Sunday, March 31, 2013

Could a 'gastric bypass in a pill' spell an end to diets and be the key to tackling obesity?

Probably not.  Any such effect would be marginal.  It's a rodent study anyway

Shedding the pounds without dieting, exercising or resorting to surgery sounds impossibly far-fetched.  But it could one day become a reality, thanks to probiotic tablets full of friendly bacteria – a ‘gastric bypass in a pill’.

The idea was developed from the observation that gastric bypass operations led to changes in bacteria in the gut, as well as quelling hunger and cravings for unhealthy food.

US researchers studied mice before and after they had a gastric bypass.

Three weeks after surgery, they had lost almost a third of their body weight. But tests also showed that their intestines contained fewer of the bugs commonly found in the digestive tracts of fat individuals, and more of those associated with leanness.

The mice were also burning more energy, despite not doing more exercise.

The researchers, from Massachusetts General Hospital and Harvard University, then took the ‘good bacteria’ and transferred it into lean mice.  These animals rapidly lost 5 per cent of their weight, despite not being put on a diet.

The scientists believe the effects could have been greater if the mice had been overweight.

The findings suggest that weight loss following gastric bypass surgery isn’t just due to the operation itself.  Changes in bacteria in the gut also play a role.

It is thought that the bacteria which colonise the digestive system after a gastric bypass produce chemicals which aid weight loss by speeding up the metabolism.

A better understanding of what the bacteria do could lead to new, effective treatments for obesity, one of which could be a pill packed with ‘friendly bacteria’.

But the study’s co-author, Dr Peter Turnbaugh, cautioned that the research is still at an early stage.  He said: ‘It might not be that we will have a magic pill that will work for everyone who’s slightly overweight.

'But if we can, at a minimum, provide some alternative to gastric bypass surgery that produces similar effects, it would be a major advance.’

The study was published in the journal Science Translational Medicine.


Full vaccine schedule safe for kids, no link to autism

A new study finds that children who receive the full schedule of vaccinations have no increased risk of autism.

"This is a very important and reassuring study," says Geraldine Dawson, chief science officer at Autism Speaks, who wasn't involved in the new paper. "This study shows definitively that there is no connection between the number of vaccines that children receive in childhood, or the number of vaccines that children receive in one day, and autism."

The study, published today in the Journal of Pediatrics, is the latest of more than 20 studies showing no connection between autism and vaccines, given either individually or as part of the standard schedule. The paper is the first to consider not just the number of vaccines, but a child's total exposure to the substances inside vaccines that trigger an immune response.

Study authors say they sought to address the fear that multiple vaccines are "overwhelming" children's immune system, possibly contributing to long-term problems. Twenty years ago, children were vaccinated against nine diseases. Today, they're vaccinated against 14, according to the Centers for Disease Control and Prevention, which funded the study.

Though kids get more needle sticks, the next-generation vaccines they receive are easier on the immune system than those used two decades ago, says Frank DeStefano, lead author of the new paper and director of the Immunization Safety Office at the Centers for Disease Control and Prevention.

That's because modern vaccines are more sophisticated, using just a few critical particles — called antigens — to stimulate the immune system, DeStefano says. These antigens, found on the surfaces of bacteria and viruses, spur the body to make antibodies, which block future infections.

For example, an older version of the pertussis (whooping cough) vaccine, used until the late 1990s, was made using an entire, killed bacteria. That vaccine, called DTP, exposed the body to more than 3,000 antigens.

A newer, streamlined version, called DtaP, uses only the four to six antigens critical to producing immunity, DeStefano says.

Because of these sorts of improvements, fully vaccinated 2-year-olds are exposed to a total of 315 antigens, the study says.

That's a drop in the bucket compared with the billions of microbes — from bacteria to yeast — that babies encounter in their first hours of life.

The new research confirms the findings of a 2010 study in Pediatrics, which compared babies who received all vaccines on time in the first year of life with those who skipped or delayed their shot. That research found no neuropsychological differences, such as stuttering, facial tics or lower scores on IQ tests.

"A lot of parents are concerned about the number of 'owies' that children get," says Michael Smith, an author of the 2010 study and pediatric infectious disease specialist at the University of Louisville School of Medicine.

"But there's no benefit to delaying vaccines," says Smith, who wasn't involved in the new study. "When you delay your child's vaccines, you put them at risk."

Myths about autism and vaccines have persisted, in spite of the scientific evidence, partly because researchers don't really know what causes autism, Dawson says. "Until we conduct the research to answer the questions about autism's causes and risk factors, parents will continue to have questions," she says.

Research increasingly suggests that many of the underlying changes that cause autism take place before birth, and even before conception. Although parents often notice symptoms of autism only after a child is 12 to 18 months old, research by Dawson and others picked up subtle changes — in eye gaze or even brain patterns — as early as 6 months.

Doubts about vaccines have led to low vaccination rates in some communities, which have fueled flare-ups of once-forgotten diseases such as whooping cough, measles and mumps, Smith says. "If someone gets on a plane from Europe or India where there is measles, then we have measles again," Smith says.

The CDC reported Thursday that the USA had three cases last year of congenital rubella syndrome, an often fatal condition that afflicts the newborns of mothers who contract rubella, or German measles, while pregnant. Affected babies often suffer from a number of painful and life-threatening problems, such as heart defects, deafness, cataracts and mental retardation.

Vaccination has eliminated person-to-person spread of rubella in the Western Hemisphere. All three of the mothers last year were from Africa, where rubella still circulates. One of the babies died.

Though some parents may never believe vaccines are safe, the new study will probably reassure many others, says Karen Ernst of Voices for Vaccines, a group of parents and other vaccine advocates.

"Those who truly benefit from this article are the children of future parents," Ernst says. "These future parents will have more confidence in vaccinating their children on time. It is the job of parent-advocates like our members to speak up and make sure news about articles like this gets out.


Friday, March 29, 2013

The cancer clusters that weren’t

A recent post in ACSH Dispatch examines an interesting question: How likely is it that some U.S. communities have elevated cancer rates, a.k.a, “cancer clusters,” because of chemical pollution? The answer: not very.

ACSH points to an enlightening article published in Slate by George Johnson, who notes:

    "Time after time, the clusters have turned out to be statistical illusions—artifacts of chance. … The Erin Brockovich incident, one of the most famous, is among the many that have been debunked. Hexavalent chromium in the water supply of a small California town was blamed for causing cancer, resulting in a $333 million legal settlement and a movie starring Julia Roberts. But an epidemiological study ultimately showed that the cancer rate was no greater than that of the general population. The rate was actually slightly less."

Erin Brockovich, the loud-mouthed extrovert who got it totally wrong  -- at huge expense to others

Johnson also discusses the alleged cancer cluster in Toms River, N.J., which is the subject of a new book: Toms River: A Story of Science and Salvation, by Dan Fagin. But contrary to Fagin’s book, Johnson concludes: “… no matter how hard I squinted at the numbers, I found it hard to be convinced that there had been a cancer problem in Toms River.”

It is true that chemicals cause cancers where people are exposed for long periods of time to very high levels. For example, populations in Taiwan whose drinking water was contaminated with extremely high levels of arsenic for many decades experienced elevated rates of skin cancer. Is that a cluster? Surely it is. Does it convey information about the risks to populations exposed to much lower concentrations? Not particularly.

Yet activists focus on relatively low-level exposures to generate headlines and push regulations, and trial lawyers bring cases to extort large settlements because no one can prove their claims wrong — or right. Ironically, there’s evidence that low-level and long-term exposures to chemicals may have benefits, an effect that scientists refer to as hormesis.

Hollywood has sensationalized “cancer cluster” allegations, producing two major motion pictures – A Civil Action and Erin Brockovich – on the alleged effects of chemicals on various communities. In both cases, tort lawyers claimed that drinking water contaminated by industrial facilities caused cancers in nearby areas. Despite the ability of trial lawyers to win such cases, it is nearly impossible to pin down the causes of such clusters. In 1990, the Centers for Disease Control and Prevention reported on 22 years of studies that covered clusters in 29 states and five foreign countries. They could not establish a clear cause for any cluster.

Part of the problem is that clusters occur by mere chance. Raymond R. Neutra of the California Department of Health Services finds that we can expect nearly 5,000 such random cancer clusters to exist in any given decade in the United States (Scientific American 275, no. 3 (1996): 85–86.).

The risks of cancer clusters resulting from low-level exposures to chemicals in the environment are simply too low to detect. But allegations about such clusters are good fodder for trial lawyers looking to make a buck, and they serve the agenda of activists who want to pass regulations on chemicals.


When The Nanny State Kills

The government told people to switch from saturated animal fats to unsaturated vegetable fats. But that advice may have killed a lot of people. As David Oliver notes, a recent study “in the British Medical Journal” shows that ”those who heeded the advice” from public-health officials “to switch from saturated fats to polyunsaturated vegetable oils dramatically reduced their odds of living to see 2013,” incurring up to a “60% increase in risk of death by switching from animal fats to vegetable oils.” This possibly deadly medical advice has a long history:

Fifty years ago the medical community did an about-face . . . and instead went all in on polyunsaturated fats. It reasoned that since (a) cholesterol is associated with cardiovascular disease and (b) polyunsaturated fats reduce serum cholesterol levels, it inescapably followed that (c) changing people’s diet from saturated fats to polyunsaturated fats would save a lot of lives. In 1984 Uncle Sam got involved – Time magazine reported on it in “Hold the Eggs and Butter” – and he made a big push for citizens to swap out animal fat in their diet for the vegetable variety and a great experiment on the American people was begun.

