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A major cause of increasing obesity is certainly the campaign against it -- as dieting usually makes people FATTER. If there were any sincerity to the obesity warriors, they would ban all diet advertising and otherwise shut up about it. Re-authorizing now-banned school playground activities and school outings would help too. But it is so much easier to blame obesity on the evil "multinationals" than it is to blame it on your own restrictions on the natural activities of kids

NOTE: "No trial has ever demonstrated benefits from reducing dietary saturated fat".

A brief summary of the last 50 years' of research into diet: Everything you can possibly eat or drink is both bad and good for you

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29 February, 2008

"Diversity" is bad for your heart

Oh dear! What a nasty finding for the Left we have below. As we know from Putnam's work (See also here), community involvement is lowest where a community is ethnically diverse. Yet this study shows that people living in low community involvement areas have more heart problems. The authors don't put it that way, of course but that is what their study shows. And it makes sense. Being afraid to go outside your front door is stressful and stress is certainly bad for your heart

Home may be where the heart is, but it could be one's surrounding community that helps keep the ticker healthy, according to a new study led by researchers at the University of California, Berkeley's School of Public Health. "This analysis points to a real effect on real people," said study lead author Richard Scheffler, UC Berkeley professor of health economics and public policy. "It speaks to the value of clubs and social organizations in providing health information and reducing stress, both of which are known to reduce heart disease." The full study is to be published online in the Feb. 28 issue of the journal Social Science & Medicine.

"This is the first study to demonstrate a link between community social capital and prognosis following heart disease," said study co-author Dr. Ichiro Kawachi, professor of social epidemiology in the Department of Society, Development and Human Health at the Harvard School of Public Health. "Other research has linked social capital to health outcomes, but most of these studies have been cross-sectional, and therefore difficult to draw conclusions about cause-and-effect relationships. The findings of this study take us in the right direction."

The researchers based the degree of social capital in any given county upon the number of people employed in various organizations, including religious, civic, political, social and alumni groups.

There is growing evidence that cardiovascular health is linked to where a person lives, but it had been unclear whether location served as a proxy for other unmeasured factors, including the type of medical treatment or health care available there. To address this gap, UC Berkeley researchers partnered with Kaiser Permanente Northern California, a non-profit integrated health care delivery system. Data was obtained from actual clinical records of nearly 35,000 Kaiser Permanente patients who had been hospitalized for acute coronary syndrome - a term describing symptoms of decreased blood flow to the heart - in Northern California between 1998 and 2002. Patients were tracked for symptoms of recurring heart problems. To protect patient privacy, only authorized Kaiser Permanente personnel had direct access to the clinical records for this study.

"Because we're using actual clinical records instead of self-reported medical information, we have a clearer picture of a person's health status and medical treatment," said Scheffler, who is also director of the Nicholas C. Petris Center on Health Care Markets & Consumer Welfare at UC Berkeley's School of Public Health. "And because all the patients are in the same health care system, we avoid the problem of comparing people with different kinds of health plans or who don't have insurance at all. We also were able to follow patients over time to track any recurrence of heart problems, which is very unique."

The authors noted that patients in low-income areas have the most to gain from higher social capital. "Our findings are consistent with the hypothesis that social capital helps more those in the lower socioeconomic spectrum," said study co-author Dr. Carlos Iribarren, research scientist at Kaiser Permanente Northern California. "Those with greater economic advantage don't seem to benefit, or benefit less, because they have other resources available to them."

The researchers pointed out that patients did not need to be members of any of the community organizations measured in order to benefit. "An area with a high density of social networks and resources changes the character of a community, regardless of whether any one particular individual joins or not," said Scheffler. "It's the opposite of having a liquor store on every corner. You don't have to shop at the liquor stores to be impacted by the type of environment they create."

Thirty-five of California's 58 counties were included in the study. The eight counties found to have the highest levels of community social capital are, in descending order, San Francisco, Lake, Sacramento, Santa Cruz, Marin, Tuolumne, Nevada and Alameda. "The majority of information available about the determinants of health is based upon individual behavior," said Leonard Syme, UC Berkeley professor emeritus of epidemiology and study co-author. "This study clearly shows that the world within which people live also has an important impact on health."

