeneity of GP supply. We find that that a 10% increase in GP supply is associated with a mean reduction in BMI of around 1 kg/m2 (around 4% of mean BMI). The results suggest that reduced list sizes per GP can improve the management of obesity.


Monday, September 22, 2008

UK: Junk food ad rules “not working”

How frustrating for the Fascists!

Adverts for unhealthy foods are still appearing during TV programmes seen by children, despite curbs introduced in January, a consumer watchdog has said. Which? said the five programmes with the most child viewers and only four of the top 20 most popular children's shows were covered by Ofcom's rules. These state that ads for "less healthy” foods are not allowed in or around programmes which "appeal" to under-16s.

But advertisers said Which's list included shows "not aimed" at children. A programme is defined as being of particular appeal to children if the proportion of those under 16 watching a programme is 20% higher than the general viewing population. This means shows like The Simpsons and SpongeBob SquarePants are covered, while shows like Beat the Star, Animals Do The Funniest Things and Emmerdale are not, even though they are watched by thousands more children.

A two-week analysis by Which? found that ads for products including Coca-Cola, Oreos and Kellogg's Coco Pops were broadcast during programmes popular with children but not covered by the restrictions. It said ITV's Beat the Star attracted more than half a million child viewers during the monitoring period, but had contained ads for Coca-Cola, Dairylea Dunkers, Nachos and Sprite.

Which? food campaigner Clare Corbett said: "The ad restrictions may look good on paper but the reality is that the programmes most popular with children are slipping through the net. "If these rules are going to be effective, then they have to apply to the programmes that children watch in the greatest numbers." She added: "We're not anti-advertising, we're just against the fact that most of the ads children see are for unhealthy products, rather than the healthier foods they should be eating more of."

But the Advertising Association said Which? seemed to want to unfairly restrict companies' ability to deliver commercial messages. Chief executive Baroness Peta Buscombe called its report "sensationalist, unconstructive and missing the point" and said the advertising industry took a "responsible approach" to food advertising. She added: "Their list includes programmes clearly not aimed at children and films screened after 10pm. "There clearly has to be an element of parental responsibility on which programmes they allow their children to view."

A Department for Culture, Media and Sport spokesman said: "For the first time, TV adverts for foods high in fat, salt and sugar are banned during programmes aimed at or of particular appeal to children under 16. "Although children still see some of these advertisements, the current Ofcom regulations mean that the viewing of these adverts by children is reduced by an estimated 50%, an impressive amount." He added: "We appreciate that there are calls for further restrictions on UK TV advertising but these should be considered once we have had a chance to assess the impact of current measures."

Ofcom is set to report to government on the success of its restrictions in December. The Food Standards Agency, which drew up a model for deciding if a food was unhealthy, is also to assess how well it is performing.


"Sports" drinks are a con

VITAMIN and sports-water drinks are so laden with sugar and caffeine that claims about their health-giving benefits should be taken with a grain of salt, nutritionists have warned. Despite labels touting their ability to revive consumers and improve focus and energy, the drinks are simply "artificial concoctions" of additives more likely to undermine drinkers' health than improve it, Foodwatch nutritionist Catherine Saxelby said. The sugar content of the drinks - which account for $100million of bottled water sales - is so high the Australian Dental Association wants them to carry warning labels.

Consumer advocate group Choice says the public is being deliberately misled about the benefits of enhanced-water drinks, with some 500ml varieties containing eight teaspoons of sugar, high levels of caffeine and many additives, including flavours and colours.

Choice has complained to the Australian Competition and Consumer Commission and the NSW Food Authority about the allegedly misleading labelling and marketing of Coca-Cola Amatil's Glaceau Vitamin Water. The drink has 6« teaspoons of sugar - that's one third of the average adult woman's recommended dietary intake of sugar. The beverage giant expects to sell 2 million bottles of the drink this year. Choice senior food policy officer Clare Hughes said many health-conscious Australians were buying Glaceau and the other leading enhanced-water brands, Nutrient Water and Smart Water, on the basis of deceptive marketing and labelling. While it purported to be healthy, a 575ml bottle of Nutrient Water had seven teaspoons of sugar, Ms Hughes said; Smart Water's 500ml bottle had eight. A 375ml can of Coca-Cola contains 10 teaspoons of sugar.