As Oliver, an expert on mass torts, points out, it is hard to ”think of any mass tort, or combination of mass torts, that has produced as much harm as the advice to change to a plant oil-based diet” may have done.

Some federal food-safety regulations have also harmed public health, such as the “poke and sniff” inspection method “that likely resulted in USDA inspectors transmitting filth from diseased meat to fresh meat on a daily basis.” The Obama administration has foolishly discouraged potato consumption, even though potatoes are highly nutritious, even as it has subsidized certain sugary and fatty foods, and promoted bad advice about salt.

Governments are killing smokers by banning safer alternatives to cigarettes. The Economist notes that Brazil and Singapore ban e-cigarettes, even though they could save countless lives, since they do not emit the smoke that makes cigarettes lethal. As it points out, “E-cigarettes do not just save the lives of smokers: they bring other benefits too. Unlike cigarettes, they do not damage the health of bystanders. They do not even smell that bad, so there is no public nuisance, let alone hazard, and thus no reason to ban their use in public places.” Countries like Austria and New Zealand restrict their sale, deeming them to be regulated “medical devices.” The Economist laments, “Instead of embracing e-cigarettes, many health lobbyists are determined to stub them out. . . .these objections seem to be driven by puritanism, not by reason. Some health lobbyists are so determined to prevent people doing anything that remotely resembles smoking—a process referred to as ‘denormalisation’—that they refuse to endorse a product that reproduces the pleasure of smoking without the harm.”

Cyprus may be in chaos, threatening another financial crisis in the European Union (EU), but as CEI’s Iain Murray notes, the good old EU knows where its priorities lie — in an effort to ban e-cigarettes. As The Commentator reports:

“On December 19th 2012, the EU produced a proposal for new laws controlling tobacco and e-cigarettes. Under the new proposals, packets of both will likely have to be brazenly branded with warning signs and unsightly images. Fine if you believe this deters people from smoking (which there is scant evidence for), not so fine if you believe that smokers should be more free or indeed encouraged to take up something less harmful to wean themselves off cigarettes."

“The proposed EU directive will make it harder for smokers to switch, and will also ban outright the least harmful tobacco products on the market – a product known as ‘snus’. It will treat e-cigarettes as ‘medicinal products’, causing concern over impossibly high standards and regulations leading to higher manufacturing costs. This means that e-cigarettes may no longer be able to compete in a lower, or even the same price band as cigarettes, which would likely cause smokers to think twice about adopting the healthier option.”

Of course, the EU isn’t alone. The FDA has been riding this pony for years. As my colleague Hans Bader wrote in 2009:

“The FDA is now moving towards banning e-cigarettes, reports syndicated columnist Jacob Sullum. Cigarettes, which contain lots of toxins and cancer-causing agents, aren’t banned, but the FDA wants to ban e-cigarettes, which contain infinitely-smaller amounts of carcinogens, complaining that e-cigarettes contain “detectable levels of known carcinogens and toxic chemicals to which users could potentially be exposed”.

“As public-health expert, and tobacco-industry critic, Michael Siegel notes, this is terrible reasoning by the FDA, since all tobacco replacement products now on the market contain small but “detectable” amounts of known carcinogens. The FDA used to be more reluctant to block smoking alternatives that have small or imaginary risks, but that seems to be changing over the last year.

“A bill supported by the nation’s largest cigarette maker that was signed into law earlier this year by Obama will keep producers of smokeless tobacco from truthfully telling smokers about the fact that smoking is more dangerous to their health than smokeless tobacco. That will harm public health, as advocates like Bill Godshall of Smoke Free Pennsylvania have noted.”


Thursday, March 28, 2013

Two teas a day reduces prostate cancer risk 'by a third', but coffee offers no benefit

So tea drinkers in a coffee drinking nation (the USA) were more elite and so had better health.  Will the sociological naivety among medical researchers ever stop?

Men who drink at least two cups of tea a day could slash their risk of prostate cancer by more than a third, according to new research.

Regular tea drinkers were 37 per cent less likely to develop a tumour than those who drank it less than once a week.

But there was no benefit from coffee, according to scientists at Maastricht University in the Netherlands, where the latest study was carried out.

Nearly 40,000 cases of prostate cancer are diagnosed every year in the UK and 10,000 men die from it - the equivalent of more than one an hour.

The risks increase with age, with men over 50 more likely to develop a tumour, and there is a strong genetic element to it.

As with some other types of cancer, diet is thought to be a key factor in the development of the disease.

But there has been conflicting evidence on the role of popular beverages.

Last year, for example, a study at Glasgow University found heavy tea drinkers were more at risk of the disease.

It tracked the health of more than 6,000 male volunteers over a period of 37 years and found those consuming over seven cups a day had a 50 per cent higher risk of prostate cancer than moderate and non tea drinkers.

But the researchers stressed they could not be sure if tea really was a risk factor, or if drinkers lived to ages where cancer was more common.

In the latest study, the Maastricht University team compared 892 men diagnosed with prostate cancer with a similar number who were in good health, studying their dietary and drinking habits.

The study was carried out on a population of men in the US, where coffee is much more popular.

Only one in five volunteers drank at least one tea a day, compared with nearly 60 per cent when it came to coffee.

But the results, published in the journal Cancer Causes Control, showed two or more teas a day appeared to have a powerful anti-cancer effect, while coffee had none.

The study did not examine how tea might help to prevent prostate tumours but previous investigations have found it contains disease-fighting chemicals, called polyphenols, that may protect vital tissues and organs against an invasion of cancerous cells.

A 2010 study discovered women drinking just one cup of tea a day were ten per cent less likely to suffer ovarian cancer.

In a report on the latest findings researchers said: 'This is further evidence that tea consumption may be a modifiable exposure that reduces the risk of prostate cancer.'


Pesky! Whole Milk Or Skim? Study Links Fattier Milk To Slimmer Kids

The job of parenting toddlers ain't easy. Consider the 2-year-old to-do list: Get tantrums under control. Potty train. Transition from whole milk to low-fat milk.

Speaking from experience, only one of these things was easy.  As my daughter turned 2 in January, we made the simple switch to reduced-fat milk. Done. Don't need to overthink this one, right?

After all, I'm following the evidence-based advice of the American Academy of Pediatrics.

The guidance is based on studies that found children who consumed low-fat milk as part of a reduced-saturated-fat diet had lower concentrations of LDL cholesterol. Given the body of evidence in adults linking high cholesterol to increased risk of heart disease, it makes sense to keep an eye on cholesterol, beginning in childhood.

And if you take fat out of milk, you've also reduced calories, which should help protect kids against becoming overweight. At least, that's been the assumption.

So here's where things gets confusing. A new study of preschool-aged children published in the Archives of Disease in Childhood, a sister publication of the British Medical Journal, finds that low-fat milk was associated with higher weight.

That's right, kids drinking low-fat milk tended to be heavier.

"We were quite surprised" by the findings, Dr. Mark DeBoer told me in an email. He and his co-author, Dr. Rebecca Scharf, both of the University of Virginia, had hypothesized just the opposite.

But they found the relationship between skim-milk drinkers and higher body weights held up across all racial/ethnic and socioeconomic groups. DeBoer says their data also show that low-fat milk did not restrain weight gain in preschoolers over time.

The study included about 10,700 children in the United States. Parents were interviewed about their child's beverage consumption on two occasions: once when the children were 2 years old and again at 4 years. Direct measurements of height and weight (to calculate body mass index) were taken by researchers.

Interestingly, this is not the first study to point in this direction.

In a 2005 study, researchers at Brigham and Women's Hospital reported that skim and 1 percent milk were associated with weight gain among 9-to-14-year-olds.

And a 2010 study by researchers at Children's Hospital in Boston, which also looked at preschool-aged children, found that higher intake of whole milk at age 2 was associated with a slightly lower BMI (body mass index). The researchers concluded that switching from whole milk to reduced-fat milk at 2 years did not appear to prevent weight problems in early childhood.

When you look at these studies together, DeBoer's findings become more intriguing, though it's unclear how higher fat could lead to lower weight.

One theory: It's possible that whole milk gives us a greater sense of satiety.

"This is speculative," says DeBoer, but if you feel fuller after drinking whole-fat milk, "it may be protective if the other food options are high in calories." In other words, if whole-fat milk saves a kid from eating an extra cookie or a second serving of mashed potatoes, he or she may end up eating fewer calories overall.

As the authors acknowledge, one of the shortcomings of the new study is that the researchers did not know how many calories the children were consuming overall or what types of foods they were eating.

So is it time to think anew about switching toddlers to low-fat milk?

"I don't think there is harm in rethinking a recommendation, particularly if there weren't rigorous data behind it," says DeBoer. He says he hopes his results lead to further, more definitive studies.

But not everyone is convinced. "I do think that the recommendation to give low-fat milk at age 2 is sound advice," says Dr. Stephen Daniels, a pediatrician at the University of Colorado and member of the AAP's Committee on Nutrition.

"I don't think the link between low-fat milk and higher weight makes much sense from a biological perspective," he says.

Some of the earliest studies evaluating diets low in saturated fat and cholesterol did find a link to less obesity among girls. And Daniels points out that in the new study, the toddlers who were on low-fat milk were already heavier.

"This leaves open the real chance that parents may have been choosing low-fat milk as a weight-management strategy for those who were already overweight," Daniels says.

Parents, if this leaves you confused, one thing to keep in mind is that — whether it's whole, 2 percent or skim — milk is probably not a major driver when it comes to childhood weight problems. Many studies have shown that sugar-sweetened beverages play a much bigger role.


