Quotulatiousness

September 11, 2012

More evidence that a bit of dirt can be a healthy thing for kids

Filed under: Health, Media, Science — Tags: , , , — Nicholas @ 00:02

Matt Ridley reviews a new book by Moises Velasquez-Manoff:

In a remarkable new book, “An Epidemic of Absence,” Moises Velasquez-Manoff draws together hundreds of such studies to craft a powerful narrative carrying a fascinating argument. Infection with parasites prevents or ameliorates many diseases of inflammation. The author briefly cured his own hay fever and eczema by infecting himself with hookworms-before concluding that the price in terms of diarrhea and headaches was too high.

I’ve touched on the “hygiene hypothesis” in these pages before. In its cartoon form the argument-that in a clean world our immune system gets bored and turns on itself or on harmless pollen-isn’t very convincing. But Mr. Velasquez-Manoff makes a far subtler, more persuasive case. Parasites have evolved to damp our immune responses so that they can stay in our bodies. Our immune system evolved to expect parasites to damp it. So in a world with no parasites, it behaves like a person leaning into the wind when it drops: The system falls over.

Moreover, just as brains outsource much of their development to the outside world-the visual system is refined by visual input, the language system can only develop in a language-using society — so the immune system seems to have happily outsourced much of its regulation to friendly microbes. Without them, the immune system becomes unbalanced.

[. . .]

One of Mr. Velasquez-Manoff’s most surprising chapters is on autism, a disorder that almost exactly parallels asthma in its recent rise among affluent, urban, mainly male, disproportionately firstborn people. Better diagnosis explains perhaps half the rise, but the brains of people with autism are often inflamed, and there’s anecdotal evidence that infection with worms or viruses can tame autistic symptoms, at least temporarily.

September 5, 2012

Our conflicted feelings about athletes “juicing”

Filed under: Football, Health, Science, Sports — Tags: — Nicholas @ 08:13

In a sport that most people don’t care about unless a local player is doing well internationally (competitive cycling, for example), a scandal over performance enhancing drugs is a good opportunity to make noises about the “purity of the sport” and demand major sanctions against those who cheat. However, as Jim Souhan points out at the Star Tribune, we’re rather good at turning a blind eye to the same thing in sports we care more about:

The advent of the NFL season will provide a respite from sports riddled with performance-enhancing drugs, such as baseball and cycling.

If you can read that sentence without laughing, you are one naive fan.

We know many baseball players cheated in the ’90s and early 2000s, and we know some cheat today. For every Melky Cabrera who gets caught there must be dozens, if not hundreds, who are smart enough to avoid testing positive in a system that is easy to beat.

We know cyclists cheat. The evidence is overwhelming. When Lance Armstrong pretended to take a principled stand by abandoning his legal fight to defend himself, he was avoiding facing public testimony by a squadron of former teammates. Now another former teammate, Tyler Hamilton, has written a book in which he details his own, and Armstrong’s, cheating, and other former Armstrong associates are speaking openly about his PED use.

[. . .]

If Armstrong could avoid testing positive for PEDs while winning the Tour de France seven times, what does that tell us about the National Football League, a sport filled with the biggest, strongest, fastest and most explosive athletes in our society?

That’s right: The NFL must be stuffed with performance enhancers.

The difference is that we don’t care.

August 28, 2012

Rehabilitating Florence Nightingale’s reputation

Filed under: Britain, Health, History, Military, Russia — Tags: , , , , — Nicholas @ 08:31

History Today has a defence of the much-maligned Florence Nightingale:

Jamaican-born Mary Seacole (1805-81), voted top of the list of the 2004 ‘100 Great Black Britons’ poll, is now slated to replace Florence Nightingale (1820-1910) as the true ‘heroine’ of the Crimean War. She is to be honoured as no less than the ‘Pioneer Nurse’ with a massive statue to be erected at St Thomas’ Hospital in London. This in spite of the strong links between Nightingale and the hospital, her base for over 40 years. It was there she established the first secular school for nurses in 1860 with funds raised in her name for her work in the Crimean War during the conflict of 1854-56. The Nightingale School operated for over a century from the hospital, whose redesign in the 1860s Nightingale also influenced.

