Continuous Productivity

Swine Flu What?

The other day I was looking for statistics to help me frame the actual risk of death via swine flu. I didn't find anything salient to post, but this post does the trick:

We overweigh new risks relative to comparable risks we are accustomed to. Around 100 people per day died in US roads in 2008, an enormous improvement over previous years but still. People obsessing about spending 5 minutes in elevators with others (an infinitesimal chance of contagion) will blithely cross the street against the light to have a artery-clogging triple cheeseburger with fries and then smoke a pack of cigarettes. These things have much higher risks, but because we have grown accustomed to them, we don’t think of the risks. They are not, in the technical term, salient; but they are much more dangerous. Still, their dangers are dry statistics and people are not good with statistics.

Anorexia and Suicide

Someone who develops anorexia is 50 to 60 times more likely to kill themselves than people in the general population. No other group has a suicide rate anywhere near as high (Archives of General Psychiatry, vol 60, p 179).

Recently, psychologists have tried to explain why anorexia and suicide are so intimately connected, something which is helping to answer the wider question of why anyone would commit suicide. If this explanation holds up, it will give psychiatrists a new tool for screening patients and determining which of them are most likely to kill themselves, perhaps saving lives.

Suicide has always been a conundrum for psychologists and other researchers interested in human behaviour. Self-preservation is one of the strongest human instincts, so the drive to commit suicide must be even more powerful. But what causes it?

Suicide is, of course, linked to depression and hopelessness, but nobody has been able to answer the question why some people commit suicide and others, in similar situations, don't. The basic question, and the hopes of understanding the answer through studying anorexia is:

The vast majority of depressed, hopeless people do not commit suicide, so why do some do it?

In 2005, psychologist Thomas Joiner, a suicide specialist at Florida State University in Tallahassee whose own father committed suicide, set out to answer that question. By studying suicide statistics and paying particular attention to the groups with above average rates, Joiner believes he has found a common thread others have missed. "It was the first grand theory of suicide in quite a while," says Nock.

In essence, Joiner proposed that people who kill themselves must meet two sets of conditions on top of feeling depressed and hopeless. First, they must have a serious desire to die. This usually comes about when people feel they are an intolerable burden on others, while also feeling isolated from people who might provide a sense of belonging.

Second, and most important, people who succeed in killing themselves must be capable of doing the deed. This may sound obvious, but until Joiner pointed it out, no one had tried to figure out why some people are able to go through with it when most are not. No matter how seriously you want to die, Joiner says, it is not an easy thing to do. The self-preservation instinct is too strong.

There are two ways people who want to die develop the ability to override the self-preservation instinct, Joiner argues. One is by working up to it. In many cases a first suicide attempt is tentative, with shallow cuts or a mild overdose. It is only after multiple attempts that the actions are fatal.

The other is to become accustomed to painful or scary experiences. Soldiers and police who have been shot at or seen their colleagues injured or killed are known to become inured to the idea of their own death. Both groups also have a higher-than-normal suicide rate. Similarly, doctors and surgeons who witness pain, injury and death are more likely to be able to contemplate it for themselves - the suicide rate for doctors is significantly higher than for the general population. Joiner describes this as a "steeliness" in the face of things that would intimidate most people.

It's the Calories, Stupid

I recently read about baseball player, Heath Bell, who lost 25lbs over the winter using the Nintendo Wii. Given my own inability to lose the lingering 20lbs that I have gained over the last few years, I diligently researched the Wii for fitness purposes. I quickly came to realize that like any other form of exercise, you actually have to commit to it and do it...and it's not really as fun as it sounds.

So, I was reassured by reading this article yesterday that basically said that you have to cut calories:

Researchers at the Harvard School of Public Health and the Pennington Biomedical Research Center put four popular diets -- high carb, high fat, low-fat and high protein -- to the test to see which of the regimens resulted in more weight-loss success.

After two years of monitoring the participants, "all the diets were winners," said study co-author Dr. Frank Sacks, a professor of cardiovascular disease prevention at the Harvard School of Public Health. "All produced weight loss and improvements in lipids, reduction in insulin.

"The key really is that it's calories. It's not the content of fat or carbohydrates, it's just calories," said Sacks. The findings are published in the latest edition of the New England Journal of Medicine.

I'd love to take the time one day and research the diet advice market, as a whole. It seems like, despite the obvious, there are so many revenue channels from books to fad diets to support groups. It seems like all you have to do is write a book with a clever name, get on a TV show, and success is guaranteed.

Dyscalculia

A very interesting learning disability that I knew nothing about:

Last November, Jill got herself screened for learning disabilities. She found that while her IQ is above average, her numerical ability is equivalent to that of an 11-year-old because she has something called dyscalculia. The diagnosis came partly as a relief, because it explained a lot of difficulties she had in her day-to-day life. She can't easily read a traditional, analogue clock, for example, and always arrives 20 minutes early for fear of being late. When it comes to paying in shops or restaurants, she hands her wallet to a friend and asks them to do the calculation, knowing that she is likely to get it wrong.

