Monitoring food and health news

-- with particular attention to fads, fallacies and the "obesity" war

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A major cause of increasing obesity is certainly the campaign against it -- as dieting usually makes people FATTER. If there were any sincerity to the obesity warriors, they would ban all diet advertising and otherwise shut up about it. Re-authorizing now-banned school playground activities and school outings would help too. But it is so much easier to blame obesity on the evil "multinationals" than it is to blame it on your own restrictions on the natural activities of kids

NOTE: "No trial has ever demonstrated benefits from reducing dietary saturated fat".

A brief summary of the last 50 years' of research into diet: Everything you can possibly eat or drink is both bad and good for you


30 September, 2008

Pot does NOT make young people depressed

The study does appear to cover heavy users of marijuana so the finding is a bit surprising. Heavy use does seem to promote paranoid psychosis to some degree but depression is apparently different. The possibility of long-term effects manifesting in later life remains, however. Abstract follows:

Adolescent Cannabis Problems and Young Adult Depression: Male-Female Stratified Propensity Score Analyses

By Valerie S. Harder et al.

Cannabis use and depression are two of the most prevalent conditions worldwide. Adolescent cannabis use is linked to depression in many studies, but the effects of adolescent cannabis involvement on young adult depression remain unclear and may differ for males versus females. In this cohort study of youth from a mid-Atlantic metropolitan area of the United States, repeated assessments from 1985 (at age 6 years) through 2002 (at age 21 years) were made for 1,494 individuals (55% female). Measured covariate differences between individuals with and without cannabis problems were controlled via propensity score techniques. The estimated risk of young adult depression for adolescents with cannabis problems was not significantly different from that for comparison adolescents for either females (odds ratio = 0.7, 95% confidence interval: 0.2, 2.3) or males (odds ratio = 1.7, 95% confidence interval: 0.8, 3.6). The evidence does not support a causal association linking adolescent-onset cannabis problems with young adult depression.

American Journal of Epidemiology 2008 168(6):592-601

The moralistic myth of the `demon drink'

The UK government's list of nine types of heavy drinker is based less on scientific research than puritan zeal. It's part of a campaign that is both absurd and insulting

Do you drink to `unwind and calm down and to gain a sense of control when switching between work and personal life'? Perhaps your preferred way to `reconnect with old friends' is to meet up in a pub. Maybe you drink in `fairly large social friendship groups' and find a `sense of community' in your local pub, or perhaps you don't go out, and just drink at the end of the day when all your chores are done.

If any of this applies to you, and if you're over 35, you'll soon be targeted by a UK government health campaign, which, according to public health minister Dawn Primarolo, will help people `understand the effects of their drinking habits and help them make changes for the better'.

Underlying this forthcoming campaign is new research by the Department of Health (DoH) which has defined nine personality types of `heavy drinkers', that is, men who drink over 50 units of alcohol a week, and women who drink over 35 units a week. These types not only include `depressed drinkers' and `border dependents', which might well indicate potentially serious alcohol-related psychological problems, but `de-stress drinkers', `re-bonding drinkers', `community drinkers', `conformist drinkers', `macho drinkers', `boredom drinkers' and `hedonistic drinkers'. The DoH hopes to use this segmentation to, in the words of one report, `tailor its propaganda to suit all the target personalities' (1).

According to the report, alcohol serves many functions: it's the `shared connector' that helps people to get along with old friends; it's the means to `feel a strong sense of belonging and acceptance' or a `sense of community' at the local pub; it's the tipple of an evening born of boredom; or it's a way to express `independence, freedom and "youthfulness"'. The net effect of the research is to transform normal behaviour like relaxing after work, socialising with your friends, or just relieving your inhibitions and having a good time, into pathological conditions dangerous to your health (2).

Yet, as with all governmental lifestyle regulation, the basis for the DoH campaign is moral and political, not scientific or medical (3). The cod-psychologising about `drinking types' aside, even the notion of a `heavy drinker' is suspect, based as it is on government-defined unit limits that have no scientific basis. A former editor of the British Medical Journal involved in the process of setting the government's recommended drinking limits, which were first introduced in 1987, recently revealed that reports advising that moderate drinking above these limits was beneficial to health were simply suppressed in favour of `useless' limits that were `plucked out of the air' (4).

Instead, the government seems intent on commissioning scientists to try to produce evidence to back up its essentially moralistic obsession with how much we drink. This July, for instance, research at the North West Public Health Observatory (NWPHO) fuelled suitably scary headlines, warning that 15,000 people die from alcohol-related deaths annually, a leap of 80 per cent on previous estimates. Alarmingly, over a quarter of all deaths among 16- to 24-year-olds were attributed to alcohol. On this basis the DoH stated alcohol-related hospital admissions totaled 810,000, costing $5bn a year (5). But on closer examination of the facts, the continued politicisation of science becomes obvious:

* The NWPHO research identifies 47 conditions caused by alcohol - 34 of them `partially', like cancer, and accidents like falls. This is actually a reduction from the previous total of 53, which was determined by the Cabinet Office in 2003, and included various scientifically unsubstantiated conditions (6). Despite this, the government continues to use its own dodgy figures to estimate alcohol-related National Health Service (NHS) costs, thereby claiming an increase from o1.7billion to o2.7billion between 2003 and 2006/7 (7). Moreover, the government continues to peddle its preferred figures of 810,000 hospital admissions and `15-20,000 premature deaths' when the NWPHO report identified significantly lower figures: 459,982 admissions and under 15,000 deaths (8). When the facts don't fit, just use your own.

* The massive leap in alcohol-related deaths is almost entirely related to the inclusion of these `partially' caused conditions (10,283 deaths out of 14,982), for which the evidence is weak. Associated risk factors are drawn from two decade-old pieces of research and have no `confidence intervals' associated with them. In other words, we don't know how reliable these numbers are. Given that we are talking about a few dozen or hundred cases of some conditions, the risk could be statistically insignificant. Furthermore, these `partially' caused conditions are largely accounted for by `mental and behavioural disorders caused by alcohol'. While it is true that many mentally ill people have alcohol problems, it is far from obvious that they are mentally ill because they drink. However, the uncertainties and qualifications scientists are compelled to indicate tend to be ignored in media commentaries and government statements. When in doubt, obliterate doubt.

* Even if we accept the figures as given, when put into context, they look far less scary. While 14,982 deaths sounds a lot, it constitutes just 3.1 per cent of deaths in the UK. Booze accounts for over a quarter of deaths among 16- to 24-year-olds, but in absolute terms this meant just 446 people in 2005; the percentage is high for the simple reason that very few people die young. Again, 459,842 hospital admissions sounds a lot, but it constitutes just 2.3 per cent of all hospital inpatient and outpatient admissions (9). Given that 70 per cent of Britons drink, these figures suggest a generally low health risk, with serious problems being confined to a hard-core minority. Despite popular belief that Britain has a serious drinking problem, the international figure for alcohol-related diseases is four per cent.

* The NWPHO report even admits that drinking seems to help prevent some conditions like heart disease, and initially its authors found drinking even saved 8,838 lives in 2005 - though they subsequently try to scale this figure back, selectively using research that found little preventive benefit, rather than the opposite (10). Still, if the context dilutes the message, dilute the context.

* The NWPHO research actually finds little evidence to substantiate the government's obsession with `heavy drinkers' beyond re-telling the already-obvious: that sustained alcohol abuse increases the risk of diseases directly caused by alcohol, like cirrhosis of the liver, alcohol poisoning and throat diseases. For some `partially' caused conditions, the evidence is very weak. The research actually finds that the incidence of cancer, hypertension and pancreatitis do not vary with alcohol consumption among men, and are in fact `attributable more to lower levels of alcohol consumption' among women. Instead of therefore questioning the link between boozing and such diseases, the report `suggest[s] that there is a requirement for harm reduction strategies to target the general population, and not just high-risk drinkers'. A failure to find the link is thus transformed into regulation for the entire population, on the basis of three diseases that account for a mere 0.07 per cent of annual hospital admissions (11).

Such contortions illustrate that scientific research is being harnessed to a pre-existing policy agenda that is rooted not in hard medical fact but in moral concerns. Put simply, elites have a moral problem with people who enjoy drinking. They describe town centres as `no-go areas', express amazement and disgust at the revelation that 5.9million of us `drink to get drunk', and hope 24-hour licensing laws will moderate our barbaric customs in the direction of `European caf, culture'. This contempt for the masses, coupled with the vacuousness of their own visions for how to take society forward, produces moralising and therapeutic interventions designed to wean us from the bottle.

The DoH suggests heavy drinkers booze because of a `general sense of malaise in their lives' and to `give their lives meaning'. Perhaps they do. But is it really the state's place to psychoanalyse us, pathologise our normal social interactions, and scare us into `making changes for the better'? After the smoking ban left them without a focus for public health policy, it's actually health ministers who experienced a `general sense of malaise' and now resort to hectoring drinkers to `give their lives meaning'.

So if you receive one of the 900,000 leaflets and self-help booklets being targeted at heavy drinkers in the next few weeks, do the rational thing: bin it, and tell the `health promotion' lobby that really should get out more.


29 September, 2008

Does early alcohol consumption make for more drinking in later life?

Some apparently epidemiological research found that children introduced to drink under the age of 15, even in supervised conditions, were more likely to become alcoholics. Once again which is cause and which is effect is assumed. Did anybody consider that parents who give alcohol to younger kids might be themselves big drinkers and that tendency to drink might be hereditary? Thus it could be the parentage that makes someone a big drinker, not how early they began drinking. The study proves NOTHING about the effect of giving kids alcohol while young

For parents it is one of the great dilemmas of child-rearing. How should you teach your children to deal with alcohol? Should you ban it altogether - and risk making it seem more attractive - or let your youngsters try a little wine at family meals in the hope that they will learn to drink responsibly? A new study from America's respected National Institute on Alcohol Abuse and Alcoholism (NIAAA) suggests the liberals may have got it badly wrong. It found that if young people have their first taste of alcohol before the age of 15 it sharply raises their risk of becoming alcohol dependent in later life. "We can see for the first time the association between an early `age of first drink' and an increased risk of alcohol use disorders that persists into adulthood," said Deborah Dawson, a research scientist at the NIAAA.

The findings come amid rising concern over teenage drinking habits in Britain, where 54% of teenagers admit to binge-drinking within the previous month. America has tougher restrictions - all states ban alcohol sales to under21s - but teen drinking still flourishes. A study found that under21s drank 20% of all alcohol consumed in the United States and that one-third of high school pupils were binge-drinking once a month or more.

Until now it had been argued that early drinking and subsequent alcohol dependency reflected underlying factors such as social deprivation, poor education or childhood abuse. Although such factors may play an important role for some people, the NIAAA study shows that early exposure to alcohol is a risk in itself. It means that giving youngsters small amounts of alcohol in the hope of teaching them restraint may have the opposite effect.

One theory is that teenagers' brains are changing so fast that exposure to intoxicants can affect long-term development, creating a link between alcohol consumption and pleasure. The NIAAA's study seems to confirm this. The researchers looked at data gathered over three years from more than 22,000 young Americans. These were divided into three groups: those who first drank under the age of 15, between 15 and 17, and 18 or over. The researchers then looked at the drinking patterns that evolved in each of the three groups and at the first incidence of alcohol abuse or dependence.

Howard Moss, associate director for clinical and translational research at the NIAAA, said the study showed that it was important to delay the onset of drinking behaviour as late as possible. "Early alcohol consumption itself, as a misguided choice, is driving the relationship between early drinking and risk for development of later alcohol problems," he said.

The findings will undermine the belief, widespread in France and southern Europe, that children should be given watered wine at meals to learn how to drink responsibly. Frederick Rousseau, a music producer who lives in Paris with his two daughters, aged 18 and 15, said such attitudes were increasingly seen as irrelevant because France was experiencing a surge in teenage drinking similar to that in Britain. "My own younger daughter got drunk at a recent party even though she is so young," he said. "Teenagers here prefer hard drink like vodka now and they drink like mad."

Sarah-Jayne Blakemore, who leads a research group at the University College London Institute of Cognitive Neuroscience, said: "The young brain is very malleable and changes fast in response to new influences, although a lot might depend on the amounts drunk as well as the exposure itself."


Ho hum! The attention-seekers will never let this one go

If you have 100 people trying to prove that cellphones are bad, you will get 5 false-positives by chance alone

CANCER experts have backed mobile phone manufacturers' rejection of the latest claims of links between mobiles and brain tumours. Researchers in Sweden said last week they had found evidence of links between mobile and cordless phones and one of the most common brain tumours. Lennart Hardell, of the University Hospital in Orebro also told a conference in London that young mobile users had a fivefold risk of getting a benign tumour called acoustic neuroma, which causes deafness. Neurosurgeon Charlie Teo said on ABC TV the association between tumours and phones was "quite compelling".

However, the Australian Mobile Telecommunications Association rejected Professor Hardell's assertions, calling it "alarmist" research that "had not undergone a proper process of review by scientific peers". "People can be confident there is no biological, medical or statistical basis to assert a link between mobile phone use and brain cancer," the association's chief executive Chris Althaus said. "The World Health Organisation's most recent health advice says none of the recent reviews have concluded that exposure to the radio frequency fields from mobile phones and their base stations cause any adverse health consequences." More than 600 studies supported these conclusions, Mr Althaus said.

Patricia McKinney, professor of pediatric epidemiology at Leeds University, agreed that there was no threat: "Overall, we found no raised risk of glioma [brain cancer] associated with regular mobile use and no association with time since first use, lifetime years of use, cumulative hours of use, or number of calls."

University of Sydney cancer specialist Bruce Armstrong said: "It's highly unlikely that that statement [fivefold risk] is true. There's no evidence of any substantial trend to an increase in risk of brain tumours in younger people in Australia."


28 September, 2008

Tackling the epidemic of `bad science'

In his new book, Ben Goldacre takes a welcome swipe at quackery, but misses the wider abuse of science for political ends.

Ben Goldacre's weekly column in the Guardian has been a breath of fresh air through the world of science journalism. A junior hospital doctor, Goldacre has done more to challenge the junk science promoted by quacks and charlatans than most elite scientists and science writers. He has exposed health gurus, such as Gillian McKeith and Patrick Holford, who claim prestigious academic qualifications and titles and enjoy the endorsement of major media organisations (newspapers, television, publishers) as well as the commercial benefits of the $10billion food supplement industry.

A book based on his column, Bad Science, offers a more comprehensive critique of some of these familiar targets while providing a primer in evidence-based medicine for the general reader. Like Goldacre's column, his book is enlightening, shocking and often hilarious.

Bad Science offers an entertaining romp through the wacky world of the once alternative, but now sadly mainstream, homeopaths and nutrititionists. Goldacre ridicules their sugar pills, their homeopathic solutions with `memories' of dissolved molecules, their detox regimes, vitamins, anti-oxidants and supplements. This is a market in which McKeith's `Fast Formula Horny Goat Weed Complex' for enhanced sexual satisfaction (now withdrawn after complaints from the medicines regulatory authorities) once competed with Holford's `Q-Link' pendant offering protection against electromagnetic radiation (constituents worth 0.5 pence, retail price 69.99 pounds). Goldacre also exposes the preposterous claims of the promoters of `Brain Gym' techniques, now apparently widely used in UK schools, and the bogus research claiming that omega-3 fish oils can improve exam performance.

Yet other examples of pseudoscience that have, arguably, greater influence on the life and health of the nation remain curiously neglected in Goldacre's account. For example, as recent contributions to spiked have argued, controversies over population, passive smoking, the HIV/Aids epidemic and the links between diet and health are characterised by the subordination of science to propaganda. Indeed, all these issues provide examples of the sort of statistical scams and scientific sharp practice (such as extrapolation from inadequate data, confusion of observational and intervention studies, over-interpretation of laboratory studies, cherry picking and data dredging) that Goldacre describes.

While Bad Science savages the nutritionists' dogmatic dietary advice, Goldacre repeatedly endorses the benefits of what he characterises as a `healthy lifestyle'. With uncharacteristic adherence to dull convention, Goldacre repeats the litany that people should be advised to stop smoking, to follow a `healthy diet' of fruit, vegetables and natural fibre and take regular exercise. But, whereas there is strong evidence against smoking, the same cannot be said for recommending any particular diet - and even less for the virtues of exercise. It is striking that, though Goldacre subsequently acknowledges that two major intervention studies - the Multiple Risk Factor Intervention Trial (MRFIT) and the Women's Health Initiative - failed to show any benefit from dietary change, in defiance of his own strictures about evidence-based medicine, he continues to preach the healthy-living gospel.

`Why do clever people believe stupid things?', asks Goldacre. Part of his explanation for the popular impact of pseudoscience goes some way towards explaining the inconsistency of his own approach: `Our values are socially reinforced by conformity, by the company we keep', he writes, emphasising the `phenomenal impact of conformity'. It appears that while Goldacre is prepared to challenge some of the anti-scientific prejudices of his Guardian readers, he shares some of the wider values that have acquired a pervasive influence in modern society.

These include a pessimistic outlook towards the prospects for nature and society, reflected in the popularity of apocalyptic and doomsday scenarios of all kinds, and notably in a willingness to embrace the likelihood of catastrophe from epidemic disease (whether in the form of AIDS, mad cow disease, SARS, bird flu or mere obesity). They also include a misanthropic outlook towards humanity, expressed in contemptuous attitudes towards the masses, notably towards people who vote for George Bush or against the EU, those who smoke or are overweight. A third theme is a growing sympathy for authoritarian interventions to deal with social problems, whether the issue is AIDS, banning smoking, banning trans fats, or banning advertising for `junk food'.

A combination of these attitudes - among scientists and politicians as much as in the general public - leads to an inclination to turn a blind eye towards pseudoscience if it furthers the wider social agenda that follows from them.

Goldacre is ambivalent in his attitude towards the public. On the one hand, he proclaims - almost as an afterthought in his epilogue - that `people aren't stupid'. On the other, in the course of a familiar radical tirade against the evils of direct advertising in the USA by Big Pharma, he writes that `patients are so much more easily led than doctors by drug company advertising'. Again forsaking his scientific principles, he provides no evidence for a proposition that is no more than a personal prejudice, though no doubt one shared by most of his medical colleagues and his Guardian readers. In fact, Goldacre's account provides numerous examples of how doctors have been misled by drug companies. I see no reason why patients, provided they have access to the appropriate information, should not be capable of making rational decisions in these matters.

`The greatest problem of all is dumbing down', concludes Goldacre. But this problem starts at the top, among scientists who share the loss of confidence and authority that afflicts the elite of contemporary society. The very fact that it has been left to a junior hospital doctor to take the lead in challenging important areas of pseudoscience in modern society reflects the abdication of responsibility by the scientific establishment. This - rather than the role of the media, abject though that has been - is the real lesson of the imbroglio over the MMR vaccine, itself the subject of an excellent chapter in Bad Science.