[. . .]

The campaign promoting Seacole over Nightingale builds on 30 years of books, articles and films denigrating the latter. While she always had detractors, the serious assault on Nightingale’s reputation can be dated to 1982, with the publication of the Australian historian F.B. Smith’s Florence Nightingale: Reputation and Power (Croom Helm, 1982). The next major hit came in 1998 with Florence Nightingale: Avenging Angel (Constable, 1998) by a retired management consultant Hugh Small, which argues that Nightingale was actually responsible for the high death rates of the Crimean War and had a nervous breakdown as a result when she supposedly recognised this. Neither claim is supported by any serious documentation. Social media goes even further: see Facebook ‘Florence Nightingale was a Murdering Bitch’, later renamed ‘Florence Nightingale: The World’s Worst Nurse’, where she is described as a ‘deluded power hungry bitch’, who ‘looks like an uptight bitch’, so that ‘the day she died’ was ‘the best thing that ever happened to the field of nursing’.

[. . .]

The French were the instigators of the Crimean War, sent more troops and were better prepared than the British. Their death rates were lower in the first year. But the British government learned from the commissions it sent out and made enormous changes. British death rates fell dramatically, from 23 per cent in the first winter to 2.5 per cent in the second — no greater than deaths among soldiers in peacetime barracks in London, as Nightingale proudly showed in a chart. In contrast, the French (lower) 11 per cent death rate in the first winter, rose to 20 per cent in the second winter. Since the French were late in publishing their statistics, neither Nightingale nor the royal commission could use them for comparison. However French doctors themselves credited the British reforms for their superior performance. Once they were properly cleansed and functioning Nightingale was proud of the Crimean hospitals. In her own charts she separated the two periods, before and after the sanitary and supply commissions, to emphasise the crucial role they played in reducing mortality.

Her analysis of what went wrong was widely accepted and led to major changes to health care in the British Army. The ‘Nightingale Fund’ raised in her honour for that work paid for the training school at St Thomas’, which led to raising nursing to the level of a profession throughout much of the world. Her experience of the war, and her reputation and research as a result of it, grounded all the social and public health work she did for the rest of her life. Her vision for health reform included bold statements, such as the belief that the poor should receive as good quality hospital care as private patients and warnings as to the dangers of hospital acquired infections. Nightingale, in short, is no mere historical figure. Her lamp should not be retired but shone brightly onto the hospital and health care problems of today.

August 25, 2012

Yet another factor in obesity

Filed under: Food, Health, Science — Tags: , — Nicholas @ 00:09

“I want to say one word to you. Just one word.” Antibiotics.

We aren’t single individuals, but colonies of trillions. Our bodies, and our guts in particular, are home to vast swarms of bacteria and other microbes. This “microbiota” helps us to harvest energy from our food by breaking down the complex molecules that our own cells cannot cope with. They build vitamins that we cannot manufacture. They ‘talk to’ our immune system to ensure that it develops correctly, and they prevent invasions from other more harmful microbes. They’re our partners in life.

What happens when we kill them?

Farmers have been doing that experiment in animals for more than 50 years. By feeding low doses of antibiotics to healthy farm animals, they’ve found that they could fatten up their livestock by as much as 15 percent. You can put the antibiotics in their feed or in their water. You can give the drugs to cows, sheep, pigs or chickens. You can try penicillins, or tetracyclines, or many other classes of antibiotics. The effect is the same: more weight.

It seems reasonable to assume that this effect is also true for humans. And we dose ourselves with antibiotics far more than we should (often for things that do not respond to antibiotics at all … a twist on the placebo effect). In addition, many of the animals we raise for meat are regularly dosed with antibiotics.

For now, two things are clear. First, antibiotics have done a huge amount of good in treating bacterial infections and if we’re even talking about reducing their use, it’s because we have the luxury of health that they have provided. Second, they are clearly overused: prescribed for illnesses that they have no power over, and used to fatten livestock that aren’t sick. Currently, on average, every American child gets a course of antibiotics ever year.