Wednesday, March 27, 2013

Has your water got sufficient ions?

Beware sarcasm

After so many years of neglect, water appears ready to emerge as a cutting-edge health food.

Perhaps it's the fault of Gatorade, that Technicolor concoction of salt, sugar and water people guzzle to "replenish their electrolytes." The Gatorade inventors, some dweeby physiologists, were just trying to keep football players from collapsing in the Florida heat. They could not have foreseen what was to transpire in the decades ahead as the concept of the "sports drink" took hold, and then, more bizarrely yet, water itself became a symbol of health and status.

With each iteration, beginning with bottled waters derived from glaciers (tres European) to the recent "enhanced water," H2O has moved closer to the first-class cabin. But the latest version is a real head-scratcher: ionised, alkalinised water.

Companies are in the game to sell you a gizmo to run your tap water through. The devices contain electrodes that purport to realign your water, split off some hydrogen atoms along the way, and rid it of various pesky problems so that it will taste better and be healthier and your arthritis will go away. In a week. Maybe two.

Water, in the western world at least, is a strange target for an expensive course in self-improvement. Top-notch plumbing remains perhaps our greatest achievement. We confront many ubiquitous environmental risks daily, but water is not among them. It is safe and unobjectionable. Plus it's cheap - and yet Americans spent $21 billion last year on bottled water.

So why all the excitement about ionised water? And didn't we go through this already with air? We were going to ionise air, too, to purify it - until that didn't work out so well. In fact, Sharper Image, a purveyor of one of these air ioniser products, lost a large lawsuit because of their too optimistic claims.

Having read many articles and viewed countless videos about ionisation and alkalisation of water, I remain uncertain how the technology being hawked will help a single soul. There isn't even a crummy clinical trial to criticise. Nothing.

Even by health fad standards, the science around ionisation and alkalinisation is remarkably thin. Here is the claim: We are ingesting food and drink that is set at a disadvantageous pH. You remember pH, the measure of acidity and its opposite, alkalinity (or baseness, as in acid-base balance), where perfect Swiss neutrality is 7.0. Any number below 7.0 refers to an acidic substance and any number above, alkaline.

A more important pH to remember is this: 7.4. That's the pH of the human bloodstream. We work very hard to stay exactly there. Every chemical reaction, all trillion or two our cells crank through daily, is optimised for 7.4. The body does not work well outside a tight range between 7.35 and 7.45; indeed much more variation and you're liable to drop dead. Here's an example of how seriously our body takes its ambient pH. People with emphysema retain carbon dioxide in the distorted nooks and crannies of their lungs, and the carbon dioxide converts to a mild acid that would upset the body's entire acid-base balance. Your heroic kidneys compensate for the extra acid by hanging onto bicarbonate, thereby maintaining the 7.4 pH and keeping the body from collapsing.

The body has a floating buffer system that shifts back and forth from the mildly alkaline (bicarbonate) to the mildly acidic (carbonic acid), depending on the need. The stomach, though, is a factory of harsh acid, creating a pH of 2 or so - the better to denature bacteria and viruses and anything else that might make you sick. So the idea that moving some water from a pH of 7.0, where it usually lives, to a pH of maybe 8.5 and claiming a major health triumph is quite puzzling. The premise, I think, is that slightly increasing the pH in your stomach will keep the stomach from having to secrete so much acid and in turn spare the pancreas from squirting out so much bicarbonate, thereby giving all your organs a bit of a holiday. And that holiday means we don't have pains or arthritis or die, maybe.

So that's alkalinisation. Ionising water for health is even more difficult to comprehend, but here goes: The ioniser splits water into its component parts, hydrogen and oxygen. The idea is that cleaving emancipates enslaved atoms from water's neutral charge (hydrogen is positive and oxygen is negative) and that this liberation is salutary. You're suddenly full of electricity, and everything feels better! This view that more ions are welcome stands in direct opposition to the free radical theory of disease. There, the bad guy is - you guessed it - a rogue negative charge looking for some unsuspecting molecule to glom onto and destroy, making you age and get arthritis and grey hair and all the problems that ionisation sets out to cure.

Water ionisation and alkalinisation is another fad without science to support it or even a particularly interesting group of nuts pitching it.

But so what? One could argue that there is nothing wrong with snake oil, that the crime is victimless but for the money lost. Surely it is unlikely that people will ionise or alkalinise their way to illness. There is harm, however, in all of this, similar to the harm that comes from tolerating a parallel universe of chronic Lyme and antioxidant cures and autism-causing vaccines and countless other persistent, willful misconceptions of what cold-hearted, gimlet-eyed science long ago has disproved.

Medicine and science are fragile entities, easily tarred and assaulted. People love to hate conventional remedies and advice, the schoolmarmish admonishments to eat less, exercise more and wear a seat belt for gosh sake. How much more fun to embrace a retro-futuristic water ioniser that does whatever it does and makes the willies all go away. Stacked up against that sort of promise, what chance does methodical, earthbound science really have? Eventually it is the physician who seems the narrow-minded, dim-witted charlatan stuck on boring Earth, heavy shoes pulled down by gravity. Because it turns out that it is not science that people want but science fiction.


Parkinson's drug 'helps' the elderly think younger and reap the rewards from the choices they make

At least this is a study of actual live people --JR

A drug used to treat Parkinson’s Disease could help older people make better decisions, say researchers.

As you get older you begin to lose the ability to learn from experiences, meaning you are less likely to be able to predict the chance of getting a reward from choices made.

This part of the brain, called the nucleus accumbens, is responsible for interpreting the difference between expected reward and actual reward.

These predictors, which come from a brain chemical called dopamine, helps us learn from our actions and in turn make better decisions in the future.

However, a drug widely used on Parkinson’s sufferers could help reverse this process helping older people think as they did when they were younger, according to a new study published in journal Nature Neuroscience.

Dr Rumana Chowdhury, who led the study at the Wellcome Trust Centre for Neuroimaging at University College London, said: 'We know that dopamine decline is part of the normal aging process so we wanted to see whether it had any effect on reward-based decision making.

'We found that when we treated older people who were particularly bad at making decisions with a drug that increases dopamine in the brain, their ability to learn from rewards improved to a level comparable to somebody in their twenties and enabled them to make better decisions.'

Researchers used behavioural testing and brain imaging techniques, to investigate the decision-making process in 32 healthy volunteers aged in their early seventies compared with 22 volunteers in their mid-twenties.

Older participants were tested on and off L-DOPA, a drug that increases levels of dopamine in the brain known as Levodopa, widely used to treat Parkinson’s.

The participants were asked to complete a behavioural learning task called the two-arm bandit, which mimics the decisions that gamblers make while playing slot machines. Players were shown two images and had to choose the one that they thought would give them the biggest reward.

Their performance before and after drug treatment was assessed by the amount of money they won in the task.

Dr Chowdhury said: 'Older volunteers who were less able to predict the likelihood of a reward from their decisions, and so performed worst in the task, showed a significant improvement following drug treatment'.

Researchers also looked at brain activity as particpantsn played the game using functional Magnetic Resonance Imaging (MRI).

They measured connections between areas of the brain that are involved in reward prediction using a technique called Diffusor Tensor Imaging (DTI).

The findings reveal that the older adults who performed best in the gambling game before drug treatment had greater integrity of their dopamine pathways.  Older adults who performed poorly before drug treatment were not able to adequately signal reward expectation in the brain - this was corrected by L-DOPA and their performance improved on the drug.

Dr John Williams, Head of Neuroscience and Mental Health at the Wellcome Trust, said: 'This careful investigation into the subtle cognitive changes that take place as we age offers important insights into what may happen at both a functional and anatomical level in older people who have problems with making decisions.

'That the team were able to reverse these changes by manipulating dopamine levels offers the hope of therapeutic approaches that could allow older people to function more effectively in the wider community.'


Tuesday, March 26, 2013

Traffic pollution causes as much childhood asthma as passive smoking (?)

This old chestnut seems to have eternal life.  There is no new data here -- just the hoary old epidemiological speculation

A study conducted in 10 European cities found that 14 per cent of chronic childhood asthma was due to pollution near busy roads.  This is similar to the burden linked to inhaling second hand tobacco smoke.

Between 4 per cent and 18 per cent of asthma cases in children are associated with passive smoking.

Lead scientist Dr Laura Perez, from the Swiss Tropical and Public Health Institute in Basel, said: 'Air pollution has previously been seen to trigger symptoms but this is the first time we have estimated the percentage of cases that might not have occurred if Europeans had not been exposed to road traffic pollution.

'In light of all the existing epidemiological studies showing that road traffic contributes to the onset of the disease in children, we must consider these results to improve policy making and urban planning.'

The findings are reported in the online version of the European Respiratory Journal.

Scientists used data from existing studies showing that children exposed to higher levels of traffic pollution also had higher rates of asthma.

A method known as population attributable fractions was employed to assess the impact of pollution near roads.

This calculates the proportional reduction in disease or death that would occur if exposure to a risk factor was lowered.

The results took account of differences in the health of different city populations, as well as other factors including passive smoking and socio-economic background.


Sweet! Just in time for Easter, scientists find chocolate cuts risk of stroke  -- but only if you're lying down

A lot of maybes below

Just in time for Easter, it's the news chocolate lovers have dreamt of – official confirmation that their favourite guilty pleasure can be good for you.

New research shows that eating just a single chocolate bar has a direct effect on the brain and may cut the risk of stroke.

