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Sugar Pills, now more effective!

Byoliveridley

Well, all sugar is not bad for you. Apparently, when given to you in pill form by someone wearing a white coat with a pleasant demeanour, it can cure all kinds of ills.

It’s not that the old meds are getting weaker, drug developers say. It's as if the placebo effect is somehow getting stronger.The fact that an increasing number of medications are unable to beat sugar pills has thrown the industry into crisis. The stakes could hardly be higher. In today's economy, the fate of a long-established company can hang on the outcome of a handful of tests.

Via Wired

An interesting article that takes the reader through a recent history of placebos, why they seem to work better now than they used to, and tangentially, why the competitive research paradigm of the pharmaceutical industry delayed recognition, and continues to delay possible fixes and therapies.

A few things about the placebo effect:

  1. There appears to be a physiological and neurological basis to the effect, something that can actually be turned off by deactivating the body’s natural production of opioids.
  2. This effect is triggered by various patient stimuli, including exposure to advertising, faith in the medicine, doctor bedside manner, etc. It appears that for minor ailments, these effects could be as strong as the medication prescribed.
  3. It is not short lived, the effects can linger well after consumption of sugar pills.
  4. Despite all this, the article states that we are no closer to finding the most appropriate way to administer placebos (Hmm, or are we? Read on!).

Pharmaceutical companies conduct hundreds of clinical trials every year. They are not required to publish them in most countries, so negative results, failures, etc. which reflect badly on the company’s stock price are routinely hushed up. This means that the mounds of data that show tested drugs as no better than placebo are not accessible for research. This is one of the greatest drawbacks of competitive research paradigms, the lack of cooperation, the inefficiency that comes from duplication of negative results, and the lack of statistical power that comes from inability to use all the data available. In a milieu where knowledge = stock price, this is the logical approach, but something to note next time an Ayn Rand acolyte comes bleating to you about the beauty and perfection of the market. You might ask “What are some options to the current patent exclusivity driven regime”? My favourite economist Dean Baker of the Center for Economics and Policy Research has written extensively about the drug development process and alternatives in his excellent (and free to download) book The Conservative Nanny State, I suggest reading at least the chapter on drug development and patents!

Anyway, back to placebos, what to do? How to administer sugar pills in a quasi-official setting for minor ailments. It’s almost like you need a parallel paradigm of medicine that dispenses sugar pills that did not have to go through double blind randomised clinical trials. it would help if this paradigm uses vaguely scientific terminology while doing very little harm. It would work in conjunction with the conventional approach, not in competition so there is little danger of people taking sugar pills for malaria!

I give you, Homeopathy!!! This blog(ger) is no stranger to this wonderful form of medicine, involving concepts such as the memory of water, similars, dilution, etc. When I wrote about homeopathy last year, it was more in relation to the psychological aspects of my experience with it. I (and I assume you did not click through to read!) wrote about my parents’ great and enduring relationship with their homeopath, and the benefits it brought them. Back in India this time around, it was suggested that I take some homeopathy for a cold I was developing, which I did (yum, sugar!). The cold went away in a few days 🙂 There was some swine flu medicine being passed around as well (I did not partake), which worked too, nobody at home got swine flu 🙂

So, how to make it work? It already works in India because belief in the efficacy of homeopathy is well established. As long as the homeopath is well qualified in basic diagnosis, and crucially, knows when to punt the patient into conventional therapy, the system works to a certain extent. But what about a society with no such foundation? Do you go to a clinic with both an allopath and a homeopath, and if your ailment is one where placebo works about as well, let the homeopath make some well diluted similars for you to consume? How to settle turf wars? Would it be better for the allopath to feign develop an expertise in homeopathy and make that work for her in treating the patient? Would they apply the most important lessons in homeopathic treatment, Listen, Empathise, Soothe?

I don’t know. It is not my nature to believe in sugar pills, faith, or advertising. So it is hard for me to say what would work. But given that sugar pills work well, it is vital for society to find a way.

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    March Babies not so Bright? – Pesticides to Blame?

    Byoliveridley

    An Indiana scientist makes a rather provocative argument that exposure to pesticides in the womb can explain why Indiana babies conceived in July-August (Born March and April?) have lower achievement scores than the other kids.

    ScienceDaily: Conception Date Affects Babys Future Academic Achievement

    Dr. Winchester and colleagues linked the scores of the students in grades 3 through 10 who took the Indiana Statewide Testing for Educational Progress (ISTEP) examination with the month in which each student had been conceived. The researchers found that ISTEP scores for math and language were distinctly seasonal with the lowest scores received by children who had been conceived in June through August.