The overuse of antibiotics has fuelled the rise of antibiotic-resistant bacteria, but their impact on our beneficial bacteria could be equally detrimental. Blaser has been vociferously banging on this drum for years. As he wrote in a comment piece for Nature, “Antibiotics kill the bacteria we do want, as well as those we don’t… Overuse of antibiotics could be fuelling the dramatic increase in conditions such as obesity, type 1 diabetes, inflammatory bowel disease, allergies and asthma… We must make use of the available technology to protect and study our bacterial benefactors before it is too late.”

June 8, 2012

Allergy season strikes

Filed under: Health, Randomness — Tags: — Nicholas @ 07:43

I’ve had fall and spring allergy issues since I was a teenager. They’re pretty predictable in symptoms: dry, itchy eyes and full sinuses followed by sneezing and/or coughing (depending on which direction the sinus overflow headed). Over the last several years, the intensity of the allergy attacks has steadily declined, which has been great. This week, however, I got the worst symptoms I’ve had in at least a decade and it came on with little warning.

I tried to tough it out for the first couple of days, but as I really wanted to be awake and de-symptomized for the GW2 Beta Weekend Event kicking off later today, I figured I’d better take some allergy medicine. It turns out the only package of Claritin I had is past its use-by date. The unopened package expired in October.

Of 2009

I guess I really have been doing well in the allergy line recently.

March 10, 2012

Some diseases may be caused by “endogenous” retrovirii

Filed under: Health, Science — Tags: , , , , — Nicholas @ 12:17

Matt Ridley on some recent discoveries in genetics and medicine that may help to explain certain diseases like multiple sclerosis:

The virus implicated in multiple sclerosis is called HERV-Fc1, a bizarre beast called an “endogenous” retrovirus. What this means is that its genes are part of the human genome. For millions of years, they have been integrated into our own DNA and passed on by normal heredity. It was one of the shocks of genomic science to find that the human genome contains more retroviral than “human” genes: some 5% to 8% of the entire genome.

Normally, the genes of endogenous retroviruses remain dormant, but — a bit like a computer virus that springs into action on a trigger — something wakes them up sometimes, and actual viruses are made from them, which then infect other cells in the body. The Danish scientists suggest that this is what happens in multiple sclerosis. Bjørn Nexø of Aarhus University writes that “retroviral infections often develop into running battles between the immune system and virus, with the virus mutating repeatedly to avoid the immune system, and the immune system repeatedly catching up. One can see the episodic nature of multiple sclerosis as such a running battle.”

The possibility that you can inherit the genes of a virus blurs the distinction between a genetic and an infectious disease. The HERV-Fc1 genes lie on the X chromosome. Since women have twice as many X chromosomes as men, this might explain why some forms of MS are more common in women. Dr. Nexø concludes hopefully: “The finding that a disease is caused by an infectious agent is an encouraging one. These are the diseases which we know best how to treat.

The research also appears to show a link between cat ownership and schizophrenia:

Human beings can also catch toxoplasma from cats, and it’s known to affect behavior: altering personalities, slowing reaction times and increasing the risk of car accidents. More than 20 studies have now found an association between schizophrenia and toxoplasma. Schizophrenia is more common among those who had pet cats in their childhood homes (but not in those who had pet dogs).

Indeed, some scientists think that schizophrenia only became common, around 1870, when keeping cats as indoor pets became fashionable. The parasite has genes for dopamine, a neurochemical found in excess in schizophrenics.

January 15, 2012

As you’d expect, healthcare costs are not evenly distributed

Filed under: Economics, Health, USA — Tags: , , , — Nicholas @ 12:20

Jordan Weissmann in The Atlantic:

When it comes to America’s spiraling health care costs, the country’s problems begin with the 5%. In 2008 and 2009, 5% of Americans were responsible for nearly half of the country’s medical spending.

Of course, health care has its own 1% crisis. In 2009, the top 1% of patients accounted for 21.8% of expenditures.

The figures are from a new study by the Department of Health and Human Services, which examined how different U.S. demographics contributed to medical costs. It looked at the $1.26 trillion spent by civilian, non-institutionalized Americans each year on health care.

The top 5% of spenders paid an annual average of $35,829 in doctors’ bills. By comparison, the bottom half paid an average $232 and made up about 3% of total costs.

