Archive for the 'Science and Medicine' Category

Jul 20 2018

Cancer Patients Using Alternative Medicine Twice As Likely To Die

This is the second study published in the last year looking at outcomes of cancer patients using alternative medicine, showing a negative effect on survival. The same author, Skylar Johnson, was the lead author on both studies. Last year’s study looked at using alternative treatments instead of standard therapy, and the newly published study looks at patients who used at least one standard therapy.

In the current study, just published in JAMA Oncology, the researchers followed a cohort of 258 cancer patients who used alternative medicine, and 1032 matched patients who did not. They found:

Patients who chose CM did not have a longer delay to initiation of CCT but had higher refusal rates of surgery (7.0% [18 of 258] vs 0.1% [1 of 1031]; P < .001), chemotherapy (34.1% [88 of 258] vs 3.2% [33 of 1032]; P < .001), radiotherapy (53.0% [106 of 200] vs 2.3% [16 of 711]; P < .001), and hormone therapy (33.7% [87 of 258] vs 2.8% [29 of 1032]; P < .001). Use of CM was associated with poorer 5-year overall survival compared with no CM (82.2% [95% CI, 76.0%-87.0%] vs 86.6% [95% CI, 84.0%-88.9%]; P = .001) and was independently associated with greater risk of death (hazard ratio, 2.08; 95% CI, 1.50-2.90) in a multivariate model that did not include treatment delay or refusal.

All that means that cancer patients who used alternative medicine in addition to at least some standard therapy were more likely to refuse chemotherapy, radiation, or surgery. As a result patients using CM (complementary medicine, in the jargon chosen for the study) had a 5-year survival that dropped from 86.6% to 82.2%. This represents twice the risk of dying over this time.

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Jun 18 2018

Gut Microbiome and Anxiety

Humans are a symbiotic creature, like pretty much all other animals. It is estimated that there are as many bacteria in your body as there are human cells. Bacterial cells are much smaller, so this amounts to 1-3% of body weight.

Bacterial cells line all mucous membranes, where they serve critical functions. They are a critical part of our immune system, crowding out other bacteria and organisms that can potentially cause infection. Many of our bacteria live in the gastrointestinal system, our “gut microbiome” , “microbiota”, or “flora”, where they also aid in digestion.

As is often the case, scientists have been discovering that our relationship with our friendly bacteria is more complex than we thought. The microbiome is not a collection of random bacteria, but a stable ecosystem. There is also evidence that there are only a few distinct types of bacterial ecosystems in people. We have an “enterotype” which may affect our health.

There is also growing evidence that our gut microbiota not only have local effects within our GI system, but may have remote effects on the brain and nervous system. This suggests that some bacteria produce neurotransmitters, hormones, or some chemical signal that can get into the blood and then travel to other parts of the body and have an effect.

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Jun 07 2018

Homeopathy Loses NHS Case

The National Health Service (NHS) in England decided in November 2017 to stop funding homeopathic treatments. That was an excellent decision, made for the right reasons – “lack of robust evidence of clinical effectiveness”. While I think that is an understatement, it is true enough, and is sufficient justification for any modern health care system to abandon homeopathy.

Now a High Court Judge has affirmed that decision by the NHS. Why was a judge even involved? Because the British Homeopathic Association (BHA) sued the NHS over that decision.

Legally, this case was fairly straight forward. The judge was  clear to point out that it was not his job to review the scientific evidence regarding homeopathy. The BHA argued in court that there is “plain evidence that homeopathic treatment does work in particular cases”. That is complete nonsense – homeopathy is nothing but magic potions, with no scientific plausibility, and the scientific evidence clearly shows that it does not work for anything.

But the judge did not have to get into that in court, which is appropriate. It should not be for a judge to make scientific decisions like that. His job was to answer the BHA complaint that the NHS was being unfair in their decision. The judge ruled, however, that the NHS process was “fair and balanced” and that “there was no evidence of ‘bias or predetermination'”.