Previous research has shown eating dark chocolate in moderation could be good for you. But the latest study, in the journal Neurology, shows for the first time how chocolate affects blood vessels.

Researchers at Glasgow University measured the speed of blood flowing through the biggest artery in the brain while subjects ate chocolate lying down.

They found that the chocolate had an effect on carbon dioxide levels which affected blood vessels, improved blood flow and, in turn, impacted on brain cells.

Professor Matthew Walters, who led the study, told The Mail on Sunday: 'Consumption of a normal chocolate bar was associated with a change in stiffness of the blood vessels.  'Our data is consistent with a direct effect of chocolate on the brain blood vessels.

'It raises the possibility that there is a direct effect of some component of the chocolate on blood vessels. This is plausible because of the flavonoid molecules contained in chocolate.

'We think a reduction in stroke risk may be caused by chocolate changing how brain blood vessels behave.'

The beneficial flavonoids, found in the cacao plant and others, are antioxidants that contribute to the prevention of heart disease.

However, chocolate  also has a high sugar and fat content which can cause obesity –  a definite risk factor for strokes.

Tom Solomon, professor of neurology at Liverpool University, said: 'We have to take the findings with caution.'


Monday, March 25, 2013

You might as well stay on the couch because keeping fit 'can't stop our muscles ageing'

Millions of us spend hours sweating and straining in the gym hoping to keep ourselves looking younger than our years.  But when it comes to slowing down the ageing process, you might as well stay on the couch.

According to scientists, regular exercise will not stop our muscles losing their tone and shape. The findings challenge the long-held belief that inactivity is largely responsible for muscle wastage in our older years.

Professor Jamie Timmons, from Loughborough University, said the research shows 'a simple link between muscle ageing and lack of exercise is not plausible'.

He added: 'When it comes to tackling ageing, experts are advising the Government that muscle ageing is caused by factors such as inactivity. However, we looked at the changes in human muscle with age, in both people from the UK and the USA.

'We did not observe physical activity altering the age-related biological changes. So for some people exercise might produce some good functional effects, but for others it will not stop the loss of muscle.'

Professor Timmons said a quarter of people 'just cannot grow muscle tissue' even when they make an effort to be physically active.

And he stressed that a 'one-size-fits-all' approach will not be effective when it comes to stopping muscles from withering away.

The researchers found specific chemical markers, or fingerprints, for muscle ageing. Once they identified the chemical signatures, the scientists were able to see how they reacted to endurance training.

They were looking for improvements in the patients who were exercising. But they soon realised that the volunteers' hard work in the gym did not stop their muscles from deteriorating.

Professor Timmons, who specialises in systems biology at Loughborough's Sport, Exercise and Health Sciences department, said: 'We found there is absolutely no connection. The major problem with ageing is loss of muscle, but 25 per cent of people don't respond to exercise and grow muscle.'

He warned that repetitive exercise could cause more than one in ten people to suffer high blood pressure and place 9 per cent at higher risk of diabetes. He said: 'Our public health strategy is to focus on physical activity, which in many cases doesn't work.

'For some people, the focus may be better spent on looking at their diet or sleep.'

The findings will come as bad news to exercise-obsessed stars who have attempted to maintain their youthful looks.

Despite her rigorous fitness regime, it is often pointed out that Madonna's hands and the veins on her arms make her look every one of her 54 years.

Last year Meg Ryan, 51, turned heads for all the wrong reasons after being spotted with blood vessels protruding from her arms.

And Sex And The City star Sarah Jessica Parker, now 47, has been forced to reduce her daily workout after her designer gowns revealed her bulging veins and sinewy biceps.

Prominent veins are usually a sign of over-exercising, and they become more evident as the body ages.


Response to Drescher on cancer and chemicals

Last week, Fran Drescher responded to my Huffington Post article on cancer trends, and today I posted a reply on the Independent Women’s Forum Inkwell blog. In a nutshell, I praise Drescher for her work promoting early detection and a healthy lifestyle that includes both a good diet and exercise, but her focus on chemicals as a significant cancer cause is problematic.

Her basic argument on the Huffington Post was as follows: Most cancers are caused by “environmental factors” and since trace chemicals are present in the human body we should take action to eliminate or reduce them if for no other reason than to simply err on the safe side.

It’s true that “environmental factors” are the cause of most cancers, but researchers define these factors as anything but genetics. As I noted in my article and elsewhere, environmental factors include tobacco, dietary choices, infections, natural radiation, and reproductive behavior among other things. Trace chemicals in consumer products are not a demonstrated cancer source.

What about the fact that chemicals are found in the human body? In its Fourth National Report on Human Exposure to Environmental Chemicals the Centers for Disease Control and Prevention (CDC) explains: “The presence of an environmental chemical in people’s blood or urine does not mean that it will cause effects or disease.” The real question is: Is exposure from consumer products ever really high enough to raise concerns about cancer?

“These everyday exposures are usually too small to cause health problems,” says the Agency for Toxic Substances and Disease Registry in its booklet titled “Chemicals, Cancer and You.” In fact, as humans increased our use of manmade chemicals, cancer rates have declined—the reverse of what you’d expect if they posed significant risks.

Finally, the idea that we should eliminate certain products “to be on the safe side” ignores the fact that these chemicals have benefits. When we arbitrarily eliminate them — either by regulation or simply bad publicity — we lose those benefits and potentially create more risks. For example, bans on the pesticide DDT — rather than policies to manage risks — have contributed to millions of deaths every year. Similar policies to ban chemicals used to make plastics and resins — including medical devices, blood bags, water bottles, and sanitary food packaging – may create additional risks for society, including some that are deadly.

So to erring on the “safe” side, I’d rather we focused on science, risk assessment, and ultimately consumer choice.


Sunday, March 24, 2013

Eating too much salt blamed for 2.3 million deaths a year worldwide... ten times more than sugary drinks (?)

This is just epidemiological batshit -- based  on the profound wisdom that correlation is causation.  I would like to see just ONE case of a person eating normal foods and in normal health who clearly died of excess salt consumption.  And even the epidemiology is not kind to the claim.  Japanese eat huge amounts of salt but are unusually long-lived.  That's one heck of an "outlier"

Excessive salt consumption accounts for an estimated 2.3 million deaths a year overshadowing the dangers of consuming sugary drinks.

Fifteen per cent of all deaths from heart attacks, strokes and other heart-related diseases throughout the world in 2010 were caused by eating too much salt according to research presented at the American Heart Association.

A recent Harvard study had found that sugary drinks contribute to the deaths of around 180,000 people annually, but these latest finding are much more worrying.

'National and global public health measures, such as comprehensive sodium reduction programs, could potentially save millions of lives,' said lead author of the study and associate professor of medicine and epidemiology at the Harvard School of Public Health Dariush Mozaffarian.

'The burden of sodium is much higher than the burden of sugar-sweetened beverages.  'That’s because sugar-sweetened beverages are just one type of food that people can avoid, whereas sodium is in everything.'

The researchers analyzed 247 surveys of adult sodium intake, stratified by age, gender, region and country between 1990 and 2010 as part of the 2010 Global Burden of Diseases Study, an international collaborative study by 488 scientists from 303 institutions in 50 countries around the world.

Nearly one million of these deaths – 40 percent of the total -- were premature, occurring in people 69 years of age and younger.

Sixty per cent of the deaths occurred in men and 40 percent were in women. Heart attacks caused 42 percent of the deaths and strokes 41 percent. The remainder resulted from other types of cardiovascular disease.

Eighty-four percent of these deaths due to eating too much sodium were in low and middle-income countries, rather than high-income countries.


Computer games: Court rightly finds a scientific "consensus" to be wrong

Do gooders regularly condemn computer games despite a lot of evidence that they do no harm.  The collective body of American psychologists has regularly ignored the body of research in their own field and joined the alarmists.  Chris Ferguson has written a long paper showing that SCOTUS was right to hose down the alarmists.  Below is just the summary.  I wonder what, if anything,  the obnoxious Susan Greenfield will have to say about it

In June 2011 the U.S. Supreme Court ruled that video games enjoy full free speech protections and that the regulation of violent game sales to minors is unconstitutional. The Supreme Court also referred to psychological research on violent video games as “unpersuasive” and noted that such research contains many methodological flaws. Recent reviews in many scholarly journals have come to similar conclusions, although much debate continues.

Given past statements by the American Psychological Association linking video game and media violence with aggression, the Supreme Court ruling, particularly its critique of the science, is likely to be shocking and disappointing to some psychologists.

One possible outcome is that the psychological community may increase the conclusiveness of their statements linking violent games to harm as a form of defensive reaction. However, in this article the author argues that the psychological community would be better served by reflecting on this research and considering whether the scientific process failed by permitting and even encouraging statements about video game violence that exceeded the data or ignored conflicting data.

Although it is likely that debates on this issue will continue, a move toward caution and conservatism as well as increased dialogue between scholars on opposing sides of this debate will be necessary to restore scientific credibility.

The current article reviews the involvement of the psychological science community in the Brown v. Entertainment Merchants Association case and suggests that it might learn from some of the errors in this case for the future.


Friday, March 22, 2013

Men who have daughters after the age of 50 are 'twice as likely to have a grandchild with autism'

This is all rather improbable and the effect is small anyway.  It is unusual to have children late in life and for some such people late marriage may reflect poor mental health.  That they pass on a tendency towards poor mental health should be no surprise.  Thus it is probably poor mental health rather than age which is the causative factor

Men who have daughters when they are over 50 have almost double the risk of a grandchild being diagnosed with autism.  The risk to grandchildren from older fathers of sons is also higher than for younger dads, warn psychiatrists.

