Healthcare: Technology is a bigger cost driver than demography

By Julia Belluz - Friday, February 10, 2012 at 12:34 PM - 0 Comments

dno1967b/Flickr

An aging population—or “gray tsunami”—is the shadow lurking in the background of health care, poised to drive up health-care spending and wipe out the system as we know it. Technology, on the other hand, is a means to improving efficiency in the system and reducing costs. Consider the early, sparkling promises of Obamacare south of the border or electronic health records in Canada. Policymakers trumpet this conventional wisdom—but it isn’t quite right.

As a recent report by the credit rating agency Standard & Poor’s argues, your grandmother’s visits to the doctor aren’t the key driver of health costs. Health technology, however—encompassing anything from drugs to diagnostic imaging—is becoming the great burden on the health systems of G20 countries.

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Mental illness: does it really affect one in five?

By Julia Belluz - Friday, February 10, 2012 at 8:29 AM - 0 Comments

Flickr

“One in five Canadians experiences a clinical mental illness and many more struggle with stress or grief.”—Globe and Mail, 02/07/2012

One in five of us has or will suffer from a mental illness: for years, we’ve peppered our news stories, health pamphlets, and advocacy campaigns with this statistic about the goings on in our heads. There are even entire mental health websites dedicated to it, such as OneInFive.ca courtesy of Dalhousie University.

It’s a number that knows no boundaries. In the U.S., a new national report found that one-fifth of American adults experienced mental illness in the past year.

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Psychotropes and children: are we ruining a generation?

By Julia Belluz - Thursday, February 2, 2012 at 12:09 PM - 0 Comments

(Dan Cepeda, Star-Tribune/AP Photo/)

There were a couple of troubling reports about the use of prescription drugs to treat attention-deficit hyperactivity disorder in children and youth this week. The Vancouver Sun reported “a striking increase” in the rate of second-generation antipsychotics prescribed to kids. South of the border, the New York Times ran a big op-ed entitled “Ritalin Gone Wrong,” in which a psychology professor rang alarm bells over the three million U.S. children who take stimulants like Ritalin and Adderall for “problems in focusing.” With more than 40 years of experience under his belt, the professor said “we should be asking why we rely so heavily on these drugs,” adding that few physicians and parents “seem to be aware of what we have been learning about the lack of effectiveness of these drugs.”

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The battle over the “cure” for autism

By Julia Belluz - Thursday, January 26, 2012 at 7:40 PM - 0 Comments

An elementary second-grader counts the days of the month in a special education class for autistic children in Idaho. (Greg Kreller/AP Photo/Idaho Press-Tribune)

UPDATE: A French court ruled against Sophie Robert on Thursday, ordering her to remove the offending segments from “Le Mur” and pay about $45,000 in various fines.

“For more than 30 years, the international scientific community has acknowledged that autism is a neurologic disorder… In France, psychiatry, being very largely dominated by psychoanalysis, ignores these discoveries.” The Wall documentary. 

Culture writes on illness. That’s evident in the battle around a French documentary about autism entitled “Le Mur” or “The Wall.” Today, a court in the northern city Lille will decide whether the film, released online last year, should be censored at the request of psychoanalysts in the country, since it essentially charges that their approach to the disorder ignores decades of scientific progress. Continue…

What is the most effective diet for losing weight?

By Julia Belluz - Wednesday, January 18, 2012 at 5:25 PM - 0 Comments

Kyle May/Flickr

This past weekend, Science-ish was disappointed to read Margaret Wente’s column on health evidence, in which she opined: “Today’s health wisdom has a way of becoming tomorrow’s bunk… This may help explain why all the standard diet and exercise advice is worthless.” Sure, evidence about the best way to eat is evolving, the media screws up reporting on science all the time, and the health sciences are particularly vulnerable to what Edmonton-based health law professor Timothy Caulfield calls, in his insightful new book A Cure for Everything!, “an unprecedented number of perverting influences” like Big Food.

But that’s no reason to discount science altogether. When you look at the evidence about diet, some things are pretty straightforward. So rather than taking a blind approach to a healthy life, Science-ish will stick to the science, and give you the six things you should know about an evidence-based approach to diet and weight loss.