Source




Breast Cancer Reprieve

The arrogant and narrowminded FDA eases up a little

In a surprise decision, the Food and Drug Administration played against type and gave approval for Avastin as a treatment for metastatic breast cancer. It was the right option for terminally ill women, who will gain another weapon against a disease that kills about 40,000 every year. In clinical trials, Genentech's biologic drug was shown to control the growth and spread of tumors, doubling the amount of time before illness worsened. That translates into an improvement in quality of life, and the results were corroborated by further studies.

Avastin shouldn't have been controversial. But an FDA panel ruled that "progression-free survival" was not sufficient, because the agency's usual acid test for anticancer agents is extending life overall. Such an analysis overlooks the real benefits to women in the months they have left. But as late as last week, it looked as though approval would be delayed or rejected outright.

The "accelerated approval" granted to Avastin is contingent on follow-up trials, and Avastin could be pulled from the market if future research fails to demonstrate that treatment prolongs life. In an interview with us on Monday, oncology drugs chief Richard Padzur said that the FDA was "not demanding" a survival advantage but would consider it a factor. In 2005, the lung cancer drug Iressa was approved and then withdrawn under similar conditions, and the danger is that history will repeat itself.

As for the notion that the decision portends a shift in the way the FDA evaluates cancer drugs, Dr. Padzur assured us that it "not a new step in our regulatory decision making." He emphasized that prolonging life was still the FDA's primary criterion, and noted that Avastin was green-lighted because its quality-of-life benefits were "statistically robust." Yet the narrowness with which the FDA balances risk and reward was the reason Avastin was contentious -- especially Dr. Padzur's statistical models.

FDA evaluation methods insist on large average effects and simplistic mortality rates. Only about 10% of patients responded to Iressa, for instance, and could be identified by genetic tests; but these targeted results didn't mesh with the arbitrary FDA approach. Other innovative medicines like Provenge (for prostrate cancer) and Junovan (for pediatric bone cancer) are pointlessly blocked by Dr. Padzur's division, and the risk is that Avastin still could be too, whatever its current reprieve.

The finality of life-and-death decisions makes the approval of such drugs fundamentally a moral issue. Avastin may have slid beneath the wire, but the FDA hasn't changed its morally indefensible standard, and further drug approvals are still subject to the whims of a bureaucracy that puts statistical models above the choices of dying patients.

Source

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Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

9). And how odd it is that we never hear of the huge American study which showed that women who eat lots of veggies have an INCREASED risk of stomach cancer? So the official recommendation to eat five lots of veggies every day might just be creating lots of cancer for the future! It's as plausible (i.e. not very) as all the other dietary "wisdom" we read about fat etc.

10). And will "this generation of Western children be the first in history to lead shorter lives than their parents did"? This is another anti-fat scare that emanates from a much-cited editorial in a prominent medical journal that said so. Yet this editorial offered no statistical basis for its opinion -- an opinion that flies directly in the face of the available evidence.

Even statistical correlations far stronger than anything found in medical research may disappear if more data is used. A remarkable example from Sociology:

"The modern literature on hate crimes began with a remarkable 1933 book by Arthur Raper titled The Tragedy of Lynching. Raper assembled data on the number of lynchings each year in the South and on the price of an acre's yield of cotton. He calculated the correlation coefficient between the two series at -0.532. In other words, when the economy was doing well, the number of lynchings was lower.... In 2001, Donald Green, Laurence McFalls, and Jennifer Smith published a paper that demolished the alleged connection between economic conditions and lynchings in Raper's data. Raper had the misfortune of stopping his analysis in 1929. After the Great Depression hit, the price of cotton plummeted and economic conditions deteriorated, yet lynchings continued to fall. The correlation disappeared altogether when more years of data were added."

So we must be sure to base our conclusions on ALL the data. But in medical research, data selectivity and the "overlooking" of discordant research findings is epidemic.

"What we should be doing is monitoring children from birth so we can detect any deviations from the norm at an early stage and action can be taken". Who said that? Joe Stalin? Adolf Hitler? Orwell's "Big Brother"? The Spanish Inquisition? Generalissimo Francisco Franco Bahamonde? None of those. It was Dr Colin Waine, chairman of Britain's National Obesity Forum. What a fine fellow!