Mounting research suggests the older age of parents might be partly responsible for growing numbers of children with autism, but for the first time the risk of autism in the grandchild has been linked to the age of the grandfather at the time of his child's birth.

Findings from a new study suggest that genetic risk factors for the condition accumulate over generations.

Researchers from Britain, Sweden and Australia analysed the family and psychiatric records of almost 6,000 individuals with autism born in Sweden from 1932.  The data was compared with that from 31,000 unaffected members of the population.

The age when grandfathers on both sides had children was analysed and details of any psychiatric diagnosis considered.

The study found that autism risk in a grandchild increased the older the grandfather was when his son or daughter was born.

Men who had a daughter at the age of 50 or older were 1.79 times more likely to have a grandchild with autism than those aged 20 to 24.  Having a son at 50 or older increased a man's chance of having an autistic grandchild 1.67 times.

The findings were published in the journal JAMA Psychiatry.

In the UK, around one in 100 adults is thought to be affected by autism, mostly men, although the true rate is far higher according to some researchers.

Autism is an umbrella term for a range of developmental disorders that have a lifelong effect on someone's ability to interact socially and communicate.

Study co-author Dr Avi Reichenberg, from King's College London's Institute of Psychiatry, said:

'We tend to think in terms of the here and now when we talk about the effect of the environment on our genome. For the first time in psychiatry, we show that your father's and grandfather's lifestyle choices can affect you.

'This doesn't mean that you shouldn't have children if your father was old when he had you, because whilst the risk is increased, it is still small. However, the findings are important in understanding the complex way in which autism develops.'

Lead researcher Emma Frans, from the Karolinska Institute in Stockholm, said: 'We know from previous studies that older paternal age is a risk factor for autism

'This study goes beyond that and suggests that older grandpaternal age is also a risk factor for autism, suggesting that risk factors for autism can build up through generations.'

Autism is known to be caused by a combination of genetic and environmental factors.

Previous studies have shown that fathers aged 50 and older are more than twice as likely to have a child diagnosed with autism than younger fathers, while some research suggests older mothers may also be more at risk.

Experts think the link with paternal age could be explained by genetic errors creeping into sperm production as men get older.

The new research suggests that 'silent' mutations that leave a son or daughter unaffected may increase the risk of autism in later generations.

A combination of mounting mutations and interactions with other risk factors including persistent environmental chemicals in the body could finally cause the disorder to emerge.


Statins bad for kidneys (and other things)

Taking statins in high doses increases the risk of emergency hospital treatment for kidney damage, warn researchers.

They found patients taking high potency statins had a 34 per cent higher risk of being hospitalised for acute kidney injury, compared with those taking low doses.

Those in the high-risk group were taking 40 milligram and higher statin pills.

More than eight million adults take statins, with most taking 20-40 mg of simvastatin a day. They are the most widely prescribed drugs in the UK, with about 61 million prescriptions in England alone in 2011.

Anti-cholesterol drugs are used to reduce the risk of cardiovascular disease, with higher doses for those most at risk, and previous research has suggested they may trigger  kidney side effects.

Canadian researchers carried out an analysis comparing patients prescribed high potency statins to those who were prescribed low potency statins in seven Canadian provinces and two international databases (UK and U.S.) between 1997 and 2008.

The health records of two million people were used from the Canadian Network for Observational Drug Effect Studies for those with and without chronic kidney disease. The average age was 68 years.

The drugs Rosuvastatin at doses of 10mg or higher, atorvastatin at doses of 20mg or higher, and simvastatin at doses of 40mg or more were defined as high potency and all others as low potency.

High potency statin users were 34 per cent  more likely to be hospitalised for acute kidney injury (AKI) compared with low potency statin users in the first 120 days of treatment.

Rates were not significantly increased in patients with chronic kidney disease. This risk seemed to remain elevated for two years after starting treatment.

The researchers estimate that 1,700 patients with no previous kidney problems need to be treated with a high potency statin instead of a low potency statin in order to cause one additional hospitalisation.

But the risk could have been ‘underestimated’ they say in a report in the online medical journal

The researchers conclude that prescribing high potency statins is ‘associated with an increased rate of hospital admission with AKI compared with lower potency statins’.

The most serious adverse reaction to statins is myopathy in about one in 1,000 users, resulting in muscle pain, tenderness and weakness.

This condition can progress to rhabdomyolysis - a complete breakdown of muscle cells that can lead to kidney failure and death.

In some patients muscle weakness may persist even after stopping the drugs.

Other side-effects include cataracts, constipation or diarrhoea, headaches, loss of appetite and loss of sensation or pain in the nerve endings of the hands and feet.

The Medicines and Healthcare Regulatory Products Agency has warned about additional risks of sleep disturbances, memory loss, sexual dysfunction, depression and (very rarely) interstitial lung disease.

The risk of type 2 diabetes is raised by 12 per cent with high dose statins compared with moderate doses, according to a study.

Lead researcher Professor Colin Dormuth, of the University of British Columbia, Vancouver, said further investigation was necessary to determine how statins might be causing kidney injury.

It could be due to the increased risk of rhabdomyolysis, or  because use of statins can deplete the body's stores of CoQ10, a naturally-occurring nutrient important for energy production in cells.

Some studies suggest statins may protect against health problems, including blood clots, Alzheimer's and eye disorders, by maintaining a healthy supply of blood to the brain.

They may also cut the risk of dying from pneumonia.


Thursday, March 21, 2013

Feeling anxious or depressed 'dramatically increases' the risk of dying from a heart attack

A lot of depressed people probably had good reason for it:  Poorer health.  My health problems sometimes depress me.  So the depression is a symptom, not a cause

Feeling depressed or anxious dramatically increases the chances of heart patients dying, new research suggests.

Death rates among those with heart disease who also suffer from anxiety and depression are tripled, one study found.

A separate team showed that moderate or severe depression increased the risk of death among patients with heart failure four-fold.

Almost 1,000 patients with an average age of 62 took part in the heart disease study, published in the Journal of the American Heart Association.

All answered questions about their feelings immediately before and after an invasive hospital procedure.

Doctors used tests based on common symptoms to decide whether participants were depressed or anxious.

Among the 133 patients who died during the next three years, 55 suffered from either one or both of the conditions.

Anxiety and depression were found to influence the risk of death in different ways. High blood pressure was strongly linked to anxiety, which on its own doubled the risk of dying from any cause.

Depression was more associated with behavioural risk factors, such as smoking and not taking medication.

Previous studies have already found that depression reduces the survival of heart disease patients and triples the risk of heart attacks.

However, this may have been partly because depressed patients are likely to be anxious as well, experts believe.

'Many studies have linked depression to an increased risk of death in heart disease patients,' said lead scientist Dr Lana Watkins, from Duke University Medical Centre in Durham, North Carolina.

'It's now time for anxiety to be considered as important as depression and for it to be examined carefully.'

As well as being more likely to die, depressed patients with heart failure had double the chance of finding themselves hospitalised, the other study found.

Heart failure is a condition that causes extreme exhaustion as a result of blood not being pumped around the body efficiently.

A total of 402 men and women from the state of Minnesota with heart failure took part in a depression survey.

Based on the answers, 59 per cent were classified as having no depression, 26 per cent as having mild depression, and 15 per cent as having moderate to severe depression. The patients had an average age of 73.

Even those who reported mild depression had an almost 60 per cent increased risk of dying over the following 18 months.

Moderate to severe depression pushed up the risk four times compared with patients who were not depressed.

Only a third of the seriously depressed patients were taking medication for their condition, according to the findings published in the journal Circulation: Heart Failure.

'We measured depression with a one-time questionnaire so we cannot account for changes in depression symptoms over time,' said Dr Alanna Chamberlain, from the Mayo Clinic, Rochester, Minnesota, who led the study.

'Further research is warranted to develop more effective clinical approaches for management of depression in heart failure patients.'


Pesky! Overweight people with heart disease are 30% LESS likely to die early than their thinner counterparts

It's widely believed that being overweight is bad for your heart and can lead to premature death.

But new study shows that overweight heart disease sufferers are actually 30 per cent less likely to die early than their counterparts of a healthy weight.

The researchers, from University College London, also found that even obese cardiac patients are 15 per cent less likely to die young than those of a normal weight.

Dr Mark Hamer, the study leader, told MailOnline: ‘The most plausible reason is that the obese patient is treated more aggressively because they have more risk factors – like high cholesterol and high blood pressure – which mean that doctors prioritise them, but that is just speculation.

‘We didn’t really get to the bottom of it but it certainly shows that it is a bad idea to focus on weight – BMI is not always a good marker of health.’

He explained that it is important to look at other factors, such as exercise, because people can improve the health of their heart significantly by exercising, even if they do not lose weight.

Dr Hamer and his colleagues followed 4,400 cardiac patients who took part in the Health Survey for England and the Scottish Health Survey.

They found that less of the overweight patients died in the seven years that they were followed than did the normal weight patients.

The researchers at UCL were not the first to find that overweight heart patients had a lower chance of premature death than normal weight ones.

Dr Hamer also explained that there is some data from previous studies to support the suggestion that overweight patients receive more aggressive treatment.

Other recent research has shown that heart attack survivors who are exposed to air pollution are more likely to die young.

Experts at the London School of Hygiene and Tropical Medicine monitored more than 154,000 patients treated for heart attacks and angina for an average period of 3.7 years.