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French breast implants: a Science-ish saga?

By Julia Belluz - Thursday, January 12, 2012 at 6:12 PM - 0 Comments

(Lionel Cironneau/AP Photo)

Since December, health authorities around the world have been scrambling about what to do with women who have French-made Poly Implant Prosthesis (PIP) breast implants lodged in their bodies. After being approved for market, it recently emerged that PIP implants were filled with non-medical grade silicone—unbeknownst to regulators—and that their manufacturer had got rid of an outer skin to keep the implants from leaking and breaking.

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Does WiFi pose health risks?

By Julia Belluz - Wednesday, January 4, 2012 at 10:49 AM - 0 Comments

Viktor Hertz/Flickr

Radiation can give life and take it away. Sunlight, therapy to kill malignant tumors, powerful x-rays, and radio waves are all forms of radiation. Lately, much has been made of the health risks related to another source of invisible waves: WiFi.

In recent years, politicians and leaders in the health field have tried to do something about the perceived threat of exposure to radio-frequency (RF) electromagnetic fields, on which WiFi, cell phone networks, radio signals, microwave ovens, and cordless home phones depend. Public fears about RF fields may have hit a fever pitch when, last summer, the World Health Organization designated them as a “possibly carcinogenic” agent—alongside others like coffee—for which evidence of harm is uncertain. Since then, we’ve heard our nation’s doctors raise concerns about the health risks related to cell phones; politicians, such as Elizabeth May, warn publicly about the potential harms posed by WiFi; and frightened parents say they’d move their children away from the invisible threat, as schools impose bans on wireless internet.

But what do we actually know about the health effects of RF exposure—and, in particular, the health risks related to WiFi?

Different technologies give off different amounts of radiation, explained Dr. Patrizia Frei (PhD), a research fellow at the Swiss Tropical and Public Health Institute, who has conducted reviews on the health effects of RF exposure. “While mobile phones cause mostly localized exposure to the head,” she said, “WiFi usually causes far-field whole-body exposures which are usually much lower.” According to the UK’s Health Protection Agency, “the signals are very low power, typically 0.1 watt (100 milliwatts) in both the computer and the router (access point), and the results so far show exposures are well within the internationally-accepted guidelines from the International Commission on Non-Ionizing Radiation Protection.”

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This year’s most outrageous attacks on science

By Julia Belluz - Friday, December 30, 2011 at 11:42 AM - 0 Comments

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‘Tis the time of year to look back, and in reflecting on Science-ish, it seemed wise to seek out all those who made outrageously science-ish statements in 2011, and ask them why—in their claims on topics as far ranging as asbestos and home care—they completely ignored the evidence. But pulling people away from the fireplace and eggnog seemed unfair over the holidays… and unlikely to elicit constructive responses, if any at all. So instead, from the Science-ish archives, here are the year’s most offensive attacks on science, with a wish list of questions I would like to see answered about these wildly unscientific ideas:

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A Science-ish year in review

By Julia Belluz - Monday, December 19, 2011 at 12:01 PM - 0 Comments

US Army Africa/Flickr

There are some things we think we know for sure when it comes to health. They manifest in the daily rituals we perform without question or doubt. Take flossing as an example. Jamming the waxy string between our teeth is the surest way to fight cavities, right? The famous “Wear Sunscreen” column-turned-song even lists “floss” alongside the things you should do for a full and healthy life.

But when scientists recently analyzed the studies comparing flossers to non-flossers, for a new Cochrane systematic review (the highest form of evidence) on the subject, they found they were mostly biased, industry-sponsored junk. Moreover, not a single study looked at the reduction of dental cavities in flossers versus non-flossers. Continue…

A Science-ish Q&A: Dr. Ben Goldacre

By Julia Belluz - Monday, December 12, 2011 at 3:20 PM - 0 Comments

Photograph by Rhys Stacker

With his “Bad Science” column in the Guardian newspaper and a best-selling book of the same title, U.K. physician Ben Goldacre has been leading the international charge in quack-busting, unpicking dubious scientific claims made by everyone from politicians to alternative-medicine practitioners and nutritionists. But Dr. Goldacre doesn’t scrutinize only the most obvious quacks among us. As he told an audience of health professionals, policy-makers, and researchers at the Evidence2011 evidence-based medicine conference in London, “We’re on a quack continuum and our work here today is unpicking the details of evidence to make sure we stay at the saintly end of that continuum rather than the dodgy one.”