    “The fetal brain begins developing soon after conception. The pesticides we use to control pests in fields and our homes and the nitrates we use to fertilize crops and even our lawns are at their highest level in the summer,” said Dr. Winchester, who also directs Newborn Intensive Care Services at St. Francis Hospital in Indianapolis.

    “Exposure to pesticides and nitrates can alter the hormonal milieu of the pregnant mother and the developing fetal brain,” said Dr. Winchester. “While our findings do not represent absolute proof that pesticides and nitrates contribute to lower ISTEP scores, they strongly support such a hypothesis.”

    Well, that is a bold leap of faith, and use of a correlation=causation argument that I don’t appreciate in most cases. Has this kind of work been done in other countries, or in urban environments without pesticide use?

    I am sure that many chemicals have subtle, but significant effects on developing fetuses. And the chemicals the authors mention have links with hypothyroidism..

    Nitrates and pesticides are known to cause maternal hypothyroidism and lower maternal thyroid in pregnancy is associated with lower cognitive scores in offspring.

    There is a link, but without further data, I think the conclusions are a stretch. But, something to keep in mind I guess if you live in Indiana and want to plan a baby!

    Disclaimer: I was conceived in June, and was in the upper echelons of achievement through school. So, by the power of personal experience, I am predisposed to scepticism. OTH, I grew up in a big city with consistently high pollution levels throughout the year and not much pesticide exposure.

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    Genes Make Indians Fat

    Byoliveridley

    Scientists have pinpointed a reason why people with Indian ancestry may be more prone to weight problems.They have found this group is more likely to carry a gene sequence linked to an expanding waist line, weight gain and type 2 diabetes.The sequence, discovered by a team led by Imperial College London, is carried by 50% of the population – but is a third more common in Indian Asians.

    BBC NEWS | Health | Genes ‘up Indians’ obesity risk’

    Relax, all desis, it’s not your fault, it’s genetics.

    Blogged with the Flock Browser
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    You breathe in toxic chemicals too.

    Byoliveridley

    Behind a frigging pay wall, as usual! Kelly et al. argue in Science that hydrophobicity, the tendency to favor oil over water (to break it down to the simplest explanation) is not the only factor that explains biomagnification. The underlying theory used to be that compounds that can dissolve in water would swiftly degrade (either chemically or biologically) and not be of any concern to humans. Compounds like dioxins, PCB’s, DDT, etc. accumulated in fat tissue of aquatic animals and these were the compounds that would biomagnify through ingestion (eating!). Kelly et al. uncover another pathway that probably made every scientist go “D’uh”! – Apparently, chemicals animals breathe in can also bioaccumulate if they are not cleared efficiently by the lungs. So, air breathing cows, chickens and pigs can also cause significant bioaccumulation of certain compounds. Which ones? I guess you’ll have to pay to find out more, but this Scientific American article adds some context. Turns out, it is about 10000 chemicals, not all of them known to be harmful, but because they were never suspect, their metabolism is unknown.

    Well, if anything, it will keep the biomonitoring folks busy for a while!

    Chemical Consequences — 317 (5835): 165g — Science

    Global regulators of commercial chemicals apply a scientific paradigm that relates the biomagnification potential of the chemical in food webs to the chemical’s hydrophobicity. However, Kelly et al. (p. 236; see the news story by Kaiser) show that current methods fail to recognize the food web biomagnification potential of certain chemicals. Certain chemicals do not biomagnify in most aquatic food chains, but biomagnify to a high degree in air-breathing animals, including humans, because of low respiratory elimination. Thus, additional criteria for evaluating biomagnification and toxicity in chemicals that biomagnify are required.

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    NC Smoking ban now inevitable?

    Byoliveridley

    Well, it has taken less than a decade (I am a pessimist), but looks like smoking in bars and restaurants may finally be over and done with in my old home state of NC.

    Note that there is currently a HUGE loophole in the senate version of the bill, it permits smoking in “private clubs”. Many bars in NC designate themselves as “private clubs” to circumvent prohibition era (or thereabouts) laws that mandate liquor serving establishments to get a certain percentage of their revenue from food. So, my favourite Chapel Hill drinking establishment, The Dead Mule (no website, sorry!) is supposedly a “private club” – You supposedly pay a one time membership fee (usually less than 5 bucks), and are supposed to “sign in” any members and guests. This was all a farce anyway, and the Mule got extremely smoky, it was quite disgusting after a while.

