Friday, May 27, 2016

Epidemics

Two news stories came out in the past week to reinforce an earlier idea I presented under the title of “Don’t Ask Your Doctor.”  At that time I explained how drug companies want patients to put pressure on doctors to increase sales (not necessarily to apply the proper cure to whatever ails you).  The two recent issues are the overuse of antibiotics and the so-called opioid epidemic.

In the case of antibiotics, it’s fairly simple.  Antibiotics kill bacteria.  If bacteria cause an ailment, antibiotics may help.  Otherwise it’s worse than a waste; it’s a danger.  Over time bacteria can mutate into forms that are resistant to the latest antibiotics.  Then anyone who is sick due to the new, modified bacteria will not be helped.  Hence, the outbreak of the super-bugs like MERSA becomes a major and growing concern in the US. 

This is an aspect of what I call “virgin in the volcano” thinking.  According to lore, primitive island people would hold an annual ceremony to toss a virgin into the volcano to appease the gods.  If there was no eruption, they assumed it worked.  If there was an eruption they formulated some excuse to justify the discrepancy and the practice continued.  Viruses, not bacteria, cause the common cold.  It goes away in a couple of weeks.  Many people believe they need antibiotics and hound the doctor for them.  Either the doctor gives in, or they find another source.  They take the pills and the cold clears up, just as it would have had they not taken the pills.

This seems harmless enough except for that nasty ability of bacteria to adapt.  When doctors prescribe too many antibiotics, which they do 30% of the time, some bacteria become resistant.  The CBS News story takes it from there.  “According to the Centers for Disease Control and Prevention (CDC), antibiotic-resistant infections affect 2 million people and lead to about 23,000 deaths annually.”

Those 23,000 are not necessarily the same ones who caused the over-use.  They just happened to catch a very strong disease, one strengthened by its newly gained antibiotic resistance.

The second, related story also from CBS News tells us about another pill problem.  In the opinion of the former head of the FDA, opioid addiction in the US amounts to an epidemic.  Over 28,000 people die each year from an overdose of painkillers.  This is a major problem, but unlike the antibiotic problem, someone else overdosing will not put you in danger.

Similar to the antibiotic problem though, the focal point is the interaction between the patient and doctor and the understanding, sometimes on the part of both parties of what constitutes proper use.  Up to now, both have assumed that the pain is the problem and the answer was to keep popping pills until the pain went completely away.  This leads to the unrealistic expectation of a totally pain-free life and on from there to addiction.  The CDC now recommends that doctors first offer over-the-counter medications before turning to the addictive opioid drugs in more limited quantities.  This, again, becomes more difficult when patients are nagging for a particular drug they saw on TV, putting the advice of pharmaceutical ads over the advice of the doctor.


Both problems call for better education and more responsibility.  We can put the blame on government agencies for being lax and the proliferation of drug advertising with the “Ask Your Doctor” tag line, but then we become victims, giving up our very real ability to fix these problems. The doctors need to be more aware.  Their patients need to ask more questions instead of initiating the conversation with a request for medicine.

Monday, May 23, 2016

IOU

When I heard that average household debt in the US was over $90,000, I went on line to find out some of the details.  I found that the $90,000 number was the amount owed spread out over all households.  Considering that about 30% are debt-free, that means only the households that are in debt owe an average of over $130,000, an even more surprising number.

This personal debt includes student loans, mortgages, credit cards and auto loans.  Now averages are tricky and summing averages does not necessarily represent reality, but such a large debt while we hear constant reports of stagnant income for the middle class is still a matter for concern.

While I was looking for the details, I ran across this article about a similar problem in Australia.  Their “household debt has skyrocketed to 185 per cent of disposable income and continues to soar.”  They blame the problem on a combination of “ill-considered public policies and lifestyle and investment choices of individual households.”  Driving these personal spending and investment choices are artificially low interest rates and other government policies and programs that discourage savings and encourage borrowing.

The article predicts that in less than five years the household debt bubble will burst leading to widespread economic hardship for those who have incurred unsustainable levels of personal debt.  As a remedy to avoid the crisis, they recommend that the Australian central bank, analogous to the Fed in the US, raise interest rates to discourage borrowing.  This will cause some short-term pain, but will avoid a likely major economic upheaval if behaviors don’t change.

This story of Australia and the urgency with which it was written made me curious about the corresponding number for the US.  I found an estimate of the household annual disposable income for the US of $41,355.  If this is, in fact, the same calculation, the average household debt in the US is not 185 per cent of disposable income – it’s almost 220 per cent!