January 11, 2012

Computers as doctors

Filed under: Health, Technology — Tags: , — Nicholas @ 12:02

An interesting post from Alex Tabarrok at Marginal Revolution:

In 2004 I wrote In Praise of Impersonal Medicine arguing:

    I have nothing against my physician but I would prefer to be diagnosed by a computer. A typical physician spends most of the day playing twenty questions. Where does it hurt? Do you have a cough? How high is the patient’s blood pressure? But an expert system can play twenty questions better than most people. An expert system can use the best knowledge in the field, it can stay current with the journals, and it never forgets.

and in 2006 I noted:

    The practice of modern medicine is surprisingly primitive … My credit card company knows far more about my shopping history than my physician knows about my medical history.

I now believe that we are on the cusp of major changes to medicine. The thousand dollar genome sequence is less than a year away, Ford has just developed a car seat that can monitor your health, many people are already using wrist monitors to measure heart and sleep patterns. All of this data will soon be combined with massive databases to offer predictive and prescriptive health diagnosis.

But my favourite part of the posting was this comment from Joseph Huntington:

Stay clear of Doctors. I am a lifelong physician. Cardiologist, Head Surgeon, UCLA for 17 years. Medicine today is riskier than any casino. I left the zoo when it became a Federal Collection Center for data that will likely be used in population selection. If you’re a model or athlete, you have nothing to fear. If you’re sub-average, or over age 35 … just sleep well, drink water, walk, breathe deeply, eat mostly fresh things, laugh, love, work honorably and again, stay away from guys like me.

August 29, 2011

TED talk: Tim Harford on trial, error and the God complex

Filed under: Economics, History, Technology — Tags: , , — Nicholas @ 09:37

April 2, 2011

The continued risk of antibiotic resistance

Filed under: Food, Health — Tags: , — Nicholas @ 11:59

The Economist has a good piece on the problems with mis-use of antibiotics:

Convenience and laziness top the list of causes of antibiotic resistance. That is because those who misuse these drugs mostly do not pay the cost. Antibiotics work against bacteria, not viruses, yet patients who press their doctors to prescribe them for viral infections such as colds or influenza are seldom harmed by their self-indulgence. Nor are the doctors who write useless prescriptions in order to rid their surgeries of such hypochondriacs. The hypochondriacs can, though, act as breeding grounds for resistant bacteria that may infect others. Even when the drug has been correctly prescribed, those who fail to finish the course are similarly guilty of promoting resistance. In some parts of the world, even prescription is unnecessary. Many antibiotics are bought over the counter, with neither diagnosis nor proper recommendations for use, multiplying still further the number of human reaction vessels from which resistance can emerge.

Nor is the problem confined to people. Analysing official figures, Louise Slaughter, an American congresswoman who is also a microbiologist, calculates that four-fifths of the antibiotics used in America are given to livestock, often to get perfectly healthy animals to grow faster. That is convenient, because it produces cheaper meat, but it creates yet more opportunities for bugs to evolve resistance.

All this matters because antibiotic resistance has both medical and financial costs. It causes longer and more serious illnesses, lengthening people’s stays in hospital and complicating their treatment. Sometimes people die unnecessarily. In one study, which sampled almost 1,400 patients at Cook County hospital in Chicago, researchers found resistant strains of bacteria infecting 188 people, 12 of whom died because they could not be treated adequately. At the moment, resistant bacteria threaten mostly children, the old, cancer patients and the chronically ill (especially those infected with HIV). However, there could be worse to come. Nearly 450,000 new cases of multidrug-resistant tuberculosis are recorded each year; one-third of these people die from the disease. More than a quarter of new cases of TB identified recently in parts of Russia were of this troublesome kind.

February 22, 2011

Iatrogenic hypertension

Filed under: Bureaucracy, Health — Tags: , — Nicholas @ 12:17

It’s possible that millions of people are on high blood pressure medication today who don’t really need to be:

Currently, anyone suspected of having high blood pressure is diagnosed by a GP with an inflatable arm cuff. Doctors then call the patient back for additional readings, but these are always taken at their surgery or in hospital.

