Friday, December 29, 2017
1. The opioid epidemic rages. “More than 63,600 people died from drug overdoses in 2016” with 66% of those deaths coming from opioid abuse. The most publicized initiatives are: increasing availability of naloxone (narcan) to revive people who have overdosed; and needle exchange programs to reduce the risk factors for AIDS and hepatitis.
This New York Times article explains the first. “Every day across the country, hundreds, if not thousands, of people who overdose on opioids are being revived with naloxone. Hailed as a miracle drug by many, it carries no health risk; it cannot be abused and, if given mistakenly to someone who has not overdosed on opioids, does no harm. More likely, it saves a life.”
Perhaps an important question to ask is whether these programs are doing anything to change behavior. One FDA study from a few years back, when the problem wasn’t as widespread, estimates that almost one in five patients are receiving naloxone not for the first time. This was based on EMT data. With it now available to many private citizens, spouses and roommates, such incidents could be higher. Some people are so seriously addicted that a brush with death is insufficient disincentive, while some taxpayers are asking how many second chances should be allowed.
Needle exchanges are likewise controversial. Some programs recommend a one-for-one swap, but don’t enforce it. Others receive objections from neighbors about an increase in discarded needles on the street.
But this from the LA Times almost 4 years ago: “Alcohol is responsible for about 88,000 deaths in the U.S. each year, according to a new government report on the toll of excessive drinking.” That’s 88,000 compared to 63,600.
What's the deal? Why is only one considered a crisis? Is it because alcohol is legal? Is it because we have been fighting (and losing) the war on drugs since 1970 but quit fighting a war on alcohol in 1933? Is it because an overdose death is immediate but an alcohol-related death is often gradual? Or is it just another instance of "shark attacks" where what makes the best headlines gets attention?
2. Back in November I wrote that when looking for reasons to be offended, some people aren’t satisfied citing ordinary matters. They will dig deep and use plenty of imagination to uncover the most obscure examples. In mid-December we learned of a Boston University professor “who has researched the origins of the popular Christmas carol ‘Jingle Bells’ [and] says she has found proof that the seemingly-innocent song is steeped in racism.” Why not add White Christmas to the list, pretending it doesn’t snow around Boston? Forget white; a quick search of the Internet reveals that using the C-word to describe the holiday is not politically correct and may be offensive.
3. A few weeks ago the New York Times reported that the pentagon spent $22 million on the Advanced Aerospace Threat Identification Program to investigate UFO sighting. A pet project of former Senate Majority Leader Harry Reid, the funds were hidden in the budget. Coincidentally, most of the money went to an aerospace research company run by one of his personal friends. Shouldn’t revelations of such waste and abuse of power be as disturbing as a senator mock-fondling an actress? Yet it goes in and out of the news cycle with almost no comment except for a few lame UFO jokes.
A couple of other comments on the UFO investigations: one on cost, the other on value. First, I heard in one report that the program was discontinued in 2012, but the government employee running it resigned only this year - good work if you can get it. Second, with cell phone cameras everywhere and the tendency to take pictures of and post every unusual (or ordinary) event, what is the likelihood of having aliens in our midst without evidence being spread all over social media?
4. Wildfires in California have burned about 300,000 acres of mostly trees and brush. The Governor conceded that this kind of devastation will become a new normal due to changing weather patterns. How would the situation improve if the State and the people who so loved trees allowed logging companies to harvest a reasonable number to build new houses instead of leaving them all in place to help spread the fires and to act as fuel, destroying occupied houses? The Governor’s real message is that they are consciously choosing to continue yesterday's policies, knowing they will get the same result. Critical thinking, anyone?
Monday, December 25, 2017
Eating healthy gets more and more difficult with so many warnings to heed. Every other day someone is telling us that some other food may cause cancer. Alternatively, we often find that the ones we were warned about last year are either less dangerous or actually good for us.
This report from the PBS News Hour is a good example. “Scientists at the University of California, San Francisco, said they have uncovered documents demonstrating that members of the sugar industry called off a study, named Project 259, in the 1960s because it linked sucrose – a common sugar – to heart disease and bladder cancer in preliminary experiments.”
Several questions spring to mind. Is the science from 50 years ago as good as the science of today? Is calling off a study that same as confirming that the unfavorable findings are true? What was the objective of this Project 259 that they happened to stumble upon these findings – surely the sugar industry didn’t say, “Look into the health benefits of our product, but if you find anything scary, stop!” Does PBS not understand that linked to is not the same as causes? And, what are these scientists doing poking around into documents from studies done in the 1960s other than trying to stir things up and make headlines? Finally, haven't we been told over and over that it's artificial sweeteners, like aspartame, not sugar, that supposedly cause cancer?
