Monday, January 22, 2018

One More Time: Magic Answers

Over the last two entries, I have focused on the tendency for Americans to look for the easy answers and the miracle cures in terms of super-foods and “magic” supplements.  I will cover one more example of weak discipline and critical thinking before turning to other subjects.

A half-page newspaper advertisement for another magical supplement caught my eye last week for a number of reasons.  It was presented to look like a news story and played on the common suspicion of drug companies.  The claims also appeared to be exaggerated.  At the bottom of the page in fainter print it had the typical disclaimer that begins, “These statements have not been evaluated by the Food and Drug Administration, this product is not intended to diagnose, treat, cure or prevent any disease individual results may vary…”  The presentation reminded me of all those similar ads promising to tell you the secrets that Wall Street, doctors, banks or credit card companies don’t want you to know.  (I saw two similar ads for different miracle products in the same newspaper over the next two days.)

In this one the headlines began “Drug Companies Fear Release of [the product]” with a sub-headline:  “Big Pharma stands to lose billions as doctors' [sic] recommend drug-free ‘health cocktail’ that adjusts and corrects your body's health conditions.”  It doesn't cure anything, but adjusts and corrects?  This sounds fishy to me and very hard to prove.

A paragraph below begins, “some doctors call it ‘the greatest discovery since penicillin’! And their patients call it ‘a miracle’!”  Of course they never specify who those doctors are except for one “top doc” who turns out to be a “company spokesperson.”

This aloe-based product is marketed to replace prescription proto pump inhibitors like Prilosec that reduce stomach acid production to help people with ulcers.  The ad does correctly mention that the FDA warned about problems and side effects with these prescription drugs in the past.

But their product is presented as new and revolutionary, “so powerful it begins to benefit your health the instant you drink it.”  It supposedly helps not only with digestion, but also supports heart health, improves brain function and memory by ensuring “healthy bacteria flows freely to your brain,” optimizes your liver, improves kidney function and delivers calcium to give you "celebrity hair and skin."  (See my comments one week ago on calcium supplements.)

A quick review of WebMD gives some reliable information about aloe, the main ingredient, particularly aloe taken by mouth.  It “can reduce constipation and also cause diarrhea” and may reduce “weight and fat mass in overweight or obese people with diabetes or prediabetes.”  All other listed benefits are for topical application with no mention of those listed in the ad.

They go on to point out that there has been some research but insufficient evidence of benefits for dry socket, cancer, canker sores, dental plaque, diaper rash, dry skin, frostbite, gum disease, hepatitis, high cholesterol, insect repellent, bedsores, dandruff, inflammatory bowel disease, wound healing, epilepsy, asthma, colds, bleeding, depression, glaucoma, vision problems, and several other conditions.  Notice again the absence of any mention of heart health, brain function, liver function or kidney function.

The next section lists warnings and side effects.  The gel is “likely safe when applied to the skin appropriately as a medicine or as a cosmetic” and is “possibly safe when taken by mouth appropriately.”  However, “taking aloe latex by mouth is possibly unsafe at any dose. . .”  Listed as possible side effects of taking it by mouth are:  stomach pain and cramps, diarrhea, kidney problems, blood in the urine, low potassium, muscle weakness, weight loss, and heart disturbances.  In high doses it may be fatal.

It’s strange that the ad lists kidney benefits and heart health while WebMD warns of possible negative side effects in both cases.

I find the whole thing very discouraging because na├»ve Americans are spending enough money on these products to pay for the development and placement of these ads, production and distribution of the product, company administration, plus company profits.  This applies to the example above plus all the other get-rich-quick and get-well-quick products on the market.  At one time hucksters rode into town in horse drawn wagons selling their cure-all snake oil.  Now they take out newspaper and radio ads, and people seem to be falling for it over and over.

Friday, January 19, 2018

What We Put in Our Mouth

A few days ago, my wife read a news story about the “raw water” movement in California.  It sounded outrageous, especially with the NBC headline:  “‘Raw water’ sound good to you? Then maybe diarrhea does, too.”  Untreated water may contain various harmful bacteria, farm runoff and other chemicals “that can cause long-term health effects, such as kidney and liver damage, nervous system disorders and birth defects.”  As people around the world crave clean drinking water, some Americans think it’s trendy to go back to nature.