"What's marketed as a sensible alternative to sugary soft drinks is nowhere near as sensible or as healthy as the package implies," Ms Hughes said. Ms Saxelby said vitamin waters are an "artificial concoction" with additives such as fructose, sucrose, flavour and food acid. "It's not like drinking juice. It's actually a formulated product from a factory," she said. "I don't think we need these drinks. We can get our vitamins and minerals from normal, natural food."

Australian Dental Association Victoria deputy president Anne Harrison said the high sugar levels could lead to tooth decay and consumers had a right to know what they were drinking.

Coca-Cola South Pacific spokeswoman Sarah Kelly said neither the ACCC nor the NSW Food Authority had contacted the company to raise concerns about Glaceau Vitamin Water, which was launched in February and had "exceeded sales expectations".


Sunday, September 21, 2008

NIMH refuses to waste money on stupid vaccine theory

The fact that autism cases rose rather than fell after thimerosal was phased out tells us all we need to know

Health officials have called off plans for a study examining a controversial type of treatment that some autism activists have touted as alternative medical therapy for children with the condition. The National Institute of Mental Health, or NIMH, part of the U.S. National Institutes of Health, said in a statement on Wednesday that it has canceled a study aimed at assessing the effectiveness of a treatment called chelation.

Chelation (pronounced key-LAY-shun) is a type of therapy in which a man-made amino acid, called EDTA, is added to the blood, and it has been used to treat heavy metal poisoning. Some autism activists have advocated it on the theory -- rejected by most scientists -- that autism is triggered by exposure to mercury, a heavy metal, from childhood vaccines. Many studies and medical experts have dismissed the notion that mercury used in a vaccine preservative causes autism, but some parents of autistic children strongly believe it does.

Since 2001, with the exception of some influenza vaccines, the mercury-containing preservative has not been used in routinely recommended childhood vaccines, according to the U.S. Centers for Disease Control and Prevention.

"NIMH has decided that resources are better directed at this time to testing other potential therapies for autism spectrum disorders, and is not pursuing the additional review required to begin the study," the institute said.


Food and Drug Administration Speaks Out in Defense of Plastic Baby Bottles

A rather pusillanimous response to a largely fraudulent study

Federal regulators this week defended their assessment that a chemical widely used in plastic baby bottles and in food packaging is safe, even as the first major study of health effects in people linked it with possible risks for heart disease and diabetes. "A margin of safety exists that is adequate to protect consumers, including infants and children, at the current levels of exposure," Laura Tarantino, a senior Food and Drug Administration scientist, told an expert panel that has been asked for a second opinion on the agency's assessment of bisphenol A or BPA, the AP reports.

However, a study released earlier this week by the Journal of the American Medical Association suggested a new concern about BPA. Because of the possible public health implications, the results "deserve scientific follow-up," the study authors said. Using a health survey of nearly 1,500 adults, they found that those exposed to higher amounts of BPA were more likely to report having heart disease and diabetes, according to the AP report.

But the study is preliminary, far from proof that the chemical caused the health problems. Two Dartmouth College analysts of medical research said it raises questions but provides no answers about whether the ubiquitous chemical is harmful.

FDA officials said they are not dismissing such findings, and conceded that further research is needed. "We recognize the need to resolve the concerning questions that have been raised," said Tarantino. But the FDA is arguing that the studies with rats and mice it relied on for its assessment are more thorough than some of the human research that has raised doubts.

The FDA has the power to limit use of BPA in food containers and medical devices but last month released its internal report concluding that BPA exposure is not enough to warrant action. Since then, another government agency released a separate report concluding that risks to people, in particular to infants and children, cannot be ruled out.

Researchers from Britain and the University of Iowa examined a U.S. government health survey of 1,455 American adults and reported whether they had any of several common diseases. A total of 79 had heart attacks, chest pain or other types of cardiovascular disease and 136 had diabetes. There were more than twice as many people with heart disease or diabetes in the highest BPA group than in the lowest BPA group. No one in the study had BPA urine amounts showing higher than recommended exposure levels, said co-author Dr. David Melzer, a University of Exeter researcher.

The American Chemistry Council, an industry trade group, said the study is flawed, has substantial limitations and proves nothing. But Dr. Ana Soto of Tufts University said the study raises enough concerns to warrant government action to limit BPA exposure, the AP reports. "We shouldn't wait until further studies are done in order to act in protecting humans," said Soto, who has called for more restrictions in the past.