They found that higher levels of tiny sooty particles in the air increased death rates among survivors of acute coronary syndrome by 12 per cent.

Another recent study showed that all people who are overweight may outlive their thinner counterparts.

Men and women who are slightly plump - essentially carrying a few extra pounds - have longer lives than those of a normal weight, according to a study of more than three million people

However, those who were any bigger than this were around a third more likely to die during the months or years they were being studied than those of normal weight.


Wednesday, March 20, 2013

Want to slim AND repair creaky knees? Have a milkshake (?)

Nothing works for long

Liquid diets have had an image problem — the idea of losing weight by mixing sachets of powder into meal replacement milkshakes or soups makes dietitians very unhappy.  They worry that losing weight too quickly could be bad for you, and such plans don’t teach you how to eat healthily afterwards.

Indeed, many people do quickly put all the weight back on.

And then there are the pyramid-selling techniques behind some of these liquid diets, which have caused doctors to be especially cautious about making use of them.

But that poor image could be due a rethink following compelling new research suggesting low-calorie liquid diets can tackle obesity and reverse type 2 diabetes.

And it was backed by an editorial in the British Journal of General Practice last month.

For three months, all your food comes in the form of a nutritionally balanced drink. Either fruit or savoury-flavoured, it supplies 800 calories a day.

‘It’s a bit of a shock for the patients to start with,’ says Mahri Swanson, the practice nurse at the surgery. She adds: ‘These are people who could have been eating 3,000-4,000 calories a day.

‘For the first few days they are really hungry. But, surprisingly, most quite quickly say it’s OK, and within a week aren’t craving food.’

According to the February issue of the British Journal of General Practice, about 30 per cent of the 90 people taking part lost 15 to 20 kilos and kept it off for a year with a lot of support.

Several Scottish health authorities are planning to make liquid diets available through GPs  as a result.

Professor Mike Lean, chair of human nutrition at Glasgow University and a lead researcher on the trial, is having discussions with Diabetes UK about funding for a larger controlled trial of 200 people to properly test the  diabetic benefit.

‘The rising number of people who are obese or diabetic is going to cost billions,’ says Professor Tony Leeds, an obesity specialist who runs a clinic at the Central Middlesex Hospital in London and has been treating patients with liquid diets for years.

‘If these results are repeated, the savings could be huge.’

Indeed, in Denmark a liquid diet is about to become the first-line treatment for people with osteoarthritis of the knee.

This follows a study which found that when 175 osteoarthritis patients were put on a liquid diet they not only lost a lot of weight, nearly all of which was fat, but more than 60 per cent also showed significant improvement in pain and disability.

‘Until a few years ago all that was on offer for these patients was painkillers and advice to lose weight that rarely worked for long,’ says Professor Henning Bliddal, a rheumatologist at Frederiksberg Hospital who led the study.

‘Osteoarthritis normally makes bones weaker by reducing bone mineral density.

'But the bones of patients on the liquid diet improve, possibly because it contains the recommended daily allowance for all amino acids, fatty acids vitamins and minerals.

'This means they get extra vitamin D, which is vital for building bones.

‘About ten per cent of people over 55 have bad knees and are overweight, and the diet has changed the way we treat them,’ adds Professor Bliddal, who is running a trial to test the possibility that it can improve the structure of damaged cartilage in the knee.

The Danish study, published in the European Journal of Clinical Nutrition in 2011, concluded that the liquid diet was ‘effective and safe’.

In fact, despite concerns that a rapid drop in calories might be bad for you, emerging evidence suggests it may lower cholesterol levels.

Some researchers have even suggested it might even reduce asthma symptoms.

But whatever calorie restriction regimen — diet or liquid diet — it’s clear that a supportive and effective follow-up programme to make sure that the weight stays off is vital.

This has been a key part of the Scottish trial.

And it’s the special focus of the Rotherham Institute for Obesity, which over the past three years has helped the local population of 250,000 lose 17 tons between them — and halved the weight loss surgery rate in the first year (30 fewer patients have had the surgery, saving around £300,000).

The institute takes 2,000 referrals a year.

‘Our team of dietitians, fitness experts, psychologists and cooks make sure they have a good chance that any weight they have lost stays off,’ says Dr Matthew Capehorn, who heads the scheme and is also clinical director of the National Obesity Forum.

Under official guidelines from the National Institute for Health and Clinical Excellence (NICE), low-calorie diets are available on the NHS for people ‘who are obese and have reached a plateau in weight loss’.

The hope is that the new evidence will give GPs more confidence to use them.


Taking Vitamin D in pregnancy 'does not help babies develop stronger bones'

Levels of vitamin D in pregnant women may not affect the baby’s bone health - contrary to official advice, say scientists.

They found no link between a mother’s levels of the vitamin while carrying the child, and the latter’s bone health at the age of 10.

Current NHS guidance says all pregnant and breastfeeding women should take a 10 microgram vitamin D supplement every day, because it is believed to help build stronger bones in their offspring.

Professor Debbie Lawlor, who led the Children of the 90s study at Bristol University, said there was ‘no strong evidence’ that pregnant women should be taking vitamin D supplements.’

But other experts said some groups of women such as those getting little sunlight and the obese were more at risk of low vitamin D stores and they should still be encouraged to do so.

The study published in The Lancet medical journal assessed vitamin D levels in 3960 women throughout their pregnancy.

The bone mineral content (BMC), a measure of bone health, of their child was then assessed at an average age of 9.9 years.

Researchers measured vitamin D levels at all stages of pregnancy.

Levels were higher in summer months and lower among non-white mothers and those who smoked during pregnancy, but overall there was no significant link between a mother’s vitamin D levels and her child’s BMC.

Dr Tony Falconer, President of the Royal College of Obstetricians and Gynaecologists, said ‘We know that Vitamin D regulates the amount of calcium in the body, which helps to keep bones and teeth healthy, and low levels have been associated with problems relating to the baby’s bone formation and a higher risk of diseases such as rickets and osteoporosis in later life.

‘Some women are more at risk of having low vitamin D levels, these women include those of south Asian, black African, black Caribbean, or Middle Eastern origin, women who have limited exposure to sunlight, obese women (pre-pregnancy BMI >30) and those who eat a diet low in vitamin D. It is particularly important these women get their required dose.

‘As healthcare professionals, it is our role to reinforce the importance for proper diet and nutrition during pregnancy and throughout a woman’s lifespan.

'It is important that at-risk women are informed, at their first antenatal booking, of the importance of adequate vitamin D during pregnancy and after, to maintain their own and their baby’s health.

‘Further research is needed to look at vitamin supplementation including potential benefits, harms and optimal dosing.’


Tuesday, March 19, 2013

Crooked science at a major university

Crookedness that became known only because of one honest Chinese statistician  -- who got fired over it.  Maybe it's my Sinophilia showing but I think the Chinese in this matter are the only ones who come out of this with any honour.  The Chinese man involved in the fraud at least had the grace to commit suicide  -- while all the whites are stonewalling and covering up -- with no hint of penitence.

The journal should obviously have published  Yuan's critique immediately.  There was no need to refer it back to the crooked authors.  I have had several critiques of my work published without prior reference to me -- JR

The numbers didn’t add up.  Over and over, Daniel Yuan, a medical doctor and statistician, couldn’t understand the results coming out of the lab, a prestigious facility at Johns Hopkins Medical School funded by millions from the National Institutes of Health.

He raised questions with the lab’s director. He reran the calculations on his own. He looked askance at the articles arising from the research, which were published in distinguished journals. He told his colleagues: This doesn’t make sense.

“At first, it was like, ‘Okay — but I don’t really see it,’” Yuan recalled. “Then it started to smell bad.”

His suspicions arose as reports of scientific misconduct have become more frequent and critics have questioned the willingness of universities, academic journals and the federal government, which pays for much of the work, to confront the problem.

Eventually, the Hopkins research, which focused on detecting interactions between genes, would win wide acclaim and, in a coup for the researchers, space in the pages of Nature, arguably the field’s most prestigious journal. The medical school even issued a news release when the article appeared last year: “Studies Linked To Better Understanding of Cancer Drugs.”

What very few readers of the Nature paper could know, however, was that behind the scenes, Yuan’s doubts seemed to be having profound effects.

In August, Yu-yi Lin, the lead author of the paper, was found dead in his new lab in Taiwan, a puncture mark in his left arm and empty vials of sedatives and muscle relaxants around him, according to local news accounts — an apparent suicide.

And within hours of this discovery, a note was sent from Lin’s e-mail account to Yuan. The e-mail, which Yuan saved, essentially blamed him for driving Lin to suicide. Yuan had written to Nature’s editors, saying that the paper’s results were overstated and that he found no evidence that the analyses described had actually been conducted. On the day of his death, Lin, 38, the father of three young daughters, was supposed to have finished writing a response to Yuan’s criticisms.

The subject line of the e-mail to Yuan, sent by an unknown person, said “your happy ending.”

But in the seven months since, he has wondered why no one — not the other investigators on the project, not the esteemed journal, not the federal government — has responded publicly to the problems he raised about the research.

The passions of scientific debate are probably not much different from those that drive achievement in other fields, so a tragic, even deadly dispute might not be surprising.

But science, creeping ahead experiment by experiment, paper by paper, depends also on institutions investigating errors and correcting them if need be, especially if they are made in its most respected journals.....

While Yuan was growing increasingly skeptical of the lab’s methodology, Yu-yi Lin, who was also working at the lab, was trying to extend it. In the past, it had been applied to the yeast genome; Lin would extend it to the human genome — and this would become the basis of the Nature paper.