I do worry when such issues come up before courts or regulatory bodies. It is easy to make the claim of bias against those who are simply following the evidence. It would, for example, be easy to make the case that I am “biased” against homeopathy. After all, I have been regularly trashing the pseudoscience for years. But in reality I am just following logic and evidence. Correctly stating that something is pseudoscience is not a bias when it is the logical conclusion of a fair process.

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Jun 05 2018

Powering Implanted Devices

One of the cutting edge medical technologies that promises to be a game-changer in terms of our ability to affect biological function is the interaction between machines and biology. Of course we already have many medical devices, from cardiac pacemakers to artificial joints. Increasingly sick and aging humans are becoming cyborgs, as we augment and replace broken body parts with machines.

We have only scratched the surface of this potential, however, and the technology is advancing quickly. There are definitely technological hurdles that limit such technology, however, and perhaps chief among them is the need for power.

MIT researchers have recently presented a new method for powering implanted devices that may open the door to a further proliferation of implantable medical devices. They use radio waves as an external power source, which eliminated the need for cumbersome batteries.

Right now power is a major limiting factor for implantable medical devices. We can make small batteries, but they still become the largest part of many devices. Especially as solid state digital technology improves, we can make very tiny electronic devices, and then we attach a relatively large battery to them. Even these “large” batteries also have a limited life span.

There are several possible approaches to this problem. One is to make better batteries, ones that can hold more energy for longer in a smaller package. This is happening, incrementally, but is still a major limiting factor.

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Jun 01 2018

Another Advancement in Prosthetic Limbs

I have been following the development of brain-machine interfaces and their application to artificial (prosthetic) limbs. A recent paper documents another incremental but significant advance – combining a new surgical technique for amputation with a prosthetic designed to take advantage of it.

The goal is to close the loop between voluntary muscle control and sensory feedback, which is critical to that control. The way our brains normally work is to constantly monitor various sensory streams in order to create the subconscious and conscious sensation that we occupy, own, and control the various parts of our body.

We may take these phenomena for granted, but they are an active construction of the brain that are critical to proper function. Without the sensation that we occupy our body, we would have “out-of-body” sensations, like we were floating in space, and this would make it difficult to interface with the physical world.

Without the sense of ownership, we don’t feel like a limb is part of us, and it is therefore not incorporated into our internal model of our own body. This is the current state-of-the art for normal prosthetics – they feel like they are attached to the user, but not part of them. It therefore takes more conscious effort to use them, and control is not as good as a normal limb.

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May 29 2018

Irradiated Food is Safe

SGU Listener, Alex, recently sent me a question about the safety of irradiated food:

“Dr. Samuel Epstein, chair of the Cancer Prevention Coalition, is quoted as saying, “Every man, woman and child who takes a bite of irradiated food increases their chance of getting cancer. It is no exaggeration to say that our government has turned the American people into guinea pigs.”

Is there any science to this? Am I irradiating my body by eating bread? Do irradiated bananas give me a double dose of dangerous death rays?”

This is another example of the general rule – for every safe and life-saving technology out there, there is a group of people fearmongering about its risks.  Irradiating food is a completely safe and effective way to reduce the risk of food borne illness and contamination. It is an underutilized technology because of unwarranted fears.

Irradiated is not radioactive

Food treated with radiation is not radioactive itself. So you will not get any extra dose of radiation from consuming such food. Radiation has simply passed through it in order to kill bacteria and insects.

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May 17 2018

California Rules Coffee a Carcinogen

California Superior Court Judge Elihu Berle ruled, in accordance with Proposition 65 law, that coffee is a carcinogen and requires a warning label in the state of California. This ruling, however, is not in accord with science and rational medicine.

What went wrong are all the things that can go wrong when trying to assess health risk.

The ruling is based on the presence of acrylamide in coffee. There is evidence that acrylamide is a potential risk factor for certain cancers. This is based mostly on animal and in vitro studies.