    One hopes that the final bill will make the ban universal. Bans like this work best when they don’t favour one group of establishments over the other for no real reason. The people who work at the Dead Mule are equally entitled to clean air.

    1.5 cautious cheers, let’s see what happens in the end…

    The state Senate voted Thursday to ban smoking in bars and restaurants in North Carolina. It set the stage for what would be a historic prohibition of a product that created thousands of jobs, built Duke and Wake Forest universities and has long been an integral part of the culture in the nation's top tobacco-producing state.

    House members passed a tougher version last month, meaning that lawmakers will still have to work out a compromise, assuming the Senate passes the measure in a second vote on Monday. The bill passed Thursday by an eight-vote margin, 26-18, so that seems likely.

    via State Senate OKs smoking ban – Politics – News & Observer.

  • Autism epidemic not caused by shifts in diagnoses; environmental factors likely

    Byoliveridley

    California’s sevenfold increase in autism cannot be explained by changes in doctors’ diagnoses and most likely is due to environmental exposures, University of California scientists reported. The scientists who authored the new study advocate a nationwide shift in autism research to focus on an array of potential factors in the environment that babies and fetuses are exposed to, including pesticides, viruses and chemicals in household products.

    Autism epidemic not caused by shifts in diagnoses; environmental factors likely — Environmental Health News

    One of the most common arguments you will see about a lot of mental health diagnoses is that doctors have changed their diagnostic practices significantly. While there is evidence of this occurring in diagnoses of childhood depression, anxiety, or even bipolar disorder due to the millions of dollars involved in medication and the attendant corruption, autism is different.

    This population study used 17 year data in California and concluded that diagnostic changes were only responsible for a 2 fold increase, not the seven fold increase seen. The rest is unexplained, and the authors attribute it to a confluence of environmental and genetic factors.

    And no, for the last time, VACCINES DO NOT CAUSE AUTISM!

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    Common chemicals are linked to breast cancer

    Byoliveridley

    The LA Times features a study arising from the Silent Spring institute.

    Common chemicals are linked to breast cancer – Los Angeles Times

    More than 200 chemicals — many found in urban air and everyday consumer products — cause breast cancer in animal tests, according to a compilation of scientific reports published today.

    Writing in a publication of the American Cancer Society, researchers concluded that reducing exposure to the compounds could prevent many women from developing the disease.

    The research team from five institutions analyzed a growing body of evidence linking environmental contaminants to breast cancer, the leading killer of U.S. women in their late 30s to early 50s.

    Experts say that family history and genes are responsible for a small percentage of breast cancer cases but that environmental or lifestyle factors such as diet are probably involved in the vast majority.

    “Overall, exposure to mammary gland carcinogens is widespread,” the researchers wrote in a special supplement to the journal Cancer. “These compounds are widely detected in human tissues and in environments, such as homes, where women spend time.”

    The scientists said data were too incomplete to estimate how many breast cancer cases might be linked to chemical exposures.

    The resources to come out of this study include two databases, one that summarizes animal mechanistic studies, and one that summarizes human epidemiological studies. It’s a good start and I hope these databases are continually expanded. The study was essentially a big lit review and data organization project.

    There are two major issues with the way carcinogenicity is studied. Firstly, animals other than humans are dosed at high levels to test for possible cancer outcomes. This leaves most researchers vulnerable to the charge that these high dose studies do not translate well to humans because the dose-response relationship at ambient levels is not well studied. So, the obvious criticism is that just because cancer endpoints were seen at high levels does not mean that the same thing will happen at low levels. This cuts both ways, though. We’re seeing with bisphenol A that low doses can cause more harm than intermediate doses. Another issue is the additivity of the interactions. Does 1 “dose” of PAH + 1 “dose” of PCB = 2 “doses” of PAH? We’re exposed to a whole host of chemicals all our lives, who knows which ones add, which ones subtract, which ones multiply, etc.

    Of course, as with most diseases, some macro variables dominate. For instance, the US has seen 8-9% decline in breast cancer incidence recently due to a decreased use of hormone replacement therapy. So, as with all diseases, taking care of some of these big ticket items is very important. One discouraging story I read today reported on a four percentage point decline in mammograms (70 to 66%) in women age 40 and older. Why? decreased access to health insurance and dropping the ball on promotion.

    The depressing fact of the matter is that the boring basics of good preventative healthcare, screening, good lifestyle and diet are the most important factors, and if we take care of these factors, we will make most health issues easier to deal with.

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