Back in the 1960s they were denying that sugar was the cause of obesity, pinning the blame instead on fat. It took scientists and the government over 50 years to get that straight and still some want to argue.
A more recent source from a couple of years ago brings this sugar/cancer issue up to date: “It’s true that sugar feeds every cell in our body – even cancer cells. But, research shows that eating sugar doesn’t necessarily lead to cancer. It’s what sugar does to your waistline that can lead to cancer.”
How do we keep these conflicting and confusing stories straight? Another source provides some helpful information.
In 2013 the American Society for Nutrition reviewed 264 studies on cancer risk for “50 common ingredients from random recipes in a cookbook.” They found at least one paper reporting a cancer risk for forty of those fifty ingredients. In total, “191 (72%) of the studies concluded that the tested food was associated with an increased (n = 103) or a decreased (n = 88) risk. It seems that if you look hard enough, you can find a study that confirms what you want to believe about the dangers or benefits of almost any food.
The conclusion of this wide-ranging review confirms that notion. “Associations with cancer risk or benefits have been claimed for most food ingredients. Many single studies highlight implausibly large effects, even though evidence is weak.”
One writer put it into perspective with this comment: “Perhaps the best example is processed red meat, which the WHO thinks will raise your relative risk of cancer by 18 percent. That sounds scary. That's still debatable, but even if it's true, then it would mean that if I declared today that I would eat an extra three pieces of bacon every day for the next 30 years, my absolute risk of colon cancer might go from 2.7 percent to 3.2 percent. That's… not that scary. And I'm not going to eat that much bacon, so it's likely much less.”
So, there we have it. If sugar causes cancer, it’s in some good company. It’s always important to put these reports in perspective, never counting on the news media to do it for us. (But do take it easy on the Christmas cookies.)
Friday, December 22, 2017
Here is an interesting exercise in ethical behavior developed by some very devious scientists. It’s usually referred to as the trolley problem. Here’s how Time framed it up a few years ago. “Imagine you are a train-yard operator who sees an out-of-control boxcar running down a track that five workers are repairing. The workers won’t have time to get out of the way unless you flip a switch to change the car to another track. But another worker is on the second track. You have just seconds to make a decision: let the five workers die – or kill the one. What do you do?” This is a challenging dilemma, even as a hypothetical.
The utilitarian answer is to pull the switch, similar to the decision of Mr. Spock in the movie “Star Trek II” (1982) – “Do not grieve, Admiral. It is logical. The needs of the many outweigh...the needs of the few…or the one.” About 90% make this choice. The rest opt not to intervene letting the natural course of events play out. But no action is also a choice.
Now let’s shift the scenario slightly to one I find very disturbing. Instead of a train or trolley we have a bus bearing down on a man and a dog. You can save only one of them. Researchers asked this question of 573 participants in 2013. They were “forced to decide whether to save humans or pets from imminent death. The level of relationship between the human shifted six times (foreign tourist, hometown stranger, distant cousin, best friend, grandparent, or sibling), while relationship to the pet had two levels (your pet, someone else's pet). Willingness to save a pet over a human consistently decreased as level of relationship between the participant and the human in the scenario increased.
Here are a few examples. Some chose the dog over a sibling (1%), over a grandparent (2%) over a distant cousin (16%) and over a foreigner (26%). More than one-quarter valued the life of a dog over the life of a fellow human being, the nondescript stranger! Furthermore, 46% of women would save their own dog rather than a foreign tourist. To me that is mindboggling.
We love our pets. Many treat them as part of the family, pampering our “furry children” with organic food, spa treatments, vacations and top-of-the-line healthcare. And how about those who would pay tens of thousands of dollars for a cloned replica of their deceased best friend. People have protested about being forced to let their neighbors take the place of their dog in a tornado shelter. But we need to get some perspective along with some critical thinking. A dog or cat has a shorter life span than humans so the grief will come, but after a reasonable period the pet is replaceable. Much of the attachment comes from the human side, especially the tendency to attribute human thoughts and feeling to other species – often based on their attractiveness. (As I’ve said before, if mosquitos had fur and big eyes, we would be shamed for swatting them.)
