Reuters Health is reporting on a new study in the Journal of Investigative Dermatology in which British researchers publish the results of their study on Vitamin D deficiency and sunshine. The short version is: you were made to be exposed to sunlight, you can get sick without it but moderation, as in all things, is the key.
There's a lot more of interest in this study available free online at Nature.
"I think people will really move on this as quickly as possible now" said Dr. Samuel Goldman of the Parkinson's Institute in Sunnyvale, CA according to the LATimes. Goldman was interviewed about a soon to be released study indicating that while other industrial solvents like xylene, toluene and n-hexane were not associated with Parkinson's, trichloroethylene (TCE) was strongly and significantly associated with the malady.
The results are to be presented in April at a meeting of the American Academy of Neurology and so there's not much to assess at the moment save the large grain of salt to be taken with any science that makes its way into the popular media before it lands in a journal. Nevertheless, the finding, if borne out by subsequent population studies, would be significant. Many substances have been blamed for Parkinson's but none with the 5.5 relative risk reported in this, well, press release.
Yesterday we reported on a new paper in JAMA counseling caution in the face of activist efforts to impose universal sodium salt reduction on the American populace. We reminded our readers that once upon a time activists demonized saturated fats and stampeded the country towards greater consumption of trans fats. Now there's a new study looking at the health outcomes of 384,000 Americans to see whether those who consumed lots of saturated fats were more likely to develop heart disease than those who avoided saturated fats.
Reuter's Health reports that the study,published in the American Journal of Clinical Nutrition, involved the combination and assessment of 21 large studies of people, their diets with regard to the consumption of saturated fat and whether or not they developed heart disease. It turns out there's no demonstrable association between saturated fat and your risk of heart disease. Eat a lot or eat a little, your risk remains the same. Somewhere my late great grandmother, who lived to 102 and who made the best pies and pastries thanks in part to lard, is smiling.
Yesterday the Illinois Supreme Court issued an opinion in which they rejected statutory caps on non-economic damages in medical malpractice actions as unconstitutional under the state’s constitution. This isn’t entirely surprising as the Illinois Supreme Court had previously held in Best v. Taylor Machine Works, 179 Ill. 2d 367 (1997) that Section 2-115.1 which provided for caps on non-economic damages in all cases were unconstitutional as they violated the special legislation clause which was intended “to prevent arbitrary legislative classifications that discriminate in favor of a select group without a sound, reasonable basis.” In Best, the court also noted that although the legislature may limit certain types of damages, such as damages recoverable in statutory causes of action, the limitation on damages in section 2–1115.1 violated the separation of powers clause.
Following its holding in Best, the Illinois high court found that the caps in the medical malpractice statute was an unconstitutional legislative remittitur that violates separation of powers. According the court, under the statute the trial court is “required to override the jury’s deliberative process and reduce any non-economic damages in excess of the statutory cap, irrespective of the particular facts and circumstances, and without the plaintiff’s consent. Section 2–1706.5 thus violates the separation of powers clause because it ‘unduly encroaches upon the fundamentally judicial prerogative of determining whether a jury’s assessment of damages is excessive within the meaning of the law.’ Best, 179 Ill. 2d at 414. Section 2–1706.5, like section 2–1115.1, effects an unconstitutional legislative remittitur.”
The Court continued that “[t]he separation of powers clause prohibits one branch of government from exercising “powers properly belonging to another.” Ill. Const. 1970, art. II, §1. Thus, the inquiry under the separation of powers clause is not whether the damages cap is rationally related to a legitimate government interest but, rather, whether the legislature, through its adoption of the damages cap, is exercising powers properly belonging to the judiciary. In other words, does the statute unduly encroach on the judiciary’s ‘sphere of authority’….”
By now you know that the Mayor of New York wants less sodium salt in your diet. You also know that the New England Journal of Medicine published an article in January claiming that if conservative assumptions about the health benefits of reduced salt intake are correct and would be true across the entire population then laws reducing salt intake would save "194,000 to 392,000 quality-adjusted life-years and $10 billion to $24 billion in health costs annually . Sounds like a law we ought to adopt tomorrow, right?
In this month's JAMA Dr. Michael H. Alderman of the Department of Epidemiology and Population Health at Albert Einstein College of Medicine has authored "Reducing Dietary Sodium: the Case for Caution". Alderman does a great job of setting out the positions of both the advocates and the skeptics of mass sodium restriction but then he points out the iron law of unintended consequences. "Multiple randomized clinical trials (RCTs) have established that reduction of sodium intake sufficient to lower blood pressure also increases sympathetic nerve activity, decreases insulin sensitivity, activates the renin angiotensin system, and stimulates aldosterone secretion. The health effects of sodium restriction will be the net of these conflicting effects."
Rather than the "rash route" of "universal sodium reduction" Alderman counsels a more cautious approach involving "rigorous, large-scale, population-based randomized clinical trials". He recognizes that a definitive answer would likely take years but, should it turn out that the supposed benefits don't materialize or the harm done to supposedly few people by universal sodium restriction turn out to be harm done to many many people, a lot of money and maybe lives, will have been saved.
A sensible recommendation given the track record of "consumer advocacy groups" - e.g. switching our diet to a starch pyramid and soon thereafter effecting the substitution of trans fats for traditional saturated fats. Maybe this time we can look before we leap.