Senior scientists must take up their responsibility to explain and defend science in public, and to set their own house in order by tackling fraud, exposing junk science and calling a halt to the abuse of university titles and academic qualifications. Then, even the arts graduates who (to Goldacre's distaste) dominate the media will soon learn to read a paper critically and provide an informed account to their readers.

As the autism expert Laura Schreibman puts it in her book The Science and Fiction of Autism: `One need not be a scientist in order to know how to evaluate information critically; one just needs to be appropriately critical.'


Britain: An endless diet of government intervention

Health authorities and food campaigners have pursued their pet projects by promoting scare stories about children's health.

Next week sees the start of celebrity chef Jamie Oliver's campaign to change the way children are fed. But while providing children with better meals and facilities at school is a worthy enough aim, lecturing the nation's parents about how they are setting up their kids for a (short) lifetime of ill-health is simply nauseating.

While campaigners call for more government intervention into our eating habits, it is surely time to call a halt. The last thing we need is a further expansion of schemes and initiatives.

We have been led to believe that we are facing a timebomb of ill-health that can only be defused by changing the way our children eat. That might be justified if children were dropping like flies from disease. In fact, the opposite is true. According to figures for England and Wales, in 1981 there were 30 deaths for every 100,000 children aged between one and 14 years. In 2006, that had more than halved to 14 deaths per 100,000. Death in childhood was rare and has become even rarer in the last 25 years or so.

Are children becoming sicker? Clearly, serious infectious disease is largely a thing of the past. Obesity may be increasing, but obesity is not a disease; at most, it is associated with a number of chronic conditions. The most obvious of these in relation to children is the apparent emergence of type-2 diabetes among children, something previously considered to be a condition of middle age. Yet research published in Diabetes Care in 2007 suggests that type-2 diabetes remains unusual in children under the age of 17. The researchers undertook a year-long survey of 2,665 consultant paediatricians in the UK and Ireland. During this period, 67 cases of type-2 diabetes were reported, all of them in the UK, suggesting an overall incidence of 5.3 cases per million children.

So, type-2 diabetes in children would seem to be, if not a one-in-a-million occurrence, not far off. Furthermore, while there is a strong association between being overweight and type-2 diabetes, the association with ethnic status is worrying. As the authors note: `The incidence rates for South Asians and blacks are an alarming 3.5 times and 11 times higher, respectively, than in whites.' This ethnic differential continues into adulthood. If the government were really serious about tackling type-2 diabetes, it would do better to devote a substantial research effort to understanding this differential rather than lecturing the whole population about our personal habits.

Nor is it the case that there is mass malnutrition among children. According to Family Food 2006, the average UK family is getting all the protein and energy required, plus plenty of vitamins and minerals. The average household now spends just 10 per cent of its income on food and non-alcoholic drinks. Food has never been so readily available and in such variety. Even where children do have rather limited tastes, we should chill out. While nutritionists may be sniffy about about children eating cheeseburger, chips and fish fingers all the time, such foods do actually provide a fair proportion of a child's nutritional needs. They may not be perfect, but such eating habits are highly unlikely to result in an epidemic of disease, either.

But there is a more fundamental principle at stake: it is not the government's business to interfere in our personal lives except in the most exceptional circumstances. Yet we are subject to endless health advice both from official sources and through the popular media, from shows like Honey, We're Killing the Kids to the much-praised but frankly hectoring series by Jamie Oliver on school meals. If that were not enough, that intervention is increasingly direct, with parents receiving letters home about their children's supposed weight problems and being given strict instructions about what to put in their lunchboxes.

It seems that the government, the health authorities and a variety of different campaigners see it as their job to overrule parents about how their children should eat. In reality, the vast majority of parents endeavour to get their children to eat well, but in the absence of eating well, they make pragmatic, personal decisions about how to ensure they eat something. Current levels of intervention are unlikely to help matters and are an insult to the decision-making abilities of parents.

If children's food is a top priority, then make school meals free, or at least cheap, at the point of delivery and give them the time and surroundings to eat them comfortably. That's not a health strategy, that's just common decency. If adults would not tolerate being forced to queue up for ages to receive mediocre food in a hall so crowded that there is often nowhere to sit, why should we assume our children should put up with it? And let those meals taste of something; salt in recent years has been treated in school canteens like it is a chemical weapon rather than a fundamental requirement of good cooking. It is noticeable that the new cookbook produced by the government to teach kids how to prepare their own meals avoids salt or sneaks it into recipes in stock. No wonder children are rejecting such bland offerings.

But before the first school bell of the day sounds, and after hometime, it would be far better if the government, the health authorities and the self-appointed guardians of our diets did what children up and down the country do at lunchtime: bugger off.


27 September, 2008

Canada: Man dies after 34-hour wait in ER

Despite him being drawn to the attention of hospital personnel several times and despite the presence of staff employed to check up on waiting patients

It's an unacceptable tragedy that a man waited 34 hours in a Winnipeg hospital emergency room and was dead for several hours before he was finally brought to the attention of medical staff, Premier Gary Doer said yesterday. Although the 45-year-old man - who CTV Winnipeg identified as a double amputee named Brian Sinclair - was "a regular" at the emergency room, regional health officials say he was never registered or seen by triage nurses over the weekend until it was too late.

"The bottom line is we are not making an excuse for this," Doer said yesterday following a grilling over the incident in the legislature. "This is a tragic incident and it shouldn't have happened."

Sinclair was dropped off at the hospital by a taxi Friday afternoon after visiting a downtown health clinic, which is part of the regional health authority. Some hospital staff did speak with the man at some point, but it was not until shortly after midnight on Sunday that he was examined and pronounced dead. The cause of death has not been released.

CTV Winnipeg quoted a man who did not want to be named as saying he had been in the emergency room on the Friday night and had seen Sinclair sitting in his wheelchair, looking like he was asleep. When the man came back the following night, he noticed Sinclair's position had not moved so he told nurses and security workers, who responded they were too busy to check on Sinclair. He also told a security officer of Sinclair's condition, but the guard told him the case would be "too much paperwork." "The nurse said we'll go and check, (but) nobody ever went and checked on him," said the man. "We waited another hour or so and we told another nurse twice to go and check."

Doer said the province followed the recommendation of an earlier task force and hired reassessment nurses who are required to check up on registered patients waiting in the emergency department, but Sinclair was never even registered with the triage nurses.

"This system broke down and there were tragic circumstances," Doer said. The hospital wasn't short-staffed at the time and a re-assessment nurse was on duty, he added. Brock Wright, chief medical officer of the Winnipeg Regional Health Authority, said he's baffled about how Sinclair could have fallen through the cracks. When the man was finally discovered by emergency room staff, Wright said he "had been dead for some time." "It's hard to imagine how somebody could be in the department for 34 hours and somehow it not be apparent that the individual was waiting for care," Wright said yesterday.

On cold nights, Wright said it's not unusual for homeless people to take shelter in the emergency room. But he said any potential confusion that may have arisen from that practice doesn't explain why Sinclair died without treatment.


Australia: Lots of surgery on wrong patients in Queensland public hospitals

THIRTY-three public hospital operations have been performed on the wrong patient or body part in a year, with four of the bungles killing or permanently impairing patients. The deaths and permanent impairments were among 127 identified as being due to bungles in the hospital system. Queensland Health today released the latest patient safety report revealing a 30 per cent spike in reported incidents within the department to 46,990 cases.

Almost a quarter of those cases involved patient harm. Three patients died or were permanently impaired after surgical tools were left inside them while six patients suffered the same fate after being given the wrong medication. Seven patients died or were permanently impaired after delays caused by long waiting lists or the department's failure to order or sanction procedures.

Queensland Health strongly defended the results, saying the increase showed more staff were reporting incidents. The report covered 2006-2007 and was compiled as part of recommendations which came from the Bundaberg Hospital Inquiry report which called for greater transparency. However, Queensland Health Patient Safety centre director Dr John Wakefield was unable to exactly how many deaths occurred during the period.

The report showed 127 patients died or suffered permanent impairment, but did not provide a break-down of deaths or impairment. Dr Wakefield said Queenslanders should have confidence in the health system, saying the figures showed it was getting safer. "Sharing information in an open and honest way is fundamental to improving patient safety and building trust in the community and our staff."


27 September, 2008


Deaths from illness are generally greatest in winter so the fact that people in tropical countries have shorter lifespans obviously reflects factors other than their warmer climate: The greater prevalence of uncontrolled insect pests, for instance, and the fact (confirmed in the study below) that blacks have greater health problems. The article below however restricts itself to different areas in California so public health measures there should be fairly uniform statewide.

It would appear however that it was only heart disease that was found to be slightly more common in warmer parts of the State. Since the authors apparently examined a large range of causes of death, this single difference almost certainly is just the result of data dredging -- random, in other words: Not to be taken seriously. I was born and bred in a very hot climate (but in an area populated by people of mainly British extraction) so if the contentions of these authors had any merit, people should have been dying like flies from heart attacks. They didn't. Abstract follows

A Multicounty Analysis Identifying the Populations Vulnerable to Mortality Associated with High Ambient Temperature in California

By Rupa Basu and Bart D. Ostro

The association between ambient temperature and mortality has been established worldwide, including the authors' prior study in California. Here, they examined cause-specific mortality, age, race/ethnicity, gender, and educational level to identify subgroups vulnerable to high ambient temperature. They obtained data on nine California counties from May through September of 1999-2003 from the National Climatic Data Center (countywide weather) and the California Department of Health Services (individual mortality). Using a time-stratified case-crossover approach, they obtained county-specific estimates of mortality, which were combined in meta-analyses. A total of 231,676 nonaccidental deaths were included. Each 10řF (c.4.7řC) increase in mean daily apparent temperature corresponded to a 2.6% (95% confidence interval (CI): 1.3, 3.9) increase for cardiovascular mortality, with the most significant risk found for ischemic heart disease. Elevated risks were also found for persons at least 65 years of age (2.2%, 95% CI: 0.04, 4.0), infants 1 year of age or less (4.9%, 95% CI: -1.8, 11.6), and the Black racial/ethnic group (4.9%, 95% CI: 2.0, 7.9). No differences were found by gender or educational level. To prevent the mortality associated with ambient temperature, persons with cardiovascular disease, the elderly, infants, and Blacks among others should be targeted.

American Journal of Epidemiology 2008 168(6):632-637

Honey could be a wonder drug

Time for a double-blind trial. I have a bottle of Manuka honey in my medicine cabinet but have never used it for anything. Being an old guy, I mostly uses iodine for asepsis. It stings but that way you know it is doing you good! (just joking)

HONEY, used for generations to soothe sore throats, could soon be substituted for antibiotics in fighting stubborn ear, nose and throat infections, according to a new study. Ottawa University doctors found in tests that ordinary honey kills bacteria that cause sinus infections, and does it better in most cases than antibiotics. The researchers have so far tested manuka honey from New Zealand, and sidr honey from Yemen. "It's astonishing," researcher Joseph Marson said of bees' unexplained ability to combine the nectar of flowers into a seemingly potent medicine.

The preliminary tests were conducted in laboratory dishes, not in live patients, but included the "superbug" methicillin-resistant Staphylococcus aureus or MRSA, which is highly resistant to antibiotics. In upcoming human trials, a "honey rinse" would be used to "flush out the goo from sinus cavities," said Marson.

The two killed all floating bacteria in liquid, and 63-91 per cent of biofilms - micro-organisms that sometimes form a protective layer in sinus cavities, urinary tracts, catheters, and heart valves, protecting bacteria from normal drug treatments and often leading to chronic infections. The most effective antibiotic, rifampin, killed just 18 percent of the biofilm samples in the tests.

"As of today, nobody is sure what in the honey kills the bacteria," Marson said, noting that "not all honeys have the same potency" and calling for more research to determine the mechanism behind the healing. Canada's clover and buckwheat honey did not work at all. Previous studies have shown honey's healing properties on infected wounds.

The results of the study were presented this week at the annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery, in Chicago.


26 September, 2008

Charming food freaks in Berkeley

All ego

As most veteran customers know, it takes a pretty thick skin to successfully navigate the Berkeley Bowl, this strident city's most popular grocery store. Outside, petitioners seeking signatures for ballot measures have come to blows with opinionated residents. In the tiny parking lot, nicknamed the Berkeley Brawl, frustrated motorists have been known to ram one another's cars. At the checkout, people have thrown punches and unripened avocados at suspected line-cutters.

When one shopper was told she couldn't return a bag of granola, she showily dumped its contents on the floor. Culyon Garrison, who works at the customer-service desk, recently had a loaf of bread thrown at him.

The produce emporium -- one of the nation's most renowned retailers of exotic fruits and vegetables -- creates its own bad behavior. Kamikaze shoppers crash down crowded aisles without eye contact or apology for fender-benders. So many customers weren't waiting to pay before digging in that management imposed the ultimate deterrent: Those caught sampling without buying will be banned for life -- no reprieves, no excuses. (Not even "I forgot to take my medication.")

Raphael Breines, who was ejected last year for eating on the premises, said he couldn't decide between two types of apricots, so he sampled both. Security stopped him in the parking lot. "They treated me like a thief," said the 37-year-old park planner, who was photographed and required to sign a no-trespass agreement. "Technically I was stealing, but I wasn't trying to hide anything. I was just deciding which type of apricot to buy." Breines, a longtime customer, sent an apology letter, asking to be reinstated. His request was denied.

Store manager Larry Evans says the policy is a fair response to doctors, lawyers and college professors who help themselves to bags of cookies, nuts and vitamins, stick their fingers in pies and guzzle from bottles of sake, assuming the rules don't apply to them. "There's a sense of entitlement to this town," Evans said. "People think, 'If I want to do it, I'll do it, just try and stop me.' "

Seven years on the job, he said, has given him insight into the city's sometimes sharp social elbows. "Berkeley residents are angry -- they're mad at the president, the economy, all kinds of stuff. And this is the place where it seems to get released, the local supermarket."

Longtime Berkeley residents also think they have a grip on the good life, so being banned from the Bowl is no small matter. On a typical summer day, a shopper at the Bowl is likely to find 20 kinds of apples, eight types of mangoes, half a dozen varieties of papaya, six kinds of garlic, five types of ginger and 40 different tomatoes.


British Doctors told to curb use of Ritalin in hyperactive children

Children with attention deficit hyperactivity disorder (ADHD) should be treated with drugs such as Ritalin only in severe cases and never when they are younger than 5, under official health guidelines issued today. Widespread concerns that medication is used too freely to calm hyperactive children have been recognised by two clinical practice watchdogs, which are now advising doctors not to prescribe drugs whenever possible.

Most children with ADHD should instead be offered psychological therapy to improve their behaviour, backed up by training to support their parents and teachers, the National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Mental Health (NCCMH) recommend. Drugs such as Ritalin and Concerta (brand names for methylphenidate) and Strattera (atomoxetine) should be used as frontline treatments only when severe ADHD is diagnosed, or when other options have failed.

While up to 3 per cent of school-age children in Britain are affected by ADHD, only about a third to a quarter of these would qualify as severe cases. In a typical school of 1,400 children, between 30 and 40 would have a diagnosis of ADHD, and about 10 would be classed as severely affected.

The symptoms of ADHD include an inability to concentrate for long periods, hyperactive and restless behaviour, and impulsive actions, such as speaking without thinking of the consequences or failing to wait and take turns. It also affects about 2 per cent of adults.

ADHD support groups welcomed the guidelines, but said that they would have to be backed by increased resources for behavioural therapy if they are to have the desired effect. Andrea Benbow, chief executive of the Attention Deficit Disorder Information and Support Service, said that many parents had to wait months or even years to be given psychological therapy and training, and that many programmes were not designed for ADHD or effective for it. "There are huge waiting lists, and many training programmes are not ADHD-specific and they're useless," she said. "We need these interventions - drugs are not the be all and end all - and parents would welcome them if they were there. "This needs to be backed by better resources. Lots of the good programmes are delivered by the voluntary sector, but the problem is, who funds them?"

The new guidance follows growing disquiet among some parents, teachers and doctors about the number of children taking medication for ADHD, who often remain on drugs for years. More than 600,000 prescriptions for the three drugs were filled in 2007 in England, though the number of children who received them is estimated at between 50,000 and 100,000 because only a month's supply is generally prescribed at once.

Ritalin is the most common ADHD drug, with 461,000 prescriptions filled in England in 2007. This compares with 199,000 in 2003, 26,500 in 1998 and 3,500 in 1993. The growth has alarmed some observers, concerned that some doctors are turning to medication too quickly to control a disorder that often responds well to other treatment strategies. Ritalin and Concerta can have side-effects that include nervousness, insomnia, appetite loss and weight loss. Strattera can cause nausea, dizziness, fatigue and mood swings. There has also been little research into the implications of taking them as long-term treatments.

Prescription rates vary widely. In July a study by the Health Service Journal found that some primary care trusts offer Ritalin up to 23 times more than others: in Wirral, pharmacists dispensed one prescription for every seven children under 16, compared with one for every 159 children in Stoke-on-Trent.

Other treatment options include sending children on courses of cognitive behavioural therapy or social skills training, and training parents in how to cope with the condition and improve their children's behaviour. Teachers can also be trained to manage children with ADHD. These can be highly effective, but drugs are often used instead because they offer a quicker solution and are not subject to long waiting lists.

The guidelines recommend a sparing approach to drug use when possible. Tim Kendall, a consultant psychiatrist in Sheffield and joint director of the NCCMH, who sat on the expert panel, said: "Quite commonly, people tend to revert to offering methylphenidate or atomoxetine. "When they do that, it's not always because there's a good balance of risk and benefits. It's because the child has got what appears to be ADHD and that's what's available. It's easier to prescribe a drug when other options like parent-training programmes are not available."

Gillian Leng, deputy chief executive of NICE, said: "Today's guideline, which is published during ADHD Awareness Week, is the first guideline to address the diagnosis and management of ADHD within both clinical and education settings. At its heart is the recognition of the importance of establishing a multidisciplinary team, including the person with ADHD, their family and their teachers in order to help support the person with ADHD achieve their full potential."

Professor Eric Taylor, of the Institute of Psychiatry in London and chairman of the guideline development group, said: "I believe these guidelines will make people with ADHD, and their families, more confident that their problems will be recognised and can often be helped, and that they will provide professionals with a framework for good practice nationally."


25 September, 2008


The study below is monumental in its stupidity. Some poor mother gives birth to a kid with a hare lip and is of course riven with guilt and self-doubt. Some earnest researchers come around with a questionnaire three month later and ask her if she boozed a lot during her early pregnancy. Tearfully, she says: "That's it! Those few drinks I had must have been too much!" So she reports to the researcher that she was indeed a boozer. And the idiotic researcher takes that as evidence that she really was a heavy drinker. So we get the report below. Self-report studies in general are notoriously unreliable but this one takes the cake. If the researchers had administered their questions BEFORE all births, they might have had something worth reporting

First-Trimester Maternal Alcohol Consumption and the Risk of Infant Oral Clefts in Norway: A Population-based Case-Control Study

By Lisa A. DeRoo et al.