But Americans do value pets and other Americans over foreigners. Perhaps that’s why when 305 people are killed in Egypt, the headline hardly raises an eyebrow and is quickly superseded by another sexual harassment scandal or another American in distress. It explains how we could so easily ignore the Rwandan genocide in 1994 with the slaughter of over 10,000 men, women and children per day for over three months. At that time the economy was beginning to boom and all seemed well; and today we are too busy looking at pictures of cute kittens and puppies on social media (and on the network news as well) to care about such things.
Pets are not human, and now the pet-owning 2/3 of the population gets to hate me for pointing this out – oh, well.
Monday, December 18, 2017
Several times in the past, I've emphasized the importance of understanding science. I wrote about science education and in 2013 even titled a piece “Sleeping Through ScienceClass.” Past essays showed how a lack of understanding and Internet hype, leads to misinterpretation of research studies that are constantly in the news, which in turn leads to wasting money buying worthless pills and other health aids and following the latest food fads.
As a quick example, National Health Service (NHS) in England will stop paying for what they consider to be "low value" treatments. The list includes: homeopathy and herbal medicines along with Omega-3 fatty acid compounds (fish oil), lidocaine plasters, glucosamine and chondroitin combination products, lutein and antioxidant combination products, oxycodone and naloxone combination products. All of these are classified by the NHS as “products of low clinical effectiveness, where there is a lack of robust evidence of clinical effectiveness or there are significant safety concerns.” [Emphasis added] How many of these do Americans see advertised and spend hard-earned money on hoping for health miracles?
But in the not too distant future, we will be called upon to make choices where the importance of understanding science goes far beyond protecting people’s wallets from their own foolishness. Decisions will be about the ethics and morality of medical procedures.
Already researchers are testing an experimental drug injected into spinal fluid to lower levels of toxic proteins in the brains of patients with Huntington’s Disease, a neurodegenerative condition. “Some patients described the condition as Parkinson's, Alzheimer's and motor neurone disease rolled into one.” In an interaction called “gene-silencing,” the drug acts to block a genetic error carried by the DNA to inhibit the formation of those bad proteins in the brain.
Beyond the idea of silencing genes to block errors is the use of gene spicing to combat other diseases. Advances in this type of gene editing are moving quickly to develop a variety of desired characteristics in animals. In Turkey a few years ago two bunnies were born glowing green when the scientists altered their DNA with jellyfish genes. But this was not a frivolous endeavor by some mad scientists. They hoped to use what they learned about manipulating genes to produce new medicine in milk, among other applications.
According to the recent book, A Crack in Creation, this process of gene splicing could soon be used to combat human diseases. Additionally, germ-line editing of human embryos could be used to eliminate birth defects or (and this is a bigger issue) to alter the characteristics of a baby in development which, in some cases, could allow improved characteristics to be passed on future generations. Scientists and doctors developing better humans in the lab could upend the idea of evolution taking place over millions of years.
Imagine the ethical questions that will arise from such tinkering! If people today are frightened by GMO wheat, think of their reaction to GMO humans, even if the DNA modifications are made only for lifesaving reasons. Next question: should DNA modification be used to prevent cancer, Alzheimer’s and other diseases? Finally, how do we regulate the use of such power to permit only wise and beneficial outcomes? Do the rich get to buy super-babies while the rest are left even further behind in the evolutionary struggle? Just as nuclear power can be used both to generate electricity without emissions and to blow up entire cities, so such advanced biological science may be used for good or destructive purposes.
In a democracy, the people should be making these kinds of decisions rather than scientists, government or the courts acting independently. How will Americans decide complex medical questions appropriately when many are unable, for example, to distinguish homeopathy from real medicine?
Some decisions are already being driven by public opinion. As one American scientist pointed out in the green-rabbit story, much of the research takes place outside the US because: “Animals [in this country] have so many rights now that it is insane. So the cost to do it in the US is extremely prohibitive. They want to stop you. That’s why we’re going abroad where regulations are a lot more sensible.” Does America abdicate the lead in this field, leaving the rest of the world to find and market cures and set regulations or do we use our influence to try to assure wise and fair outcomes?
As long as public opinion is so easily swayed by junk science claims and political scare tactics, the future of medicine is in question.
Friday, December 15, 2017
Every few months it pops up on social media: “I paid into Social Security and the government is using my money without my permission!” It’s listed as “Fun Facts” and says that it’s your money, politicians are using it without your permission, and they are lying about insolvency because it is running a huge surplus. Let’s take a look at the validity of that outrage.
