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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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    South Asians: Watch your Heart

    Byoliveridley

    Seems like us South Asians die earlier from heart attacks.

    ScienceDaily: South Asians Have Higher Levels Of Heart Attack Risk Factors At Younger Ages

    Deaths related to cardiovascular disease occur 5 to 10 years earlier in South Asian countries than in Western countries, according to background information in the article. This has raised the possibility that South Asians exhibit a special susceptibility for acute myocardial infarction (AMI; heart attack) that is not explained by traditional risk factors.

    But why?

    The prevalence of protective risk factors (leisure time physical activity, regular alcohol intake, and daily intake of fruits and vegetables) were markedly lower in South Asian study participants compared with those from other countries.

    Um, it is mainly behavioral, not genetic according to the authors, and hence can be mitigated by lifestyle changes.

    Well, I guess it is time to take a personal stock as of 1-18-2007:

    • Weight – Well, I am in the lower end of the healthy BMI.
    • Exercise – 4-5 days of 45 minutes – 1 hour per day, pretty good.
    • Food – Well, mostly good, especially if the candy can be avoided. I need to eat more vegetables, but I eat a lot of high fibre, and whole wheat food, probably not enough protein, mostly vegetarian.
    • Alcohol (1-2 drinks is apparently a heart protector) – Amen, I am a religious one drink a day partaker, more on weekends :-;
    • Smoking – Well, gave that up a while back, now to quit that occasional “party” smoke.
    • Stress – Well, not so good, this is probably the area I would need to work on the most.
    • Hypertension – Well, I am borderline on my blood pressure readings 🙁 Need to work on that.
    • Cholesterol – Still waiting for results on my physical.

    On the whole, I seem to be in decent shape. It’s good to take stock once in a while.

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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.

  • U.K Hospitals – Get that filthy tie out of here!

    Byoliveridley

    It may be no surprise to some that doctors frequently transmit diseases amongst patients in hospitals. And bugs in hospitals, raised on a steady diet of antibiotics, tend to be hardy, drug resistant and deadly. Among the many sensible things doctors need to do (ahem, wash your hands doc!), turns out that the clothes you wear make a difference. So, in the U.K, where they worry about these things, doctors are being issued a dress code. Read on for some biting criticism of that most pointless of neck appendages.

    U.K. hospitals issue doctors’ dress code – Yahoo! News

    “British hospitals are banning neckties, long sleeves and jewelry for doctors — and their traditional white coats — in an effort to stop the spread of deadly hospital-borne infections, according to new rules published Monday.

    Hospital dress codes typically urge doctors to look professional, which, for male practitioners, has usually meant wearing a tie. But as concern over hospital-borne infections has intensified, doctors are taking a closer look at their clothing.

    ‘Ties are rarely laundered but worn daily,’ the Department of Health said in a statement. ‘They perform no beneficial function in patient care and have been shown to be colonized by pathogens.’

    Please frame that statement, ties are pointless, ties perform no beneficial functions, down with ties!

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    High fructose corn syrup makes you fat

    Byoliveridley

    This well designed and well executed study provides rather conclusive proof that High Fructose Corn Syrup, the sweetener most commonly used in North America, makes you gain weight in a way not explained by calories alone. These rats gained more weight on HFCS compared to a sucrose (regular sugar) diet even though they were fed the same calories. The effect was seen in the short term and in the long term, and abdominal fat increased the most. Gut fat, if you did not know is related to the infamous metabolic syndrome, causing diabetes, hypertension, coronary disease, etc.

    High-fructose corn syrup (HFCS) accounts for as much as 40% of caloric sweeteners used in the United States. Some studies have shown that short-term access to HFCS can cause increased body weight, but the findings are mixed. The current study examined both short- and long-term effects of HFCS on body weight, body fat, and circulating triglycerides. In Experiment 1, male Sprague–Dawley rats were maintained for short term (8 weeks) on (1) 12 h/day of 8% HFCS, (2) 12 h/day 10% sucrose, (3) 24 h/day HFCS, all with ad libitum rodent chow, or (4) ad libitum chow alone. Rats with 12-h access to HFCS gained significantly more body weight than animals given equal access to 10% sucrose, even though they consumed the same number of total calories, but fewer calories from HFCS than sucrose. In Experiment 2, the long-term effects of HFCS on body weight and obesogenic parameters, as well as gender differences, were explored. Over the course of 6 or 7 months, both male and female rats with access to HFCS gained significantly more body weight than control groups. This increase in body weight with HFCS was accompanied by an increase in adipose fat, notably in the abdominal region, and elevated circulating triglyceride levels. Translated to humans, these results suggest that excessive consumption of HFCS may contribute to the incidence of obesity.

    Miriam E. Bocarsly, Elyse S. Powell, Nicole M. Avena, Bartley G. Hoebel. High-fructose corn syrup causes characteristic of obesity in rats: Increased body weight, body fat and triglyceride levels. Pharmacology Biochemistry and Behavior, 2010; DOI: 10.1016/j.pbb.2010.02.012

    For a more layman friendly summary of the article, read the sciencedaily release.

    Do reconsider your food habits to avoid HFCS. Note that this whole corn syrup boondongle is made possible by the US government’s insistence on providing billion dollar subsidies to its farmers to grow corn while imposing tariffs on cane sugar from the tropics to make it less attractive. Free trade, my A$$.

    Thanks to Tom Laskawy at grist for the blog post.

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    Ethanol significantly worse than gasoline for air pollution

    Byoliveridley

    So, Mark Jacobson from Stanford, an accomplished atmospheric chemist and modeler from Stanford, puts ethanol into his modeling mix as an automobile fuel and comes up with increased ozone, peroxyacetyl nitrate (PAN, an ozone precursor) and acetaldehyde, leading to a possible increase in mortality. Without reading his paper, I cannot comment on the assumptions used, but this is an additional issue to be concerned about as our politicians continue to binge on alcohol. It’s weird, almost as if there’s something intoxicating and addictive about this fuel :-;

    Effects of Ethanol E85 versus Gasoline Vehicles on Cancer and Mortality in the United States

    Ethanol use in vehicle fuel is increasing worldwide, but the potential cancer risk and ozone-related health consequences of a large-scale conversion from gasoline to ethanol have not been examined. Here, a nested global-through-urban air pollution/weather forecast model is combined with high-resolution future emission inventories, population data, and health effects data to examine the effect of converting from gasoline to E85 on cancer, mortality, and hospitalization in the United States as a whole and Los Angeles in particular. Under the base-case emission scenario derived, which accounted for projected improvements in gasoline and E85 vehicle emission controls, it was found that E85 (85% ethanol fuel, 15% gasoline) may increase ozone-related mortality, hospitalization, and asthma by about 9% in Los Angeles and 4% in the United States as a whole relative to 100% gasoline. Ozone increases in Los Angeles and the northeast were partially offset by decreases in the southeast. E85 also increased peroxyacetyl nitrate (PAN) in the U.S. but was estimated to cause little change in cancer risk. Due to its ozone effects, future E85 may be a greater overall public health risk than gasoline. However, because of the uncertainty in future emission regulations, it can be concluded with confidence only that E85 is unlikely to improve air quality over future gasoline vehicles. Unburned ethanol emissions from E85 may result in a global-scale source of acetaldehyde larger than that of direct emissions.

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