The disability is analogous to dyslexia and effects the same percent (5%) of the population. But, it clearly does not get the same level of care.

Sleep Deprivation? Doesn't Exist

I always suspected that the various sleep deprivation studies were a bit spurious. Now, some proof:

Another line of evidence trotted out for chronic sleep deprivation is that we typically sleep longer on vacation and at weekends, often up to 9 or 10 hours a night. It is often assumed that we do this to pay off a sleep debt built up during the week.

However, just because we can easily sleep beyond our usual daily norm - the Saturday morning lie-in, the Sunday afternoon snooze - it doesn't necessarily follow that we really need the extra sleep. Why shouldn't we be able to sleep to excess, for indulgence? After all, we enthusiastically eat and drink well beyond our biological needs. Why shouldn't it be the same with sleep?

Most mammals will sleep for longer than normal if overfed, caged or bored. The three-toed sloth is a good example. Sloths kept in zoos sleep around 16 hours a day - yet in their natural, wild state they sleep less than 10. Niels Rattenborg and colleagues at the Max Planck Institute for Ornithology in Starnberg, Germany, recently found this out by using miniature EEG recorders attached to the heads of sloths in Panama, the first such experiment on a free-ranging wild animal. Why this difference in its sleep? The most likely explanation is that sloths simply sleep to excess when caged (Biology Letters, vol 4, p 402). This is seen in domestic animals too. Sheep in pens, horses in stables and cows in barns sleep much more than when in open fields, and pet cats sleep extensively compared with feral cats.

One of the favorite examples of these studies is that we sleep longer when we can. Wouldn't you know it, of course we do, it's like anything else we indulge in. I think sleep, like many things in life (alcohol, food, drugs), etc, is something we do when we have nothing better to do. Anecdotally, the most active, diverse, and inquisitive people I know sleep the least. And it doesn't seem to be just the socially active folks, but rather people with diverse interests whether they be sports or reading or even meditating.

I Feel Itchy

A very informative article at the New Yorker:

But how, exactly, itch works has been a puzzle. For most of medical history, scientists thought that itching was merely a weak form of pain. Then, in 1987, the German researcher H. O. Handwerker and his colleagues used mild electric pulses to drive histamine, an itch-producing substance that the body releases during allergic reactions, into the skin of volunteers. As the researchers increased the dose of histamine, they found that they were able to increase the intensity of itch the volunteers reported, from the barely appreciable to the “maximum imaginable.” Yet the volunteers never felt an increase in pain. The scientists concluded that itch and pain are entirely separate sensations, transmitted along different pathways.

Go read the entire piece, it's well worth it.

Obesity and Oil Again

Typical of McKenzie's interests is a recent paper that notes the average weight of Americans has increased 24 pounds since 1960, and how that has had a direct impact on gasoline prices. He contends Americans are using 1 billion gallons more gasoline per year hauling all that extra weight around, and airlines are using 1 billion gallons of additional jet fuel. And that extra demand contributes to the rising costs of gas (BusinessWeek.com, 6/3/08). 

"My inconvenient truth for Al Gore is you can save polar bears by going on a diet, at least if it's done nationwide," says McKenzie.

I can see the obesity and oil thing becoming an increasingly common theme given how intuitively easy it is to explain to the layperson.

Obesity and Oil Prices

A really interesting study that determines that the impact of obesity is far greater than individual health issues:

The London School of Hygiene and Tropical Medicine calculated the obese consume 18% more calories than average.

They are also responsible for using more fuel, which has an environmental impact and drives up food prices as transport and agriculture both use oil.

The result is that the poor struggle to afford food and greenhouse gas emissions rise, the Lancet reported.

This is the first time that I have ever seen a study like this, but it makes absolute sense. I am really intrigued by the potential solutions:

Phil Edwards, who co-authored the article, said: "Urban transport policies that promote walking and cycling would reduce food prices by reducing the global demand for oil and promotion of a normal weight.

We need to incentivize the obese to lose weight. Having society push for these measures since it impacts the masses could finally lead to individual changes.

Doctors and Suicide

There's a grim, rarely talked-about twist to all that medical know-how doctors learn to save lives: It makes them especially good at ending their own. An estimated 300 to 400 U.S. doctors kill themselves each year -- a suicide rate thought to be higher than in the general population, although exact figures are hard to come by.

Some doctors believe the stigma of mental illness is magnified in a profession that prides itself on stoicism and bravado. Many fear admitting psychiatric problems could be fatal to their careers, so they suffer in silence.

And when the pain is too much, doctors have easy access to prescription drugs and a precise knowledge of both how the body works and the amount of a drug needed for an overdose to stop breathing and halt the heart.

This is something that I was completely unaware of. I could have guessed that policemen, firemen, and maybe even social workers are at the high end of the suicide spectrum, but not doctors. It seems to me that a profession which brings so much hope would not have these issues, but alas it's extremely common. The explanation as to why the suicide rate is so much higher for doctors is equally intriguing:

One explanation is that most suicide attempts in the broader population are unsuccessful, while doctors know how to successfully commit suicide, said Dr. Erika Frank, who specializes in research on physician health.