The first person to claim Social Security was Ida May Fuller. She paid in a total of $25.75 over the three years of working in the 1930s and had collected $22,888.92 by the time she died at age 100. How could that all be her money merely held in a lock box and paid back to her? NO. Social Security is a tax, set up like an insurance policy or annuity. Everyone is required to pay the “premiums” to get in return an agreed amount upon retirement. All the money goes into a pool and is paid out to retirees as promised. It is workers’ money going in, retirees’ money coming out.
Initially with more workers than retirees, that pool grew. The Treasury doesn’t keep it hidden in a mattress or invest in gold. They don’t put it in the local credit union or bank; nor do they buy stocks or corporate bonds. They are required to invest it in government bonds, considered one of the safest possible investments. But those bonds are the vehicle for the government to borrow money when it spends more than it has – which is most of the time.
So yes, the government spends that money, but it has an obligation to pay it back to the Social Security Trust with interest, the same obligation it has to anyone else that buys government bonds. This isn’t raiding the trust fund; it’s spending money that was borrowed.
Why are we worried as long as there is this huge surplus ($2.85 trillion) in the fund? With more people retiring and a smaller workforce contributing – more going out than coming in – soon that huge surplus will be gone. Here is what the government writes in the press release announcing the 2017 annual report: “The year when the combined trust fund reserves are projected to become depleted [i.e., all gone]…is 2034…[after that] there will be sufficient income coming in to pay [only] 77 percent of scheduled benefits.” What could extend that date is a continuing strong economy with high employment with good paying jobs.
Once we pay the tax, it is no longer our money. Politicians are not robbing the Social Security bank, but are treating the money as they would any other borrowed funds. The surplus is large now but could easily disappear in less than two decades – in other words, if you are 45 years old today, expecting to collect full benefits at 65 is iffy. When nothing is done and the fund runs out, it is highly likely that Washington will avoid the unpopular action of cutting benefits, thereby adding costs. That will impact the debt.
So most of what is posted is neither fun nor is it facts. It’s mean and nasty, a scheme in support of a political agenda to get people all upset – and it works! Critical thinking is impossible when people fail to do even a little research.
Monday, December 11, 2017
We start with a CNBC story about a new miracle product advertised to help people achieve optimal human performance – whatever that is. A reader sent me an email with the subject line “If only people read your blog” along with the link to that story.
The headline reads: “This start-up raised millions to sell 'brain hacking' pills, but its own study found coffee works better.” So what do conscientious business people do when their own study shows that pills they are selling for $40 a bottle are “less effective in many ways than a cup of coffee”? They try to “delay publication of the study and asked researchers to change the name of the product [studied] to distance it from the analysis.”
The company claims their “supplements such as chewable caffeine pills help the human system become ‘quantified, optimized, and upgraded’…and that they may unlock the ‘next-level thinking’ that will be key to humanity's evolution.” Pay no attention to that pesky research comparing it unfavorably to coffee or to the general lack of scientific evidence backing their claims. The news report concludes with information that one month after receiving the results of the study, they changed the company name and hired a scientist, as neither co-founder “has a scientific background.”
Of course these products are marketed as dietary supplements to sidestep FDA regulations. They are therefore only subject to investigation after problems are reported. Problems may include illness, injury or major physical side effects; the financial side effects of tossing away $40 for a bottle of chewable caffeine pills are left to the individual. (For a more in-depth discussion of the problems with nutritional supplements in general, see my comments here, here and here.)
What is frightening is that they are selling millions of dollars of these products to people who should know better. (But that’s a drop in the bucket compared to the revenue generated by the supplement industry as a whole.) P. T. Barnum was right!
And speaking of people knowing better – after much legal foot-dragging, stalling and negotiating by the defendants, a Federal Judge has ordered tobacco companies who lied to the American public about the dangers of cigarette smoking to take corrective action. They are forbidden to use any health descriptors including "the words ‘low tar,’ ‘light,’ ‘ultra light,’ ‘mild,’ ‘natural,’ and any other words which reasonably could be expected to result in a consumer believing that smoking the cigarette brand using that descriptor may result in a lower risk.” In addition, they’ve been ordered to undertake a broad campaign, advertising the dangers of smoking including: website postings, labels on cigarette packages, and newspaper and television ads.
That’s all fine, but a few weeks ago I was out with my granddaughter on the day after my birthday. She asked how old I was now. When I told her, she said, “It’s a good thing you didn’t smoke or you would be dead already.” So if a five-year-old can figure it out and express it that clearly, I think it’s more a matter of motivation than information for teens and adults.
A little critical thinking and paying attention goes a long way to making us healthier and wealthier. Isn’t it worth a try?