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28 February, 2008

Antidepressants don't work?

The report discussed below has required more thought from me than the usual crap that I find in reports of medical research. The study concerned has many strong features. I note that the study was led by a psychologist. I am not usually very supportive of my fellow psychologists (See here) but I do note that a much higher standard of evidence seems to be required for publication in psychology than in medicine.

In the end, however, I think the study below confirms something I have been saying for some years: That our taxonomy of depression is a big problem. There is a strong tendency for any mental state characterized by suicidal thoughts to be seen as depression. But there are in fact TWO broad mental states characterized by such thoughts: True depression and what used to be called anxious depression. And those states are so different as to be almost opposite. The first is characterized by very low levels of activation and the second by very high levels of activation.

The DSM has now given anxious depression a fancy new name and listed it separately but I doubt that the distinction is as yet commonly made by practitioners. ANY suicidal state will often be given Prozac etc. And where Prozac is probably helpful in livening up true depressives, it would tend to push anxious depressives over the top and cause them actually to commit suicide -- which we know does happen. It is however crazy for a drug that helps some in a category to have the opposite effect for others in the same category so it seems to me that the fault lies with patient categorization. Prozac should be rigorously EXCLUDED as a treatment for anxious depression.

And I think the same distinction helps make sense of the report below. It is true that the therapeutic responses tabulated are often not much different from placebo. That overall statement, however, ignores what seem to me to be important details. The most striking is that in their Table 1, the difference from placebo varies markedly. In some studies, a LOT of the patients were helped by the drug while in others few were. And there were in fact two instances where placebo gave a better response than the drug! The latter result is about as crazy as Prozac driving you to suicide. My hypothesis would be that the samples where few were helped included a lot of anxious depressives and, in the two very deviant cases, a predominance of anxious depressives.

So I think we are still at the "Don't know" stage. I think we need studies from which anxious depressives have been rigorously excluded before we can evaluate the therapeutic effect of drugs on true depressives. If I were prescribing, however, I would certainly give Prozac etc. to anyone who was obviously a true depressive. I suspect that it has a much stronger effect for them than would at first appear from the results of the existing poorly-categorized studies.

I am particularly concerned about the response to this study from NICE. NICE are well-known for depriving Brits of drugs that might help them and I am afraid that this study will cause NICE to issue guidance that will deprive many Brits of relief from their suffering -- leading to suicide in some cases. Not to put to fine a point on it, I think this study could kill. Popular summary of the research follows. -- JR

Millions of people taking commonly prescribed antidepressants such as Prozac and Seroxat might as well be taking a placebo, according to the first study to include unpublished evidence. The new generation of antidepressant drugs work no better than a placebo for the majority of patients with mild or even severe depression, comprehensive research of clinical trials has found. The researchers said that the drug was more effective than a placebo in severely depressed patients but that this was because of a decreased placebo effect. The study, described as “fantastically important” by British experts, comes as the Government publishes plans to help people to manage depression without popping pills.

More than 291 million pounds was spent on antidepressants in 2006, including nearly 120 million on SSRIs. As many as one in five people suffers depression at some point. With that in mind, ministers will today publish plans to train 3,600 therapists to treat depression. Spending on counselling and other psychological therapies will rise to at least 30 million a year.

The study, by Irving Kirsch, from the Department of Psychology at the University of Hull, is the first to examine both published and unpublished evidence of the effectiveness of selective serotonin reuptake inhibitors (SSRIs), which account for 16 million NHS prescriptions a year. It suggests that the effectiveness of the drugs may have been exaggerated in the past by drugs companies cherry-picking the best results for publication. The National Institute for Health and Clinical Excellence (NICE), which is due to review its guidance on treating depression, said that it would consider the study.

Mental health charities say that most GPs admit that they are still overprescribing SSRIs, which are considered as effective as older drugs but with fewer side-effects. SSRIs account for more than half of all antidrepressant prescriptions, despite guidelines from NICE in 2004 that they should not be used as a first-stop remedy.