I put it aside until I saw this CBS story about teens daring each other to eat laundry detergent.  That makes an interesting comparison to adults following every food trend that comes along.

First a brief summary of the detergent story – the latest social media fad is teens daring each other to put poisonous detergent pods in their mouths.  It’s called the "Tide Pod Challenge."  Those are the same pods government agencies have been recommending parents be very careful about buying, because toddlers and seniors with dementia mistake the colorful pods for candy.  Ten deaths have been reported.  Teens have no excuse and most know better, but at that age peer pressure is a powerful force.

The raw water story inspired me to look for other food trends.  What a surprise!  The search results for “2018 food trends” listed pages of sites.  I chose just a few to see what they held and soon I came to understand that what adults put in their mouths is often influenced by peer pressure as well – even if they too should know better. 

The first one I scanned asked:  “Always looking to be ahead of the curve when it comes to food trends?”  (Talk about pretentious!)  “The National Restaurant Association compiled the data by surveying 700 American Culinary Federation members earlier this year and asking them to rate over 100 items as 2018’s predicted ‘hot trend,’ ‘yesterday’s news,’ or ‘perennial favorite,’ respectively.”  Well, who would want their friends to find out that their food choices were so last year?  This is ridiculous on its face – hot trends, an American Culinary Federation?

But there was more.  Another site informed me:  “In recent years, quinoa, sorghum, teff and buckwheat have been the ‘superfoods’ of choice, but times are changing and other foods are taking the spotlight thanks to their spot-on nutritional content.”  The superfoods of last year are being replaced by the latest food trends that “may include nut oils, maqui berries, chaga mushrooms and tiger nuts.”  Later in the story appears a picture of two cartons of hemp milk, one labeled as a superfood, the other contains Omega 3 – 6, vitamin B12, vitamin D, and is gluten free, soy free, and carrageenan free, carrageenan, derived from seaweed is used for its gelling, thickening, and stabilizing properties.  Apparently we should avoid it like the plague!  You won’t find any of that stuff in a superfood, no matter how natural the seaweed is!

Finally, I ran into a discussion of something called hydrogen water, great for athletes as it promises to boost energy, supply antioxidants, and remove lactic acid.  (Lactic acid is another subject to look up before believing the negative press.  See this in Runner’s World.)  You can order hydrogen water on Amazon.  For $17.99 (with $12.00 shipping) you get 7 pouches holding slightly more than one quart each.   That’s 1.75 gallons of water for only $30!  Better hurry; when I checked, there were only 18 left in stock.  Compare that with tap water, which costs about a quarter of a penny per gallon.

The article goes on:  “Admittedly, the science in this area [of hydrogen water] is weak at best, but we love the clean crisp flavor (and it might have helped to make our hangover a little less intense). If you're thirsty and feeling like the tap water isn't cutting it, give this a go.”  If tap water isn’t cutting it you can also buy a beer at a baseball game for less!  But food trends are not to be approached with logic.

In the end we have teens following trends and adults following trends.  The difference is that the consequences to the teens and the “raw water” crowd may be near-term and very uncomfortable, if not fatal.  For the rest, the consequences are delayed and disconnected.  They wonder why they have to work well into retirement, forgetting that tap water was not good enough or that they have no savings left after throwing away good money on the latest superfood.

Monday, January 15, 2018

In Search of Longer Life

We love to believe that certain products will help us live longer and healthier lives.  The problem is we are often wrong, but continue to spend lots of money on these supposed preventions and cures.

In light of this, the latest research should come as no surprise.  “Calcium and vitamin D supplements may not help prevent bone loss and fractures, according to a new study released Tuesday in the Journal of the American Medical Association.”  This article goes on to say that in 2016 Americans spent close to $2 billion on these supplements hoping to enjoy the benefit of stronger bones.  In conclusion the researchers remind us that the best way to get nutrients is not through supplements, but through food rich in vitamin D and calcium.  And stronger bones are also promoted by regular exercise.