Should we be as panicked as the Australians?  I’m not sure.  But it seems to be at least a wake-up call about personal borrowing and spending.  Overspending is a discipline issue and the consequences, whatever they are, will catch up sooner or later.

Friday, May 20, 2016

More on Scientific Studies

As a follow-up to Monday’s article about scientific studies, why they are often contradictory and the need to understand how they are structured to assess their credibility, I came across this excellent example in my reading file.

Remember the key points from last time:
  • Negative results, those that show something doesn’t work or there is no danger, often don’t get a lot of publicity – even if knowing that information could be important;
  • Lack of funding for unexciting project leads to reduced efforts by researchers to replicate or validate previous studies;
  • When studies are not replicated and validated the strength or their results is questionable, and they are likely to be overturned;
  • Small sample sizes are prone to yield weakly supported results;
  • Even with a larger sample, a one-time study may produce a statistical fluke rather than a real scientific finding;
  • Finally, a lot of charlatans on TV and the Internet describe themselves as scientists and use scientific-sounding jargon to make a sale.
Related to the last item, when a sufficient number of Americans buy into a certain belief, companies will go to great lengths to meet the resultant demand.  They usually have no vested interest in educating the public when they can use junk science to sell as much product as real science.

Now comes the example from Business Insider.  The headline reads, “Scientists who found gluten sensitivity evidence have now shown it doesn't exist.”  The same people whose small study in 2011 concluded that “gluten-containing diets can cause gastrointestinal distress in people without celiac disease,” a condition they called non-celiac gluten sensitivity, went back to question their own results.  In the follow-up study they tested thirty-seven self-identified gluten-sensitive patients.

Here’s how it went.  The researchers provided every meal for twelve weeks.  The meals cycled through high-gluten, low-gluten, and no-gluten diets.  Without knowing which diet plan they were on at any given time, the participants reported pain, bloating, nausea, and gas to a similar degree for each of the diets.  The researchers could find “absolutely no specific response to gluten” and were forced to rethink their original (2011) conclusions.  The participants “expected to feel worse on the study diets, so they did. They were also likely more attentive to their intestinal distress, since they had to monitor it for the study.”

Does that matter to the food industry? – Of course not!  As long as 30 percent of people want to eat less gluten and gluten-free products produce $15 billion in sales, why should they care?  The good news is for the 1 percent who actually has celiac disease.  They don’t have to search so hard for gluten-free food.  The other 29 percent with a problem that’s all in their head puts pressure on the manufacturers to make sure the labels are big and bold, regardless of the science.


This is the drawback to the labeling argument that regardless of the science everyone has a right to know what they are eating and should be able to make an informed choice.  If that informed choice is based on faulty assumptions, superstition and scientific advice from Facebook friends, it is a drain on society.  When resources are spent to satisfy fantasy fears, they cannot be used to better purposes.

By the way, the example comes from August 2015 showing the truth in the first bullet point above that studies showing no danger get far less publicity.

Monday, May 16, 2016

Scientific Studies

A link to an interesting YouTube segment has been going around.  John Oliver talks about scientific studies in his humorous and irreverent way.  But many of the points he makes should be taken seriously.

Television and FaceBook are filled with studies and many of them seem to contradict each other.  The problems he points out include that scientists are under pressure from their academic institutions or employers, and negative results don’t get published – even if it would be important to know those negative results (to keep from wasting money, for example).  The confusion about which study to take seriously comes from the lack of efforts to replicate previous studies, a very important step in the scientific process.  If a study cannot be replicated by peers, as well as reviewed to ensure proper procedures were followed, its result is not considered valid.  But the pressure to find something new and exciting reduces the availability to get funding for replication studies, meaning those one-time results may have been a statistical fluke rather than a great scientific finding.

To get those all-important, positive, newsworthy results, researchers may resort to various gimmicks, such as using a small sample size, testing for so many variables that at least one will by chance show a statistically significant result, publishing results from lab rat studies as if they are equally valid for humans (which they are not) or publishing a press release with a sexy headline hoping the journalists will not dig too deeply into the substance of the limited experimental findings.  In addition, there are a lot of charlatans on TV and on the Internet describing themselves as scientists and using a lot of scientific-sounding jargon to sell whatever they have to offer.

This is an important subject, and if treating it humorously gets the point across, all the better.

After spending the 19 minutes watching that YouTube version of the Last Week Tonight episode from HBO, I soon saw an example of the problems.  The next day a Health Minute episode on local TV news featured a new study proclaiming that one minute of vigorous exercise was as good as a 45-minute moderate workout.  “Not having the time to exercise is no longer an excuse,” they announced.  I couldn’t find the same piece on the Internet, but instead found this New York Times wellness blog with exactly the same message.  The headline read:  “1 Minute of All-Out Exercise May Have Benefits of 45 Minutes of Moderate Exertion.”