American and British experts led by Professor Kirsch examined the clinical trials submitted to gain licences for four commonly used SSRIs, including fluoxetine (better known as Prozac), venlafaxine (Efexor) and paroxetine (Seroxat). The study is published today in the journal PLoS (Public Library of Science) Medicine. Analysing both the unpublished and published data from the trials, the team found little evidence that the drugs were much better than a placebo.

“Given these results there seems little reason to prescribe antidepressant medication to any but the most severely depressed patients, unless alternative treatments have failed,” Professor Kirsch said. “The difference in improvement between patients taking placebos and patients taking antidepressants is not very great. This means that depressed people can improve without chemical treatments.” He added that the study “raises serious issues that need to be addressed surrounding drug licensing and how drug trial data is reported”.

The data for all 47 clinical trials for the drugs were released by the US Food and Drug Administration under freedom of information rules. They included unpublished trials that were not made available to NICE when it recommended the drugs for use on the NHS. “Had NICE seen all the relevant unpublished studies, it might have come to a different conclusion,” Professor Kirsch said.

Tim Kendall, a deputy director of the Royal College of Psychiatrists Research Unit, who helped to formulate the NICE guidance, said that the findings were “fantastically important” and that it was “dangerous” for drug companies not to have to publish their full data. He added: “Three of these drugs are some of the most commonly used antidepressants in this country. It’s not mandatory for drug companies to publish all this research. I think it should be.”

SSRIs are not prescribed to patients under 18 because of the risk of suicide.Drugs watchdogs in Europe are considering tighter controls on the development of new medicines, The Times reported this month, and may soon require regulators to monitor psychiatric effects and the risk of suicide more closely during clinical trials.

A spokesman for GlaxoSmithKline, which makes Seroxat, said: “The authors have failed to acknowledge the very positive benefits these treatments have provided to patients and their families dealing with depression and their conclusions are at odds with what has been seen in actual clinical practice. This one study should not be used to cause unnecessary alarm and concern for patients.” A spokesman for Eli Lilly, which makes Prozac, said: “Extensive scientific and medical experience has demonstrated that fluoxetine is an effective antidepressant.”

Source. Original journal article here

****************

Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

9). And how odd it is that we never hear of the huge American study which showed that women who eat lots of veggies have an INCREASED risk of stomach cancer? So the official recommendation to eat five lots of veggies every day might just be creating lots of cancer for the future! It's as plausible (i.e. not very) as all the other dietary "wisdom" we read about fat etc.

10). And will "this generation of Western children be the first in history to lead shorter lives than their parents did"? This is another anti-fat scare that emanates from a much-cited editorial in a prominent medical journal that said so. Yet this editorial offered no statistical basis for its opinion -- an opinion that flies directly in the face of the available evidence.

Even statistical correlations far stronger than anything found in medical research may disappear if more data is used. A remarkable example from Sociology:

"The modern literature on hate crimes began with a remarkable 1933 book by Arthur Raper titled The Tragedy of Lynching. Raper assembled data on the number of lynchings each year in the South and on the price of an acre's yield of cotton. He calculated the correlation coefficient between the two series at -0.532. In other words, when the economy was doing well, the number of lynchings was lower.... In 2001, Donald Green, Laurence McFalls, and Jennifer Smith published a paper that demolished the alleged connection between economic conditions and lynchings in Raper's data. Raper had the misfortune of stopping his analysis in 1929. After the Great Depression hit, the price of cotton plummeted and economic conditions deteriorated, yet lynchings continued to fall. The correlation disappeared altogether when more years of data were added."

So we must be sure to base our conclusions on ALL the data. But in medical research, data selectivity and the "overlooking" of discordant research findings is epidemic.

"What we should be doing is monitoring children from birth so we can detect any deviations from the norm at an early stage and action can be taken". Who said that? Joe Stalin? Adolf Hitler? Orwell's "Big Brother"? The Spanish Inquisition? Generalissimo Francisco Franco Bahamonde? None of those. It was Dr Colin Waine, chairman of Britain's National Obesity Forum. What a fine fellow!

*********************



27 February, 2008

You There! Step Away From The Happy Meal, Laddie!