The part about skipping the supplements and getting vitamins and minerals through healthy eating is standard in much of this scientific health advice, but often ignored.  Taking a pill or two is much easier, and the idea of exercise to promote health just seems like too much work.  The result is $2 billion wasted.

Calling it a waste may seem harsh, but here is a direct quote from WebMD from about 3 weeks ago:  Seniors are wasting their time and money taking calcium and vitamin D supplements to ward off the brittle bones of old age.”  They are unnecessary and there is little evidence that they work.  But try to tell that to anyone committed to a daily regimen of supplements of any kind and they will resist, saying it works for them or it makes them feel better.

The problem is even greater for those buying homeopathic remedies.  Here is an excerpt from a Food and Drug Administration (FDA) press release from last month with the subtitle “FDA continues to find that some homeopathic drugs are manufactured with active ingredients that can create health risks while delivering no proven medical benefits.”

The press release continues:  “Until relatively recently, homeopathy was a small market for specialized products. Over the last decade, the homeopathic drug market has grown exponentially, resulting in a nearly $3 billion industry that exposes more patients to potential risks associated with the proliferation of unproven, untested products and unsubstantiated health claims.”  The Federal Trade Commission is also cracking down due to the unsubstantiated claims that these substances cure anything.

I don’t think it is a coincidence that the popularity has grown over that last decade when social media began to spread so many false reports about health, miracle cures, and vast conspiracies by the medical profession and insurance companies to keep the truth from the public.  Again I am not being harsh in exposing this information.  Consumer Health Digest puts it even more bluntly:  Although homeopathic products have no proven effectiveness and their theoretical basis is senseless, a complete ban is not politically feasible.”  Isn’t it a shame that popularity trumps science in this and so many other cases?

These ideas get embedded so deeply in the social consciousness that no amount of persuasion will change habits.  Take for another brief example this from the New York Times a little over a year ago:  “Misconception: Drinking buckets of cranberry juice can cure, and even prevent bladder, infections.”  Yet how many will continue to swear by cranberry juice for those mythical benefits?

There is no fighting it.  Weakness in discipline leads us to rejoice at the thought of an easy answer and weakness in critical thinking leads to the victory of emotion and popular opinion over science.  What’s the problem here?  After all, it’s only $5 billion wasted, and the cranberry juice will at least keep us hydrated.

Friday, January 12, 2018

Opioid Lawsuits

Recently states and cities, large and small, have made threats or begun the process of suing drug companies that manufacture opioids, blaming them for the epidemic of addiction and over-dose deaths that is sweeping the nation.

Here is a summary of one attorney general’s stance.  “Historically, opioid pain medications were considered too addictive and debilitating for anything but short-term acute pain and end-of-life care.”  But using sophisticated marketing campaigns in the 1990s, they “changed the prescribing culture, convincing doctors that opioids were not very addictive,” encouraging them to prescribe these drugs for chronic pain, using every trick at their disposal to increase sales.  They must take responsibility!

But the form of that responsibility is not specified.  The lawsuits reported on from cities in suburban Chicago “do not specify the amount of damages sought.”  So apparently their idea of responsibility means paying fines to governments.  A class action suit in West Virginia seems to be more focused and specific, seeking “relief for the following damages:
  •  Medical expenses, including money (often thousands of dollars) spent on the prescription drugs in question
  •  Costs for drug treatment programs
  •  Lost wages
  •  Pain and suffering
  •  Funeral expenses (if they lost a loved one to overdose)
  •  Any other relief the Court deems fair and just”
You would hope that such threat of penalties would motivate the drug companies to stop enticing doctors to do their dirty work.  These accusations certainly don’t cast a favorable light on the medical profession as a whole, but it’s probably like politics where everyone thinks their representative (or in this case doctor) is good, but the rest are despicable.
It reminds me of the lawsuits against Big-Tobacco, the primary difference being that tobacco has no redeeming characteristics, whereas opioids help people cope with severe pain.  Shutting tobacco companies down or at least fining them and requiring them to widely advertise the evils of their product makes sense, especially if it drives up the cost of cigarettes.  Driving up the cost of drugs or making them less available for the people who need them, on the other hand, would not be optimal.