New draft guidance to be published today by the National Institute for Health and Clinical Excellence (Nice) says as many as one in four people experiences a surging pulse rate on entering a GP’s surgery.

This nervous response, termed “white coat hypertension”, can significantly raise blood pressure readings and many people are being misdiagnosed as a result.

To counter this, Nice is recommending that doctors do not rely solely on readings taken in their own surgeries. After the initial assessment, a patient should be sent home and asked to wear an ambulatory blood pressure monitoring (ABPM) device.

A suspicious mind might wonder if there’s a financial benefit to drug companies large enough to have them pressure physicians to diagnose high blood pressure even in people whose readings are not far off normal.

H/T to Eric Kirkland for the link.

January 7, 2011

How not to handle public health issues like influenza

Filed under: Bureaucracy, Health, Media — Tags: , , , , , — Nicholas @ 09:38

I was astonished to hear a radio reporter yesterday admit that much of the reason for the drop in people getting flu shots is the massively overblown oh-my-god-we’re-all-going-to-die media panic last year over Swine flu H1N1. In case you somehow managed to miss out on it last year, every news broadcast seemed to feature yet another doctor or public health official telling us that we faced a worldwide pandemic of H1N1 which was the invincible, all-conquering Überflu to top all plagues we’d ever faced before. Death tolls in the millions were confidently predicted. Every individual who died seemed to be mentioned personally . . . because there were so relatively few compared to those poor folks who died of “ordinary” seasonal flu.

Lorne Gunter gives a bit of credit where it’s due:

Give Allison McGeer credit for being frank about what’s behind this winter’s flu outbreak in Ontario: unnecessary panic over last year’s swine flu “pandemic.” Dr. McGeer, head of infection control at Toronto’s Mount Sinai Hospital, says flu cases are way up this season because vaccinations are way down; and vaccinations are way down, likely, because too much was made of the swine flu by media and officialdom last winter.

It is a medical case of the doctors who cried wolf, in other words.

[. . .]

There is a fine line between erring on the side of caution and crying wolf. And last year, the UN’s World Health Organization (WHO) blew through that barrier with abandon.

Just as it had on SARS and bird flu and the Ebola virus, the WHO overreacted to swine flu, issuing cautions that were out of all proportion to the risk the disease posed to the public. (Remember in 2003 when the WHO recommended people from around the world stay away from Toronto because the city was host to a few hundred SARS infections?)

But unlike those earlier panics, the WHO pulled out every stop on swine flu. It was as if the UN agency had been surprised that its earlier scares had failed to grow into full-blown pandemics; and so they figured that, finally, swine flu was due to become a worldwide infection requiring a dramatic response from international health officials.

As I wrote last year in May, when even the most panic-stricken media outlets were no longer playing the JuggernautOfDoom theme:

This would have been a good opportunity for de-escalating the panic mongering (and perhaps even attempting to rein-in the media, who were equally to blame for the tone of the information getting to the public). They chose, instead, to actively hide the fact that H1N1 cases were running below the level of ordinary seasonal flu cases (total H1N1 deaths: approximately 18,000 — typical annual death toll from seasonal flu: 250,000-500,000).

The biggest problem isn’t that they over-reacted this time, it’s that it has reduced their credibility the next time they start issuing health warnings. And that’s a bad thing. Unless they pull the same stunt next time, too. In which case, we may start hearing talk about setting up competing organizations to do the job the current entities appear to have given up on.

December 23, 2010

Aspirin, the rediscovered wonder drug

Filed under: Health — Tags: , — Nicholas @ 08:51

A recent study intended to verify that small doses of aspirin did reduce the chances of heart attack and stroke has also shown that it reduces the incidence of certain cancers:

In trials lasting between four and eight years, the patients who had been given aspirin were 21% less likely to die from cancer than those who had been given a placebo. These results were based on 674 cancer deaths, so are unlikely to represent the kind of statistical oddity that can beset studies on cancer risks that sometimes create headlines.

The benefits of aspirin were also apparent many years after the trials had ended. After five years, death rates for all cancers fell by 35% and for gastrointestinal cancers by 54%. A long-term follow-up of patients showed that the 20-year risk of cancer death remained 20% lower in those who had taken aspirin.