It very well might, according to "Diabetes Mellitus Type 2 - An Independant Risk Factor for Cancer?" More alarming is the finding that significant risk of cancer is incurred even at blood glucose levels simply on the high side of "normal". A doubling of the risk for the following cancers has been found among those with type 2 diabetes: colorectal, breast, endometrial, renal, liver and pancreatic.
That metaphors help us communicate new ideas by casting them in the terms of something similar yet familiar is well known. But did you know that your body not only tends to act out metaphors (e.g. leaning into the future) but also to impose them on the brain (shifting one's judgment about the personality of someone based on whether the perceiver's hands are cold or warm)? Well, it's true, and I was writing up a summary of the recent work when I came across an excellent article by Natalie Angier in The New York Times that does it better than I could. You can find it here: Abstract Thoughts? The Body Takes Them Literally
There's a mind/body debate in there that can wait for another day but in the meantime be conscious of the unconscious impact of metaphors.
Tomorrow, February 4, is World Cancer Day and the International Union Against Cancer (UICC) is calling for greater awareness of the contribution of infectious disease to cancer cases around the world. "Cancer can be prevented too" is the theme of the effort. According to the press release the campaign is backed by a new scientific report: Protection Against Cancer Causing Infections which focuses on the nine known infections that can lead to cancer.
There's already a highly effective vaccine against human papillomavirus that prevents cervical cancer, a dreadful disease that took the life of one of my law school classmates within a year of her graduation, though it's still not widely given for a variety of reasons associated with culture and values. There's also a vaccine to protect against hepatitis B virus which causes a staggering number of cases of liver cancer worldwide yet it too is grossly underutilized. For more on World Cancer Day 2010 try these links: UICC World Cancer Campaign, World Health Organization, European Hospital and this book: Infections Causing Human Cancer
Today The Lancet announced: "it has become clear that several elements of the 1998 paper by Wakefield et al are incorrect, contrary to the findings of an earlier investigation. In particular, the claims in the original paper that children were "consecutively referred" and that investigations were "approved" by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record."
Though this final, and finally complete, retraction is based on a determination of ethical lapses on the part of the author the fact remains that the results reported in the article have never been replicated. Nevertheless, contrary to what most lay people might assume published scientific papers aren't retracted just because the "science" within them turns out to be wrong.
In a 1971 paper that profoundly influenced how scientists and policy makers approached public health issues Abdel Omran set out his theory of "The Epidemiologic Transition". He hypothesized that societies went through three different ages, or phases, that defined their experience with regard to mortality and life expectancy. In the first, the "age of pestilence and famine", life expectancy is low and episodes of widespread death are common. In the second, the "age of receding pandemics", infectious diseases are overcome and life expectancy increases dramatically. Finally, in the third, the "age of degenerative and man-made diseases", diseases of aging and self-inflicted suffering becomes the predominant determinant of mortality. Eventually others, noting the dramatic increase in life expectancy due to the rapid decline in deaths due to heart attack and stroke, posited a fourth age; essentially the same as the original third age but with cardiovascular disease removed from the "degenerative disease" category.
Now in an editorial in this month's JAMA Dr. Michael Gaziano asserts that we may be entering a fifth phase, or age, of the epidemiologic transition. We are now, he writes, entering the "age of obesity and inactivity" in which ailments due to gluttony and sloth predominate on death certificates. The editorial references two new articles in the same issue purporting to show Americans are fat and getting fatter; especially the children.
But wait a minute. The age of man-made diseases barely materialized. Certainly there have been many many cases of people suffering terribly as a result of some man-made health hazard. Look no further than the cases of mesothelioma among the men who served aboard amosite laden Navy ships. And smoking continues to exact its terrible toll. Yet if you throw all the deaths due to occupational diseases and every last lung cancer/COPD death into the same category you can't get to 10% using worst case estimates. More sober estimates put the percentage of deaths due to man-made diseases at considerably less than one. Nevertheless, this powerful meme - that most of our woes are self-inflicted and due to some failure to live in a natural way - still propels not only mass tort litigation but also much scientific and political thinking.
However, there's more than just AIDS to demonstrate that we never really saw the "disappearance" of infectious diseases. Go to www.pubmed.gov/ and do some searches on helicobacter pylori and humanpapilloma virus and you'll see just how many cancers are now being attributed to just these two organisms. Investigate mollicutes and you'll find that all sorts of microbes are suddenly being found associated with disease and they're only now being found because the technology to identify them is only now being refined.
Finally, remember to read the fascinating journey of Barry Marshall and Robin Warren from authors of an abstract rejected as one of the year's worst to winners of the Nobel Prize in Medicine for the very same work. In the end, the view, supported by the work of one of the world's preeminent public health researchers, that peptic ulcers were caused by that most modern of man-made insults, stress, only gave way to the understanding that the cause was in fact a bacteria when the evidence was irrefutable.
In the Proof and Refutation of arguments it is appropriate to adopt an Arrangement of the following sort: (1) the strongest arguments should be placed at the beginning and at the end of the pleading; (2) those of medium force, and also those that are neither useless to the discourse nor essential to the proof, which are weak if presented separately and individually, but become strong and plausible when conjoined with the others, should be placed in the middle.
- Cicero "Ad Herennium"
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