How scientists determine that a substance is potentially a cancer risk is a little complex, since we cannot do direct clinical studies. It is unethical to expose a subject to a potential carcinogen to see if they get cancer. So we start with studies on cells and animals.


These types of pre-clinical studies, however, can only tell us about hazard, not risk. A hazardous substance is something which can theoretically cause harm depending on exposure, while risk is actual harm caused by exposure in a certain population to a certain dose over a certain period of time.

Think of it this way – sharks are hazardous, but a shark in a tank poses very little risk. Swimming with sharks in that tank, however, poses a high risk.

So how do we determine the risk to humans of a substance which is potentially hazardous based on pre-clinical studies? For that we rely on epidemiology and observational studies. If we, for example, ask people about their coffee drinking habits, and then track them over time for the development of cancer, we can then make comparisons and see if drinking coffee correlates with increased cancer risk.

There are many shortcomings from this type of data, however, specifically the potential for confounding factors. Drinking more coffee may correlate with more smoking, or consumption of other hazardous products, for example. You can try to control for possible confounding factors, but not the ones you are not aware of. So this limits the utility of such data.

Even still, it is possible to build a robust base of evidence clearly showing risk. If the observational studies all triangulate to only one plausible cause, then we can be highly confident of that interpretation of the correlations. Smoking, for example, correlates with risk of lung cancer every possible way you can look at the data. This is a solid causal link.

The same solid link does not exist for acrylamide in coffee. Therefore coffee is deemed only a probable cause of cancer by the IARC, which is a notoriously cautious body that errs on the side of calling substances “probable” carcinogens. Essentially, if some hazard shows up in pre-clinical studies, but there is no clinical evidence of actual risk, they still call it “probable.”

California law then takes the IARC “probable” and turns that into “coffee causes cancer.” In each step the precautionary principle ratchets up the warning, until we go from no clinical evidence of actual risk, to a required warning label that it does cause cancer.

This approach, however, is not without its own risk, turning the precautionary principle on its head.

As I reported previously on SBM, a 2013 study found that 72% of random ingredients from a cookbook had published data showing that they increased the risk of some cancer. What is the public supposed to do with this information?

There are two real risks here, the first of which is what is called alarm fatigue. If you set your threshold for warning alarms too low, then the alarms will always be going off, and people will learn to ignore them.

Do you think many people will stop drinking coffee because of the warning? I wonder what percentage will give up their daily coffee habit based on this decision. Most people will likely (and correctly) file this away as a manifestation of the overly cautious CYA nanny state and ignore the warnings. But this makes it more likely they will ignore more meaningful warnings about actual risk that they should be listening to.

If everything causes cancer, then perhaps nothing really does, and you should ignore all such warnings. The warnings themselves become useless.

There is also the opposite risk, that some people, in the sincere desire to be healthy or out of anxiety, will try to heed all such warnings. This can lead to what some are calling “orthorexia” (not currently a recognized clinical term), in which people excessively restrict their diet in the hopes of avoiding risky food.

If 72% or so of foods or ingredients can be linked to cancer, and you try to avoid them all, then what will you eat? What are the risks of such a highly restrictive diet? I strongly suspect that if you followed all the warnings about potential risks of foods, there would be net harm from poor nutrition.

There is also an opportunity cost to spending so much time and effort carefully vetting everything you eat for any possible risk. That time could be better spend on more fruitful healthy activities.

There is also an industry of self-help advice turning these public warning into marketable fearmongering. They have essentially been “weaponized” for either marketing or to promote various ideological agendas. The anti-GMO campaign is perhaps the best example.

The state should be trying to mitigate these counterproductive forces, not aid them. If anything they should be a mediating force, putting together panels of experts to create sober and useful bottom-line advice for the public, advice that people can plausibly used, and designed to minimize unintended consequences.

California’s approach, I think, is harmful. In an endeavor to protect the health of their citizens I think they are harming health. They are also potentially undercutting faith in experts an expertise itself, which has further downstream negative consequences.