Lin, who was from Taiwan, was an up-and-comer. As a graduate student at Johns Hopkins just a few years before, he’d won an award for his work in cell metabolism and aging. He was also arranging for a prestigious spot at National Taiwan University.

At one point, when he was still at the Boeke lab at Hopkins, Lin asked Yuan to help analyze the data that would become the basis for the Nature paper, Yuan says. Yuan said he declined to get involved because he thought the methodology still had deep flaws.

Interactions between Lin and Yuan at the lab were few, Yuan said, and at any rate, Yuan had other things to worry about. He was slowly being forced out. He was demoted in 2011 from research associate to an entry-level position. A disagreement over whether Yuan should have asked Boeke if he wanted a byline on a paper erupted into further trouble, e-mail and other records show.

The Johns Hopkins spokeswoman, Hoppe, declined to discuss Yuan’s job termination.

On Dec. 15, 2011, Yuan was forced to leave the lab. He wasn’t allowed to make copies of his cell collection. He spent the next month trying to keep his mind busy. He read books about JavaScript and Photoshop, which he thought would enrich his research abilities. As he looked for other research jobs, he sensed that he had been blackballed.

Then, in February 2012, the Nature paper was published.

The research was a “profound achievement” that would “definitely be a great help to solve and to treat many severe diseases,” according to a news release from National Taiwan University, where Lin was now working.

Upon reading it, Yuan said, he was astonished that Lin had used what he considered a flawed method for finding genetic interactions. It had proved troublesome in the yeast genome, he thought. Could it have possibly been more reliable as it was extended to the human genome?

Lin, Boeke and their co-authors reported discovering 878 genetic interactions, or “hits.”

But Yuan, who was familiar with the data and the statistics, reanalyzed the data in the paper and concluded that there was essentially no evidence for any more than a handful of the 878 genetic interactions.

One of the key problems, Yuan wrote to the Nature editors, was that the numerical threshold the investigators used for determining when a hit had arisen was too low. This meant they would report far more hits than there actually were.

Yuan also calculated that, given the wide variability in the data and the relative precision required to find a true hit, it would have been impossible to arrive at any conclusions at all. By analogy, it would be like a pollster declaring a winner in an election when the margin of error was larger than the difference in the polling results.

“The overwhelming noise in the ..... data and the overstated strength of the genetic interactions together make it difficult to reconstruct any scientific process by which the authors could have inferred valid results from these data,” Yuan wrote to the editors of Nature in July.

His analysis attacks only the first portion of the paper; even if he is correct, the second part of the paper could be true.

Nevertheless, Yuan wanted Nature to publish his criticism, and following instructions from the journal, he forwarded his letter to Boeke and Lin, giving them two weeks to respond.

Just as the two weeks were to elapse, Boeke wrote to Nature asking for an extension of time — “a couple weeks or more” — to address Yuan’s criticism. Boeke explained that end-of-summer schedules and the multiple co-authors made it difficult to respond on time.

A day later, Lin was discovered dead in his office at National Taiwan University.

If there was a suicide note, it has not been made public, and it is difficult to know what went through Lin’s mind at the end of his life. The apparent suicide and the e-mail to Yuan suggest only that Lin may have been distraught over the dispute; they do not prove that he acted improperly.

Shortly after the Nature paper appeared, Yuan hired lawyer Lynne Bernabei to challenge the way he was terminated at Hopkins.

In late August, Yuan asked the Nature editors again whether they would publish his criticism. Lin was dead, but Boeke and the others had had a month to respond, and Yuan hadn’t heard a thing.

On Sept. 28, a Nature editor informed Yuan by e-mail that the journal was still waiting on a fuller response from Boeke and that “experiments are being done and probably a Correction written.”

Such a correction has not appeared.

So as a last attempt, he figured he’d try the federal government, which paid for much of the research. But the government suggested that the threat to the federal research, if there was any, ended with Lin’s death.

“It is our understanding that these allegations are being investigated by Johns Hopkins University,” said the letter from the Office of Research Integrity.


What if New York's Nanny Is Actually a Thug?

And what will they let the government do to us next?

 What if a dictator in America used the force of law to tell you what to eat? What if the same dictator told you what to drink? What if the dictator told you the sizes of the containers in which you could purchase a lawful beverage? What if the dictator just made up the rules according to his own personal taste? What if the product he regulated was lawful, sold nearly everywhere and consumed by nearly everyone? What if that product came in flavors and degrees of sweetness the dictator didn't like? What if that product was part of a huge national market that provides choices to consumers and jobs for those who want them? What if that product was simple soda pop?

What if the dictator declared that you could consume all the soda pop you wish to consume, but you need to purchase it in small containers? What if the enforcement of this container-size rule raised the price of soda pop? What if the container size was just something the dictator dreamed up? What if the dictator believed his judgment was superior to yours with respect to deciding what you should drink and how you should drink it?

What if the dictator pretended his container-size restrictions were based on sound science? What if he hired and appointed medical personnel who feared for their jobs if they did not agree with him? What if he ordered those people to support his container-size regulations whether or not they agreed that this is the proper role of government? What if he constituted these medical lackeys into a Board of Health? What if the Board of Health pretended it seriously studied the detrimental effect of sugar-based soda pop on human beings but never did?

What if the rules for container size were written in secret? What if those rules were so complicated that a judge concluded they would be impossible to enforce? What if the rules only applied to certain sugar-based drinks, such as soda pop and coffee, but not to others, such as chocolate milk and alcohol? What if the rules only applied to some stores and shops but not to all? What if the rules were so ridiculous that in order to buy a cup of coffee larger than 16 ounces, they required you to put milk and flavoring and sugar in yourself, and the seller of the coffee could not lawfully help you or do so for you, even at your request?

What if under the fundamental law of the land the dictator was not authorized by law to write laws but only to enforce them? What if the dictator knew that the governing body elected by the people to write laws would never write the laws he wanted because its members like power and fear losing it, which could happen if they try to tell the voters who elected them how to live? What if the dictator never presented his proposals on sugar-based drinks to the elected governing body because he knew they'd be rejected?

What if the dictator was more interested in his own legacy as a reformer than in personal liberty in a free society? What if he believed he could write any law and regulate any event because his knowledge of human behavior and unintended consequences was superior to that of the people he swore to serve?

What if the same dictator once made campaign contributions to members of the governing board so that they would change the fundamental law of the land -- which only the people directly can lawfully change -- so as to let the dictator stay in office longer than the fundamental law permitted? What if that law could only be changed by the voters themselves, but the dictator persuaded the lawmakers to take his campaign cash and change the fundamental law for him? What if the dictator was very unpopular but continued to impose his will on the people because he desperately wanted a legacy?

What if some people who sell soda pop challenged the dictator in a court he did not control? What if a judge of that court told the people they could buy soda and coffee in whatever sizes it was sold because the dictator did not have the power to regulate their intake of liquids? What if the judge even recognized that there are areas of human behavior immune to regulation by the government?

What if all of this really happened? What if this is not a fable but a fair recounting of life today in America's biggest city? What is the state of human freedom in New York City when the mayor can tell people what soft drinks to consume and how to consume them and the voters let him do it? What will they let the government do to us next?


Monday, March 18, 2013

The key to preventing a stroke? One coffee and four cups of green tea a day, say scientists

It is not clear who the comparison group is here.  I would have thought that ALL Japanese drank tea or coffee.  People in Japan who drink neither must be very poor  -- and THAT may be the reason for their worse health

When it comes to choosing between tea or coffee, the best answer may be to opt for both.

Scientists have found that individuals who enjoy a daily cup of coffee were 20 per cent less likely to have a stroke compared to those who shunned the drink.  And those that drank at least four cups of green tea a day also benefitted from a similarly reduced stroke risk.

But as the popular beverages are thought to protect against the often fatal condition in different ways, the study suggests regularly drinking both could provide the greatest benefit.

Researchers looked at the drinking habits of almost 84,000 Japanese adults over a 13-year period.

'This is the first large-scale study to examine the combined effects of both green tea and coffee on stroke risks,' said lead author Dr Yoshihiro Kokubo, from Japan's National Cerebral and Cardiovascular Centre.

'You may make a small but positive lifestyle change to help lower the risk of stroke by adding daily green tea to your diet.'

The study, published in American Heart Association's journal Stroke, found that the greater amounts of coffee or green tea consumed, the lower their stroke risk.

The report found that 'combination of higher green tea and coffee consumptions contributed to the reduced risk of stroke as an interaction effect for each other.'

But even in lower quantities, green tea helped protect against the condition, with those drinking between two to three cups seeing their chance of a stroke fall by 14 per cent.

Participants in the study were 45 to 74 years old and were free from cancer and cardiovascular disease, and all the findings were adjusted to take into account age, sex and lifestyle factors like smoking, alcohol, weight, and exercise.

Green tea drinkers in the study were more likely to exercise compared to non-drinkers, while coffee drinkers tended to be younger, and were more likely to smoke and take exercise

Although it is unclear how green tea affects stroke risks, scientists believe a compounds known as catechins may provide some protection to blood vessels.

Several chemicals in coffee are believed to provide a boost to health, including caffeine and chlorogenic acid, which researchers suggest could help cut stroke risks by lowering the chances of developing type 2 diabetes.

Both drinks also helped to protect from the risk of heart attacks, according to the researchers.  'The regular action of drinking tea, coffee, largely benefits cardiovascular health because it partly keeps blood clots from forming,' said Dr Kokubo.'

