Category Archives: Health Care

System for Approving New Medical Options Needs Improvement

Not only did the team find that evidence for Infuse’s benefits over existing alternatives for most patients was questionable; they also discovered in a broad array of published research that risks of complications (including cancer, male sterility and other serious side effects) appeared to be 10 to 50 times higher than 13 industry-sponsored studies had shown. And they learned that authors of the early studies that found no complications had been paid between $1 million and $23 million annually by the company for consulting, royalties and other compensation. Carragee, MD ’82, estimates Medtronic has sold several billion dollars’ worth of Infuse for uses both approved and “off label.”
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Without a rigorous, data-driven context, medicine’s expensive traditions and hunch-based treatments threaten to bankrupt us. “People say that we shouldn’t delay science; people are dying; we should get new treatments out there. I do not feel the pressure to do that until we have solid evidence,” Ioannidis asserts. “The resources many procedures draw are enormous.” And that leaves insufficient funds for the prevention plans and treatments we know actually work.

I have written about the problems with our health care research system several times. The existing system is in need of improvement and is made much worse by the general state of the broken health care system in the USA. Dr. John P.A. Ioannidis, the focus of the article, is doing fantastic work in this area.

Cancer Risks From Our Food

comic showing the dangers of drawing false conclusion based on statistical significance

Randall Munroe illustrates RA Fisher’s point that you must think to draw reasonable conclusions from data. Click the image to see the full xkcd comic.

Pretty much everything you eat is associated with cancer. Don’t worry about it. by Sarah Kliff

The changes in cancer risk were all over the map: 39 percent found an increased risk, 33 percent found a decreased risk and 23 percent showed no clear evidence either way.
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The vast majority of those studies, Schoenfeld and Ioannidis found, showed really weak associations between the ingredient at hand and cancer risk. A full 80 percent of the studies had shown statistical relationships that were “weak or nominally significant,” as measured by the study’s P-values. Seventy-five percent of the studies purporting to show a higher cancer risk fell into this category, as did 76 percent of those showing a lower cancer risk.

Sadly the evidence is often not very compelling but creates uncertainly in the public. Poorly communicated results and scientific illiteracy (both from publishers and the public) leads to more confusion than is necessary. Even with well done studies, good communication and a scientifically literate population nutrition and human health conclusion are more often questionable than they are clear.

Drug Company Funding Taints Published Medical Research

Science provide the opportunity for us to achieve great benefits for society. However, especially in medical research money can make what are already very difficult judgments even less reliable. Add that to a very poor understanding of science in those we elect and you have a dangerous combination. That combination is one of the largest risks we face and need to manage better. I wish we would elect people with a less pitiful appreciation for science but that doesn’t seem likely. That makes doing a better job of managing the conflicts of interest money puts into our current medical research a top priority.

How Drug Company Money Is Undermining Science by Charles Seife

In the past few years the pharmaceutical industry has come up with many ways to funnel large sums of money—enough sometimes to put a child through college—into the pockets of independent medical researchers who are doing work that bears, directly or indirectly, on the drugs these firms are making and marketing. The problem is not just with the drug companies and the researchers but with the whole system—the granting institutions, the research labs, the journals, the professional societies, and so forth. No one is providing the checks and balances necessary to avoid conflicts.
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Peer-reviewed journals are littered with studies showing how drug industry money is subtly undermining scientific objectivity. A 2009 study in Cancer showed that participants somehow survived longer when a study’s authors had conflicts of interest than when the authors were clean. A 1998 study in the New England Journal of Medicine found a “strong association” between researchers’ conclusions about the safety of calcium channel blockers, a class of drugs used to reduce blood pressure, and their financial relationships with the firms producing the drugs.

Most of those in the system have an interest in minimizing an effort to clean this up. It is just more work they don’t want to do. Or it goes directly against their interest (drug companies that want to achieve favorable opinions by buying influence). The main political message in the USA for a couple decades has been to reduce regulation. Allowing research that is tainted because you find regulation politically undesirable is a bad idea. People that understand science and how complex medical research is appreciate this.

Sadly when we elect people that by and large are scientifically illiterate they don’t understand the risks of the dangerous practices they allow. Even if they were scientifically illiterate but understood their ignorance they could do a decent job by getting scientific consultation from experts but they don’t (to an extent they listen to the scientists that those that give them lots of money tell them to which does help make sure those giving the politicians cash have their interests served but it is not a good way to create policy with the necessary scientific thinking needed today).

Smoking Bans at Work and Public Places Result in Significant Drops in Hospitalization for Heart Attacks, Strokes and Asthma.

Laws that end smoking at work and other public places result in significantly fewer hospitalizations for heart attacks, strokes, asthma and other respiratory conditions, a new UCSF analysis has found.