As of this fall, Dr. Goldacre was on a break from the bedside to work as a research fellow on clinical trials and publication bias at the London School of Hygiene and Tropical Medicine. (He’s also the Science-ish patron saint.) Julia Belluz sat down with him in London to learn about how other doctors can undertake similar quack-busting work, about his forthcoming book on the pharmaceutical industry, and why understanding the mechanics of bad science is the best way to arrive at good science.

Q: In a presentation here, you said we can put all evidence on a “quack continuum.” Can you explain what that is? Continue…

Science-ish calls for submissions

By Julia Belluz - Monday, December 5, 2011 at 2:42 PM - 0 Comments

At a time when politicians are casting doubts on evolution theory, large sections of the public seem to have given up on one of the single greatest advances in health sciences of the last century (vaccines), and the Canadian government is telling the world that asbestos is safe to use, the discourse around science may have hit its nadir.

But there is a silver lining: there are more science myths around to explore and, if necessary, debunk.

After six months of writing this column, I’ll do a year-end round up of the most pressing Science-ish debates of 2011, based on your reactions, opinions, and views.

Do you have a burning question about science or a health claim you’ve seen this year that seems dubious? Please write a brief description of the question or claim that most baffles you, and send it to julia.belluz@medicalpost.rogers.com or, on Twitter, at @juliaoftoronto.

The deadline is Tuesday, Dec. 13.

Science-ish is a joint project of Maclean’s, The Medical Post, and the McMaster Health Forum. Julia Belluz is the associate editor at The Medical Post. Got a tip? Seen something that’s Science-ish? Message her at julia.belluz@medicalpost.rogers.com or on Twitter @juliaoftoronto

Why the markets can’t run hospitals

By Julia Belluz - Monday, December 5, 2011 at 10:24 AM - 0 Comments

“The evidence is very, very clear that the core provision of health services is more effectively done through the public model.”—Roy Romanow, Nov. 27, 2011

It’s an exciting time in the world of health care. Like our neighbours to the south and other developed countries across the ocean, we’re in the midst of another discussion about the future of our health-care system. But there’s one debate that rears its head no matter what decade we’re in: private versus public health-care. After a meeting on the new health accord in Halifax last month, Roy Romanow—the former Saskatchewan premier who led a landmark commission on how to improve the health system in 2002—stated very clearly that expanding “private” care would be perilous. But does the evidence support the mighty Romanow’s claim?

Defining public vs. private care

Before we go any further, let’s clear up what private and public funding and delivery means in the Canadian context. Continue…

The flu shot: to vaccinate or not?

By Julia Belluz - Thursday, November 24, 2011 at 3:58 PM - 0 Comments

Rich Pedroncelli/AP Photo

“… those who are so willing to inject mercury containing vaccines into people under the delusion that they are forwarding public health… should be required to submit the scientific evidence for their decisions.” — Flu vaccine statistics don’t add up, in the Nelson Star, 15/11/2011

In a world where paranoia and distrust of science abound, this op-ed in a local B.C. paper certainly fueled uncertainty around flu vaccines. In the piece, the writer suggests that public health officials and the media were deliberately misinterpreting data from a recent Lancet review about the flu shot by concluding that it’s effective for most people.

Science-ish poked around in the studies, and found a more nuanced story about the flu shot. Continue…

Insite: ‘Too early to tell’ if it works?

By Julia Belluz - Thursday, November 17, 2011 at 3:56 PM - 0 Comments

“I think it’s just too early to tell.”—Ontario health minister Deb Matthews on whether she opposes safe-injection sites, 11/02/2011

In the 1990s, Vancouver was Canada’s capital of drug-related crime and home to the fastest-growing AIDS epidemic in North America. Back then, drug users injecting were a common sight in the city’s Downtown Eastside. They were doing so against the backdrop of a changing HIV epidemic in Canada, with the concentration of the disease shifting from men who have sex with men to addicts sharing needles.