Well, if you read only the headline, you have gotten two things:  another excuse to take it easy and a bunch of bad information.  As it turns out some folks at McMaster University in Canada chose 25 out-of-shape young men, took some biometric data from each and randomly split them into 3 groups:  one to ride moderately on an exercise bike for 45 minutes 3 times a week for 12 weeks, one to ride for only 10 minutes with three 20-second bursts of intense riding, and one to do nothing out of the ordinary (the control group).  They compared readings at the end of the test and found that the physical improvement for groups one and two were comparable and better than the control.

This is good information for those interested in interval training effectiveness, but the sample size was so small (8 per group) that the room for statistical error based on individual differences was huge.  Also, dividing groups randomly is a good default when there is not a better way to do it, but with only 25 people, it shouldn’t have been that difficult to come up with a more careful method.

Without getting too deep into the experimental design, it’s pretty easy to see that this was a small test without much rigor and certainly not what the headlines would lead us to believe.


This is why critical thinking is so important.  The news media, even the reputable NY Times, don’t care so much about the details as they do about catchy headlines to sell newspapers and airtime.  We can easily be led astray.  We can waste money or go down a dead-end path with our lives by putting our faith only in those studies that seem to tell us what we want to believe anyway.  And if you don’t like the study this week, just wait for the next one to come around.

Friday, May 13, 2016

Guns and Sunscreen

Summer is coming.  Traditionally this is a time for vacation and for visiting the beach.  But even these activities require a little thought, a little critical thinking to avoid the consequences of poor behavioral choices.

Critical thinking about vacation means more than just planning the itinerary.  A recent news headline read:  “TSA Hits New Record After Confiscating 73 Guns In One Week From Carry-on Bags.”  Wow, guns are not allowed on an airplane?  These are not terrorists, just travelers.  Apparently people either forgot or were distracted or didn’t check their bags themselves before leaving for the airport.  Not only were they confiscated but the TSA carry-on screeners found that 68 of them were loaded and more than two dozen had a round in the chamber.  People inadvertently trying to take loaded weapons onto an airplane is crazy, but not in a funny way.  If they were surprised to find out there was a gun in their luggage, they were probably more surprised to be facing a citation of up to $11,000 or in some cases even being arrested, regardless of their intent or degree of inattention.  All that lack of thinking can put a really damper on that highly anticipated and well deserved vacation.

Besides flying, another activity associated with summer (but often throughout the year) is getting a nice, healthy-looking tan.  To those who are so inclined this news will come as an unpleasant surprise.  The Federal Trade Commission (FTC) has permanently banned an Illinois company from marketing or selling indoor tanning systems.  These systems, the term tanning systems sounds more modern and scientific than tanning beds, were intended for home use and ranged in price from $1200 to $4000.  The FTC objection is that the marketers “ran ads claiming that their indoor tanning systems are safe, that research proves indoor tanning does not increase the risk of melanoma skin cancer, and that their systems which deliver both ultraviolet (UV) light and red light can ‘reverse the appearance of aging.’” The FTC labeled these claims as “false, misleading, or unsubstantiated.”  The company “also falsely stated that the U.S. Food and Drug Administration has endorsed the use of indoor tanning systems as safe.”

It takes about 30 seconds of Internet research to find the facts.  American Academy of Dermatology website states, “Evidence from multiple studies has shown that exposure to UV radiation from indoor tanning devices is associated with an increased risk of melanoma and non-melanoma skin cancer, including squamous cell carcinoma and basal cell carcinoma." [They include 9 citations in footnotes to back up this statement].

Several other sources tell us the following: 
  • ·      Researchers estimate that indoor tanning may cause upwards of 400,000 cases of skin cancer in the U.S. each year.  That’s more than smoking.
  • ·      There is no such thing as a safe tan and the beds may be more dangerous than the sun. 
  • ·      Tanning can cause permanent structural damage to the skin, including wrinkling, age spots, and loss of elasticity, not make the skin younger.
  • ·      A base tan does not protect skin from damage. In fact, people who base tan are more likely to report getting sunburned, perhaps from overconfidence.
  • ·      Some who become addicted to tanning also are more likely to suffer from anxiety or mood problems.
  • ·      Indoor tanning has been banned by a number of countries.

Surprise, surprise!  Even a simple thing like a summer vacation requires a modicum of critical thinking.  One of these errors will have immediate consequences and the other will have a delayed effect.  In any case, check the carry-on.  Pack the sunscreen and unpack the revolver.