Another problem arises from the fact that some of the people who became addicted and overdosed, did so using drugs that they obtained illegally.  Do we reward people for breaking the law by reimbursing them for lost wages, pain and suffering or money spent on their drugs?  That is for the courts to decide. 

Something to consider is how such a precedent may play out, suing companies that make a legal, beneficial product that can also be used irresponsibly or to break the law.  Some have already raised the idea of suing gun manufacturers.  Will cities move on to sue paint companies because they can’t control the spread of graffiti?  Will ladder makers be held accountable for the actions of cat burglars?  Why not sue glove companies or towel companies when no fingerprints are left behind at the scene of the crime?  Why didn’t this come up years ago when drivers were buying radar detectors for the sole purpose of warning them to slow down before they're caught speeding?  That was a product that, only with a great deal of subterfuge, could be represented as a benefit to society.  Lawsuits of this kind have already driven companies to plaster packaging and inserts with a host of, often ridiculous, warnings.

Some of those examples are farfetched, but the point is that states, cities and individuals seem to be surrendering, admitting the problem is beyond their control, their resources and their abilities, while looking for a scapegoat.  But isn’t this search for someone else to blame typical behavior of the addict they are trying to help and one of the first things they must overcome before recovery is possible?  Does no one else see the irony?

Monday, January 8, 2018

When Numbers Get Too Large

There is a concept in probability called the Law of Large Numbers.  Basically, it says that the more attempts you make at a measured activity, the more accurately you will understand the distribution of that activity.  For example, you may get a lucky streak at a casino or racetrack and come out ahead on a given day; but if you play long enough, you will lose.  The rules of the game stack the odds slightly against you.  Short term streaks occur, but results are predictable in the long run.

If you toss a coin ten times, you will get an equal number of heads and tails only about one in four tries.  More than 75% of the time you would get a different result.  But toss it a thousand times and the chance of getting closer to 50% heads and 50% tails is much better.  As you increase the number of coin tosses (or any similar activity), you are much more likely to be close to the expected outcome.  The same is true of experiments and studies as I have fussed about many times in the past when writing about science and medicine.  The bigger the sample size or number of trials, the more likely the results will be consistent with real life.

But I have created a different law of large numbers.  It states that it is almost impossible for anyone to really understand numbers greater than one million.  To most people numbers commonly tossed around in politics and science, like billions and trillions, are just words designating a big number or a whole bunch.  Even one million is beyond the grasp of most.

A million is a thousand thousands.  Counting to one million at one number per second nine hours a day would take a month – not time very well spent.  A stack of a million one dollar bills would stand almost 360 feet high and weigh over 1.1 tons.  A million of anything (or one chance in a million) is extremely hard to picture.  Such a large number means very little to most of us in real terms.

Now a billion is a thousand millions.  Politicians in Washington talk about a billion dollars as if it’s pocket change – a billion here, a billion there.  Here is an example given by a teacher to a class of seventh graders.  “If I gave you $1,000 a day, seven days a week, how long would it take you to collect 1 billion dollars?”   Most guessed around 4 years.  The answer is 2,737 years, 10 months, 7 days.  If this exercise started in the manger on the first Christmas, you would still be over 700 years away from collecting your billionth dollar.

A trillion is a thousand billion.  Count all the hairs on all the heads of everyone in a football stadium.  That’s a measly 6 billion or so.  To get a trillion of anything, load 38 and a half dump trucks like the one shown here with fine sand and count all the grains of sand – incomprehensible!
 Photo Credit:

Today our national debt hovers above 20 trillion dollars.  How big is that number?  If everyone in the US cancelled holiday shopping and sent all that money to pay off the debt, American children would be without Christmas for over 30 years – no tree, no lights, no presents, no special meal, just empty stockings for a generation and a half.

Perhaps the lack of urgency about government spending is due to the fact that those numbers are so big, bigger than anyone is able to grasp or imagine.