This is the precautionary principle out of all control.

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May 15 2018

Homeopathic Nosodes

Homeopathy is bunk. Most people I encounter who disagree with this statement do not actually know what homeopathy is. They think it is some kind of herbalism or natural medicine. No – it is a prescientific superstition-based system of magic potions.

The basic idea is that you start with a fanciful treatment based on notions like sympathetic magic and incidental characteristics (like hair color). Then you dilute that fanciful treatment out of existence – so it doesn’t really matter anyway. Homeopathy is literally nothing, but homeopaths believe that the magical “essence” of the substance remains.

Unsurprisingly, clinical trials of homeopathic potions have convincingly shown that homeopathy works for nothing. So it can’t work, and in fact it doesn’t work.

So why is homeopathy still a thing? That is a fascinating question dealing with culture, human psychology, and political failure.

There is also an aspect of homeopathy that dovetails with another pseudoscience – the anti-vaccine movement. Homeopathic nosodes, which are just as useless as all other homeopathic potions, are offered as a substitute for vaccines. This way you not only waste money on a worthless health scam, you also forgo safe and effective medicine – a nice double whammy.

Nosodes are prepared by taking body fluid from a diseased person or animal and then diluting it so that you have – water. This water is then given to prevent the disease that the person or animal from which the fluid was taken had.

In addition to giving fake medicine instead of effective medicine to prevent a serious and communicable disease, there is some risk to the preparation process itself. Homeopaths are making nosodes of HIV, ebola, Hepatitis, and other serious infectious diseases. That’s right – their answer to the HIV epidemic in Africa, or to ebola outbreaks, is to give their fake medicine.

Are there any clinical trials of homeopathic nosodes that show they work? No. Homeopaths largely rely upon what they call a “homeopathic pathogenetic trials.” This is a great example of pseudoscience, because it follows some of the forms of real science, but isn’t doing actual science.

Here is one of an HIV nosode – they basically give 15 volunteers water, I mean an HIV nosode, and 7 volunteers water, I mean placebo. The volunteers are trained to record every symptom they experience. Over four weeks the HIV nosode water group recorded 130 symptoms, while the placebo water group recorded 60 symptoms. Those ratio’s are remarkably similar to the number of people in each group – twice as many people reported twice as many random symptoms. Shocking.

This is what passes for science in homeopathy. What they rarely do are actual efficacy trials designed to answer the real question – do the potions work? When high quality efficacy trials of homeopathy are done, they usually turn out negative, and systematic reviews have all been negative. So they mostly don’t bother with such trials, instead doing their HPTs, and observational trials, or looking at markers, so that they can pretend they are doing science.

This nonsense isn’t limited to humans. Recently there was outrage over homeopathic nosodes given to pets. These cats and dogs might get serious and preventable diseases because their owners relied on homeopathic nosodes they purchased on Amazon instead of real vaccines.

Opting for homeopathic remedies in favour of vaccines can be the cause of fatal viral diseases including parvovirus and herpes virus, the RSPCA said.

The former kills nine in 10 dogs who contract it, the latter can prompt a pregnant dog to abort her puppies or kill an entire litter of young puppies to die over 24 hours.

The British Veterinary Association said that skipping vaccinations can also be the cause of zoonotic diseases, such as canine leptospirosis, which can be infectious to humans.

Allowing people to die from fake vaccines is one thing, but you cross a line when you allow cats and dogs to die from preventable infections.

What I don’t get is the unwillingness to properly deal with homeopathy from a regulatory standpoint. Why is the political will lacking? It seems that part of the problem is that many politicians are not scientists or even minimally scientifically literate. But odds are most still realize that homeopathy is snake oil, or at least would listen to the overwhelming scientific consensus that homeopathy is snake oil.