Research last year found the more coffee you drink, the less likely you are to die from a number of different ailments, including heart disease, respiratory disease, diabetes and infections - but not cancer.

Researchers at the National Cancer Institute, National Institutes of Health, Maryland, said they could not establish whether coffee was the cause of a lowered risk of death, but there was definitely a link.

The research, published in The New England Journal of Medicine, followed 229,000 men and 173,000 women aged between 50 and 71, between 1995 and 2008. Participants were classified according to how much coffee they drank.

There were 52,000 deaths during the period, with an 'inverse association' between coffee consumption and death. This means the greater the amount of coffee participants drank, the lower their risk of dying during the study.


Could manuka honey beat drug-resistant superbugs?

There has long been persuasive anecdotal evidence about this so it is good to see it put on a firmer footing

It is a natural medicine used for thousands of years to clean wounds and fight bacteria.  Now, however, honey could hold the key to combating the very modern threat of drug-resistant superbugs.

A study has shown that manuka honey can fight back on two fronts. Not only can it help to kill MRSA and other superbugs, it can also prevent bacteria from becoming resistant to antibiotics.

The danger of the rise of bugs which do not succumb to drugs was outlined this month by the Chief Medical Officer.

Professor Dame Sally Davies described it as a ‘ticking timebomb’ which could leave millions vulnerable to untreatable germs within a generation.

But a study in Australia offers a solution. At the University of Technology Sydney (UTS), tests were carried out on manuka, kanuka and clover honeys to find which was best at treating bacteria commonly found in chronic skin wounds

Researchers looked at key ingredients known to inhibit bacterial growth.

The best at doing this was Comvita medical-grade manuka honey, made by bees foraging on New Zealand’s manuka trees.

When combined with common antibiotics, the treatment hampered the spread of bacteria on wounds.

Crucially, scientists found the honey prevented the bugs from developing any resistance to the antibiotic.

Professor Liz Harry, of UTS, said: ‘Manuka honey should be used as a first resort for wound treatment, rather than the last resort, as it so often is.’

Commercial honey bought at shops is not suitable as it needs to be sterilised to make it medical grade.

Infections are becoming more difficult to defeat but no new class of antibiotic has been discovered since the 1980s.

It follows a previous study that found manuka honey is effective against more than 80 different types of bacteria, including hospital superbug MRSA.

Professor Liz Harry at UTS said: ‘We have shown bacteria do not become resistant to honey in the laboratory. Consistent with these facts, we also found that if MRSA were treated with just rifampicin [antibiotic], the superbug became resistant very quickly,’ she said.

‘However, when manuka honey  and rifampicin are used in combination to treat MRSA, rifampicin-resistant MRSA did not emerge. In other words, honey somehow prevents the emergence of rifampicin-resistant MRSA – this is a hugely important finding.’

With overuse of antibiotics partly blamed for the increase in resistant superbugs, GPs will be asked to prescribe fewer antibiotics to patients.

Dr Harry added: ‘With the existence now of bacteria that are resistant to all available antibiotics, and the death of new antibiotics on the market, manuka honey should be used as a first resort for wound treatment, rather than the last resort as it so often does.

‘What we need is an acceptance by society that antibiotics are not going to provide all that we hoped for when they were discovered in the 1940s; and that we need to start getting very serious about using alternatives to this, or use honey in addition to them.’

While all types of honey have some antibacterial properties, the ingredients of manuka honey make it particularly powerful.

It is possible to buy dressings that already contain the honey, as well apply honey directly to bandages and other dressings.

However, supermarket honey will not do.  Any honey used be sterilised to make it of medical grade.


Sunday, March 17, 2013

Breast cancer patients who eat cheese, yogurts or ice cream could HALVE their chances of survival

This is based on self-report data so is very low-quality information without controls.  Maybe the fatty food eaters were working class and less healthy because of that

One ice cream or yoghurt a day could hinder the survival of women with breast cancer, scientists say.  Those with the disease who eat a single portion daily of a product containing full-fat milk could be 50 per cent more likely to die.

US scientists suspect this is because milk and other dairy foods contain the hormone oestrogen, which encourages tumour growth.

There is already some evidence that diet plays a role in improving the chances of surviving cancer and preventing it returning. But this is the first study to show such a strong link between dairy products and breast cancer.

Around one in eight women will develop breast cancer at some point in their lives and there are around 50,000 new cases a year.

Although survival chances are far better than other forms of the illness it still leads to 11,800 deaths annually.

Scientists from the Kaiser Permanente research centre in California looked at the records of 1,500 women diagnosed with breast cancer between 1997 and 2000.

They had all completed questionnaires on how often they consumed dairy products, the sizes of portions and what specifically they ate.  The most common were ice cream, yogurts, cheese, full-fat lattes and hot chocolates.

The scientists found that those who ate just one portion of one of these products a day were 50 per cent more likely to die from the illness within 12 years.

They point out that most milk consumed in Britain and the U.S. comes from pregnant cows and is rich in the hormone oestrogen.  This is known to trigger tumour growth and there are particularly high levels in full-fat dairy foods.

In fact women who ate one portion of full-fat dairy a day were 64 per cent more likely to die from any cause - not just breast cancer.

Dr Bette Caan, who led the research said: 'High-fat dairy is generally not recommended as part of a healthy diet. 'Switching to low-fat dairy is an easy thing to modify.'

Many women who have just been diagnosed with breast cancer ask their doctor whether they should change their diet.

But so far there is just too little research on the subject for them to give any specific advice.

Susan Kutner, chair Kaiser Permanente Northern California Regional Breast Care Task Force, said: 'Women have been clamouring for this type of information.

'They're asking us, 'Tell me what I should eat?' With this information, we can be more specific about recommending low-fat dairy products.'

Sally Greenbrook, Senior Policy Officer at Breakthrough Breast Cancer, said: 'This study specifically looks at women who have already been diagnosed with breast cancer and how low or high fat dairy products may affect them.

'Any women who have had breast cancer and are concerned about their diet should discuss this with their doctors.

'For a number of health reasons it's advisable that all women should follow a healthy balanced diet. It helps you to maintain a healthy weight which, together with good practices such as lower alcohol intake and regular physical activity, can help to reduce your breast cancer risk and improve overall well-being.

'There are many risk factors for breast cancer, not just diet.' 


New Analysis Says Evidence Lacking for HRT-Breast Cancer Link

I said this from the beginning  -- and I have never received one cent from drug companies etc. -- JR

Although several large studies in recent years have linked the use of hormone therapy after menopause with an increased risk of breast cancer, the authors of a new analysis claim the evidence is too limited to confirm the connection.

Dr. Samuel Shapiro, of the University of Cape Town Medical School in South Africa, and his colleagues took another look at three large studies that investigated hormone therapy and its possible health risks -- the Collaborative Reanalysis, the Women's Health Initiative (WHI) and the Million Women Study.

Together, the results of these studies found overall an increased risk of breast cancer among women who used the combination form of hormone therapy with both estrogen and progesterone. Women who have had a hysterectomy and use estrogen-only therapy also have an increased risk, two of the studies found. The WHI, however, found that estrogen-only therapy may not increase breast cancer risk and may actually decrease it, although that has not been confirmed in other research.

After the WHI study was published in July 2002, women dropped hormone therapy in droves. Many experts pointed to that decline in hormone therapy use as the reason breast cancer rates were declining.

Not so, Shapiro said: "The decline in breast cancer incidence started three years before the fall in HRT use commenced, lasted for only one year after the HRT drop commenced, and then stopped."

For instance, he said, between 2002 and 2003, when large numbers of women were still using hormone therapy, the number of new breast cancer cases fell by nearly 7 percent.

In taking a look at the three studies again, Shapiro and his team reviewed whether the evidence satisfied criteria important to researchers, such as the strength of an association, taking into account other factors that could influence risk. Their conclusion: The evidence is not strong enough to say definitively that hormone therapy causes breast cancer.

The study is published in the current issue of the Journal of Family Planning and Reproductive Health Care.

The new conclusion drew mixed reactions from experts.

In an editorial accompanying the study, Nick Panay, a consultant gynecologist at the Queen Charlotte's & Chelsea Hospital in London, supported the conclusions of the new analysis. "If there is a risk, the risk is small, and the benefits of HRT can be life-altering," he wrote. "It is vital that we keep this in perspective when counseling our patients."

The hormone therapy in use today, Panay said, is lower in dose than those used in the previous research. "In principle, we tend to start with lower doses than we used to and increase as required until full symptom relief has been achieved," he said.

What is needed now, he said, is a clinical trial in which the hormone therapy in use today is compared with placebo, to evaluate the risks and benefits.

Another expert took a more middle-of-the-road view about the potential link.  "It would be hard to say the entire decline [in breast cancer rates] is due to the decline in HRT use," said Dr. Steven Narod, the Canada Research Chair in Breast Cancer at the University of Toronto.

According to Dr. Susan Gapstur, vice president of epidemiology for the American Cancer Society, the new analysis overlooks some other important information. "Indeed, there is a much larger body of scientific evidence from clinical trials and from observational epidemiologic studies comparing breast cancer incidence rates in women who used HRT to those who did not that demonstrate the risks and benefits of HRT for chronic diseases," she said.

"Women need to discuss with their doctors the risk and benefits of taking HRT for the primary prevention of chronic disease, including breast cancer," she added.

Narod said hormone replacement is an excellent therapy for some women. Therapy that includes progesterone carries more risk, he said, and limiting use to five years or less seems wise.

Shapiro has performed consulting work for the manufacturers of hormone therapy, and Panay has received grants from pharmaceutical companies.