Warm

John is a kid with cancer, a senior at Freedom in Beaver County who was told a few weeks ago by doctors that cancer was winning and it was close to the end. The disease that started in his liver was now taking over his lungs.

"They said it could be only two months," he said, fighting back tears.

He paused before his seemingly never-ending optimism came through again.

"I told my mom I still think I can get two more years."

But his story isn't about dying. It's about inspiring.

I would suggest reading the entire article about an 18-year-old dying from cancer. He doesn't have much time to live, but quotes like this show that he understands how valuable the time he has left is:

"I used to be afraid, but I'm not afraid of dying now, if that's what you want to know," he said. "Because life ain't about how many breaths you take. It's what you do with those breaths."

Happy Meal Bad?

Be careful what you eat as a kid, because those extra fries could make it harder to shed pounds years later in life.

A team of Swedish researchers has found that humans determine their total number of fat cells in childhood. New cells spring up and old ones perish, but their numbers change little after adolescence.

By measuring radiation absorbed after nuclear bomb tests in the 1950s and 60s, researchers found that our fat cells quickly regenerate.

But obese people turn over far more fat cells than others, says Kirsty Spalding, a biologist at the Karolinska Institute in Stockholm. The difference could explain why people battle to keep weight off after a diet.

"The take-home message is be careful what you feed your child," Spalding says. "Do everything you can to make sure you don't blow out your fat cell number when you are young."

Well, it certainly makes sense that we should watch what our children eat. Now, we have some evidence.

Wow

It is perhaps the biggest drug scandal of recent years. Before Merck withdrew Vioxx in 2004, the popular painkiller was linked to heart attacks in tens of thousands of people. Now researchers have alleged that Merck knew of the dangers years earlier, but tweaked statistics and hid data so that regulators remained in the dark.

Numbers don't lie, but apparently, numbers can be easily manipulated to justify death for profit:

But an analysis of documents released during the litigation process that led to that settlement, carried out by Richard Kronmal, a statistician at the University of Washington, Seattle, who acted as an expert witness in the Merck lawsuits, suggests that company scientists were aware of the problems well before 2004.

Kronmal's study, co-authored with colleague Bruce Psaty, focuses on a 2001 internal company report. In it, Merck staff describe two recently completed trials involving around 1000 patients on Vioxx and a roughly equal number taking a placebo. Thirty-four people taking the drug died, compared with just 12 on the placebo.                                                                                
But when Merck submitted the results to the US Food and Drug Administration (FDA) the same year, the company analysed the data in a different way. Deaths that occurred after patients completed their course of Vioxx appear to have been removed from the results, even though the drug can cause problems after patients stop taking it. Removing the deaths reduced the risk attributed to Vioxx.

The studies still prompted the FDA to ask whether the risk associated with the drug was enough to warrant stopping another ongoing trial, but Merck replied that it wasn't. According to documents cited by Psaty and Kronmal, the company described the increase in mortality – which its own report revealed to be threefold – as "small numeric differences… most consistent with chance fluctuations".

Chance fluctuations?  Unbelievable.  Let's end this post with a quote:

"It completely clouds your ethical responsibility," says Merrill Goozner, director of the Center for Science in the Public Interest in Washington, D.C.

You think?

Google Health

Google continues its expansion into all things "data":

Google Inc. will begin storing the medical records of a few thousand people as it tests a long-awaited health service that's likely to raise more concerns about the volume of sensitive information entrusted to the Internet search leader.

The pilot project to be announced Thursday will involve 1,500 to 10,000 patients at the Cleveland Clinic who volunteered to an electronic transfer of their personal health records so they can be retrieved through Google's new service, which won't be open to the general public.

The expansion by technology companies into health care record management will inevitably lead to a revision of HIPAA.  Interestingly, as it stands, Google can use the health records they store for marketing or other analytic purposes. 

Barring the obvious privacy concerns, storing medical records (much like everything else) online is an inevitability and will provide for both greater transparency and efficiency within the healthcare industry.  Currently, a medical records request is a multi-step, tedious process that takes too much time, wastes labor resources (not to mention paper) and doesn't always get the job done on the first try.

Veganism Beckons

The U.S. Department of Agriculture announced Sunday that a California meatpacking company had launched the recall of 135 million pounds of beef -- the largest meat recall in U.S. history -- following questions about the company's treatment of cattle that were slaughtered even though they could not stand up.

The recall by the Hallmark/Westland Meat Packing Co., in Chino, Calif., covers meat produced since February 2006. USDA officials said that, given the nature of ground beef production and its shelf life, much of the recalled meat has likely already been consumed. Federal authorities said they don't have solid evidence of illnesses linked to the meat.

I usually stop consuming beef when I read about meat recalls, mad-cow, or E. coli.  It's most likely a moot gesture, but it does give me a false sense of control.  The above bold statement is a stark reminder that most recalls of this nature happen after the fact. 

It's also disturburing to note, as this article points out,  that Hallmark/Westland sold over 37 million pounds of beef to federally run nutrition programs such as the national school lunch program.