Monday, 23 June 2014

Rule of Thumb

Wise words from @RoyalStatSoc:

Friday, 13 June 2014

The Thrifty Gene

The thrifty-gene hypothesis has reigned as the dominant explanation for soaring rates of obesity and diabetes among many aboriginal groups.  The Globe & Mail dig a little deeper in to the substance of this meme:

  • Dr. Neel, an influential geneticist at the University of Michigan, felt that genes were partly to blame. He speculated that genetic traits among the world's prehistoric hunter-gatherers enabled them to store calories during times of feast in order to survive in times of famine.

    But with "the blessings of civilization," he wrote, these thrifty genes had become hazardous baggage in a sedentary world of all feast and no famine, predisposing carriers to obesity and the diseases it brings.

Thursday, 12 June 2014

Time on Fat

The Truth About Fat

Different dogma but a fine conclusion!

General Health Checks

A thoughtful editorial in the BMJ - General Health Checks Don't Work (my emphasis):
  • We check our cars regularly, so why shouldn’t we also check our bodies so that we can find and treat abnormalities before they cause too much harm? It seems so easy, but the human body is not a car, and, in contrast to a car, it has self healing properties. Actually, the first thing we know about screening is that it will cause harm in some people. This is why we need randomised trials to find out whether screening does more good than harm before we decide whether to introduce it.
The medicalisation of each part of our life leads us to focus on numbers and simple solutions; focus on a metric (often something we measure because we CAN, rather than because we SHOULD), sell pill or lifestyle to shift this metric towards the (currently) 'approved' value.  As we move to the age of the quantified self, this nonsense will get worse.  We end up chasing numbers and lose the bigger picture.

What drives this medicalisation is money.  Lots of it.  The most obvious manifestation of which is the marketing arm of pharma, and the BEHAVIOURS thusly generated:
  • Our drug regulators approve diabetes drugs solely on the basis of their glucose lowering effect without knowing what they do to patients. The only large trial of tolbutamide was stopped prematurely because the drug increased cardiovascular mortality, but nothing material happened with its regulatory status and people continued to use it. More recently, rosiglitazone, which was the most sold diabetes drug in the world, was taken off the market in Europe, as it causes myocardial infarction and cardiovascular death and pioglitazone could also face trouble, as it has been linked to heart failure and bladder cancer.
There are good reasons to go to your doctor and to get an issue seen.  But there is a line to be drawn - if you eat well, exercise appropriately, address stress, get your sleep and generally feel 'well', then you are probably fine and you don't want to create an issue for yourself from the side effects of an unneeded treatment.

Even if a single metric (whatever that may be) is outside of 'normal' (whatever THAT may be), you should still exercise some cation before sucking up the pills.  Put diagnosis in to the context of lifestyle.  Lifestyle should be the first line of any non-urgent intervention.

Health is a moving target.  Our 'numbers' will change as the body adapts. As I said in Polypharmacy & the Inverse Care Law, the 'worried well' seem to be complicit in much over diagnosis (see Inverse Care Law).  Let's not make it easy for pharma's marketing arm eh?

Tuesday, 10 June 2014

What's the Story?

The HuffPo ask Are All Calories Created Equal? It isn't a bad article and covers the more nuanced ideas behind obesity that you'll have read around these here parts for the past seven years:

- A calorie is a calorie (ACIAC).
- We are not bomb calorimeters.
- A physicist would correctly state calories in vs calories out (CICO) as fundamental to an increase in the mass of the human body. But obesity is a problem of biology, not of maths.
- CICO contains no causal information, it just restates the problem.

Still not convinced? Consider this; we could get two people (unknown to one another and with no contact), to each write a story in any genre they wish - the only constraint being that they use the same number of letters and the story is in English.

The physicist or mathematician could state that the number of letters in each story were identical.

What are the chances these two stories are the same? 

A letter is a letter. A word is a word. English is English (notwithstanding dialects and patois). Grammar is grammar.  All these statements are true, but this tells us little about the subject of each story.

It's about time this nuance in the story of obesity became mainstream.

Monday, 9 June 2014

Keep Yourself Healthy

Dr Aseem Malhotra is spot on with this article:
  • Most of us value our health but engage in behaviours that undermine it. It's all too easy to understand, tempted as we are by that extra pint at the pub or the brightly coloured chocolate bar at the checkout. But, viewed from inside the NHS, I think that as a nation we've also lost perspective about what healthcare and modern medicine can achieve. Don't worry if we let things slip, we think, we can always find a pill to fix things or secure a hospital makeover. (It's a belief, often encouraged, I have to admit, by a medical profession too ready to administer drugs.)
 His anti-sugar rhetoric is perhaps a bit too strong for my liking at times, but hell, he is putting in a good fight against the dessertification of our diets!

Sunday, 1 June 2014

The Antibiotic Winter

A great article on 'Why antibiotics are making us all ill'.

What caught my eye was that finally scientists are looking at many modern ailments as different manifestations of the same underlying cause:

"Why are all of these maladies rapidly rising at the same time across the developed world and spilling over into the developing world as it becomes more westernised? Can it be a mere coincidence? If there are 10 of these modern plagues, are there 10 separate causes? That seems unlikely.

Or could there be one underlying cause fuelling all these parallel increases? A single cause is easier to grasp; it is simpler, more parsimonious. But what cause could be grand enough to encompass asthma, obesity, oesophageal reflux, juvenile diabetes, and allergies to specific foods, among all of the others? Eating too many calories could explain obesity, but not asthma – in which many of the ill children are slim. Air pollution could explain asthma but not food allergy."

A thoughtful read.