Although alcohol is a recognized teratogen, evidence is limited on alcohol intake and oral cleft risk. The authors examined the association between maternal alcohol consumption and oral clefts in a national, population-based case-control study of infants born in 1996-2001 in Norway. Participants were 377 infants with cleft lip with or without cleft palate, 196 with cleft palate only, and 763 controls. Mothers reported first-trimester alcohol consumption in self-administered questionnaires completed within a few months after delivery. Logistic regression was used to calculate odds ratios and 95% confidence intervals, adjusting for confounders. Compared with nondrinkers, women who reported binge-level drinking ~5 drinks per sitting) were more likely to have an infant with cleft lip with or without cleft palate (odds ratio = 2.2, 95% confidence interval: 1.1, 4.2) and cleft palate only (odds ratio = 2.6, 95% confidence interval: 1.2, 5.6). Odds ratios were higher among women who binged on three or more occasions: odds ratio = 3.2 for cleft lip with or without cleft palate (95% confidence interval: 1.0, 10.2) and odds ratio = 3.0 for cleft palate only (95% confidence interval: 0.7, 13.0). Maternal binge-level drinking may increase the risk of infant clefts.

American Journal of Epidemiology, 2008 168(6):638-646

Autism: Charlatans to the Rescue

Comment on "Autism's False Prophets" By Paul A. Offit, M.D.

Ever since psychiatrist Leo Kanner identified a neurological condition he called autism in 1943, parents whose children have been diagnosed with the most severe form of the illness -- usually in the toddler stage, before age 3 -- have found themselves desperately searching for some way not to lose their children to autism's closed-off world. Unfortunately, such parents have often found misguided doctors, ill-informed psychologists and outright charlatans eager to proffer help.

Paul A. Offit, a pediatrician and the chief of infectious diseases at the Children's Hospital of Philadelphia, has gathered this sorry parade of self-styled samaritans for "Autism's False Prophets," an invaluable chronicle that relates some of the many ways in which the vulnerabilities of anxious parents have been exploited.

First, though, some basics about the disorder: According to the Autism Society of America, children and adults with autism "typically show difficulties in verbal and non-verbal communication, social interactions, and leisure or play activities." But there is a wide range of severity, hence the use of the umbrella term "autism spectrum disorder." At the less severe end of the spectrum, a diagnosis of Asperger's syndrome is sometimes applied to cases where there is no delay in children's acquisition of language. (The Austrian pediatrician Hans Asperger noted this milder form of autism in 1944, but it wasn't formalized as a diagnosis until the 1990s.)

For a disorder that has been noticed and described relatively recently, autism is quite common, affecting as many as one in 150 children. And the frequency of the diagnosis is increasing, according to the Centers for Disease Control and Prevention. The natural reaction to such an increase is: "Something must be causing it." The next step is: "Someone is to blame" -- followed by lawsuits, if only people can figure out whom to sue.

Dr. Offit notes two likely causes of the increase in autism diagnoses. One is that the definition of the disorder has broadened over time, so that children with mild symptoms are now being diagnosed when once they would have been regarded as merely quirky. That's certainly plausible. My son, now in his mid-30s, sought a formal evaluation a year ago, just to satisfy his curiosity about whether he's really an Aspy, as those with Asperger's sometimes call themselves. And indeed he is. But when he started school three decades ago, and his teachers worried about why he seemed to have trouble making friends, no one so much as mentioned a neurological problem as a possible explanation. Today they would, and they'd also have more useful guidance on what might help him (he seemed fine to us, his parents).

The second cause of the rise in autism diagnoses, according to Dr. Offit, is that in earlier times children with severe symptoms of what we now recognize as autism were more likely to be diagnosed, often incorrectly, as mentally retarded.

Just as autism is being found more often, so, it seems, are dubious explanations for the source of an illness that so far has defied medicine's attempts to find its origins. The parade of "false prophets" began lining up soon after the disorder was defined.

At mid-century, psychoanalyst Bruno Bettelheim set up a school in Chicago, and published a book, based on his theory that autism was precipitated by the "black milk" of mothers who treated children with a frosty emotional distance. His claims of successful treatment were widely disseminated; that the claims were fraudulent, not so much.

Next in Dr. Offit's parade are the advocates of "facilitated communication" from the 1970s and 1980s, who claimed that their approach enabled nonverbal children to express their true selves. Facilitated communication entailed having a "facilitator" support a child's hand or arm, helping the child type on a keyboard or use other devices. The method was easily debunked with a simple experiment: Don't allow the facilitator to see what the child is seeing and suddenly the child's communication skills evaporate. But facilitated communication flourished for years. Nobody thought to do the experiments until the children's true selves -- or at least their imaginative helpers -- began recounting false tales of sexual abuse.

In 1998, a British doctor named Andrew Wakefield joined the ranks of autism explainers, announcing in The Lancet that the disorder was caused by the triple vaccine for measles, mumps and rubella (MMR) given to young children. Only later did it emerge that the children he studied were clients of a lawyer who was searching for evidence he could use in a lawsuit. The disclosure prompted most of the co-authors of Dr. Wakefield's article to disavow it.

The MMR episode seems like just a prelude to the American manifestation of the childhood-vaccines panic of recent years. As Dr. Offit reports, the autism bogeyman is now the use of thimerosal, a preservative in vaccines. Thimerosal, as many studies in several countries have shown, is safe; whatever may be causing the increase in autism diagnoses, thimerosal isn't it. But in an excess of caution, federal agencies pushed to have thimerosal removed from almost all childhood vaccines.

The government's action was unnecessary but in itself not harmful. The problem was that removing the preservative seemed to confirm parents' fears: If thimerosal wasn't harmful, why get rid of it? The government's action did have the useful side effect of setting up a natural experiment. If thimerosal had been a cause of autism, the appearance of new cases should have begun to slow. In fact, autism diagnoses continued to climb.

Of course, the evidence rejecting thimerosal as a cause of autism had no effect on true believers, whose ranks include distraught parents and those beating the drums for their own patented remedies. Dr. Offit wonders why parents who distrust scientists and public health officials for refusing to admit that vaccines cause autism -- after all, they don't -- "haven't been similarly skeptical of the vast array of autism therapies, all of which are claimed to work and all of which are based on theories that are ill-founded, poorly conceived, contradictory, or disproved." Good question.


24 September, 2008


Latest abstract below. They found that the closer you stick to what they regard as a typical Mediterranean diet (oil not butter; More vegetables and less meat; plenty of garlic; red wine rather than beer etc.) the longer you live, though only by a small amount. For all we know, however, it could be that it is people who are careful of their health who are most likely to stick to such a heavily-hyped diet and that people who are more careful of their health live longer anyway. And the pesky facts about Australia are ignored too. Australia has exceptionally long life expectancies despite being as gastronomically different from Southern Europe as it is geographically distant. The usual Australian diet is about as "wrong" as you can get by Mediterranean standards.

And let me get REALLY pesky here. Have you ever seen Mediterranean people (particularly Southern Italians) in later life? They are mostly shaped like barrels. So how does that fit in with the obesity war?

Adherence to Mediterranean diet and health status: meta-analysis

By Sofi F et al.

OBJECTIVE: To systematically review all the prospective cohort studies that have analysed the relation between adherence to a Mediterranean diet, mortality, and incidence of chronic diseases in a primary prevention setting.

DESIGN: Meta-analysis of prospective cohort studies.

DATA SOURCES: English and non-English publications in PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials from 1966 to 30 June 2008. Studies reviewed Studies that analysed prospectively the association between adherence to a Mediterranean diet, mortality, and incidence of diseases; 12 studies, with a total of 1 574,299 subjects followed for a time ranging from three to 18 years were included.

RESULTS: The cumulative analysis among eight cohorts (514,816 subjects and 33,576 deaths) evaluating overall mortality in relation to adherence to a Mediterranean diet showed that a two point increase in the adherence score was significantly associated with a reduced risk of mortality (pooled relative risk 0.91, 95% confidence interval 0.89 to 0.94). Likewise, the analyses showed a beneficial role for greater adherence to a Mediterranean diet on cardiovascular mortality (pooled relative risk 0.91, 0.87 to 0.95), incidence of or mortality from cancer (0.94, 0.92 to 0.96), and incidence of Parkinson's disease and Alzheimer's disease (0.87, 0.80 to 0.96).

CONCLUSIONS: Greater adherence to a Mediterranean diet is associated with a significant improvement in health status, as seen by a significant reduction in overall mortality (9%), mortality from cardiovascular diseases (9%), incidence of or mortality from cancer (6%), and incidence of Parkinson's disease and Alzheimer's disease (13%). These results seem to be clinically relevant for public health, in particular for encouraging a Mediterranean-like dietary pattern for primary prevention of major chronic diseases.

BMJ. 2008 Sep 11;337:a1344


Arthritis surgery now found to be useless. Opening up an arthritic joint, cleaning out the junk and smoothing out the rough bits should so SOME good, right? 'Fraid not. Once again a proper controlled study detonates assumptions

A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee

By Alexandra Kirkley, M.D. et al.


Background: The efficacy of arthroscopic surgery for the treatment of osteoarthritis of the knee is unknown.

Methods: We conducted a single-center, randomized, controlled trial of arthroscopic surgery in patients with moderate-to-severe osteoarthritis of the knee. Patients were randomly assigned to surgical lavage and arthroscopic d‚bridement together with optimized physical and medical therapy or to treatment with physical and medical therapy alone. The primary outcome was the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (range, 0 to 2400; higher scores indicate more severe symptoms) at 2 years of follow-up. Secondary outcomes included the Short Form-36 (SF-36) Physical Component Summary score (range, 0 to 100; higher scores indicate better quality of life).

Results: Of the 92 patients assigned to surgery, 6 did not undergo surgery. Of the 86 patients assigned to control treatment, all received only physical and medical therapy. After 2 years, the mean (~SD) WOMAC score for the surgery group was 874~624, as compared with 897~583 for the control group (absolute difference [surgery-group score minus control-group score], -23ń605; 95% confidence interval [CI], -208 to 161; P=0.22 after adjustment for baseline score and grade of severity). The SF-36 Physical Component Summary scores were 37.0~11.4 and 37.2~10.6, respectively (absolute difference, -0.2~11.1; 95% CI, -3.6 to 3.2; P=0.93). Analyses of WOMAC scores at interim visits and other secondary outcomes also failed to show superiority of surgery.

Conclusions: Arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.

NEJM, 2008, Volume 359:1097-1107 Number 11

23 September, 2008

Sexually active girls get depressed?

The journal abstract is here. Prepublication version here. The authors have made some attempts at control but I cannot see that they have ruled out the possibility that girls who have low self-esteem to start with might consent to sex at a younger age. We could have the cart before the horse here

YOUNG girls who are sexually active are far more likely to suffer from depression than those who remain virgins, according to a controversial study. Academics found that teenage sex leaves many girls with feelings of guilt and low self-esteem.

Following a study of more than 14,000 US teens aged between 14 and 17, researchers said the feelings could be directly ascribed to sexual activity, rather than outside influences. The study, published in the Journal of Health Economics, found that having sex doubled the chances of girls becoming depressed, with 19 per cent of those who had sex exhibiting symptoms of depression, compared with 9.2 per cent who had abstained. The study also found that the mental health of boys in the same age group did not correlate with sexually active.



This is an amusing one. Some more cart before the horse logic. The authors find that people are slimmer where there are more doctors. But, despite hailing from good old class-conscious England, they have missed the obvious. Middle class people are slimmer and live in nicer areas. And doctors like living in nicer areas and seeing middle class people. So it is nicer areas that cause both the slimness and the increased presence of doctors. The presence of more doctors is not causal. Abstract follows:

GP supply and obesity

By Stephen Morris and Hugh Gravelle


We investigate the relationship between area general practitioner (GP) supply and individual body mass index (BMI) in England. Individual level BMI is regressed against area whole time equivalent GPs per 1000 population plus a large number of individual and area level covariates. We use instrumental variables (area house prices and age weighted capitation) to allow for the endogeneity of GP supply. We find that that a 10% increase in GP supply is associated with a mean reduction in BMI of around 1 kg/m2 (around 4% of mean BMI). The results suggest that reduced list sizes per GP can improve the management of obesity.


22 September, 2008

UK: Junk food ad rules “not working”

How frustrating for the Fascists!

Adverts for unhealthy foods are still appearing during TV programmes seen by children, despite curbs introduced in January, a consumer watchdog has said. Which? said the five programmes with the most child viewers and only four of the top 20 most popular children's shows were covered by Ofcom's rules. These state that ads for "less healthy” foods are not allowed in or around programmes which "appeal" to under-16s.

But advertisers said Which's list included shows "not aimed" at children. A programme is defined as being of particular appeal to children if the proportion of those under 16 watching a programme is 20% higher than the general viewing population. This means shows like The Simpsons and SpongeBob SquarePants are covered, while shows like Beat the Star, Animals Do The Funniest Things and Emmerdale are not, even though they are watched by thousands more children.

A two-week analysis by Which? found that ads for products including Coca-Cola, Oreos and Kellogg's Coco Pops were broadcast during programmes popular with children but not covered by the restrictions. It said ITV's Beat the Star attracted more than half a million child viewers during the monitoring period, but had contained ads for Coca-Cola, Dairylea Dunkers, Nachos and Sprite.

Which? food campaigner Clare Corbett said: "The ad restrictions may look good on paper but the reality is that the programmes most popular with children are slipping through the net. "If these rules are going to be effective, then they have to apply to the programmes that children watch in the greatest numbers." She added: "We're not anti-advertising, we're just against the fact that most of the ads children see are for unhealthy products, rather than the healthier foods they should be eating more of."

But the Advertising Association said Which? seemed to want to unfairly restrict companies' ability to deliver commercial messages. Chief executive Baroness Peta Buscombe called its report "sensationalist, unconstructive and missing the point" and said the advertising industry took a "responsible approach" to food advertising. She added: "Their list includes programmes clearly not aimed at children and films screened after 10pm. "There clearly has to be an element of parental responsibility on which programmes they allow their children to view."

A Department for Culture, Media and Sport spokesman said: "For the first time, TV adverts for foods high in fat, salt and sugar are banned during programmes aimed at or of particular appeal to children under 16. "Although children still see some of these advertisements, the current Ofcom regulations mean that the viewing of these adverts by children is reduced by an estimated 50%, an impressive amount." He added: "We appreciate that there are calls for further restrictions on UK TV advertising but these should be considered once we have had a chance to assess the impact of current measures."

Ofcom is set to report to government on the success of its restrictions in December. The Food Standards Agency, which drew up a model for deciding if a food was unhealthy, is also to assess how well it is performing.


"Sports" drinks are a con

VITAMIN and sports-water drinks are so laden with sugar and caffeine that claims about their health-giving benefits should be taken with a grain of salt, nutritionists have warned. Despite labels touting their ability to revive consumers and improve focus and energy, the drinks are simply "artificial concoctions" of additives more likely to undermine drinkers' health than improve it, Foodwatch nutritionist Catherine Saxelby said. The sugar content of the drinks - which account for $100million of bottled water sales - is so high the Australian Dental Association wants them to carry warning labels.

Consumer advocate group Choice says the public is being deliberately misled about the benefits of enhanced-water drinks, with some 500ml varieties containing eight teaspoons of sugar, high levels of caffeine and many additives, including flavours and colours.

Choice has complained to the Australian Competition and Consumer Commission and the NSW Food Authority about the allegedly misleading labelling and marketing of Coca-Cola Amatil's Glaceau Vitamin Water. The drink has 6« teaspoons of sugar - that's one third of the average adult woman's recommended dietary intake of sugar. The beverage giant expects to sell 2 million bottles of the drink this year. Choice senior food policy officer Clare Hughes said many health-conscious Australians were buying Glaceau and the other leading enhanced-water brands, Nutrient Water and Smart Water, on the basis of deceptive marketing and labelling. While it purported to be healthy, a 575ml bottle of Nutrient Water had seven teaspoons of sugar, Ms Hughes said; Smart Water's 500ml bottle had eight. A 375ml can of Coca-Cola contains 10 teaspoons of sugar.

"What's marketed as a sensible alternative to sugary soft drinks is nowhere near as sensible or as healthy as the package implies," Ms Hughes said. Ms Saxelby said vitamin waters are an "artificial concoction" with additives such as fructose, sucrose, flavour and food acid. "It's not like drinking juice. It's actually a formulated product from a factory," she said. "I don't think we need these drinks. We can get our vitamins and minerals from normal, natural food."

Australian Dental Association Victoria deputy president Anne Harrison said the high sugar levels could lead to tooth decay and consumers had a right to know what they were drinking.

Coca-Cola South Pacific spokeswoman Sarah Kelly said neither the ACCC nor the NSW Food Authority had contacted the company to raise concerns about Glaceau Vitamin Water, which was launched in February and had "exceeded sales expectations".


21 September, 2008

NIMH refuses to waste money on stupid vaccine theory

The fact that autism cases rose rather than fell after thimerosal was phased out tells us all we need to know

Health officials have called off plans for a study examining a controversial type of treatment that some autism activists have touted as alternative medical therapy for children with the condition. The National Institute of Mental Health, or NIMH, part of the U.S. National Institutes of Health, said in a statement on Wednesday that it has canceled a study aimed at assessing the effectiveness of a treatment called chelation.

Chelation (pronounced key-LAY-shun) is a type of therapy in which a man-made amino acid, called EDTA, is added to the blood, and it has been used to treat heavy metal poisoning. Some autism activists have advocated it on the theory -- rejected by most scientists -- that autism is triggered by exposure to mercury, a heavy metal, from childhood vaccines. Many studies and medical experts have dismissed the notion that mercury used in a vaccine preservative causes autism, but some parents of autistic children strongly believe it does.

Since 2001, with the exception of some influenza vaccines, the mercury-containing preservative has not been used in routinely recommended childhood vaccines, according to the U.S. Centers for Disease Control and Prevention.

"NIMH has decided that resources are better directed at this time to testing other potential therapies for autism spectrum disorders, and is not pursuing the additional review required to begin the study," the institute said.


Food and Drug Administration Speaks Out in Defense of Plastic Baby Bottles

A rather pusillanimous response to a largely fraudulent study

Federal regulators this week defended their assessment that a chemical widely used in plastic baby bottles and in food packaging is safe, even as the first major study of health effects in people linked it with possible risks for heart disease and diabetes. "A margin of safety exists that is adequate to protect consumers, including infants and children, at the current levels of exposure," Laura Tarantino, a senior Food and Drug Administration scientist, told an expert panel that has been asked for a second opinion on the agency's assessment of bisphenol A or BPA, the AP reports.

However, a study released earlier this week by the Journal of the American Medical Association suggested a new concern about BPA. Because of the possible public health implications, the results "deserve scientific follow-up," the study authors said. Using a health survey of nearly 1,500 adults, they found that those exposed to higher amounts of BPA were more likely to report having heart disease and diabetes, according to the AP report.