The research provides evidence that smoke-free laws that cover workplaces, restaurants and bars have the biggest impacts on hospitalizations, reduce health care costs and also raise quality of life, the researchers said. The research is published in closed science journal; for an “association” (when you act as though your focus is just growing your income I have trouble seeing the claim for being an association as legitimate) to do that is particularly pitiful. Adding to the sad commentary on the lack of respect for open scient this is research done by a “public” university with grants from the federal government. So sad how little some that should care about science do when it conflicts with their outdated notions of how to publicize research. We really should not tolerate such behavior.

“The public, health professionals, and policy makers need to understand that including exemptions and loopholes in legislation — such as exempting casinos — condemns more people to end up in emergency rooms,” said senior author Stanton A. Glantz, UCSF professor of medicine and director of the Center for Tobacco Control Research and Education at UCSF. “These unnecessary hospitalizations are the real cost of failing to enact comprehensive smoke-free legislation,” he said.

The inquiry consisted of a meta-analysis of 45 studies published prior to Nov. 30, 2011. Altogether, the research covered 33 different smoke-free-laws in cities and states around the United States as well as several countries, including New Zealand and Germany. The laws variously prohibit smoking in such public spots as restaurants, bars, and the workplace.

The authors found that comprehensive smoke-free laws were followed rapidly by significantly lower rates of hospital admissions than before the laws went into force:

A 15% drop in heart attack hospitalizations;
A 16% drop in stroke hospitalizations;
A 24% drop in hospitalizations for respiratory diseases including asthma and chronic obstructive pulmonary disease.

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Does Diet Soda Result in Weight Gain?

Most of us want medical studies to provide clearer (more certain, more specific, more universal) indications than they actually provide. The conclusion of medical studies are often very clouded. Each person has a myriad of complex factors effecting how nutrition, activity and medication will affect us. Certain general conclusion can be drawn but it is very complex and difficult to universally state without various equivocations.

Advice For Diet Soda Lovers: Skip The Chips

Researchers at the University of North Carolina-Chapel Hill found that diet soda drinkers who ate a so-called “prudent” diet, rich in fruit, fish, vegetables, whole grains, nuts and milk, were significantly less likely to develop metabolic syndrome over 20 years than those who ate a “Western diet” heavy in fried foods, meats and sugars.

Metabolic syndrome is a condition characterized by excess abdominal fat, elevated blood sugar, high blood pressure, elevated triglycerides and low HDL cholesterol. About 32 percent of the participants in the “Western diet” cluster developed the condition.

The question of whether diet soda truly helps people manage their weight turns out to be a very tough one to answer.

Conflicting findings abound. A large study published in the New England Journal of Medcine last year found that diet soda had no effect on weight. But another one, published in 2008, found that drinking more than three diet drinks a day led to weight gain.

I would like to know, with much greater certainty what nutritional and food related advice I need to consider when making my choices. To a significant degree I think there is going to be quite a bit of uncertainty (much more than we want) for at least the next 30 years (projecting far out into the future with any accuracy seems very difficult to me.

I am skeptical of purely correlational results. You can try to have similar subsets of people but that is actually hard and if you allow for similar groups and then let the choose something (like diet sodas or not) the chance of that actually being a significant choice that results in many other decisions being different between the subgroups seems a big risk (that makes accepting the correlation as evidence as risky). When you have a scientific explanation it makes the evidence much more compelling, but it is also easy to be taken in by explanations meant to fit the results of a study.

I can believe diet soda can do some bad things to your health. I believe if you are trying to reduce your weight by reducing calories drinking diet soda in place of sugary soda is a big help. I can believe drinking water instead of diet soda would be even better. I want caffeine and don’t like coffee. I have cut down drinking Mountain Dew to less than 2 a week. I have substituted diet soda over the last year. I am not sure that is the right choice, but it is the one I have made so far.

Medical Studies Showing Largest Benefits Often Prove to be False

There is another study showing the results of health studies often are proven false. Medical studies with striking results often prove false

If a medical study seems too good to be true, it probably is, according to a new analysis.

In a statistical analysis of nearly 230,000 trials compiled from a variety of disciplines, study results that claimed a “very large effect” rarely held up when other research teams tried to replicate them.
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The report should remind patients, physicians and policymakers not to give too much credence to small, early studies that show huge treatment effects, Ioannidis said.

The Stanford professor chose to publish this paper in a closed science publication. But previously he published openly on: Why Most Published Research Findings Are False.

Toyota Human Support Robot

Toyota continues to develop their partner robot initiative. Demographics in Japan make a compelling case for the need to provide solutions to those who need assistance to support independent living.

The aim is to contribute to the maintenance and improvement of quality of life.

In cooperation of the Yokohama Rehabilitation Center, Toyota conducted experiments for disabled people, using HSR in their homes, in 2011. Toyota has been integrating the feedback to the design, based on actual user experience.

The Human Support Robot (HSR) can pick up something on and bring it to the person. Also it can do small tasks such as opening the curtains.

Controlling the robot can be done easily, by using the voice recognition function or using a tablet control. In addition, Toyota is designing it to directly assist the person, helping them get into and out of a bathtub, for example.