Post below lifted from Blue Crab. See the original for links

The increasingly authoritarian "liberals" in Britain are now working on banning the humble McDonald's Happy Meal. The people's republic city of Liverpool is set to enact a ban on the meals. It's for the children, of course.

McDonald's Happy Meals are to be banned in Liverpool over claims they are contributing to the epidemic of childhood obesity. The city council is planning to outlaw the meals on the grounds that they are damaging the heath of children - particularly as they offer free toys in order to encourage parents to buy junk food for their children. The Liberal Democrat-controlled authority claims the credit for taking the lead in the campaign that led to the ban on smoking in public places.

Members of Liverpool City Council's Childhood Obesity Scrutiny Group want a bye-law that would forbid the sale of fast foot accompanied by toys. Councillors say the promotional items are used to boost sales through the "Pester Power" phenomenon - children pestering parents for Happy Meal toys. The scrutiny Group has ordered a report from town hall officials that would pave the way for the bye-law that would be the first of its kind in the UK.

Lib Dem councillor Paul Twigger said: "The Scrutiny Group is recommending that a bye-law be enforced to stop the circulation of free toys associated with junk food promotions. "We consider it is high time that cash-hungry vultures like McDonald's are challenged over their marketing policies which are directly aimed at promoting unhealthy eating among children.

"Childhood obesity is a dire threat to the health in this country and it needs to be nipped in the bud urgently. "Children are directly targeted with junk food and McDonald's use the Happy Meals to exploit Pester Power of children against which many parents give in. "In most Happy Meals the toy is sold with a burgers containing four or five tablespoons of sugar, along with high-calorie fries and milkshakes. "These fattening meals are being shamelessly promoted through free toys and it is clear that it is going to take legislation to combat the practice.

The left has become much worse than what they rebelled against forty years ago. They now think their groupthink mentality is the only way to think and that decisions must not be made by anyone but them. The lovely "cash-hungry vultures" remark is especially telling. It just doesn't say what Mr. Twigger thinks it does. Nice jackboots, Mr. Twigger.




Obesity "kills more people than terrorism"

So does slimness. It's the people of middling weight who live longest. So FORCE-FEED THE SKINNIES!

A GLOBAL fight against flab would save more lives than the war on terror now that obesity-related chronic diseases have emerged as among the world's biggest killers. Lawrence Gostin, a US government adviser who helped draft laws in the US to combat bioterrorism, will tell a global health summit in Sydney today that he considers chronic diseases the greater of the two threats to humanity. "The human costs are frightening when we consider that obesity could shorten the average lifespan of an entire generation, resulting in the first reversal in life expectancy since data collecting began in 1900," Professor Gostin said.

The Oxford Health Alliance of private and public sector groups that want to reduce obesity and smoking rates will issue a "Sydney Resolution" during the three-day meeting, which starts today. The resolution will be sent toKevin Rudd ahead of the Prime Minister's own high-profile think tank, the 2020 summit, in April. It will recommend ways to reduce sugar, fat and salt content in food, improve labelling, regulate advertising, make fresh food more affordable, workplaces healthier and cities more cycle- and pedestrian-friendly.

Summit facilitator Rob Moodie from the Nossal Institute for Global Health at the University of Melbourne said that eating too much, exercising too little and smoking were proving ultimately more dangerous than the acts committed by terrorists.

They had contributed over time to global epidemics in heart disease, diabetes, lung disease and some cancers. "It's in the hundreds of thousands times more deadly in terms of claiming victims," Professor Moodie said. "There are really three or four diseases that cause 50 per cent of the world's deaths, and a huge amount of it is preventable." Professor Moodie said governments needed to control and reduce the economic incentives that were driving unhealthy lifestyle choices. "Making fat is good for business," he said. "Unhealthy foods and unhealthy drinks sell far better than healthy ones. "Inactivity is much more the norm - and it makes more money - whether it is cars, or e-entertainment or video games."

Professor Moodie said it would take "a lot of political guts" to pursue solutions to obesity such as imposing congestion charges, shifting money to public transport, parks and cycle ways, changing city planning practices, and regulating advertising to children. However, it made no sense to spend just 2 per cent of the health budget on public health and similar measures to keep people out of hospitals,

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