But the study is preliminary, far from proof that the chemical caused the health problems. Two Dartmouth College analysts of medical research said it raises questions but provides no answers about whether the ubiquitous chemical is harmful.

FDA officials said they are not dismissing such findings, and conceded that further research is needed. "We recognize the need to resolve the concerning questions that have been raised," said Tarantino. But the FDA is arguing that the studies with rats and mice it relied on for its assessment are more thorough than some of the human research that has raised doubts.

The FDA has the power to limit use of BPA in food containers and medical devices but last month released its internal report concluding that BPA exposure is not enough to warrant action. Since then, another government agency released a separate report concluding that risks to people, in particular to infants and children, cannot be ruled out.

Researchers from Britain and the University of Iowa examined a U.S. government health survey of 1,455 American adults and reported whether they had any of several common diseases. A total of 79 had heart attacks, chest pain or other types of cardiovascular disease and 136 had diabetes. There were more than twice as many people with heart disease or diabetes in the highest BPA group than in the lowest BPA group. No one in the study had BPA urine amounts showing higher than recommended exposure levels, said co-author Dr. David Melzer, a University of Exeter researcher.

The American Chemistry Council, an industry trade group, said the study is flawed, has substantial limitations and proves nothing. But Dr. Ana Soto of Tufts University said the study raises enough concerns to warrant government action to limit BPA exposure, the AP reports. "We shouldn't wait until further studies are done in order to act in protecting humans," said Soto, who has called for more restrictions in the past.

Several states are considering restricting BPA use, some manufacturers have begun promoting BPA-free baby bottles, and some stores are phasing out baby products containing the chemical. The European Union has said that BPA-containing products are safe, but Canada's government has proposed banning the sale of baby bottles with BPA as a precaution.


20 September, 2008

Now paracetamol is in the gun

Finding: Sickly babies (i.e. ones given lots of painkillers) tend to have more illness in later life. Big news! Big stupidity to blame the problem on the remedy, though. There are other grounds for caution with paracetamol but the stuff below is negligible grounds for caution. It's just more data dredging

Giving paracetamol-based medicines such as Calpol to babies can increase their chances of developing asthma in later life, a large international study suggests. Researchers who analysed data on more than 200,000 children found strong links between their exposure to paracetamol as infants and the development of asthma and other allergic conditions.

Mothers are advised that after two months, in babies weighing over 4kg (9lb), they can treat fevers with medicines or suspensions that contain paracetamol. But the study raises questions about the long-term effects of using medicines such as junior paracetamol and Calpol at such a young age.

Children under 12 months who were given a paracetamol-based medicine at least once a month more than tripled the chances of suffering wheezing attacks by the age of 6 or 7, the researchers found. The painkiller was also associated with an increased risk of rhinoconjunctivitis - or hay fever - and eczema. The researchers add that increased use of paracetamol - because of earlier fears about giving children aspirin - could be a factor in causing rising rates of asthma in many countries.

Previous research had already suggested a link between paracetamol and asthma, and scientists believe that the painkiller may cause changes in the body that leave a child more vulnerable to inflammation and allergies.

The authors of the study, published in The Lancet medical journal, emphasise that the findings do not constitute a reason to stop using paracetamol for relief of pain and fever in children. Instead, they support existing guidelines of the World Health Organisation that paracetamol-based medicines should not be used routinely, but should be reserved for those with a high fever (38.5C or above). Experts point out that in these cases, giving children medication outweighs the risks of not doing so.

Paracetamol is not licensed for use in infants under 2 months old by mouth and is only recommended after that in "junior" doses or medicines that contain less than the standard adult dose. More than one million children in the UK - equivalent to one in ten - now have asthma and the number of cases has trebled since the 1960s. The rise has in part coincided with paracetamol becoming the preferred drug to treat fevers and pain in children.

The study, part of a worldwide investigation called the International Study of Asthma and Allergies in Childhood, spanned 73 centres in 31 countries. It found that giving children paracetamol in the first year of life increased the risk of later asthma symptoms in children aged 6 and 7 by 46 per cent. Taking paracetamol at least once a month - classified as "high use" - increased the symptoms risk 3.23 times. Using the drug in the first year of life increased the risk of hay fever and eczema at the age of 6 and 7 by 48 per cent and 35 per cent respectively.

The researchers had to rely on written answers from parents who filled in questionnaires about their children's health and use of paracetamol, which may be subject to error.

Professor Richard Beasley, who led the study at the Medical Research Institute of New Zealand, said that there were good reasons to suggest that paracetamol was a factor in causing health problems, rather than merely being associated with them. The research highlights a "dose-dependent" response, with more exposure to the drug resulting in more asthma attacks, pointing to a cause-and-effect relationship, he said. [Rubbish! It just shows that the sicklier kids get more asthma]

The researchers said that more research, in the form of randomised controlled trials, was needed urgently. [Indeed!]


Is marriage good for your health?

The article below is from an interview with Peter McDonald, a Professor of Demography. He says that marriage does go with better health but has a refreshing skepticism about why that is so. He points out a number of reasons why marriage of itself may not be the crucial factor. That people who are unhealthy to start with are less likely to get married seems to escape most commentators on the subject

There are many things you can do if you want to live a long, happy and healthy life - get plenty of exercise, watch what you eat [So I can eat all the Big Macs I want as long as I watch them?], don't smoke or drink too much, or you can get married.

While for many years demographers found that men in spousal relationships lived longer than women in the same situation, recent Australian Bureau of Statistics (ABS) data on death rates shows people living in intimate relationships - both men and women - have lower death rates than single people in almost all age groups.

The ABS data, which compares the rate of death per 1,000 for single people versus married ones (including those in de facto relationships), shows the difference in death rates between single and married people starts in the 40s and continues across the lifespan. The difference spikes in the 70-84 year old age group where the death rate for single people is almost double that of their married friends.

In the last 20 years, married women have started to enjoy a longer life span than their single counterparts, says Professor Peter McDonald from the Australian Demographic and Social Research Institute. While demographers are not altogether sure why the situation has changed for married women in recent times, McDonald says there are several reasons experts believe married couples live longer. For a start, those who are at greater risk of dying are less likely to get hitched.

"If you're going to die then you don't get married, or if you've got some terrible disease you don't get married," he says. "So those with potentially high death risks are selected out into the single population."

There's also the 'in sickness and in health' factor. People living in intimate relationships are more likely to have someone looking after them when they're sick, telling them when to go to the doctor or encouraging them to live a healthier lifestyle. "Single people don't have someone there caring for them and suggesting their lifestyle needs changing," McDonald says.

And then there's the power of two incomes. "There's probably an economic advantage, married people are probably better off in economic terms, there's a strong association between economic well being and expectation of life as well - those who are well off live longer."

So if you're single and you want to live a long and healthy life, if the stats are anything to go by, you might want to consider adding 'find partner for life' to your next New Year's resolution list.


19 September, 2008


This scare never seems to die. Weak epidemiological associations below based on small samples of sufferers -- with causal inferences speculative, as usual. Interesting that one of the study participants did not think much of the results. Note that the vast majority of the sample were NOT ill and yet had bisphenol in them also. Also note that an unspecified number of both "heart" and "diabetic" patients were UNDIAGNOSED heart-disease and diabetes sufferers!

Exposure to a ubiquitous chemical used in plastic baby bottles, food cans and a host of other products may increase the risk of developing heart disease and diabetes, a study suggests. In the first significant study of the effects of bisphenol A (BPA), one of the world's most mass-produced substances, researchers found that even small traces in the body were potentially linked to health problems.

BPA, used in hardened plastics including food containers and compact discs, can be found in detectable levels in nine out of ten people. It enters the body primarily through food and drink but also through drinking water, dental sealants, through the skin or inhalation of household dusts.

The researchers, from the Peninsula Medical School, Exeter, found that relatively high levels of the chemical present in urine were associated with a threefold risk of cardiovascular disease and double the risk for type 2 diabetes. With possible public health implications, the results "deserve scientific follow-up", the study's authors said.

Previous studies of adverse effects in animals have created concern over long-term, low-level exposure to BPA in humans. But the findings, from a "snapshot" study of the American population, do not prove that the chemical causes health problems, the researchers said.

Heart disease is reckoned Britain's biggest killer, with about 270,000 heart attacks occurring each year, while 100,000 cases of type 2 diabetes, which is associated with obesity, are diagnosed each year.

The study, published in the Journal of the American Medical Association, looked at BPA levels in the urine of 1,455 American adults, and whether they had ever been diagnosed with one of eight main diseases, including arthritis and thyroid disease. In total 79 had had heart attacks, chest pain or other types of cardiovascular disease and 136 had diabetes. The average level of BPA exposure was 20 micrograms per day.

But 25 per cent of participants with highest BPA concentrations (between 35 to 50 micrograms per day) were nearly three times likelier to be diagnosed with cardiovascular disease than those in the lowest 25 per cent (10 micrograms per day). Similarly, those with highest BPA concentrations were 2.4 times likelier to have had diabetes diagnosed compared with those at lowest levels. Current guidelines suggest that an adult can safely consume up to 3,250 micrograms a day, a much higher amount than the study suggests.

BPA leaches from drinks bottles made from some polycarbonate plastics and from the epoxy linings of canned foods, especially if heated. "BPA-free" baby bottles have been sold in recent years, but there is little information for consumers on BPA.

David Melzer, who led the study at the University of Exeter, said: "At the moment we can't be sure BPA is the direct cause of the extra cases of heart disease and diabetes. If it is, some cases of these conditions could be prevented by reducing BPA exposure."

Iain Lang, a co-author of the study, added, "Measuring who has disease and high BPA levels at a single point in time cannot tell you which comes first. I'm not changing my behaviour on the basis of this single study."


Association of Urinary Bisphenol A Concentration With Medical Disorders and Laboratory Abnormalities in Adults

By Iain A. Lang et al.

Context: Bisphenol A (BPA) is widely used in epoxy resins lining food and beverage containers. Evidence of effects in animals has generated concern over low-level chronic exposures in humans.

Objective: To examine associations between urinary BPA concentrations and adult health status.

Design, Setting, and Participants: Cross-sectional analysis of BPA concentrations and health status in the general adult population of the United States, using data from the National Health and Nutrition Examination Survey 2003-2004.

Participants were 1455 adults aged 18 through 74 years with measured urinary BPA and urine creatinine concentrations. Regression models were adjusted for age, sex, race/ethnicity, education, income, smoking, body mass index, waist circumference, and urinary creatinine concentration. The sample provided 80% power to detect unadjusted odds ratios (ORs) of 1.4 for diagnoses of 5% prevalence per 1-SD change in BPA concentration, or standardized regression coefficients of 0.075 for liver enzyme concentrations, at a significance level of P <.05.

Main Outcome Measures: Chronic disease diagnoses plus blood markers of liver function, glucose homeostasis, inflammation, and lipid changes.

Results: Higher urinary BPA concentrations were associated with cardiovascular diagnoses in age-, sex-, and fully adjusted models (OR per 1-SD increase in BPA concentration, 1.39; 95% confidence interval [CI], 1.18-1.63; P = .001 with full adjustment). Higher BPA concentrations were also associated with diabetes (OR per 1-SD increase in BPA concentration, 1.39; 95% confidence interval [CI], 1.21-1.60; P <.001) but not with other studied common diseases.

In addition, higher BPA concentrations were associated with clinically abnormal concentrations of the liver enzymes gamma -glutamyltransferase (OR per 1-SD increase in BPA concentration, 1.29; 95% CI, 1.14-1.46; P < .001) and alkaline phosphatase (OR per 1-SD increase in BPA concentration, 1.48; 95% CI, 1.18-1.85; P = .002).

Conclusion: Higher BPA exposure, reflected in higher urinary concentrations of BPA, may be associated with avoidable morbidity in the community-dwelling adult population.

JAMA. 2008;300(11):1303-1310

Antibiotics given to delay labour can harm baby

Another disgraceful attempt to worry pregnant women. The report below is a very partial summary of two papers that were published simultaneously. This paper found no effect of antibiotic use while this paper found no effect of antibiotic use on anything other than rate of cerebral palsy, which was rare in any case. It's just data dredging. If you look at enough variables, you will find differences by chance alone. The real conclusion should be that antibiotics in pregnancy are almost certainly safe

Giving women antibiotics to delay premature labour may increase the risk of developmental problems for the baby, a study suggests. The study by the University of Leicester, published in The Lancet, assessed seven-year-olds whose mothers had been involved in a clinical trial at the time of their birth. The children of those given an antibiotic were much more likely to have cerebral palsy. The Health Department has written to doctors asking them to discontinue the practice, which is not routine.

Experts say that the more common use of antibiotics for pregnant women who show signs of an infection when their waters break early can be lifesaving, and should be continued.

Many new mothers get too little postnatal support, a poll of 6,000 mothers by found. Six out of ten felt they had not seen their health visitor enough during the first year of their child's life.


18 September, 2008


The various studies seem to oscillate between condemning and praising alcohol intake. So it is interesting to see an attempt at a systematic literature review designed to see whether it has any effect on your going ga-ga in later life. And the good news for those of us who appreciate the occasional assistance of Mr John Walker of Scotland is that moderate consumption seems to help rather than hinder. See below. I hate to be a spoilsport but I feel obliged to note, however, that the evidence is epidemiological. Moderate drinkers were healthier but moderate drinkers probably engage in safer behaviour in lots of ways (e.g less illegal drug taking). So the booze may have NOTHING to do with their better health. Sad, isn't it?

Alcohol, dementia and cognitive decline in the elderly: a systematic review

By Ruth Peters et al.

Background: dementia and cognitive decline have been linked to cardiovascular risk. Alcohol has known negative effects in large quantities but may be protective for the cardiovascular system in smaller amounts. Effect of alcohol intake may be greater in the elderly and may impact on cognition.

Methods: to evaluate the evidence for any relationship between incident cognitive decline or dementia in the elderly and alcohol consumption, a systematic review and meta-analyses were carried out. Criteria for inclusion were longitudinal studies of subjects aged ~ 65, with primary outcomes of incident dementia/cognitive decline.

Results: 23 studies were identified (20 epidemiological cohort, three retrospective matched case-control nested in a cohort). Meta-analyses suggest that small amounts of alcohol may be protective against dementia (random effects model, risk ratio [RR] 0.63; 95% CI 0.53-0.75) and Alzheimer's disease (RR 0.57; 0.44-0.74) but not for vascular dementia (RR 0.82; 0.50-1.35) or cognitive decline (RR 0.89; 0.67-1.17) However, studies varied, with differing lengths of follow up, measurement of alcohol intake, inclusion of true abstainers and assessment of potential confounders.

Conclusions: because of the heterogeneity in the data these findings should be interpreted with caution. However, there is some evidence to suggest that limited alcohol intake in earlier adult life may be protective against incident dementia later.

Age and Ageing 2008 37(5):505-512.


Aspirin seems to loosen up the blood flow generally and that should be a good thing for the restricted bloodflow found in aged brains -- and thus keep the brains concerned a bit younger. So is regular aspirin intake a good thing if you want to avoid going ga-ga? Sorry. No effect! Pesky things, these placebo controls!

Low dose aspirin and cognitive function in middle aged to elderly adults: randomised controlled trial

By Jackie F Price et al.

Objective To determine the effects of low dose aspirin on cognitive function in middle aged to elderly men and women at moderately increased cardiovascular risk.

Design Randomised double blind placebo controlled trial.

Setting Central Scotland.

Participants 3350 men and women aged over 50 participating in the aspirin for asymptomatic atherosclerosis trial.

Intervention Low dose aspirin (100 mg daily) or placebo for five years.

Main outcome measures Tests of memory, executive function, non-verbal reasoning, mental flexibility, and information processing five years after randomisation, with scores used to create a summary cognitive score (general factor).

Results At baseline, mean vocabulary scores (an indicator of previous cognitive ability) were similar in the aspirin (30.9, SD 4.7) and placebo (31.1, SD 4.7) groups. In the primary intention to treat analysis, there was no significant difference at follow-up between the groups in the proportion achieving over the median general factor cognitive score (32.7% and 34.8% respectively, odds ratio 0.91, 95% confidence interval 0.79 to 1.05, P=0.20) or in mean scores on the individual cognitive tests. There were also no significant differences in change in cognitive ability over the five years in a subset of 504 who underwent detailed cognitive testing at baseline.

Conclusion Low dose aspirin does not affect cognitive function in middle aged to elderly people at increased cardiovascular risk.

BMJ 2008;337:a1198.

17 September, 2008

Top Statistician Says Cancer Risk from Vytorin/Inegy 'Not Ruled Out'

The stuff doesn't work anyway. That you have to do statistical marvels to detect any effects shows how weak the effects concerned are. I would worry about its overall efficacy (effect on mortality) rather than anything else

One of the most prominent statisticians in the U.S. is taking issue with an analysis that claims there is no credible evidence the cholesterol drug Vytorin increases the risk of cancer death. "There are clinically important ["clinically important" is waffle. It can mean "not statistically significant"] increases in the risk of cancer-related death that are not ruled out by this data," writes Thomas Fleming of the University of Washington in an editorial published on the Web site of the New England Journal of Medicine.

Moreover, he argues in the editorial, the analysis arguing against a risk of cancer death for Vytorin should never have been made public because it could compromise ongoing studies of the drug. That would mean clear evidence about Vytorin's safety and effectiveness might never be obtained.

The editorial spells more trouble for Vytorin and its sister drug, Zetia--which share an active ingredient--and for their makers, Merck and Schering-Plough. Vytorin is a combo pill of Zetia and the generic drug Zocor. The pills generated $5 billion in sales last year, but U.S. prescriptions have dropped by a third as a result of the controversy over Zetia's effectiveness at preventing heart attacks.

In July, researchers hastily released a study, called SEAS, in which patients on Vytorin developed and died of cancer more often than those in a placebo group. But, at the same time, they presented an analysis by Oxford University's Sir Richard Peto, who argued there is "no credible evidence" of a link between the active ingredient in Vytorin and Zetia and cancer. Both the study and the analysis were published in the New England Journal on Sept. 2.

Many cardiologists who defend Vytorin and Zetia rest their arguments on Peto's brilliance. Eugene Braunwald, a prominent Harvard cardiologist who is running a Vytorin trial, called Peto "the best statistician in the universe" while telling reporters that any cancer risk with the drug is unlikely.

But Fleming is also highly regarded. A frequent adviser to the Food and Drug Administration, Fleming was a key player in sorting through the confusing data surrounding the link of arthritis drugs Vioxx and Bextra to heart risks. He also warned the FDA not to approve the cancer drug Iressa because of limited data; use of the medicine was substantially restricted after it failed to demonstrate a survival benefit in big trials.

In a statement, Merck and Schering-Plough said they believe the cancer finding "is likely to be an anomaly that, taken in the light of all the available data, does not support an association with Vytorin."