The study revealed that the effect takes time to accrue, so aspirin must be taken over a long period. The latent period for improving oesophageal, pancreatic, brain and lung cancer was about five years of aspirin taking on a daily basis. For stomach and colorectal cancer the effects took ten years and for prostate cancer about 15 years. The means by which aspirin prevents cancer is not well understood. It is believed that it inhibits an enzyme that promotes cell proliferation in tumours.

August 5, 2010

Examining DNA testing from the client’s point of view

Filed under: Bureaucracy, Government, Health, Media, Science — Tags: , , , — Nicholas @ 07:19

Mary Carmichael is writing a multi-part series about DNA testing:

On July 22, Congress held a hearing on direct-to-consumer (DTC) genetic tests, services that analyze your DNA and interpret the results in exchange for a few hundred bucks — no doctor necessary. The hearing could have been a thoughtful national conversation about science, business, and ethics. Alas, it devolved instead into a series of gotcha moments, starring a General Accounting Office sting operation that came off like a cross between the ACORN videos and the world’s worst ad for snake oil.

Time and again, on tape, an undercover agent called up an unidentified testing company and asked an ill-informed question. (“Is it OK if I stop taking my cholesterol meds and instead take the nutritional supplements you sell? If I can manage to get hold of my fiancé’s saliva without him knowing, will you run it through your machines so I can surprise him with the ‘gift’ of his own data?”) And time and again, the phone rep sank to the occasion and made the company look awful. (Sure, lay off the pills and take our supplements! Of course we’ll analyze your fiancé’s spit without his permission even though that’s illegal, unethical, and weird!)

I listened to the tape several times the day it was released, despairing at the way people were taking advantage of gullible, albeit fictional consumers, which was clearly how the congressmen who held the hearing wanted me to react. Then I started to worry about something else. How much time did I even have left to decide whether I was going to take a test myself? Even before the hearing, the FDA had announced its plans to regulate all DTC genetic tests, possibly so heavily as to keep them off the market; the hearing was just the sort of thing that could push it to move faster. What if, by the time I finally decided if I wanted one of these tests, I couldn’t buy one anymore? My credit card was sitting next to my laptop. I did something that in retrospect seems a bit rash. There’s a DNA-collection kit on my desk now, taunting me — because although I bought the thing, I still can’t decide whether I actually want to use it.

The sheer volume of misinformation on DNA testing — combined with public belief in the amazing accuracy of DNA testing (probably induced by watching too many crime investigation TV shows) — leaves the legitimate companies in an awkward situation. The actual DNA self-tests don’t tell you what you might expect, and can tell you things you don’t want to know. Politicians jumping in now (at the prompting of bureaucrats who want more power to regulate) will only make the situation more confused.

H/T to BoingBoing for the link.

August 4, 2010

Canada’s (lack of) abortion rules

Filed under: Cancon, Government, Health, Law — Tags: , , , , — Nicholas @ 09:31

Apparently lots of Canadians think that the country’s laws are far more restrictive of abortion than they really are:

Two-thirds of Canadians do not know that Canada has no abortion law, according to a new poll that indicates Canadians are woefully misinformed about a landmark ruling in the country’s history.

The poll, which asked 1,022 Canadian adults about their understanding of the country’s abortion regulations, found that just 22% of Canadians correctly identified a woman’s right to an abortion with no governmental restrictions. Canada has not had legislated abortion rules since 1988, making the country an “absolute outlier” on the issue, according to a medical ethicist.

“There’s really only a very small number of Canadians that correctly identify the current situation in Canada,” says pollster Jaideep Mukerji, who worked on the Angus-Reid poll, which was released on Tuesday. “That could be problematic.”

This was highlighted over the last couple of months, with the government and opposition wrangling over Stephen Harper’s initiative to increase funding for maternal health in the developing world. Because opinions widely differ over what the law covers in Canada, it was easy for the opposition to portray Harper’s plan as being ideological rather than humanitarian due to the exclusion of abortion.

Canadians don’t want to re-open the debate, although most appear to want more restrictions in place.

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