Several states are considering restricting BPA use, some manufacturers have begun promoting BPA-free baby bottles, and some stores are phasing out baby products containing the chemical. The European Union has said that BPA-containing products are safe, but Canada's government has proposed banning the sale of baby bottles with BPA as a precaution.


Saturday, September 20, 2008

Now paracetamol is in the gun

Finding: Sickly babies (i.e. ones given lots of painkillers) tend to have more illness in later life. Big news! Big stupidity to blame the problem on the remedy, though. There are other grounds for caution with paracetamol but the stuff below is negligible grounds for caution. It's just more data dredging

Giving paracetamol-based medicines such as Calpol to babies can increase their chances of developing asthma in later life, a large international study suggests. Researchers who analysed data on more than 200,000 children found strong links between their exposure to paracetamol as infants and the development of asthma and other allergic conditions.

Mothers are advised that after two months, in babies weighing over 4kg (9lb), they can treat fevers with medicines or suspensions that contain paracetamol. But the study raises questions about the long-term effects of using medicines such as junior paracetamol and Calpol at such a young age.

Children under 12 months who were given a paracetamol-based medicine at least once a month more than tripled the chances of suffering wheezing attacks by the age of 6 or 7, the researchers found. The painkiller was also associated with an increased risk of rhinoconjunctivitis - or hay fever - and eczema. The researchers add that increased use of paracetamol - because of earlier fears about giving children aspirin - could be a factor in causing rising rates of asthma in many countries.

Previous research had already suggested a link between paracetamol and asthma, and scientists believe that the painkiller may cause changes in the body that leave a child more vulnerable to inflammation and allergies.

The authors of the study, published in The Lancet medical journal, emphasise that the findings do not constitute a reason to stop using paracetamol for relief of pain and fever in children. Instead, they support existing guidelines of the World Health Organisation that paracetamol-based medicines should not be used routinely, but should be reserved for those with a high fever (38.5C or above). Experts point out that in these cases, giving children medication outweighs the risks of not doing so.

Paracetamol is not licensed for use in infants under 2 months old by mouth and is only recommended after that in "junior" doses or medicines that contain less than the standard adult dose. More than one million children in the UK - equivalent to one in ten - now have asthma and the number of cases has trebled since the 1960s. The rise has in part coincided with paracetamol becoming the preferred drug to treat fevers and pain in children.

The study, part of a worldwide investigation called the International Study of Asthma and Allergies in Childhood, spanned 73 centres in 31 countries. It found that giving children paracetamol in the first year of life increased the risk of later asthma symptoms in children aged 6 and 7 by 46 per cent. Taking paracetamol at least once a month - classified as "high use" - increased the symptoms risk 3.23 times. Using the drug in the first year of life increased the risk of hay fever and eczema at the age of 6 and 7 by 48 per cent and 35 per cent respectively.

The researchers had to rely on written answers from parents who filled in questionnaires about their children's health and use of paracetamol, which may be subject to error.

Professor Richard Beasley, who led the study at the Medical Research Institute of New Zealand, said that there were good reasons to suggest that paracetamol was a factor in causing health problems, rather than merely being associated with them. The research highlights a "dose-dependent" response, with more exposure to the drug resulting in more asthma attacks, pointing to a cause-and-effect relationship, he said. [Rubbish! It just shows that the sicklier kids get more asthma]

The researchers said that more research, in the form of randomised controlled trials, was needed urgently. [Indeed!]


Is marriage good for your health?

The article below is from an interview with Peter McDonald, a Professor of Demography. He says that marriage does go with better health but has a refreshing skepticism about why that is so. He points out a number of reasons why marriage of itself may not be the crucial factor. That people who are unhealthy to start with are less likely to get married seems to escape most commentators on the subject

There are many things you can do if you want to live a long, happy and healthy life - get plenty of exercise, watch what you eat [So I can eat all the Big Macs I want as long as I watch them?], don't smoke or drink too much, or you can get married.

While for many years demographers found that men in spousal relationships lived longer than women in the same situation, recent Australian Bureau of Statistics (ABS) data on death rates shows people living in intimate relationships - both men and women - have lower death rates than single people in almost all age groups.