Fleming agrees with Peto on one point. Peto's analysis looked at data taken from two incomplete studies of Vytorin: SHARP, which compares Vytorin with a placebo in patients with kidney disease, and IMPROVE-IT, which compares Vytorin with Zocor. Some critics have said Peto should have lumped all three trials together. Fleming writes Peto's was the right approach, since the point was to see if the cancer risk that shows up in SEAS would show up elsewhere.

Doing the analysis this way showed no increase in the number of cancers, but an increase in the number of deaths from cancer. Fleming argues that this still leaves a possibility that the pills are linked to cancer death. In fact, the data are consistent with a 34% increase in cancer death, and don't rule out an 84% increase.

Fleming also argues that Peto's analysis of the IMPROVE-IT and SHARP studies raises "important concerns" about the integrity of those clinical trials. Studies are normally kept secret until they are completed. Only a special committee charged with monitoring patient safety is allowed to look at the unblinded data, so that a trial can be stopped if a drug turns out to be dangerous. (Forbes raised these issues this morning.)

Fleming writes there is a "serious risk" that data from incomplete studies will be misinterpreted. He also argues that making unblinded data available to the public could disturb the existing studies, potentially making the results less valid when the trials are eventually released. He writes the data in the Peto analysis should only have been made available to the committees monitoring the safety of the patients in SHARP and IMPROVE-IT.

He concludes that more data are needed to "adequately address the signal that [Vytorin] is associated with an increased risk of death from cancer." He adds that getting more data is "especially important" because Zetia has a safety signal of major illness or death, while evidence of its efficacy is limited to lowering cholesterol.


Small Packages May Lead to Overeating

Another counterproductive idea from the food Fascists

Tempting treats are being offered in small package sizes these days, presumably to help consumers reduce portion sizes. Yet new research in the Journal of Consumer Research found that people actually consume more high-calorie snacks when they are in small packages than large ones. And smaller packages make people more likely to give in to temptation in the first place.

Authors Rita Coelho do Vale (Technical University of Lisbon), Rik Pieters, and Marcel Zeelenberg (both Tilburg University, the Netherlands) found that large packages triggered concern of overeating and conscious efforts to avoid doing so, while small packages were perceived as innocent pleasures, leaving the consumers unaware that they were overindulging.

"The increasing availability of single-serve and multi-packs may not serve consumers in the long-run, but-because they are considered to be innocent pleasures-may turn out to be sneaky small sins," write the authors.

One fascinating aspect of the research is the difference between belief and reality. In an initial study, researchers found that consumers believe that small packages help them regulate "hedonistic consumption," where self-restraint is at stake. When participants were asked to choose phone plans, those who thought the plan was for social rather than work purposes tended to choose smaller plans.

The researchers then moved on to food. Participants in one group had their "dietary concerns" activated by completing a "Body Satisfaction scale," a "Drive for Thinness scale," and a "Concern for Dieting scale." They were then weighed and measured, in front of a mirror, to fully activate their awareness. Then those participants (and a control group, which didn't have its "dietary concerns" activated) watched episodes of Friends interspersed with commercials. They believed they were there to evaluate the ads.

But researchers were really monitoring their consumption of potato chips. Chips were available to participants in large packages or small ones. The study found that consumption was lowest when dieting concerns were activated and package size was large. People were less likely to open large packages, and participants deliberated longer before consuming from the larger packages.

"Maybe the answer lies in consumers taking responsibility for their consumption and monitoring internal cues of sufficiency, rather than letting package size take control," conclude the authors.


16 September, 2008

Fatty Burgers for 36 Years

(Fond Du Lac, Wisconsin) A 54-year-old local man, Don Gorske, 6' 2" and 185 lbs., claims to have eaten 23,000 McDonald's Big Macs over a period of 36 years.

So, somebody please tell me why this guy doesn't look like Michael Moore after a couple of heart attacks? Surely, most of the burgers he consumed were made in establishments before trans fats were banned. I'm also confident that Mr. Groske couldn't resist McDonald's french fries, arguably the most popular item on the menu.

It's inexplicable. Listening to and reading the news, we learn that scientists are convinced that there's an obesity crisis caused specifically by the stuff Mr. Groske has been consuming.

Look at his picture. Does he appear to be a man in crisis due to body mass. I contend that he looks absolutely normal, well, except for the goofy Moe Howard haircut.

So, congratulations, Mr. Gorske! May you continue to eat two Big Macs a day for another 36 years.


Humans have an inborn math co-processor

HUMANS have an inborn, intuitive grasp of numbers that varies sharply from one person to the next and is closely linked to advanced math skills, according to a study released today. In experiments with teenagers in the US, scientists discovered that children whose "approximate number system" (ANS) was highly developed were also good in school-taught mathematics from an early age.

The ability to roughly estimate quantities in the blink of eye - without any training - has also been found in monkeys, rats and four-month-old infants, and probably has deep evolutionary roots, the study said. "It is difficult to overstate the importance of the 'number sense' for all kinds of animals," said lead researcher Justin Halberda, a cognitive scientist at Johns Hopkins University in Baltimore, Maryland. "Maximising your search for food, finding a seat on the bus, recognising the difference between a mating call and an alarm call in a particular species of bird by the number of warbles - all of these require the ANS," he said by email.

Previous research had shown an innate sense of numbers is entirely controlled by a non-verbal region of the brain called the intraparietal sulcus. But to do exact arithmetic and precise calculations, humans require language, which is governed by another part of the brain.

Mr Halberda and two colleagues tested this hard-wired ability to judge quantities by showing 64 14-year-olds a series of images containing between 10 and 32 dots that were either blue or yellow. In some images - flashed for only one-fifth of a second - there were twice as many dots of one colour. In other images, however, the ratio was closer to parity with, for example, seven yellow dots and eight blue, and thus much harder to discern.

The results showed a wide variation in the capacity to pick the colour with the most dots at least 75 per cent of the time, suggesting that some people are simply much better at such lightning-fast "guesstimates". Even more unexpected, however, was the extent to which the two distinct kinds of number-crunching cognition - ANS and learned mathematics - are linked. Children that performed best in the image test were also those who scored the highest in standard math achievement tests, going back almost 10 years to kindergarten.

The same held true at the other end of the spectrum, even after additional factors, such as IQ levels, were taken into account, according to the study, which was published in the London-based science journal Nature. "What is surprising is that the formal mathematics we work so hard to learn in school... is related in any way to what a rat is doing when it is out looking for scraps of food, or what you and I are doing when we look for a seat on a bus," said Mr Halberda.

This does not mean that one cannot be good in math without a keen ANS, or that having a strong "number sense" is a guarantee for good grades in school. Nor is it clear whether one's ANS can be boosted. "It remains to be seen if one can improve a student's innate number sense by practice and training, and whether such training will lead to improvements in school math performance," Mr Halberda said.


15 September, 2008

AIDS epidemic? It was a `glorious myth'

The author of 1987's "The Truth About the AIDS Panic" welcomes two new whistleblowing texts on the opportunism of the AIDS industry.

There is a widely accepted view that Britain was saved from an explosive epidemic of heterosexual AIDS in the late 1980s by a bold campaign initiated by gay activists and radical doctors and subsequently endorsed by the government and the mass media. According to advocates of this view, we owe our low rates of HIV infection today largely to the success of initiatives such as the `Don't Die of Ignorance' leaflet distributed to 23million households and the scary `Tombstones and Icebergs' television and cinema adverts (though they are always quick to add that we must maintain vigilance and guard against complacency).

Now former AIDS industry insiders are challenging the imminent heterosexual plague story and many of the other scare stories of the international AIDS panic. James Chin, author of The AIDS Pandemic: The Collision of Epidemiology with Political Correctness, is a veteran public health epidemiologist who worked in the World Health Organisation's Global Programme on AIDS in the late 1980s and early 1990s. Elizabeth Pisani, a journalist turned epidemiologist and author of The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS, spent most of the past decade working under the auspices of UNAIDS, which took over the global crusade against HIV in 1996. Once prominent advocates of the familiar doomsday scenarios, both have now turned whistleblowers on their former colleagues in the AIDS bureaucracy, a `byzantine' world, according to Pisani, in which `money eclipses truth'.

For Chin, the British AIDS story is an example of a `glorious myth' - a tale that is `gloriously or nobly false', but told `for a good cause'. He claims that government and international agencies, and AIDS advocacy organisations, `have distorted HIV epidemiology in order to perpetuate the myth of the great potential for HIV epidemics to spread into "general" populations'. In particular, he alleges, HIV/AIDS `estimates and projections are "cooked" or made up'.

While Pisani disputes Chin's claim that UNAIDS epidemiologists deliberately overestimated the epidemic, she admits to what she describes as `beating up' the figures, insisting - unconvincingly - that there is a `huge difference' between `making it up (plain old lying) and beating it up'. Pisani freely acknowledges her role in manipulating statistics to maximise their scare value, and breezily dismisses the `everyone-is-at-risk nonsense' of the British `Don't Die of Ignorance' campaign.

Chin's book offers a comprehensive exposure of the hollowness of the claims of the AIDS bureaucracy for the efficacy of their preventive campaigns. He provides numerous examples of how exaggerated claims for the scale of the HIV epidemic (and the risks of wider spread) in different countries and contexts enable authorities to claim the credit for subsequently lower figures, as they `ride to glory' on curves showing declining incidence. As he argues, `HIV prevalence is low in most populations throughout the world and can be expected to remain low, not because of effective HIV prevention programmes, but because. the vast majority of the world's populations do not have sufficient HIV risk behaviours to sustain epidemic HIV transmission'.

By the late 1980s, it was already clear that, given the very low prevalence of HIV, the difficulty of transmitting HIV through heterosexual sex and the stable character of sexual relationships (even those having multiple partners tend to favour serial monogamy), an explosive HIV epidemic in Britain, of the sort that occurred in relatively small networks of gay men and drug users, was highly improbable, as Don Milligan and I argued in 1987 (1).

As both Chin and Pisani indicate, high rates of heterosexually spread HIV infection remain the exceptional feature of sub-Saharan Africa (and parts of the Caribbean) where a particular pattern of concurrent networks of sexual partners together with high rates of other sexually transmitted infections facilitated an AIDS epidemic. Though this has had a devastating impact on many communities, Chin suggests that HIV prevalence in sub-Saharan Africa and the Caribbean has been overestimated by about 50 per cent. The good news is that, contrary to the doom-mongering of the AIDS bureaucracy, the rising annual global HIV incidence peaked in the late 1990s and the AIDS pandemic has now passed its peak.

Most significantly, the sub-Saharan pattern has not been replicated in Europe or North America, or even in Asia or Latin America, though there have been localised epidemics associated with gay men, drug users and prostitution, most recently in South-East Asia and Eastern Europe.

Many commentators now acknowledge the gross exaggerations and scaremongering of the AIDS bureaucracy. It is clear that HIV has remained largely confined to people following recognised high-risk behaviours, rather than being, in the mantra of the AIDS bureaucracy, a condition of poverty, gender inequality and under-development. Yet they also accept the argument, characterised by Chin as `political correctness', that it is better to try to terrify the entire population with the spectre of an AIDS epidemic than it is to risk stigmatising the gays and junkies, ladyboys and whores who feature prominently in Pisani's colourful account.

For Chin and Pisani, the main problem of the mendacity of the AIDS bureaucracy is that it leads to misdirected, ineffective and wasteful campaigns to change the sexual behaviour of the entire population, while the real problems of HIV transmission through high-risk networks are neglected. To deal with these problems, both favour a return to traditional public health methods of containing sexually transmitted infections through aggressive testing, contact tracing and treatment of carriers of HIV. Whereas the gay activists who influenced the early approach of the AIDS bureaucracy favoured anonymous and voluntary testing, our whistleblowers now recommend a more coercive approach, in relation to both diagnosis and treatment.

Pisani reminds readers that `public health is inherently a somewhat fascist discipline' (for example, quarantine restrictions have an inescapably authoritarian character) and enthusiastically endorses the AIDS policies of the Thai military authorities and the Chinese bureaucrats who are not restrained from targeting high-risk groups by democratic niceties. The problem is that, given the climate of fear generated by two decades of the `everyone-is-at-risk nonsense', the policy now recommended by Chin and Pisani is likely to lead to more repressive interventions against stigmatised minorities (which will not help to deter the spread of HIV infection).

Chin confesses that he has found it difficult `to understand how, over the past decade, mainstream AIDS scientists, including most infectious disease epidemiologists, have virtually all uncritically accepted the many "glorious" myths and misconceptions UNAIDS and AIDS activists continue to perpetuate'. An explanation for this shocking betrayal of principle can be found in a 1996 commentary on the British AIDS campaign entitled `Icebergs and rocks of the "good lie"'. In this article, Guardian journalist Mark Lawson accepted that the public had been misled over the threat of AIDS, but argued that the end of promoting sexual restraint (especially among the young) justified the means (exaggerating the risk of HIV infection): as he put it, `the government has lied and I am glad' (2).

This sort of opportunism is not confined to AIDS: in other areas where experts are broadly in sympathy with government policy - such as passive smoking, obesity and climate change - they have been similarly complicit in the prostitution of science to propaganda. It is a pity that Chin and Pisani did not blow their whistles earlier and louder, but better late than never.


'Don't blame fat kids on Maccas'

THE Australian head of McDonald's says there's no mystery surrounding childhood obesity - kids are fat because they don't exercise as much as they used to. Chief executive Peter Bush also says McDonald's, according to the chain's own research, provides just one in every 72 meals an average child eats. "You've got to look at those other 71 meals kids consume that often come out of the cupboard at home," Mr Bush told a federal parliamentary inquiry into obesity sitting in Sydney.

"Where we sit on this is that we probably look at it as a very perplexing and complicated issue. "Certainly the studies have indicated that the issue is linked to a change on lifestyle - kids exercising less, watching more TV, kids playing video games."

Mr Bush said academics where now properly studying the causes of obesity, but most pre-existing data blaming fast food was inconclusive. "When the very first obesity summit was held in Sydney in October 2002, my predecessor sat through the two days of that session," he said. "Through that time, overwhelming evidence was presented, but not substantiated, that fast food was the culprit. "What also emerged at that time was there were very few studies completed worldwide at that stage." Mr Bush said fear of crime was a factor in obesity, arguing parents do not allow children to walk to school anymore.

The House of Representatives standing committee inquiry, which began in May, is looking at the increasing prevalence of obesity and future implications for the health system. University of Sydney Associate Professor Jenny O'Dea presented the findings of a study on obese children and a survey of 345,713 adults. It showed poorly-educated parents were more than twice as likely to have obese children as well-educated mums and dads.

The Roy Morgan survey also showed the rate of obesity for adults in the lowest socio-economic groups grew at almost triple the rate of those belonging to the highest earning and educated groups between April 2000 and March 2007. Nearly a third of people in the lowest socio-economic group were regarded as obese in March last year, compared with 26.6 per cent in April 2000. In the highest socio-economic group, 17.8 per cent were obese, up from 15.9 in 2000.

Dr O'Dea said governments should rethink obesity campaigns, saying they must address social inequities rather than opting for "shame and blame" strategies, which did not work. She also said the international standard for measuring obesity was generally fair, but the label should be treated with care as the body mass of some ethnic groups differed. "You can't assume that an overweight, obese child is carrying too much fat," she said. "There are kids who fit into that category. They are the the Samoan kids and the Fijian kids and the Greek boys who are very muscular and the Lebanese boys."

Dr O'Dea studied 960 families of children, from years two to six, in 10 primary schools across regional and rural NSW. She discovered 2.7 per cent of tertiary-educated mothers had obese children compared with six per cent of mums who had completed year 10 or less. Seven per cent of fathers in the low-educated group had obese children, while the figure was three per cent for those in the highly-educated group.


14 September, 2008

Basil could fight the effects of ageing

Only if the "free radical" theory is correct and some results have called that into serious question. The "antioxidant" pills that are supposed to "mop up" free radicals do after all cause early death. See here and here and here. So basil could in fact kill you! LOL

A type of basil could help combat the harmful effects of ageing, according to new research. Holy basil is a close relative of the herb commonly used in Western cooking and its sharp-tasting leaves are incorporated in Asian dishes. Native to India, its extract has long been used in the ancient system of Ayurvedic medicine practised in India and other parts of Asia as a rejuvenation drug

In the first formal study of the herb, pharmacy researchers found that holy basil extract was effective at protecting against free radicals - cancer-causing chemicals which can attack key organs such as the heart, liver and brain and damage genes and nerve cells. The researchers, led by Dr Vaibhav Shinde from Poona College of Pharmacy, Maharashtra, India, studied the herb for anti-oxidant and anti-ageing properties. They presented their findings at the British Pharmaceutical Conference in Manchester.

Dr Shinde said: "The study validates the traditional use of herb as a youth-promoting substance in the Ayurvedic system of medicine. It also helps describe how the herb acts at a cellular level." He added: "We have had some very exciting results. I am now using holy basil in my own cooking and I hope it will be beneficial."

The herb, whose Latin name is Latin name Ocimum sanctum, is also known as tulsi and is traditionally grown in an earthenware pot in homes and gardens in India. In the past it has been used to treat a variety of disorders including fevers, colds, malaria and diabetes.


LOL: Thinking can make you fat

I guess I must have been thinking a lot in recent years! Eating as one way of responding to stress is often observed however so the finding below probably has some truth in it. If the stress concerned is frequent, however, adaptation might reduce or eliminate any effects

Researchers found the stress of onerous mental tasks caused subjects to overeat. The results may help suggest how modern lifestyles have contributed to an obesity epidemic. The research team, supervised by Dr Angelo Tremblay, measured the spontaneous food intake of 14 students after each of three tasks.

The first was relaxing in a sitting position, the second reading and summarizing a text, and finally completing a series of memory, attention, and vigilance tests on the computer. After 45 minutes at each activity, participants were invited to eat as much as they wanted from a buffet. The researchers had already calculated that each session of intellectual work requires only three calories more than the rest period. However, despite the low energy cost of mental work, the students spontaneously consumed 203 more calories after summarizing a text and 253 more calories after the computer tests.

This represents a 23.6 per cent and 29.4 per cent increase, respectively, compared with the rest period. Blood samples taken before, during, and after each session revealed that intellectual work causes much bigger fluctuations in glucose and insulin levels than rest periods.

Jean-Philippe Chaput, the study's main author, said: "These fluctuations may be caused by the stress of intellectual work, or also reflect a biological adaptation during glucose combustion." The body could be reacting to these fluctuations by spurring food intake in order to restore its glucose balance, the only fuel used by the brain.

Mr Chaput added: "Caloric overcompensation following intellectual work, combined with the fact we are less physically active when doing intellectual tasks, could contribute to the obesity epidemic currently observed in industrialised countries. "This is a factor that should not be ignored, considering that more and more people hold jobs of an intellectual nature." The results of the study, carried out at Universite Laval in Quebec, Canada, are published in the most recent issue of Psychosomatic Medicine.


