Dry Vodka Martini Shots
· 1 shot, medical science
· 1 dash, persuasion
· 1 ice filled shaker
· stir in shaker, pour, then enjoy!
Too much persuasion in the world for individual posts. Let’s do short ones with Journal Watch. See you under the table!
Tooth Fairy Tales with Omega-3
You may recall or you can do the search if you don’t, that the Tooth Fairies told the Tale that taking Omega-3 Fatty Acids would save your life and they had the scientific science to prove it. Now, we’re getting the science and, guess what?
JW reports on a randomized controlled trial with Omega-3 supplements for people with diabetes to prevent cardiovascular problems. No difference in outcomes over six years. An earlier meta-analysis also found no effect for CVD outcomes for people without diabetes. Look for a new Tooth Fairy Tale with a new and expanded list of Confounders! Like . . . hmmmm . . . randomization?
The ORIGIN Trial Investigators. n–3 fatty acids and cardiovascular outcomes in patients with dysglycemia. N Engl J Med 2012 Jun 11; [e-pub ahead of print].
Prediabetes Associated With Stroke Risk
Prediabetes can cause strokes! Maybe! It depends upon how you define Prediabetes. If you define it with one set of figures, you get absolutely no effect. If you define it with others, you get one half of a Small Windowpane (RR = .20, d = .10), about a 47/53 effect size. Persuasion loves that variability in definition. You can talk out of all sides of your mouth and still wear a white lab coat. For one half of a Small Windowpane in an observational design.
Lee M et al. Effect of pre-diabetes on future risk of stroke: Meta-analysis. BMJ 2012 Jun 7; 344:e3564.
Should Anyone Not Take A Statin?
Anyone who writes double negative headlines is aiming at persuasion, not science. And, any scientist who frames a hypothesis like this is saying Prove Me Wrong rather than Prove It Right. Oh. All the studies are with The Lancet. Now it makes sense. These researchers do some kind of meta to prove that everyone should take a statin pill to lower cholesterol even though prior metas on healthy people show no benefit and small risk. The Lancet is the National Enquirer of journals.
Cholesterol Treatment Trialists’ (CTT) Collaborators. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: Meta-analysis of individual data from 27 randomised trials. Lancet 2012 May 17; [e-pub ahead of print].
Ebrahim S and Casas JP. Statins for all by the age of 50 years? Lancet 2012 May 17; [e-pub ahead of print].
Radiation As Therapy Or Not
Doctors are running medical tests with radiation at increasing rates, so that means Other Guys are getting more doses of radiation across the life span. Gee. Can that be a problem? The JAMA researchers estimate that 2% of future cancers will stem from this radiation, and that 2% is likely an underestimate of the harm. But, the JW editorialist cautions, hey, these are just estimates and not direct observations. How about that? Even guessing that a standard medical test will cause 2% of all cancers should be kept tentative while Sitting Is Smoking and Full Strength Soda Pop Is Smoking and Distracted Driving Is Smoking and on and on with the same kind of effect sizes and methods that medical science knows is a serious threat to humanity? If you do it, then it’s a risk; if physicians do it, More Research! Not like Attribution Theory explains medical scientists.
Smith-Bindman R et al. Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996–2010. JAMA 2012 Jun 13; 307:2400.
Self-Referral for Imaging
Doctors send Other Guys for imaging tests. Gee. Do doctors who own an MRI send more Other Guys to it than doctors who don’t own an MRI? Yes. Small Windowpane, about a 45/55 effect. If your doc owns the machine, she’s more likely to recommend the test than if she doesn’t. But only a Small Windowpane. Sure that’s 2 to 5 times larger than what you typically read in medical research, but it’s just a field observational study of two orthopedia practices in the same city. Won’t generalize past Cincinnati.
Paxton BE et al. Physician self-referral of lumbar spine MRI with comparative analysis of negative study rates as a marker of utilization appropriateness. AJR Am J Roentgenol 2012 Jun; 198:1375.
Calcium Supplements and the Heart
This sounds like a broken record, but Tooth Fairies told a Tale that calcium supplements (not Omega-3, see above) would be good for you at least according to their scientific science. A different team looked at Supplements versus Diet and found that, gee whiz, Supplements actually gave people myocardial infarctions (HR = 1.86), a Small plus Windowpane, about a 45/55 effect. Stop the sticks. The Supplement hurts people. Calcium in the diet, however, showed no harms. The Harvard School of Public Health is probably writing a new grant proposal right now, or at least after they finish the one on Omega-3, to prove that Supplements don’t produce heart attacks, but rather attract people who were getting ready to have a heart attack anyway before they took the Supplements.
Li K et al. Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg). Heart 2012 Jun; 98:920.
Subconcussive Head Impact In Sports
An interesting study of college athletes in contacts sports finds no clinically significant cognitive effects from a season of activity. Athletes (males and females playing football or ice hockey) wore specially designed helmets that recorded hits as they occurred. Athletes in non contact sports (track, crew, Nordic skiing) were tracked as a no contact control. Pre and post tests of cognition showed no differences between the contact and noncontact athletes. Sure. No randomization. No control of hits. Huge selection bias between people choosing either contact or noncontact sports. But, a lot better than that awful Tooth Fairy observational work on NFL concussions.
If you believe that science makes a difference, read any of those NFL Dements studies and then read this one. If you don’t see the difference in how the authors operate, you don’t know Jack Kennedy.
T.W. McAllister, MD, et al. (2012). Cognitive effects of one season of head impacts in a cohort of collegiate contact sport athletes. Neurology May 29, 2012 vol. 78 no. 22 1777-1784.
PSA Screening Recommendations and JW Readers, A Poll
A scientific panel reviewed the evidence on PSA screening and concluded that the testing made things worse and advised against routine screening in men. As you can imagine there was some disagreement, most from the Likely Gang Of Suspects. What about all the Other Guy Physicians? According to an online poll of JW readers, 22% disagree with the Task Force recommendations and the remaining 78% generally agree with most or all of the recommendations. So. Assuming the Task Force is right and this online poll is a representative sample, men have a 1 in 5 chance of getting killed or maimed with the wrong physician! Of course, if the Doubting Dr. Thomases are correct, then you have a 4 in 5 chance of death or dysfunction! If the Task Force is wrong, we’ll be seeing a lot more dead men fairly soon.
More seriously, read about this controversy as much for the demonstration of persuasion principles and human nature as for the science of prostate cancer. Anyone who claims to have the science on this stone cold and who recommends something like PSA screening or extensive surgery for prostate cancer is the scientific equivalent of the Queen of Tomorrow who knows not the Rules, but the Laws.
If you’re still standing after all these shots, huzzah! See how much persuasion there is in life and death and science. Everytime you worry about your body, you need to worry about your psychology, too. Pain and fear are not what I’d prescribe to produce High WATT Objective Processing for most Other Guys most of the time. Even if you’re just doing research!