The ABS data, which compares the rate of death per 1,000 for single people versus married ones (including those in de facto relationships), shows the difference in death rates between single and married people starts in the 40s and continues across the lifespan. The difference spikes in the 70-84 year old age group where the death rate for single people is almost double that of their married friends.

In the last 20 years, married women have started to enjoy a longer life span than their single counterparts, says Professor Peter McDonald from the Australian Demographic and Social Research Institute. While demographers are not altogether sure why the situation has changed for married women in recent times, McDonald says there are several reasons experts believe married couples live longer. For a start, those who are at greater risk of dying are less likely to get hitched.

"If you're going to die then you don't get married, or if you've got some terrible disease you don't get married," he says. "So those with potentially high death risks are selected out into the single population."

There's also the 'in sickness and in health' factor. People living in intimate relationships are more likely to have someone looking after them when they're sick, telling them when to go to the doctor or encouraging them to live a healthier lifestyle. "Single people don't have someone there caring for them and suggesting their lifestyle needs changing," McDonald says.

And then there's the power of two incomes. "There's probably an economic advantage, married people are probably better off in economic terms, there's a strong association between economic well being and expectation of life as well - those who are well off live longer."

So if you're single and you want to live a long and healthy life, if the stats are anything to go by, you might want to consider adding 'find partner for life' to your next New Year's resolution list.


Friday, September 19, 2008


This scare never seems to die. Weak epidemiological associations below based on small samples of sufferers -- with causal inferences speculative, as usual. Interesting that one of the study participants did not think much of the results. Note that the vast majority of the sample were NOT ill and yet had bisphenol in them also. Also note that an unspecified number of both "heart" and "diabetic" patients were UNDIAGNOSED heart-disease and diabetes sufferers!

Exposure to a ubiquitous chemical used in plastic baby bottles, food cans and a host of other products may increase the risk of developing heart disease and diabetes, a study suggests. In the first significant study of the effects of bisphenol A (BPA), one of the world's most mass-produced substances, researchers found that even small traces in the body were potentially linked to health problems.

BPA, used in hardened plastics including food containers and compact discs, can be found in detectable levels in nine out of ten people. It enters the body primarily through food and drink but also through drinking water, dental sealants, through the skin or inhalation of household dusts.

The researchers, from the Peninsula Medical School, Exeter, found that relatively high levels of the chemical present in urine were associated with a threefold risk of cardiovascular disease and double the risk for type 2 diabetes. With possible public health implications, the results "deserve scientific follow-up", the study's authors said.

Previous studies of adverse effects in animals have created concern over long-term, low-level exposure to BPA in humans. But the findings, from a "snapshot" study of the American population, do not prove that the chemical causes health problems, the researchers said.

Heart disease is reckoned Britain's biggest killer, with about 270,000 heart attacks occurring each year, while 100,000 cases of type 2 diabetes, which is associated with obesity, are diagnosed each year.

The study, published in the Journal of the American Medical Association, looked at BPA levels in the urine of 1,455 American adults, and whether they had ever been diagnosed with one of eight main diseases, including arthritis and thyroid disease. In total 79 had had heart attacks, chest pain or other types of cardiovascular disease and 136 had diabetes. The average level of BPA exposure was 20 micrograms per day.

But 25 per cent of participants with highest BPA concentrations (between 35 to 50 micrograms per day) were nearly three times likelier to be diagnosed with cardiovascular disease than those in the lowest 25 per cent (10 micrograms per day). Similarly, those with highest BPA concentrations were 2.4 times likelier to have had diabetes diagnosed compared with those at lowest levels. Current guidelines suggest that an adult can safely consume up to 3,250 micrograms a day, a much higher amount than the study suggests.

BPA leaches from drinks bottles made from some polycarbonate plastics and from the epoxy linings of canned foods, especially if heated. "BPA-free" baby bottles have been sold in recent years, but there is little information for consumers on BPA.

David Melzer, who led the study at the University of Exeter, said: "At the moment we can't be sure BPA is the direct cause of the extra cases of heart disease and diabetes. If it is, some cases of these conditions could be prevented by reducing BPA exposure."

Iain Lang, a co-author of the study, added, "Measuring who has disease and high BPA levels at a single point in time cannot tell you which comes first. I'm not changing my behaviour on the basis of this single study."


Association of Urinary Bisphenol A Concentration With Medical Disorders and Laboratory Abnormalities in Adults

By Iain A. Lang et al.