13 September, 2008

Meat, fish and milk protect against brain shrinkage?

This study was conducted with some caution about confounding factors (Abstract here) so deserves some respect. The causal inferences are speculative nonetheless. The possibility of a third factor influencing both B12 levels and brain shrinkage could not be excluded and this is, after all, a poorly understood field. If the theory is correct, however, we should see a lot of vegetarians with shrunken brains! I must say that I would not be too surprised if that were found! There has after all been some evidence to suggest that tofu causes dementia!. So maybe tofu eating is the third factor! (Just joking)

A diet rich in fish, meat and milk could help to protect against memory loss in old age, a new study has shown. The findings suggest a key vitamin found in the foods helps to prevent brain shrinkage, which has been linked to memory problems.

Researchers at the University of Oxford studied 107 people aged 61 to 87 and found those with lower levels of the vitamin in their blood were six times more likely to experience brain shrinkage than those with higher levels. The vitamin, B12, found in meat, fish, fortified cereals and milk, is crucial to the formation of red blood cells and the maintenance of a healthy nervous system. Research has shown that many elderly people have low levels of the vitamin.

Rebecca Wood, chief executive of the Alzheimer's Research Trust, which helped fund the research, published in the journal Neurology, said: "This study suggests that consuming more vitamin B12 through eating meat, fish, fortified cereals or milk as part of a balanced diet might help protect the brain. Liver and shellfish are particularly rich sources of B12. "Vitamin B12 deficiency is a common problem among elderly people in the UK and has been linked to declining memory and dementia. "700,000 people live with dementia in the UK, and more research like this is urgently needed if we are to tackle this cruel condition."


Australia: Parent anger over lunchbox police

Rules on junk food in schools will be sent to all principals this week amid parent anger over teachers inspecting children's lunchboxes and confiscating items viewed as unhealthy. Education Department chief executive Chris Robinson told The Advertiser last night guidelines would be reissued to all state schools and preschools. This follows reports yesterday of several schools ordering teachers to search children's lunchboxes for "inappropriate" food. In some cases, confiscated items were not replaced, leaving children to go hungry.

Mr Robinson said the department's ban on junk food under the Right Bite strategy launched last year by Health Minister John Hill and Education Minister Jane Lomax-Smith, applied only to food and drinks sold in school canteens and vending machines. Birthday cakes and food or drinks from home are not covered by the ban. But according to a February 27 memo sent to principals and preschool directors by department deputy chief executive Jan Andrews, each school has discretion to ignore those instructions. "It is up to each school and preschool community and their governing council to decide how to use the guidelines to encourage healthier eating beyond the requirement that bans junk food in school canteens and vending machines," the memo said.

Opposition education spokesman David Pisoni said schools were confused by the "mixed message". "Parents are rightly angry - it should be about education and not confiscation, and kids should not go hungry because food is taken from lunchboxes," he said.

Mr Robinson, speaking yesterday on radio FIVEaa, said: "Teachers don't have any role in going through children's lunchboxes, that's entirely a matter for parents and the healthy eating guidelines don't cover (them)."

But Seaview Downs mother Cassandra Liebeknecht told The Advertiser that staff at her son's preschool had, over time, confiscated a small packet of potato chips and fruit bars. "Where do you draw the line? Is white bread with jam on it healthy," she asked.

Child psychologist Dr Michael Carr-Gregg said: "This is an abuse of power. "No school teacher has the right to go into a child's lunchbox and arbitrarily deem some food acceptable and some not. It is a blatant interference in the rights of parents and has to stop now."


12 September, 2008

Another stupid theory: Brush your teeth to avoid heart attacks

This is all based on one-factor modelling. We await a double blind study. In the way of these things we will one day no doubt be told that teeth brushing is BAD for you

HERE's another reason to brush your teeth: poor dental hygiene boosts the risk of heart attacks and strokes, a pair of studies reported this week. Heart disease is the No.1 killer worldwide, claiming upward of 17 million lives every year, according to the World Health Organisation. Smoking, obesity and high cholesterol are the most common culprits, but the new research shows that neglected gums can be added to the list.

"We now recognise that bacterial infections are an independent risk factor for heart diseases,'' said Howard Jenkins of the University of Bristol in Britain, at a meeting of the Society for General Microbiology in Dublin. "In other words, it doesn't matter how fit, slim or healthy you are, you're adding to your chances of getting heart disease by having bad teeth,'' the professor said.

There are up to 700 different bacteria in the human mouth, and failing to scrub one's pearly whites helps those germs to flourish. Most are benign, and some are essential to good health. But a few can trigger a biological cascade leading to diseases of the arteries linked to heart attacks and stroke, according to the new research. "The mouth is probably the dirtiest place in the human body,'' Steve Kerrigan of the Royal College of Surgeons in Dublin said. "If you have an open blood vessel from bleeding gums, bacteria will gain entry to your bloodstream.'' Once inside the blood, certain bacteria stick onto cells called platelets, causing them to clot inside the vessel and thus decreasing blood flow to the heart.

"We mimicked the pressure inside the blood vessels and in the heart, and demonstrated that bacteria use different mechanisms to cause platelets to clump together, allowing them to completely encase the bacteria,'' he said. This not only created conditions that can provoke heart attacks and strokes, it also shielded the bacteria from both, immune system cells and antibiotics. "These findings suggest why antibiotics do not always work in the treatment of infectious heart disease,'' Prof Jenkins said.

In separate research, a team led by Greg Seymour of the University of Otago Dunedin in New Zealand showed how other bacteria from the mouth can provoke atherosclerosis, a disease that causes hardening of the arteries. All organisms - including humans and bacteria - produce "stress proteins", molecules produced by conditions such as inflammation, toxins, starvation, or oxygen deprivation. One function of stress proteins is to guide other proteins across cell membranes. But they can also can latch onto foreign objects, called antigens, and deliver then to immune cells, provoking an immune reactions in the body.

Normally, the body does not attack its own stress proteins. But bacterial stress proteins - which are similar - do trigger a response, and once that has happened the immune system can no longer differentiate between the two, said Dr Seymour. "White blood cells can build up in the tissue of arteries, causing atherosclerosis,'' he said.


Save the planet by cutting down on meat? That's just a load of bull

By the inimitable Boris Johnson. Never before has London had such a jolly and irreverent Mayor. The man is a living national treasure

Look, I hate to be rude to the UN. I don't want to seem churlish in the face of advice from a body as august and well-meaning as the Intergovernmental Panel on Climate Change. But if they seriously believe that I am going to give up eating meat - in the hope of reducing the temperature of the planet - then they must be totally barmy.

No, Dr Rajendra Pachauri, distinguished chairman of the panel, I am not going to have one meat-free day per week. No, I am not going to become a gradual vegetarian. In fact, the whole proposition is so irritating that I am almost minded to eat more meat in response.

Every weekend, rain or shine, I suggest that we flaunt our defiance of UN dietary recommendations with a series of vast Homeric barbecues. We are going to have carnivorous festivals of chops and sausages and burgers and chitterlings and chine and offal, and the fat will run down our chins, and the dripping will blaze on the charcoal, and the smoky vapours will rise to the heavens. We will call these meat feasts Pachauri days, in satirical homage to the tofu-chomping UN man who told the human race to go veggie.

And the reason I respond so intemperately to his suggestion is that he completely misses the point. Everybody knows the reality, and everybody - every environmentalist, every Guardian columnist - pussyfoots around it. The problem is not the cows; the problem is the people eating the cows. The problem is us. Oh, Dr Pachauri is quite right to be concerned at the emissions of noxious vapours from farm animals. As the UN revealed in 2006, livestock make a bigger contribution to the greenhouse effect - to global warming - than every motor vehicle on the planet.

Cows are spreading remorselessly over the earth, as jungle is turned into pasture, and pasture is turned into cud, and cud is turned into the terrible ruminant efflatus that rises from the fields and the farms and swaddles the globe in a tea cosy of methane, 23 times as damaging as CO2.

Livestock now use 30 per cent of the earth's surface, and farming now produces 37 per cent of the methane created by human activity, and every extra cow means thousands of extra cowpats, each cowpat seemingly innocent enough, but together capable of emitting enough steaming gas to change the composition of the upper air.

Yes, Dr Pachauri is spot on in his analysis. It is his prescription that is absurd. He is quite right that if you want to buy a gas-guzzler 4x4 Range Rover and you want to offset your greenhouse emissions, you just have to pop into the nearest field and assassinate a cow. And he is quite right that if we were to kill all the cows in the world, and all the sheep, we would greatly reduce our methane output.

What he neglects in his argument are the 1.3 billion people whose livelihoods depend on agriculture, and above all he forgets the global population of human beings. It is our appetite for meat that supports those farmers, and it is our insatiable desire for burgers that has called those poor cows into existence.

Why, oh why will the modern UN say nothing about the real issue, the prior issue, the unspeakable truth that is at the heart of deforestation, global warming, the depletion of the seas, the destruction of species and just about every environmental problem that afflicts us? The biggest threat to the planet is not the lowing of the cows as they take over the Latin American savannah. It is the dizzying increase in the numbers of people driving those cows and then eating them. The world's population is up to 6.72 billion, and set to rise to 9 billion by 2050.

Now let me tell you something about the year 2050. It is not that far off. I fully intend to see it in, since I will be a mere 84, and I must say that I do not look with enthusiasm at the prospect of sharing the planet with another 2.3 billion people. I am sure that they will all each be individually charming and they will all have much to contribute to the intellectual and spiritual life of our species. But they will also make life that much more crowded, sweaty and exhausting than it already is. They will accelerate the urbanisation of the world and the turning of rural south-east England into a gigantic suburbia.

And whatever Dr Pachauri may say, I do not think they will be persuaded to eat nut cutlets. Millions of years of evolution are not to be reversed by a spot of preaching from the UN. Man is an omnivore, culturally and probably biologically programmed to take protein from meat; and those meat animals must be farmed. We cannot all eat moose, like Sarah Palin. We need cows. Not so long ago I stood in the vast canteen in the Beijing Olympic village and on one side were long salad bars, with virtually no one in the queue.


11 September, 2008

Low salt levels in ham and bacon risk botulism

Salty ham and bacon are keeping us healthy, according to meat firms protesting new salt-reduction targets. Meat manufacturers have rejected calls to cut salt levels in processed meats, claiming salt is used to prevent the deadly food bug botulism. The Food Standards Agency has called for salt content to be reduced to 2.13g per 100g by 2010 and to 1.75g by 2012. It suggested last month that 14,000 premature deaths a year could be avoided if adults reduced salt intake to just 6g a day. The current average is 8.6g per day, down from 9.5g in 2001.

But ham and bacon processors say the move will reduce the shelf life of products, and put customers off. A 10-slice packet of ham contains just under two teaspoons of salt. Claire Cheney, director-general of the Provision Trade Federation, representing leading processed meats companies and supermarkets said the targets were a potential health risk. She told The Grocer magazine: 'If you have not got sufficient preservative in a product like ham you get pockets where the salt levels are too low to prevent the formation of the botulism toxin. 'This will force us to reduce the shelf life further and with that come serious food safety concerns, not least the risk of botulism.'

She was backed by Elizabeth Andoh-Kesson, technical manager of the British Meat Processors Association. She said: 'We are very worried about the stricter targets and believe that reducing salt further has implications for food safety and the shelf life of products.'

Health campaigners have urged the FSA to stand firm, and resist pressure from the meat industry which is reluctant to change its manufacturing practices. Trade associations, including the 5billion pounds a year sandwich industry, complained consumers would find the taste of their products too bland without salt.


Tips for living to 100

Utter crap based on epidemiological speculation but with no support from the double-blind studies.

FROM the mythical fountain of youth to cryogenics, throughout history mankind has sought the secret to eternal life. Advances in medical science are helping us live longer, though not necessarily healthier. Author Dr Trisha Macnair may not have stumbled on the fabled fountain but she can help you live a longer life. The solution, Macnair says, is as simple as washing your hands or brushing your teeth. In her new book, The Long Life Equation, she lists activities that either add years to your life or strip them away. Washing your hands adds two years, and good dental hygiene will see you live six years longer.

Simple everyday activities can also lead to an early demise. For example, if you smoke, eat fast food, do not exercise and lead a stressful life, you'll be in your grave 20 years earlier. "There's no doubt younger people take life and health for granted - more than any generation before, they idle time away watching TV or playing computer games, ignoring the activities that keep them healthy or develop meaning in their lives," Macnair says.

"As we get older and start to feel the years slipping away, we suddenly realise how precious it is. "But by then we may have already established habits (smoking, drinking, obesity, lack of exercise, stressful occupations) which take their toll and are difficult to reverse. "Still, it's never too late to change. Also, our attitudes to older age are changing so there is more freedom now to do things later in life if we are healthy and able."

If you were unlucky enough to be born during the Bronze Age, your life expectancy was only 18 years. Fast-forward to the early 20th century and the worldwide average was 30 to 40 years. The current world average is 66, but in Australia that average is 77 for men and 82 for women.

We may be living longer but are we living better? The idea for The Long Life Equation came during time Macnair spent working with the elderly in a rehabilitation hospital. "Working with the elderly has made me very aware of the changes that we experience as we get older, how this can reduce quality of life and how many people regret not doing more when they were younger to stay healthy for longer," she says.


10 September, 2008

No link between MMR and autism say doctors after recreating controversial study

A fresh study has ruled out a link between the MMR vaccine and autism. Scientists said they hoped their findings - which contradict an identical British study ten years ago - would encourage parents to immunise their children. Fears over the combined measles, mumps and rubella jab have contributed to the highest numbers of measles cases seen in Britain and the U.S. and parts of Europe in many years. The disease kills about 250,000 a year globally, mostly children in poor nations.

This latest U.S. study attempted to replicate 1998 research led by Dr Andrew Wakefield, then of the Royal Free Hospital, in London, which suggested the MMR vaccine was linked to autism and gastro-intestinal problems. His study has since been discredited and he is currently undergoing disciplinary action for professional misconduct.

Scientists at Columbia University in New York looked for evidence of genetic material from the measles virus in intestinal tissue samples taken from 25 children with autism who also had gastro-intestinal problems. They compared these to samples from 13 children who had gastro-intestinal problems but no autism, and found no differences. The team also collected data about the children's immunisation histories but found no relationship between the timing of the MMR vaccine and the onset of either gastrointestinal complaints or autism. However, the study did find evidence that children with autism have persistent bowel troubles that should be addressed.

The samples were analysed in three laboratories that were not told which came from the children with autism. One of the labs had been involved in the original study suggesting a link between measles virus and autism. 'We found no difference in children who had GI complaints and no autism and children who had autism but no GI complaints,' Dr Ian Lipkin of Columbia University said.

The team also collected data about the children's health and immunisation histories from parents and physicians to see if vaccinations preceded either their autism or bowel trouble. 'We found no relationship between the timing of MMR vaccine and the onset of either GI complaints or autism,' Dr Mady Hornig, also of Columbia, added. Recent research suggests that around 1 in 100 people have some form of autism in the UK.


Doomed by mother's diet: Calorie- cutting during pregnancy 'puts your baby at risk of obesity in later life'

A nice little dilemma the food Fascists have dreamed up for mothers

Women who count calories during pregnancy could be condemning their unborn children to a lifetime of obesity, scientists have warned. It is thought that a lack of food in the womb alters the programming of the baby's fat cells, leading to weight problems in later life. As they grown into adulthood the child may find their body is still trying to compensate for the food shortages it experienced years before, a science conference heard yesterday.

Dr Helen Budge, of University Hospital Nottingham, warned that dieting during pregnancy or when trying to conceive could have long-lasting consequences. She said: 'Women diet to get pregnant and try to restrict their food intake during pregnancy because they don't want to become overweight. 'But the baby needs them to gain some weight. 'Whether we become obese is often established before, and soon after, we are born and is influenced by both the eating habits of our mothers and by the nutrition we receive as babies in the months after birth. 'Processes set in motion early on in our lives can have life-long effects.'

Dr Budge's work shows that lack of nutrition in the womb alters the chemistry of the developing fat cells. 'We know the chemistry of these cells is upset,' she said. 'There is more inflammation and stress on the cells and the hormone balance is upset.' With overweight mothers-to-be also running the risk of obese children, Dr Budge said a balanced diet was essential during pregnancy.

She told the British Association's Festival of Science in Liverpool: 'They should avoid food fads and diets and avoid over-eating. 'The message is about getting the balance right. 'If we want to successfully tackle obesity, it is essential that we improve understanding amongst women of the importance of having a healthy balanced diet before and during pregnancy and how this can affect the health of their child for decades at a time.'

Their average daily calorie intake was lower than both that recommended during pregnancy and that for women who aren't pregnant. They also put on less weight than advised by the Department of Health - gaining around 2.5lb under the recommended 27.5lb. The women were also lacking in iron, which prevents anemia, and folic acid, a form of vitamin B which helps prevent brain and spine defects such as spina bifida.

And research on rats suggest that children develop a taste for junk food in the womb, raising their risk of obesity, heart disease and diabetes in the years to come. Even babies fed a healthy diet after birth - meaning they had never eaten junk food themselves - tended to be overweight.

Dr Pat Goodwin, of the Wellcome Trust, which funded the junk food research, said: 'Obesity has increased dramatically over the last few years and needs to be tackled urgently. 'Pregnancy can be a difficult time for many mothers, but it is important that they are aware that what they eat may affect their offspring.'


9 September, 2008

It's official: you can be fat and fit

Contrary to the government hysteria, being obese is not an indicator of ill-health, and it's far from a death sentence.

One of the more depressing things about the constant talk of an obesity epidemic that is killing us all, and most particularly our children, is the media's constant readiness to give room to almost any nonsense so long as the word fat appears in it, while ignoring significant research that fails to fit the now-conventional wisdom that `being fat = death'.

Recently this trend has been on display in the way in which the British press has uncritically reported the views of Professor David Hunter of Durham University. Described by the Daily Telegraph as a `leading public health expert', Hunter has claimed that the UK National Health Service (NHS) will become unaffordable due to the costs of treating obesity-related diseases, opined that obesity requires `strong action' from government, and demanded that the government require tobacco-like warnings on foods that are high in fat, salt or sugar. Claiming that the obesity epidemic posed as significant a threat as terrorism, Hunter derided the official response as nothing more than `piddling'. According to Hunter, half the British population will be obese by 2032 (1).

Yet just days before Hunter's outburst, the quality dailies, with the exception of the Telegraph, which published a small piece deep inside the paper, failed to cover two new studies published in the same issue of Archives of Internal Medicine which give the lie to a good many of today's doomsday scenarios as well as to much of the government's propaganda about overweight and obesity, not to say its `obesity strategy'.