There just doesn’t seem to be any political incentive to do so. This is a manifestation of a broken political system, where there is insufficient motivation to do something so obviously beneficial and correct like banning 100% fake medicine. But I also think this is a failure of the scientific and academic communities. There is a paucity of outrage at the infiltration of pseudoscience into our culture and our medical system. That is our fault. And if we lack proper outrage, how can we expect others to have it?

The underlying problem is that many snake oils like homeopathy fly under the radar. Many doctors don’t know what it is, do not know how much it has insinuated itself into the system, and don’t know the regulations. They are happy to ignore it and assume it is a small and benign fringe. They are wrong. This situation is easily remedied through education. Once properly informed, most health care professionals are properly outraged. Let’s have more of that.

 

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May 04 2018

Be Wary of Dubious Brain Cancer Study

We have yet another example of a scientifically complex study being mangled by the mainstream media, who simply do not have the chops to provide an adequate analysis. The Telegraph reports:

Fresh fears have been raised over the role of mobile phones in brain cancer after new evidence revealed rates of a malignant type of tumour have doubled in the last two decades.

They further report about the study:

They analysed 79,241 malignant brain tumours over 21 years, finding that cases of GBM in England have increased from around 1,250 a year in 1995 to just under 3,000.

This sounds alarming. The mainstream reporting was not horrible (unlike some of the fearmongering by advocacy groups) but was completely inadequate to really put this study into context. The Science Media Center put together analysis from various experts, and the entire page is worth a read. It is a good demonstration of how to really analyze a scientific paper.

The Telegraph article does point out that this new study is looking at brain cancer incidence only, and did not present any data that correlates the risk of brain cancer with any specific risk factor. The paper only speculates about possible causes, including the rise in cell phone use. But that is just scratching the surface.

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May 01 2018

A Healthy Lifestyle Matters

I see patients nearly every day who sincerely want to live a healthy lifestyle. Most people want to be healthy and I don’t know anyone who is looking forward to a premature death from a preventable disease. That is why health products and advice are a huge market.

For those looking to adopt healthy habits there is good news and bad news. The good news is that we are among the first generations to have comprehensive scientific data to tell us how to do that. The bad news is that we are also living at a time of massive misinformation, and so many people get distracted from the real scientific answers by slick marketing and ideology.

There is even more good news – you already know the answer to healthy living, and it is mostly simple (maybe not easy, but simple). A new study now confirms with the largest set of epidemiological data on the topic to date what previous studies have already shown. There are five basic lifestyle factors that have a dramatic effect on longevity and the risk of death from heart disease, cancer, or other causes.

The researchers used two datasets –  Nurses’ Health Study (1980-2014; n=78,865) and the Health Professionals Follow-up Study (1986-2014, n=44,354), which means they have data from 34 years with 123,219 subjects. That’s a powerful study. They tracked the correlation between five lifestyle factors – healthy diet, regular exercise, lean body mass, not smoking, and limited alcohol use – with longevity and risk of dying. They found:

We estimated that the life expectancy at age 50 years was 29.0 years (95% CI, 28.3-29.8) for women and 25.5 years (95% CI, 24.7-26.2) for men who adopted zero low-risk lifestyle factors. In contrast, for those who adopted all 5 low-risk factors, we projected a life expectancy at age 50 years of 43.1 years (95% CI, 41.3-44.9) for women and 37.6 years (95% CI, 35.8-39.4) for men. The projected life expectancy at age 50 years was on average 14.0 years (95% CI, 11.8-16.2) longer among female Americans with 5 low-risk factors compared with those with zero low-risk factors; for men, the difference was 12.2 years (95% CI, 10.1-14.2).

So a 50 year old woman who drinks, smokes, is overweight, does not exercise regularly, and has a poor diet overall will die 14 years earlier than someone with none of those risk factors (and for men it is 12.2 years). That is significant. If you look at the full data, there is a fairly linear relationship between the number of risk factors and life expectancy – so each healthy lifestyle you adopt adds a couple years to your life expectancy.

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