Context: Bisphenol A (BPA) is widely used in epoxy resins lining food and beverage containers. Evidence of effects in animals has generated concern over low-level chronic exposures in humans.

Objective: To examine associations between urinary BPA concentrations and adult health status.

Design, Setting, and Participants: Cross-sectional analysis of BPA concentrations and health status in the general adult population of the United States, using data from the National Health and Nutrition Examination Survey 2003-2004.

Participants were 1455 adults aged 18 through 74 years with measured urinary BPA and urine creatinine concentrations. Regression models were adjusted for age, sex, race/ethnicity, education, income, smoking, body mass index, waist circumference, and urinary creatinine concentration. The sample provided 80% power to detect unadjusted odds ratios (ORs) of 1.4 for diagnoses of 5% prevalence per 1-SD change in BPA concentration, or standardized regression coefficients of 0.075 for liver enzyme concentrations, at a significance level of P <.05.

Main Outcome Measures: Chronic disease diagnoses plus blood markers of liver function, glucose homeostasis, inflammation, and lipid changes.

Results: Higher urinary BPA concentrations were associated with cardiovascular diagnoses in age-, sex-, and fully adjusted models (OR per 1-SD increase in BPA concentration, 1.39; 95% confidence interval [CI], 1.18-1.63; P = .001 with full adjustment). Higher BPA concentrations were also associated with diabetes (OR per 1-SD increase in BPA concentration, 1.39; 95% confidence interval [CI], 1.21-1.60; P <.001) but not with other studied common diseases.

In addition, higher BPA concentrations were associated with clinically abnormal concentrations of the liver enzymes gamma -glutamyltransferase (OR per 1-SD increase in BPA concentration, 1.29; 95% CI, 1.14-1.46; P < .001) and alkaline phosphatase (OR per 1-SD increase in BPA concentration, 1.48; 95% CI, 1.18-1.85; P = .002).

Conclusion: Higher BPA exposure, reflected in higher urinary concentrations of BPA, may be associated with avoidable morbidity in the community-dwelling adult population.

JAMA. 2008;300(11):1303-1310

Antibiotics given to delay labour can harm baby

Another disgraceful attempt to worry pregnant women. The report below is a very partial summary of two papers that were published simultaneously. This paper found no effect of antibiotic use while this paper found no effect of antibiotic use on anything other than rate of cerebral palsy, which was rare in any case. It's just data dredging. If you look at enough variables, you will find differences by chance alone. The real conclusion should be that antibiotics in pregnancy are almost certainly safe

Giving women antibiotics to delay premature labour may increase the risk of developmental problems for the baby, a study suggests. The study by the University of Leicester, published in The Lancet, assessed seven-year-olds whose mothers had been involved in a clinical trial at the time of their birth. The children of those given an antibiotic were much more likely to have cerebral palsy. The Health Department has written to doctors asking them to discontinue the practice, which is not routine.

Experts say that the more common use of antibiotics for pregnant women who show signs of an infection when their waters break early can be lifesaving, and should be continued.

Many new mothers get too little postnatal support, a poll of 6,000 mothers by Netmums.com found. Six out of ten felt they had not seen their health visitor enough during the first year of their child's life.


Thursday, September 18, 2008


The various studies seem to oscillate between condemning and praising alcohol intake. So it is interesting to see an attempt at a systematic literature review designed to see whether it has any effect on your going ga-ga in later life. And the good news for those of us who appreciate the occasional assistance of Mr John Walker of Scotland is that moderate consumption seems to help rather than hinder. See below. I hate to be a spoilsport but I feel obliged to note, however, that the evidence is epidemiological. Moderate drinkers were healthier but moderate drinkers probably engage in safer behaviour in lots of ways (e.g less illegal drug taking). So the booze may have NOTHING to do with their better health. Sad, isn't it?

Alcohol, dementia and cognitive decline in the elderly: a systematic review

By Ruth Peters et al.

Background: dementia and cognitive decline have been linked to cardiovascular risk. Alcohol has known negative effects in large quantities but may be protective for the cardiovascular system in smaller amounts. Effect of alcohol intake may be greater in the elderly and may impact on cognition.