The studies come from Germany and the US. The US study found that despite claims, such as Hunter's, about the dangers of obesity and the risks of the diabetic obese overwhelming the NHS, roughly half of overweight people in the US - about 36million people - do not have raised blood pressure or cholesterol levels. The same applies to about a third of the people - 20million - who are categorised as `obese'. Moreover, about a quarter of normal-weight individuals have high blood pressure or problematic levels of cholesterol. As the authors concluded, `the present data suggest a high prevalence of cardiometabolic abnormality clustering among normal-weight individuals, as well as a high prevalence of obese individuals who are metabolically healthy.' The conclusions were based on a representative sample of over 5,400 adults surveyed in the National Health and Nutrition Examinations from 1999 to 2004 (2).

The German study found that insulin sensitivity was not statistically different in obese individuals compared with normal weight individuals. In effect, the image of hordes of fatties with metabolic problems leading to high levels of heart disease and diabetes is a myth. As the German research team put it, a `metabolically benign obesity that is not accompanied by insulin resistance and early atherosclerosis exists in humans' (3).

This is indeed unwelcome news to the obesity crusaders, for it shows just how scientifically unjustified their claims are, how generally untruthful the government's claims about the dangers of being overweight are, how compromised is their health advice about overweight and obesity, and how unwarranted are the calls for draconian government interventions such as tobacco-like warnings on so-called unhealthy foods. As MaryFran Sowers, one of the co-authors of the US study, told the New York Times: `We use "overweight" almost indiscriminately sometimes. But there is lots of individual variation within that, and we need to be cognizant of that as we think about what our health messages should be.'

Of course, none of this should come as a surprise since there is considerable evidence that `fat-and-fit' is not an oxymoron. For instance, last December the Journal of the American Medical Association published a study which followed 2,600 American adults aged over 60 for 12 years. Two striking findings emerged from the study. First, as in other studies, the overweight - that is those with a body mass index (BMI) of 25 to 30 - had slightly lower death rates than those of `normal' weight. Second, levels of fitness, not BMI, was the most reliable predictor of death. Those with the lowest levels of fitness were significantly more likely to die, regardless of body weight.

Despite the incessant claims that the government's obesity strategy is `evidence-based', don't expect to hear about any of this research from anyone connected with the Department of Health. After all, having invested so much time and money in spreading fears, it would be a shame now to have to stop picking on the overweight and obese and find a genuine health problem on which to focus.


Cancer cell suicide research

TOUGH cancer cells would be stopped with a drug designed to flick the death switch, says an eminent scientist. Professor Peter Colman, best known for the world's first anti-influenza drug, trained at the University of Adelaide. He made his prize-winning anti-influenza discovery in Melbourne at the CSIRO. Prof Colman now works in medical biology at the Walter and Eliza Hall Institute. He says his work involves taking photos of molecules using X-ray crystallography "to see what it is, at the level of the atom, that makes molecules stick together".

The anti-influenza drug sold under the trade name Relenza stops the virus from spreading by interfering with a protein at the surface. Now Prof Colman is trying to find a way to stop cancer cells spreading by causing them to commit suicide. Deep inside every cell lies the machinery for programmed cell death or "apoptosis".

Normal cells know when it is time to go, but Prof Colman says the cells of many cancers are "seriously screwed up". "The machinery in every cell - which it uses when it needs to die - has somehow been corrupted," he said. By using X-ray crystallography to look at the structure of the death switch, Prof Colman realised a drug could be designed to flick the death switch. "There are some medicines useful against certain tumors, but none of them work this way, by getting their hands on the death switch of every cell," he said. The drug is likely to be most useful in cases that do not respond to chemotherapy or radiotherapy.


8 September, 2008

Women with a wiggle: Gait may be associated with orgasmic ability

This is a VERY preliminary study with a tiny sample but there may be something in it

A new study found that trained sexologists could infer a woman's history of vaginal orgasm by observing the way she walks. The study is published in the September 2008 issue of The Journal of Sexual Medicine, the official journal of the International Society for Sexual Medicine and the International Society for the Study of Women's Sexual Health.

Led by Stuart Brody of the University of the West of Scotland in collaboration with colleagues in Belgium, the study involved 16 female Belgian university students. Subjects completed a questionnaire on their sexual behavior and were then videotaped from a distance while walking in a public place. The videotapes were rated by two professors of sexology and two research assistants trained in the functional-sexological approach to sexology, who were not aware of the women's orgasmic history.

The results showed that the appropriately trained sexologists were able to correctly infer vaginal orgasm through watching the way the women walked over 80 percent of the time. Further analysis revealed that the sum of stride length and vertebral rotation [wiggle?] was greater for the vaginally orgasmic women. "This could reflect the free, unblocked energetic flow from the legs through the pelvis to the spine," the authors note.

There are several plausible explanations for the results shown by this study. One possibility is that a woman's anatomical features may predispose her to greater or lesser tendency to experience vaginal orgasm. According to Brody, "Blocked pelvic muscles, which might be associated with psychosexual impairments, could both impair vaginal orgasmic response and gait." In addition, vaginally orgasmic women may feel more confident about their sexuality, which might be reflected in their gait. "Such confidence might also be related to the relationship(s) that a woman has had, given the finding that specifically penile-vaginal orgasm is associated with indices of better relationship quality," the authors state. Research has linked vaginal orgasm to better mental health.

The study provides some support for assumptions of a link between muscle blocks and sexual function, according to the authors. They conclude that it may lend credibility to the idea of incorporating training in movement, breathing and muscle patterns into the treatment of sexual dysfunction.

"Women with orgasmic dysfunction should be treated in a multi-disciplinary manner" says Irwin Goldstein, Editor-in-Chief of The Journal of Sexual Medicine."Although small, this study highlights the potential for multiple therapies such as expressive arts therapy incorporating movement and physical therapy focusing on the pelvic floor."


The world's fattest nation is using increasingly controversial methods to try to trim its waistline

New York has outlawed cooking fats that lead to heart disease. In Arkansas and Pennsylvania, schools weigh every child in the state and tell their parents if they are overweight.

Now, Los Angeles - a city synonymous with freeways and drive-thru' restaurants - has banned the opening of any new fast-food outlets for a year in a poor area swamped by McDonald's and Pizza Huts. Restaurant operators in South Los Angeles say the moratorium imposed by the city council is a form of oppression, but authorities and health advocates hope the bold move will allow fresh alternative eateries to flourish.

The concentration of fast-food outlets in the financially disadvantaged community, combined with a lack of grocery stores, mean residents struggle to buy fresh fruit and vegetables. With residents prevented by poverty and geography from gaining access to healthy produce, critics have labelled the ban as "food apartheid". [The basic fact that shops stock what people will buy is obviously too deep for these lamebrains] Los Angeles City Council member Bernard Parks said the ban was necessary, allowing people to buy mangos as well as McDonald's. "Our communities have an extreme shortage of quality foods," he said. [What he means is that people buy food he disapproves of]

Critics have not been so positive, calling councillors who backed the plan "fascists" and "nanny-staters". Councilwoman Jan Perry said the ban, coupled with tax breaks and assistance such as discounted electricity offered for fresh food businesses to set up in the area, were already having an impact. "I've had four businesses contact me already," she said. "[Sit-down] restaurants that want to see the sites we have available, want to get started."

The council voted unanimously to ban new fast-food outlets in the economically depressed area of 500,000 people and 83 square kilometres, where more than 30 per cent of the children are obese - double the LA County average - and almost three-quarters of restaurants don't provide cutlery. Even though there are more than 400 fast-food outlets in the district, the ban was opposed by the California Restaurant Association and is being closely watched by large chains, which are concerned it could spread across the city and state. An association spokesman, Andrew Casana, told the Los Angeles Times in July that the moratorium, which could be extended up to two years, was misguided. He said: "[Fast food] is the only industry that wants to be in South LA. Sit-down restaurants don't want to go in. If they did, they'd be there. This moratorium isn't going to help them relocate."

There are only a handful of mainstream "name brand" supermarkets in South LA, complemented by smaller independent outlets. Zoning decisions, a failure to plan and what Ms Perry calls "a form of bias" have conspired against the district. Perhaps the most astonishing aspect about the lack of supermarkets, grocers and family restaurants in the area is it runs counter to the strongest force in the US: capitalism. The councilwoman said $US400 million ($477 million) was drained from the community each year because its residents were forced to shop elsewhere. "That's money leaking out of South LA," she said. "Everybody needs to eat, and even [poor] people will find money to feed their families," Ms Perry said.

Several years ago the British retail giant Tesco bought the Fresh & Easy supermarket brand, which operates on the US west coast. Its store in the city of Compton, which borders South LA, serves a similar socio-economic group and is Tesco's highest-grossing store in the US. "People are literally starving for options," Ms Perry said.

South LA may be emblematic of the lack of access to fresh food, but the area is hardly alone. A similar ban in San Jose, near San Francisco, was defeated in controversial circumstances, voted down while its proponent was giving birth prematurely.

Newark, in New Jersey, which sits just outside New York City and is home to 283,000 people, making it equivalent in size to Wollongong, has just two large supermarkets. An economic adviser working with the Newark City Council, who asked not to be named, said the perception of high property prices and endemic crime had deterred retailers from setting up shop. Most people buy groceries near their work in the Big Apple, or at corner shops - bodegas - which provide only limited access to fresh food. "The suburban [supermarket] model just doesn't work here," she told The Sun-Herald. "An urban model is required and it's very difficult to get them to see the benefits of somewhere like Newark."

Two-thirds of adults in the US are considered overweight or obese. Rates of adult obesity have doubled since 1980 - from 15 to 30 per cent - and the population of adults with diabetes has risen from 5.2 per cent in 1980 to more than 8 per cent. These figures come from a report by non-profit organisations the Robert Wood Johnson Foundation and the Trust for America's Health, which estimate the direct health-care costs of obesity exceed $US61 billion annually. The survey also found a correlation between poverty and obesity, with seven of the 10 states with the highest obesity rates also in the top 10 for poverty rates. The statistics mirror those in Australia. Weight once denoted wealth, but now it almost certainly suggests you are poor. Trust executive director Jeff Levi said the US was "not treating the obesity crisis with the seriousness" it required. "The only thing going down is the money spent to prevent this epidemic," he said.

Authorities at local government levels are taking it upon themselves to tackle the problem, to improve the lives of their citizens and to avoid a financial catastrophe caused by increased health costs.

The South LA ban is the most sweeping legislative action against obesity since trans fats were outlawed in New York City in 2006, a process enforced from July this year. An artificial substance created when hydrogen is used to turn liquid oils into solid fats, trans fat contributes to heart disease by raising so-called "bad" cholesterol and lowering "good" cholesterol simultaneously. New York City now requires chain restaurants to list the calorie count of items next to menu prices. California will ban trans fats in 2010. "California is a leader in promoting health and nutrition," Governor Arnold Schwarzenegger said recently, after his state became the first in the US to phase out the fats.

The US has exported its profitable model of franchised fast-food restaurants with deep-fried, super-sized portions. Now the world is waking up to a new century in which some medical experts suggest obesity will shorten life expectancy unless drastic measures are taken to improve people's health.

Ms Perry said South LA's athletics tracks were being upgraded, school menus reviewed and parks improved to tempt citizens to make healthier choices. Not having a new fast-food restaurant in the area, she said, would hurt no one.


7 September, 2008

Birthweight and insanity

More "correlation is causation" nonsense below. Let me put up just one altenative explanation of the findings: Mentally ill people have a very high rate of smoking and smoking mothers do tend to have low birthweight babies. And mental illness is largely hereditary. So all we have is an unsurprising finding that the mentally ill mothers included in the smoker group increase the incidence of mentally ill babies in that group. The mental state of the mother caused the effect -- not her smoking

Low birth weight may increase the risk of psychiatric problems in children, claims new research in the Archives of General Psychiatry, suggesting these children should be monitored more closely for symptoms. Researchers recruited 823 children from urban and suburban areas of Detroit, Michigan. Their psychiatric problems were rated by their mothers and teachers at ages six, 11 and 17. Those with a birth weight of less than 2.5 kilograms were 53 per cent more likely to show delinquent or aggressive behaviour and 28 per cent more likely to be withdrawn, anxious or depressed throughout their school years. Among city-dwelling children, attention deficit hyperactivity disorder (ADHD) was nearly three times more common in low birth weight children than in those from the normal weight range.

Arch Gen Psychiatry 2008;65:1080-1086 (Bohnert KM, et al)


Exercise and pregnancy

More childish reasoning below. They find that depressed women exercise less. Fine. So if they exercised more they would be less depressed? It does not follow at all.

EXERCISE can improve the body image of expectant mothers and help prevent depression during and after pregnancy, claims a new study in the Annals of Behavioral Medicine. The authors surveyed 230 women throughout pregnancy and after birth about their exercise habits, symptoms of depression and feelings about their weight and appearance. Women who reported more depressive symptoms during the first trimester tended to exercise less during this time. And those who exercised more prior to pregnancy had greater body satisfaction and less depressive symptoms during the second trimester. Women could maintain moderate exercise if they were active pre-pregnancy, say the authors, but shouldn't start strenuous exercise if they were sedentary before.

Ann Behav Med 2008;35 (Downs DS, et al)


6 September, 2008

Men marry their mothers?

Men tend to wind up with life partners who look like their mother, while a woman is lured to a partner who looks like her father, scientists reported today. Heterosexuals are deeply attracted to individuals whose faces are similar to that of their opposite-sex parent, they said, suggesting that this characteristic is rooted in an evolutionary drive.

A team led by Tamas Bereczkei at the University of Pecs in Hungary created a model of facial ratios - width of jaw, distance between mouth and brow and so on - comprising 14 facial zones. They measured 312 Hungarian adults from 52 different families using this method. Each family included a couple, along with two sets of parents. The researchers found a significant correlation in facial similarities between a woman's mate and her father, and also between a man's partner and his mother. The team tested the model on faces that were randomly selected from the general population and repeated the experiment with a panel of judges, who also picked out the same pairings from randomly selected groups of photos.

Interestingly, men and women focused on different parts of the face when they home in on a potential mate, they found. A man's lover and his mother tended to have similar fullness in the lips, width of mouth, as well as length and width of jaw. But for women, the critical features were the distance between mouth and brow, the height of the face, distance between the eyes and the size of a man's nose.

The choices are driven less by psychology and socialisation and more by evolutionary pressures, suggests Bereczkei. Too much genetic overlap - as can happen with incest - is an evolutionary no-no. But seeking similar genetic traits "may confer individuals with additional adaptive advantages," he wrote. It could increase the degree to which parents share genes with offspring, enhancing the genetic representation of future generations.

Finding similar partners might also help perpetuate genetic complexes that have evolved to adapt to a particular environment. There may be an additional bonus, which probably has more to do with happiness than a genetic imperative. "Human couples who are similar in physical and psychological characteristics are more likely to remain together than dissimilar partners, possibly leading to an increase in fertility," the study concludes.

The research appears in the journal Proceedings of the Royal Society B. The Royal Society is Britain's de facto academy of sciences.


A drug for everything

Bad, quirky and obsessive behaviour is not new. Now there's a drug for everything - but is that the answer? Spending too much time on the internet? Worried about a low sex drive, shyness or lack of social skills? Or do you lose your temper too easily, blush too readily or spend too much time and money shopping?

There was a time when such behaviours might have been regarded as individual differences, or put down to lack of self-control and restraint. But not any more. Increasing numbers of behavioural conditions are being treated with drug therapy. Bereavement issues, blushing, low sex drive, high sex drive, sex addiction, lack of orgasm, gambling, fear of public speaking, stealing, domestic violence and phobias are all being targeted with drugs that are either in clinical trials or already available.

For drug companies, this market is potentially huge. It is claimed, for example, that almost half of women have a sexual problem. Nearly 8 per cent of adults, it seems, have intermittent explosive disorder; another 8 per cent are compulsive shoppers. Thirteen to 15 per cent are said to be social phobics, and up to 10 per cent have a fear of public speaking. On top of that are gamblers, phobics and the depressed - all suitable cases for treatment.

But critics argue that some of these treatments amount to medicalisation of individual differences and traits. Unlike physiological diseases such as cancer, behaviour disorders are a grey area, with no clear boundary between normality and illness. People at the extreme end need treatment, but others who may have symptoms may not.

Another problem is defining symptoms of some conditions. Take intermittent explosive disorder, the definition of which seems to defy even people in the field. "It is a vaguely defined condition for which effective treatments have not been identified," say researchers at the University of Chicago who have been involved in one drug trial.

One of the major areas for trials of new drugs is sexual problems. Reports have suggested that one in three women have low sex drive - and one drug trial has involved women whose symptoms include failure to achieve orgasm in half of their sexual encounters.

Professor Graham Hart, of the University of Glasgow, co-author of a paper on this issue in the British Medical Journal, says that the imperative now is for more and better sexual gratification. "Celibacy is the new deviance," he says. "The problem with such an overly medical approach to sexual behaviour is that social and interpersonal dynamics may be ignored.

"People choose one another for their uniqueness. The last century saw a considerable increase in acceptance of diversity of sexual expression - it would be a shame if this century saw diversity replaced by uniform expectations of performance and desire."

At the University of East Anglia, DrRay Crozier, an expert on shyness, makes a similar case about the medicalisation of blushing. He argues that, in many cases, there is nothing inherently wrong, painful or unhealthy about blushing, yet it is treated both with surgery and drugs. More often than not, he says, the problem is in the eye of the perceiver.

"Shame and embarrassment are powerful experiences that lead people to find a way to escape from them," he says. "But anxiety about blushing is not caused by inherent properties of the blush, and something important would be lost if blushing were eradicated."

More here

5 September, 2008

Cholesterol lowering drug 'increases risk of cancer by 50 per cent'

LOL! Conventional "wisdom" again. How often have I repeated the old saw that the medical miracle of today is the iatrogenic disaster of the future! The solons are spinning like tops, of course -- even though the evidence for harm is similar to the evidence for benefit -- weak in both cases

A cholesterol-lowering drug may increase the risk of cancer by half, according to new findings. Researchers found there were 105 cases of cancer in people taking Inegy compared to 70 in those on a dummy drug over a four year period. The study also suggested that Inegy, which combines a statin called simvastatin and another drug called ezetimibe, has little effect in reducing the risk of heart attacks and strokes

Prof Heinz Drexel, of the University of Innsbruck in Austria and spokesman for the European Society of Cardiology, said: "I am not sure that the efficacy is proven and I am not sure that the safety is proven. I wouldn't take the drug myself. "In patients with an urgent need to reduce cholesterol I would give them the drug but that is they are the exception and that is not consistent with how it is being used currently. "It is being more widely used than I think it should be. We can use something else in patients whose cholesterol is not sky high."

In the last two years 300,000 prescriptions for Inegy were dispensed in England and Wales and between four and five million people are thought to be taking standard statins. The National Institute for health and Clinical Excellence (Nice) has approved ezetimibe for use in people with an inherited high cholesterol disorder who cannot take normal statins. Doctors have not been told to stop prescribing the drug but the British Heart Foundation said any patients with concerns should speak to their GP.

