science

Found a couple more stories relating to how screwed up our medical system is -- specifically how it is profoundly unscientific due to pressures to be profitable.

As I have recently noted, modern medicine has serious shortcomings in the scientific method department. Another article in The Atlantic reminds us that many of the peer reviewed studies published aren't even written by the authors but are instead ghost written by third parties.

The mechanics of the ghostwriter’s job are fairly simple, David says. Early on, a medical-communications agency and its pharmaceutical-company sponsors will agree on a title for an article and a potential author, usually an academic physician with a reputation as a “thought leader.” The agency will ask the thought leader to “author” the article, sometimes in exchange for a fee. The ghostwriter will write the article, or perhaps an extended outline containing the message the company wants to transmit, and send it along to the physician, who may make some changes or simply sign it as written and submit it to a journal, usually scrubbed of any mention of the ghostwriter, the agency, or the pharmaceutical company. David says he rarely even sees the published articles he writes.

And Newseek covered Dr. Ioannidis, who I wrote about last week.

The November, 2010, issue of The Atlantic has a stunning article about the damning ineffectiveness of medical studies. Damning.

I recently noted an article revealing shoddy studies at the University of Minnesota, a school for which I have very high regard. In the field of medicine, it seems that the profit-motive has gone toe-to-toe with the Hippocratic Oath... the Oath may not be knocked out, but medical studies are gamed by the companies pushing drugs and submitted to privatized, rubber stamp Institutional Review Boards before being published in peer-reviewed journals. The whole enterprise is shameful.

As profiled by The Atlantic, Dr. John Ioannidis is revealing just how screwed up the system is and how it leads to a crapshoot for Doctors who cannot know the best course of action for their patients.

He’s what’s known as a meta-researcher, and he’s become one of the world’s foremost experts on the credibility of medical research. He and his team have shown, again and again, and in many different ways, that much of what biomedical researchers conclude in published studies—conclusions that doctors keep in mind when they prescribe antibiotics or blood-pressure medication, or when they advise us to consume more fiber or less meat, or when they recommend surgery for heart disease or back pain—is misleading, exaggerated, and often flat-out wrong. He charges that as much as 90 percent of the published medical information that doctors rely on is flawed. His work has been widely accepted by the medical community; it has been published in the field’s top journals, where it is heavily cited; and he is a big draw at conferences. Given this exposure, and the fact that his work broadly targets everyone else’s work in medicine, as well as everything that physicians do and all the health advice we get, Ioannidis may be one of the most influential scientists alive. Yet for all his influence, he worries that the field of medical research is so pervasively flawed, and so riddled with conflicts of interest, that it might be chronically resistant to change—or even to publicly admitting that there’s a problem.

Read the full article - I cannot do it justice.

What I think about is conversations in Public Policy grad school, when we discussed how to structure the necessary trials for new medicines. Should it be controlled by the companies who stand to gain from approving the treatments? The knee-jerk reaction is absolutely not, for obvious reasons. But the main alternative would be for tax dollars to pay for these studies -- amounting to a massive taxpayer subsidy for costs that should be incurred by those developing the drugs. Perhaps a solution where the drug studies are funded by those who stand to profit from the medicine but designed and controlled by independent labs.

I'm not enough of an expert to know the best structure for solving this problem, but the pendulum has clearly swung far too far in favor of the private sector companies producing these treatments. Washington DC's obsession with the private sector solving every problem, no matter how poorly suited to markets to solve, has clearly set back medical science.

Those of us who regularly defend science and get pissed at those who don't understand science should beware the pitfalls of _bad_ science. As in, when big pharma is perverting science in the holier name of profits. Mother Jones has an article that hits close to home -- the University of Minnesota's dark side.

Update: I encourage readers to also see my medical "science." post.

This story illustrates the disconnect Americans have with science and public policy.

From NPR: Dishes Still Dirty? Blame Phosphate-Free Detergent.

In a nutshell, dishwasher detergent can no longer uses phosphates, the magical ingredient that makes dishwashers so effective, even with very soiled plates.

Seventeen states banned phosphates from dishwasher detergents because the chemical compounds also pollute lakes, bays and streams. They create algae blooms and starve fish of oxygen.

Enter some Texas lady:

But dirty and damaged dishes are turning many people into skeptics, including Wright.

"I'm angry at the people who decided that phosphate was growing algae. I'm not sure that I believe that," Wright adds.

She's not sure she believes that??? What the fuck does she know about phosphates in waterways? Almost nothing, I'll bet.

What she does know is that she has to rinse dishes before putting them in her friggin dishwasher and some pots have to be washed by hand. She knows that this is just about the greatest inconvenience she'll encounter in her life, and therefore phosphates could NOT POSSIBLY cause algae blooms. I would have paid money to see a quick follow up question posed to her: "Sure, you doubt the science... one question: What is an algae bloom?"

Listen people, the science is what it is. Phosphates are fucking up our waterways. Dumping megatons of carbon into the atmosphere is changing the climate in ways unprecedented in human history. If you are too fucking content with your lifestyle to be bothered making changes that will allow future generations to do things like fish or live along present-day coastline, then that is your problem, not a problem with the science!

A few weeks ago, Sports Illustrated ran a fascinating cover story about evolution, genetics, doping, and sports. I think the insights into human evolution will be interesting even to those who are generally uninspired by sports.

It notes that all human are fundamentally built to be distance runners... and they mean distance! In fact, there is an argument that running was fundamental to our human development.

Even our large brains developed because we ran, growing only once our endurance enabled us to gorge on animal fat and protein. We are who we are—the only sweating, largely hairless bipedal mammals—because we ran. As Lieberman puts it, "Endurance running is hardwired into our anatomy and physiology."

The article goes into a great discussion of investigations into why the Kenyan runners have succeeded so well at long distances ... and it seems far more behavioral than genetic.

The discussion turns to brain injuries and what we can predict based on genetic markers and predisposition to slow healing from brain trauma:

The more ApoE has been studied, though, the more it has been associated not only with Alzheimer's but also with the ability of the brain to heal from all manner of trauma. People with ApoE4 variants who hit their heads in car accidents, for example, are more likely to have permanent damage or to die than those who have other variants. And a series of small studies suggests that athletes with ApoE4 variants who get hit in the head are more likely to recover slowly and to suffer greater dementia later in life. It is not entirely clear how ApoE affects brain recovery, but the gene is involved in the inflammatory response of the brain after injury, and people with the ApoE4 variant appear to take longer to clear their brains of a particular protein called amyloid, which floods in following head trauma.

I highly recommend the whole article, but I also wanted to note that our intelligence evolved because of our ability to maintain a high-fat and high-protein diet... from our ability to hunt animals. Those who argue that eating meat is inherently unnatural are wrong. Not only is it tasty - it was essential to our human development. Now, I do agree with those that argue much of our modern meat industrial complex is unhealthy, but that is different from arguing we should simply avoid meat because eating other animals is somehow wrong.