Methods: to evaluate the evidence for any relationship between incident cognitive decline or dementia in the elderly and alcohol consumption, a systematic review and meta-analyses were carried out. Criteria for inclusion were longitudinal studies of subjects aged ~ 65, with primary outcomes of incident dementia/cognitive decline.

Results: 23 studies were identified (20 epidemiological cohort, three retrospective matched case-control nested in a cohort). Meta-analyses suggest that small amounts of alcohol may be protective against dementia (random effects model, risk ratio [RR] 0.63; 95% CI 0.53-0.75) and Alzheimer's disease (RR 0.57; 0.44-0.74) but not for vascular dementia (RR 0.82; 0.50-1.35) or cognitive decline (RR 0.89; 0.67-1.17) However, studies varied, with differing lengths of follow up, measurement of alcohol intake, inclusion of true abstainers and assessment of potential confounders.

Conclusions: because of the heterogeneity in the data these findings should be interpreted with caution. However, there is some evidence to suggest that limited alcohol intake in earlier adult life may be protective against incident dementia later.

Age and Ageing 2008 37(5):505-512.


Aspirin seems to loosen up the blood flow generally and that should be a good thing for the restricted bloodflow found in aged brains -- and thus keep the brains concerned a bit younger. So is regular aspirin intake a good thing if you want to avoid going ga-ga? Sorry. No effect! Pesky things, these placebo controls!

Low dose aspirin and cognitive function in middle aged to elderly adults: randomised controlled trial

By Jackie F Price et al.

Objective To determine the effects of low dose aspirin on cognitive function in middle aged to elderly men and women at moderately increased cardiovascular risk.

Design Randomised double blind placebo controlled trial.

Setting Central Scotland.

Participants 3350 men and women aged over 50 participating in the aspirin for asymptomatic atherosclerosis trial.

Intervention Low dose aspirin (100 mg daily) or placebo for five years.

Main outcome measures Tests of memory, executive function, non-verbal reasoning, mental flexibility, and information processing five years after randomisation, with scores used to create a summary cognitive score (general factor).

Results At baseline, mean vocabulary scores (an indicator of previous cognitive ability) were similar in the aspirin (30.9, SD 4.7) and placebo (31.1, SD 4.7) groups. In the primary intention to treat analysis, there was no significant difference at follow-up between the groups in the proportion achieving over the median general factor cognitive score (32.7% and 34.8% respectively, odds ratio 0.91, 95% confidence interval 0.79 to 1.05, P=0.20) or in mean scores on the individual cognitive tests. There were also no significant differences in change in cognitive ability over the five years in a subset of 504 who underwent detailed cognitive testing at baseline.

Conclusion Low dose aspirin does not affect cognitive function in middle aged to elderly people at increased cardiovascular risk.

BMJ 2008;337:a1198.

Wednesday, September 17, 2008

Top Statistician Says Cancer Risk from Vytorin/Inegy 'Not Ruled Out'

The stuff doesn't work anyway. That you have to do statistical marvels to detect any effects shows how weak the effects concerned are. I would worry about its overall efficacy (effect on mortality) rather than anything else

One of the most prominent statisticians in the U.S. is taking issue with an analysis that claims there is no credible evidence the cholesterol drug Vytorin increases the risk of cancer death. "There are clinically important ["clinically important" is waffle. It can mean "not statistically significant"] increases in the risk of cancer-related death that are not ruled out by this data," writes Thomas Fleming of the University of Washington in an editorial published on the Web site of the New England Journal of Medicine.

Moreover, he argues in the editorial, the analysis arguing against a risk of cancer death for Vytorin should never have been made public because it could compromise ongoing studies of the drug. That would mean clear evidence about Vytorin's safety and effectiveness might never be obtained.

The editorial spells more trouble for Vytorin and its sister drug, Zetia--which share an active ingredient--and for their makers, Merck and Schering-Plough. Vytorin is a combo pill of Zetia and the generic drug Zocor. The pills generated $5 billion in sales last year, but U.S. prescriptions have dropped by a third as a result of the controversy over Zetia's effectiveness at preventing heart attacks.

In July, researchers hastily released a study, called SEAS, in which patients on Vytorin developed and died of cancer more often than those in a placebo group. But, at the same time, they presented an analysis by Oxford University's Sir Richard Peto, who argued there is "no credible evidence" of a link between the active ingredient in Vytorin and Zetia and cancer. Both the study and the analysis were published in the New England Journal on Sept. 2.