The lead author of the new study, Prof Terje Pedersen, of Ulleval University Hospital in Oslo, called for caution, saying the findings could be down to "chance". An analysis carried out by a team at Oxford University also said two other trials had not found the same link and the findings probably were due to chance. But Prof Drexel said there were 50 per cent more cases of cancer among patients taking the drug, which suggested it was unlikely to be a statistical fluke. He agreed that the findings, presented at the European Society of Cardiology congress in Munich, do not prove the drug causes cancer and said a longer follow up will be needed to know for sure.

The research involving 1,873 people with a mild to moderate aortic stenosis - which causes partially blocked heart valve - also showed that although the drug did lower cholesterol, it appeared to have little effect on the number of cardiovascular events such as heart attacks and strokes. There was also a higher proportion of deaths from cancer with 39 deaths in the Inegy group and 23 deaths in those on the placebo. The cancers in both groups were across all major areas of the body including the skin and lungs, according to the findings, which were also published in the New England Journal of Medicine.

An editorial in the journal said it should not be assumed that the cancer finding is down to chance until more data is available. It said ezetimibe interfered with the absorption of cholesterol but also affected the absorption of other molecules which could affect the growth of cancer cells. The editorial states: "Physicians and patients are unfortunately left for now with uncertainty about the efficacy and safety of the drug." British and American drugs regulators are investigating the findings but doctors have not been advised to stop prescribing the drug.

Dr Mike Knapton, Director of Prevention and Care at the British Heart Foundation (BHF) said: "People should be reassured that drug regulators will act quickly if robust evidence of risk to patient health appears. "If you have been prescribed ezetimibe you should continue to take it. If you have concerns about side effects of this or other medication, you should talk to your doctor to weigh up the risks and benefits."

A spokesman for Merck and Schering-Plough, makers of Inegy, said: "We do believe that the cancer findings in the study are likely to be an anomaly and that in light of all the available data does not support an association with Inegy. "We are working with regulatory agencies to further evaluate the data. However, we do not believe that changes in the clinical use of Inegy are warranted."


We need a change of heart on statins

They say love is blind, and if there is one thing that doctors can be accused of, it is being in love with statins. Over the past few years, prescribing figures at my practice have constantly been topped by these drugs.

They also say love endures and our love affair with statins is likely to survive yesterday's report of a link between a combination statin and an increased risk of cancer (especially as this link has not been seen when patients have been on statins alone).

Love has its basis in attraction, and statins are extremely alluring - between four and five million of us are being prescribed the standard version. Their prescription, in combination with other powerfully effective medicines, makes a real difference to those with diabetes or existing cardiovascular disease (the so-called secondary prevention). The inexorable decline of the "heart patient" can often be arrested and, following a heart attack, or the development of angina or diabetes, patients are able to maintain a level of health unimaginable a decade or two ago. No wonder GPs are so enthused.

Love, though, can go to your head. And while no one would dispute the use of statins in secondary prevention, there is increasing pressure to prescribe them to people who are fit and well - but who may be worried about their cholesterol levels, or their risk of cardiovascular disease (this is primary prevention). Here the drug's power is not so great, and so doctors and patients should listen to their heads as well as their hearts when embracing statins.

What the drug cannot do is turn vice into virtue. No drug can yet do this. Patients may be half joking when they ask me for something to lower their cholesterol so they can continue eating their high-dairy, high-fat diet, but their request reflects the increasingly prevalent perception that the magic of modern medication can overcome the need for lifestyle changes. Stopping smoking, taking exercise, modifying diet, paying rigorous attention to blood pressure - in many instances these changes can be more effective in warding off cardiovascular disease than taking a statin.

But the power that has been handed to doctors by medical advances often leads patients to believe that science can conquer all, no matter what the ravages of our lifestyle or our age. Why bother going to the gym or eating five a day when you can take one of those new-fangled anti-obesity drugs? Why use sunblock and sit in the shade when Botox will get rid of those wrinkles? And from there, we move on to: I don't have one of those affluent happy lifestyles I see all about me, I must be depressed. Can I please have a happy pill?

We have irrational expectations about our health and wellbeing, which are, ironically, often fuelled by a medication culture. Preventative medicine makes us miserable - reportedly, the higher a population's exposure to medication, the lower its people rate their health. That's the trouble with prescribing biologically active chemicals to those who aren't necessarily high-risk cases: once you're on the tablet, you are medicalised. You have entered the world of checks and monitoring and have replaced the assumption of health with the fear of illness.

I see it in the reactions of patients when I discuss the necessity of medication to lower their blood pressure, replace their deficient thyroid or other long-term treatments. It is a step out of the fearlessness of youth to the multiple medications of old age. So if the love of statins has spun heads, including mine, it is only because they are so wonderful at improving the longevity and function of those already at risk. Those who aren't, however, must resist the siren call of medication which so easily blinds us to the other preventative measures that very often lie within our own grasp. Even if the lure of a magic pill seems like an easier alternative.


4 September, 2008

Combining drugs `sees off child fevers sooner'

Thousands of children could spend less time with a fever if they were given ibuprofen first and then a combination of paracetamol plus ibuprofen, according to research. Parents have been told not to combine the drugs because of a lack of evidence on the safety of doing so, but scientists from the University of Bristol and the University of the West of England found that children could recover more quickly if both drugs were used over 24 hours.

Guidance from the National Institute for Health and Clinical Excellence says that it is "OK to give your child paracetamol or ibuprofen if they have a fever and they are distressed or unwell", but that the drugs should not be given together.

Alastair Hay, consultant senior lecturer in primary healthcare at the University of Bristol, who led the study, said that parents should not combine liquid paracetamol and ibuprofen in one solution, but could provide the doses separately. The study is published online by the British Medical Journal.


Atkins diet and Weight Watchers 'the best ways to lose weight'

The Atkins diet and the calorie-counting Weight Watchers plan are the best ways for slimmers to lose weight, new findings suggest. Dieters lost an average of 11 pounds over two months by following the Atkins plan, while the calorie-counting Weight Watchers method helped people shed more than 10 pounds, a study of four popular weight loss plans shows. People following the Slim Fast Plan and a Rosemay Conley diet plan both lost between eight and nine pounds on average.

Despite claims that the low-carbohydrate Atkins diet could be dangerous due to its reliance on red meat and fat, researchers also found that all the diets tested were healthy. Dr Helen Truby, from the Royal Children's Hospital in Queensland, Australia, one of the co-authors of the study, said that it provided "reassuring and important evidence for the effectiveness and nutritional adequacy of the ... diets tested".

However, few slimmers increased their intake of fruit and vegetables, the research found, despite being recommended to do so by all of the diets except Atkins.

Scientists, including researchers from five British universities, tested the weight loss regimes on almost 300 overweight and obese volunteers. All of the slimmers were asked to try the slimming plans for eight weeks and keep a food diary of everything that they ate. The results, published in the journal Nutrition, show that dieters on the Atkins plan, in which slimmers cut out carbohydrates such as bread and pasta, as well as, initially, fruit and vegetables, performed best, losing an average of 11.4 pounds during the study.

A close second was the Weight Watchers diet, on which volunteers lost an average of 10.4 pounds, by limiting their food intake to a certain number of "points" a day. Both diets were significantly ahead of the other two tested, the Slim Fast Plan and the Rosemary Conley "Eat Yourself Slim" plan, although both of these still performed well. Following the Rosemary Conley plan reduced weight by an average of 8.8 pounds over the two months, while replacing some meals with Slim Fast "shakes" helped slimmers to lose 8.1 pounds.

The results also show that those on the Atkins diet did not substantially increase the total amount of fat that they ate, although the proportion of their meals that were made up of fat did rise. The findings suggest that the secret to the success of the diet, which has been condemned by critics who claim it could place undue stress on the heart and lead to extra weight gain when carbohydrates are reintroduced, could be that it reduces slimmers' appetite, decreasing the overall amount of food that they eat.

All four diets gave the volunteers enough crucial vitamins and minerals, the study found. However, those on the Atkins diet did have lower levels of iron, which the study suggests could be because bread and other carbohydrates are fortified with this and other vitamins.

Despite the fact that all of the diets apart from Atkins advise people to increase their fruit and vegetable intake, only those on the Weight Watchers diet actually did so, and even they only had one extra portion a day.

Dr Truby said: "These disappointing findings suggest that people remain resistant to the advice to 'eat more fruit and vegetables', even when they are advised to as part of a modified weight loss programme".


2 September, 2008

Fish oil outperforms statins in heart failure study??

This is quite amazing misreporting. The study in fact shows that NEITHER statins NOR fish oil had any effect. Both gave results which were as close to placebo as you would ever normally get. So when the Omega 3 religion gets a double blind test, it is shown to be useless. Shock, Horror! We can't have that!

Fish oil supplements may work slightly better than a popular cholesterol-reducing drug to help patients with chronic heart failure, according to new research released Sunday. Chronic heart failure is a condition that occurs when the heart becomes enlarged and cannot pump blood efficiently through the body. With few effective options for heart failure patients, the findings could give patients a potential new treatment and could change the dietary recommendations for them, said Dr. Jose Gonzalez Juanatey, a spokesman for the European Society of Cardiology, who was not connected to the research. "This reinforces the idea that treating patients with heart failure takes more than just drugs," Juanatey said.

The study findings were published online in the medical journal The Lancet on Sunday. They were simultaneously announced at a meeting of the European Society of Cardiology in Munich. "With a lot of these patients, you have no other choice," said Dr. Helmut Gohlke, a cardiologist at the Heart Center in Bad Krozingen, Germany. "They've tried other treatments and are at the end of the road."

Italian researchers gave nearly 3,500 patients a daily omega-3 pill, a prescription-formulation pill derived from fish oils, produced by Norway's Pronova BioPharma. But doctors said people should get the same benefits from taking cheaper options like fish oil supplements - or just eating more oily fish like salmon. Roughly the same number of patients were given placebo pills. Patients were followed for an average of four years.

In the group of patients taking the fish oil pills, 1,981 died of heart failure or were admitted to the hospital with the problem. In the patients on placebo pills, 2,053 died or were admitted to the hospital for heart failure. [Negligible difference, in other words]

In a parallel study, the same team of Italian doctors gave 2,285 patients the drug rosuvastatin, also known as Crestor, and gave placebo pills to 2,289 people. Patients were then tracked for about four years. The doctors found little difference in heart failure rates between the two groups.

Comparing the results from both studies, the researchers concluded that fish oil is slightly more effective than the drug because the oil performed better against a placebo than did Crestor. "It's a small benefit, but we should always be emphasizing to patients what they can do in terms of diet that might help," said Dr. Richard Bonow, chief of cardiology at Northwestern University Hospital in Chicago and past president of the American Heart Association. Both studies were paid for by an Italian group of pharmaceuticals including Pfizer, Sigma Tau and AstraZeneca.

Previous studies that investigated the benefits of omega-3 fatty acids have largely been observational, and have lacked a direct comparison to a placebo. It has also been unknown whether taking fish oil supplements would be as good as eating fish. "This study changes the certainty of the evidence we have about fish oils," said Dr. Douglas Weaver, president of the American College of Cardiology. Weaver said that guidelines in the United States would probably change to recommend that more heart patients eat more fish or take supplements. "This is a low-tech solution," he said, "and could help all patients with cardiovascular problems."

Source. Fuller details here.

Coffee may lower cancer risk

More epidemiogical crap. The big coffee drinkers were presumably more Westernized and many aspects of that could have been responsible for the differences observed

WOMEN who drink a lot of coffee may have less risk of developing cancer of the uterus, a Japanese study said today. The study led by Japan's health ministry monitored some 54,000 women aged 40 to 69 over about 15 years, during which time 117 women developed cancer in the womb, according to the medical team.

The researchers at Japan's National Cancer Center divided the women into four groups by the amount of coffee they drank. They found the group of women who drank more than three cups of coffee every day were more than 60 per cent less likely to develop uterine cancer than those who had coffee fewer than two times a week, the study said. "Coffee may have effects in lowering insulin levels, possibly curbing the risks of developing womb cancer," the study said.

The medical team also studied the effects of drinking green tea, but did not find any link to uterine cancer. According to the US Centres for Disease Control, uterine cancer is the fourth most common cancer in women.


1 September, 2008

Traditional fried breakfast a cancer risk?

Another volley in the puritanical war on fried foods below. It is all speculative (epidemiological) nonsense that has been contradicted by the double blind studies. See e.g. here and here

It has been called a "heart attack on a plate" but now the traditional Australian fry-up has also been branded a cancer risk. Experts claim those who regularly tuck into a fried breakfast with the lot have a 63 per cent increase in the risk of bowel cancer. Data from the World Cancer Research Fund warns that eating 150g of processed meat a day - equivalent to about two sausages and three rashers of bacon - increased the chance of diagnosis by two-thirds.

According to the charity, the evidence was so strong we should avoid eating these foods as much as possible. And it wasn't a matter of all or nothing, they said. Even a sausage a day could increase the risk by a fifth. The extra calories can also lead to obesity, which is linked to six types of cancer - including bowel and breast cancers - as well as heart disease.

Apart from smoking, excess weight is considered the biggest cause of human suffering from disease. Bowel cancer is the second most common in Australia, after prostate cancer. In 2005, there were about 14,237 new cases - 7765 in men and 6472 in women. The cancer kills more than 4000 Australians each year, claiming 80 lives a week - almost three times the national road toll.

Professor Martin Wiseman, medical and scientific adviser for the WCRF, said: "For some people, having a fry-up with bacon and sausages might seem like a good way to start the day. But if you are doing this regularly, then you are significantly increasing your risk of bowel cancer."

But food experts say you do not have to say goodbye to your favourite breakfast because simply changing the way the food is cooked can transform a coronary platter into a nutrient-packed plate. Dr Tim Crowe, senior lecturer of nutrition at Deakin University, said poaching eggs, adding cancer-fighting tomatoes and ensuring you don't over-cook meat can reduce the risk. He also said the findings did not mean people should avoid meat altogether. "Red meat is an important part of a healthy diet because it contains valuable nutrients - it's the processed stuff you need to be careful of," he said.


Leave the fat alone - state bullying won't curb obesity

Comment from a British writer. She has swallowed a lot of the official propaganda but still comes to a reasonable conclusion

Fat is not a feminist issue, despite what feminists used to say. It is a class issue. Well-to-do, well educated people are rarely fat, still less obese. You see few fat children in private schools. Fatness and obesity are directly related to low income and low education. A fat map was published last week by Dr Foster Intelligence, showing the areas with the fattest populations, and sure enough the poorest industrial areas in the north of England and in Wales produce the most obese people. The problem seems to be getting worse, fast.

You hardly need expert medical data analysis to understand that. You need only to go to a few supermarkets. At a Tesco in western Scotland this summer I was astonished by the number of horribly obese shoppers waddling round the aisles with their elephantine children, who could not possibly have squashed themselves into an ordinary one-person chair. Young women, with eyes reduced to slits by the pressure of the fat on their faces, laughed grimly with each other as they scanned the shelves. And this is a rich country.

Even though the vast Oban Tesco is full of good food, the trolleys at the checkout were heaped with stuff that is either useless or positively bad to eat - crisps, snacks, swizzlers, twizzlers and guzzlers, cheesy dips and fatty whatsits, cakes puddings and pies, heavily dusted in additives. The obese seem to fill their carts regularly with several times their own weight in eatables that can make them only fatter, that they shouldn't eat and that nobody should produce, as if they were determined to lay down yet more adipose tissue. Yet you rarely see such bloated people and trolleys in smart supermarkets in rich areas. These days you can easily tell people's precise socioeconomic bracket and body weight by the contents of their trolleys.

Obesity seems to be the issue of the day, possibly because we are still in the silly season. Coincidentally last week, Andrew Lansley, the Tory health spokesman, spoke against obesity in a long speech to the Reform think tank. He was widely understood as saying that fatties have only themselves to blame; they must take responsibility for themselves and their weight because "we all have a choice". And while that is a slightly unfair take on his speech, he does seem to mean something of the sort. Yet at the same time he offers what's now called a whole raft of measures to stop people getting fat. This is awkward for Conservatives; either you interfere with people's choices or you don't. Empowerment, a word he used, is often just a weasel word for state intervention.

The question is why a Conservative government should interfere at all in people's inalienable freedom to choke on deep-fried Mars bars if they choose to. The argument is that the fat and the obese (people with a body mass index over 30, which is something you could spot without a calculator) cost the country squillions in lost productivity and increased National Health Service costs. The obese tend to develop serious illness, particularly heart disease and diabetes, and are, generally speaking, crocked up and expensive to look after.

Somebody somewhere has come up with a figure for the cost of all this, which Lansley quotes - $14 billion a year, for what it's worth. Last year's Foresight report said this cost could go up by six times by 2050. And fat is getting fatter so fast. According to NHS figures, the proportion of obese men in the population rose during Labour's time in office from 13.2% in 1993 to 23.1% in 2005. Among women it was even worse, from 16.4% to 24.8%. That is nearly a quarter of all women. If you consider people who are not obese but overweight (with a BMI of 25-30), 46% of men in England are overweight and 32% of women.

Fat is also an ethnic issue. According to NHS figures published in 2006, Irish and black Caribbean men had the highest incidence of obesity (25% each) and among women black Africans had 38%, black Caribbean 32% and Pakistani 28%. So, with migration trends and immigrant fertility, the costs of obesity are going to rise fast as well.

However, I wonder how much, if anyone knew the facts, the final cost of obesity would be to the taxpayer. For fat people die sooner and obese people die much sooner than others, thus relieving the NHS and the economy of their needs. It's true that obese people need expensive treatment for diabetes and heart disease before they die, but that might easily be offset if they had significantly shorter lives - and they do. Current thinking seems to be that the obese die between five and seven years earlier than otherwise they would.

Few papers I've looked at on this subject discuss the possible cost-benefit of obesity, although one from an insurance company coyly mentioned the advantage to pension providers if a person died before he reached pensionable age. For years I used to argue that smokers were a net benefit, purely financially speaking, to the exchequer, because they died early. I still feel rather proud of being the first, I believe, to get a known expert (Professor Richard Peto in 1993) to agree publicly to this idea, now accepted. Might not the same be true of obesity? The real drain on the NHS is geriatric medicine; the obese might not reach old age.

If the only reason for interfering with what fat people eat is how much it costs the rest of us, perhaps we should leave them alone. It's well known that obesity (and fatness) are associated with poor education, poor housing, poor employment or none, low expectations, low opportunities and all the rest. These are all social ills that this government has been trying to deal with for more than a decade. Yet little has improved and obesity - as an indicator of that fact - has swollen vastly while Labour has been in office. What prevents obesity is a good income, a good education, good opportunities and the kind of background that develops self-confidence. Prosperity, in short.

Obesity cannot be defeated by taskforces, better labelling on packets or investing in health accreditation schemes. This has all been tried and has failed. In the presence of a complex problem, and in the absence of a workable solution, perhaps it is better to leave people to their own devices. Nobody can pretend they don't know what they're doing. They should be left alone to do it.