They are also developing new features for remote viewing and remote operation (to provide off site help to make the robot more useful). They are working with health care professionals, including nurses, and research institutions aimed at practical use for such a robot.

Toyota, along with several other Japanese companies, continue to invest a great deal to create personal care robots.

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Key Indicator for Malignant Melanoma Found

Skin cancer detection breakthrough

The researchers found that certain biochemical elements in the DNA of normal pigment-producing skin cells and benign mole cells are absent in melanoma cells. Loss of these methyl groups — known as 5-hmC — in skin cells serves as a key indicator for malignant melanoma. Loss corresponded to more-advanced stages of melanoma as well as clinical outcome.

Strikingly, researchers were able to reverse melanoma growth in preclinical studies. When the researchers introduced enzymes responsible for 5-hmC formation to melanoma cells lacking the biochemical element, they saw that the cells stopped growing.

“It is difficult to repair the mutations in the actual DNA sequence that are believed to cause cancer,” said Christine Lian, a physician-scientist in the Department of Pathology at BWH and one of the lead authors. “So having discovered that we can reverse tumor cell growth by potentially repairing a biochemical defect that exists — not within the sequence but just outside of it on the DNA structure — provides a promising new melanoma treatment approach for the medical community to explore.”

Because cancer is traditionally regarded as a genetic disease involving permanent defects that directly affect the DNA sequence, this new finding of a potentially reversible abnormality that surrounds the DNA (thus termed “epigenetic”) is a hot topic in cancer research, according to the researchers.

In the United States, melanoma is the fifth most common type of new cancer diagnosis in men and the seventh most common type in women. The National Cancer Institute estimates that in 2012 there will be 76,250 new cases and 9,180 deaths in the United States owing to melanoma.

Thankfully scientists keep making great progress in understanding and finding potential clues to treating cancer. And big gains have been made in treating some cancers over the last few decades. But the research successes remain difficult to turn into effective solutions in treating patients.

I am thankful we have so many scientists doing good work in this difficult and important area (cancer).

Man in Coma for 7 Years was Given a Sleeping Pill and Woke Up

Lazarus pill miracle for E Cape man, 9 September 2012

After reading a report in City Press last month, his wife, Nomfundo, insisted that he be given a prescription for the sleeping pill Stilnox, which has the opposite effect on those with brain injuries.

It worked – and brought him out of a seven-year coma.
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But on August 12, family friend Nceba Mokoena came across an article in City Press about a miracle recovery made by another car crash victim, hundreds of kilometres away in Gauteng.

Louis Viljoen was given the sleeping pill by chance by his mother, Sienie.

She had noticed he wasn’t sleeping peacefully and asked her doctor if she could give him half a sleeping tablet. After she did, Louis opened his eyes and said “Hello Mamma”, his first words in five years.

Very cool anecdote and example that modern medicine has many miraculous cures but the medical system can’t always use them as well as we would hope. Even with all the knowledge we have today just getting that information into the right doctor’s minds is very hard. And the complexity of diagnoses and interactions makes medical care still an art as well as a science.

So is this just some freak accident. Partially, in the mother giving her son a sleeping pill to reduce his seeming restlessness in the coma. But the effect of Stilnox in bringing coma victims out of a coma has been documented previously.

Reborn from persistent vegetative state, 12 September 2006

Four three years, Riaan Bolton has lain motionless, his eyes open but unseeing. After a devastating car crash doctors said he would never again see or speak or hear. Now his mother, Johanna, dissolves a pill in a little water on a teaspoon and forces it gently into his mouth. Within half an hour, as if a switch has been flicked in his brain, Riaan looks around his home in the South African town of Kimberley and says, “Hello.” Shortly after his accident, Johanna had turned down the option of letting him die.

Three hundred miles away, Louis Viljoen, a young man who had once been cruelly described by a doctor as “a cabbage”, greets me with a mischievous smile and a streetwise four-move handshake. Until he took the pill, he too was supposed to be in what doctors call a persistent vegetative state.

Across the Atlantic in the United States, George Melendez, who is also brain-damaged, has lain twitching and moaning as if in agony for years, causing his parents unbearable grief. He, too, is given this little tablet and again, it’s as if a light comes on. His father asks him if he is, indeed, in pain. “No,” George smiles, and his family burst into tears.

It all sounds miraculous, you might think. And in a way, it is. But this is not a miracle medication, the result of groundbreaking neurological research. Instead, these awakenings have come as the result of an accidental discovery by a dedicated – and bewildered – GP. They have all woken up, paradoxically, after being given a commonly used sleeping pill.

Medical care is still today an extremely difficult area where highly trained and continuously learning doctors still have a great deal of trouble keeping up with the latest medical knowledge.

Great Webcast Explaining the Digestive Systems

You will learn things like why it is so important to chew your food well (increase the surface area for enzymes to get at the food). Our bodies also have adapted to provide a huge surface area for the digestive system to work; the small intestine alone has a surface area of 250 square meters (larger than the size of most apartments). Your small intestine is 4.5 to 10.5 meters long.