Many cardiologists who defend Vytorin and Zetia rest their arguments on Peto's brilliance. Eugene Braunwald, a prominent Harvard cardiologist who is running a Vytorin trial, called Peto "the best statistician in the universe" while telling reporters that any cancer risk with the drug is unlikely.

But Fleming is also highly regarded. A frequent adviser to the Food and Drug Administration, Fleming was a key player in sorting through the confusing data surrounding the link of arthritis drugs Vioxx and Bextra to heart risks. He also warned the FDA not to approve the cancer drug Iressa because of limited data; use of the medicine was substantially restricted after it failed to demonstrate a survival benefit in big trials.

In a statement, Merck and Schering-Plough said they believe the cancer finding "is likely to be an anomaly that, taken in the light of all the available data, does not support an association with Vytorin."

Fleming agrees with Peto on one point. Peto's analysis looked at data taken from two incomplete studies of Vytorin: SHARP, which compares Vytorin with a placebo in patients with kidney disease, and IMPROVE-IT, which compares Vytorin with Zocor. Some critics have said Peto should have lumped all three trials together. Fleming writes Peto's was the right approach, since the point was to see if the cancer risk that shows up in SEAS would show up elsewhere.

Doing the analysis this way showed no increase in the number of cancers, but an increase in the number of deaths from cancer. Fleming argues that this still leaves a possibility that the pills are linked to cancer death. In fact, the data are consistent with a 34% increase in cancer death, and don't rule out an 84% increase.

Fleming also argues that Peto's analysis of the IMPROVE-IT and SHARP studies raises "important concerns" about the integrity of those clinical trials. Studies are normally kept secret until they are completed. Only a special committee charged with monitoring patient safety is allowed to look at the unblinded data, so that a trial can be stopped if a drug turns out to be dangerous. (Forbes raised these issues this morning.)

Fleming writes there is a "serious risk" that data from incomplete studies will be misinterpreted. He also argues that making unblinded data available to the public could disturb the existing studies, potentially making the results less valid when the trials are eventually released. He writes the data in the Peto analysis should only have been made available to the committees monitoring the safety of the patients in SHARP and IMPROVE-IT.

He concludes that more data are needed to "adequately address the signal that [Vytorin] is associated with an increased risk of death from cancer." He adds that getting more data is "especially important" because Zetia has a safety signal of major illness or death, while evidence of its efficacy is limited to lowering cholesterol.


Small Packages May Lead to Overeating

Another counterproductive idea from the food Fascists

Tempting treats are being offered in small package sizes these days, presumably to help consumers reduce portion sizes. Yet new research in the Journal of Consumer Research found that people actually consume more high-calorie snacks when they are in small packages than large ones. And smaller packages make people more likely to give in to temptation in the first place.

Authors Rita Coelho do Vale (Technical University of Lisbon), Rik Pieters, and Marcel Zeelenberg (both Tilburg University, the Netherlands) found that large packages triggered concern of overeating and conscious efforts to avoid doing so, while small packages were perceived as innocent pleasures, leaving the consumers unaware that they were overindulging.

"The increasing availability of single-serve and multi-packs may not serve consumers in the long-run, but-because they are considered to be innocent pleasures-may turn out to be sneaky small sins," write the authors.

One fascinating aspect of the research is the difference between belief and reality. In an initial study, researchers found that consumers believe that small packages help them regulate "hedonistic consumption," where self-restraint is at stake. When participants were asked to choose phone plans, those who thought the plan was for social rather than work purposes tended to choose smaller plans.

The researchers then moved on to food. Participants in one group had their "dietary concerns" activated by completing a "Body Satisfaction scale," a "Drive for Thinness scale," and a "Concern for Dieting scale." They were then weighed and measured, in front of a mirror, to fully activate their awareness. Then those participants (and a control group, which didn't have its "dietary concerns" activated) watched episodes of Friends interspersed with commercials. They believed they were there to evaluate the ads.

But researchers were really monitoring their consumption of potato chips. Chips were available to participants in large packages or small ones. The study found that consumption was lowest when dieting concerns were activated and package size was large. People were less likely to open large packages, and participants deliberated longer before consuming from the larger packages.

"Maybe the answer lies in consumers taking responsibility for their consumption and monitoring internal cues of sufficiency, rather than letting package size take control," conclude the authors.