Thus, the city on Canada’s west coast was a fitting locale for Insite, the first safe-injection site on the continent. Allowing people to use pre-obtained drugs under medical supervision could potentially reduce the harms associated with this type of drug use—namely, the risk of overdose and infectious diseases such as HIV and hepatitis C.

Insite fell into the category of what health policy wonks call “harm reduction,” or policies and programs implemented to reduce the adverse health, social and economic consequences of illegal drugs (and other high-risk activities). International health organizations—such as the WHO and UNAIDS—believe in harm-reduction interventions, and endorse them as a key part of a global HIV-prevention strategy. Continue…

The Oprah effect and why not all scientific evidence is valuable

By Julia Belluz - Wednesday, November 9, 2011 at 1:09 PM - 0 Comments

One of the inspirations behind Science-ish was the seemingly endless barrage of complaints by friends in medicine regarding the “Oprah effect” on their offices and hospital wards: patients making important decisions about a lifestyle choice or treatment option based on something they had seen on Queen of daytime talk.

Now, the Oprah Winfrey Show is off the air, but the after-effects of her work on childhood vaccination and menopause will surely haunt doctors’ visits for years to come. Of course, other media—before and after Oprah—have a powerful sway over patient decisions. Every day, newspapers dole out advice on how much alcohol and coffee to consume, how best to manage your diabetes, and the benefits of probiotics. New media play a big role in purveying health knowledge, too. In research into YouTube as a source of information on immunization, the investigators found that about half of the videos posted had anti-immunization messages, and the negative videos were more highly rated and viewed more often than those backed by science. Continue…

Q&A: Edzard Ernst on alternative medicine

By Julia Belluz - Wednesday, November 2, 2011 at 3:41 PM - 0 Comments

Dancing Lemur/Flickr

Steve Jobs’ tragic death may have added a new urgency to Edzard Ernst’s work. In October 2003, when Jobs was diagnosed with pancreatic cancer, he turned not to conventional medicine but acupuncture, macrobiotic diets, and visits to a spiritualist, delaying surgery some doctors suspect could have saved his life. About ten years before that diagnosis, Ernst—an award-winning, U.K.-based physician—began establishing an evidence base for alternative therapies. Since then, Ernst has become the world’s first professor of complementary medicine at Peninsula Medical School in Exeter, England, founded two academic journals on the topic (Perfusion and Focus on Alternative and Complementary Therapies), and published more than 1,000 papers and over 40 books (including the recent Trick or Treatment? Alternative Medicine on Trial).

So far, only five per cent of the alternative therapies Ernst turned his critical gaze to have shown curative powers beyond those of a placebo. The demise of Apple’s founder, then, seems a fitting occasion to reflect on the powerful allure that alternative medicine holds—even for the geniuses among us. “My first thought was, ‘How tragic,’ and the second, ‘When will we learn the lesson?’” said Ernst. “People—even if they are smart—are all too easily misled to do the most stupid things, particularly with the promotion of alternative medicine being as viciously effective as it is.” Indeed, Jobs wasn’t the first VIP to use alternative medicine: Bob Marley, Peter Sellers and Steve McQueen were all enthusiastic proponents. And in this country, recent estimates put our out-of-pocket spending on alternative-care providers at $5.6 billion.

So what does Ernst think we need to know about this type of care? I caught up with him at Evidence2011 to discuss the evidence base for alternative therapies.

Q: You’ve said you are fed-up for being known as a quack buster. Why?

A: Quack busters, just like enthusiasts of alternative medicine, do their work to confirm their prior beliefs. They are not even trying to be objective. Scientists test hypotheses initially with an open mind and bend over to be objective.

Q: So what areas of alternative medicine are helpful or effective, according to your research?

A: The best evidence by far emerges from herbal medicine. Some herbs, like St. John’s Wort, are both effective and safe if used properly.

Q: If you had to pick, are there particular claims that alternative medicine practitioners make that irk you most?

A: That their pet therapy somehow defies scientific scrutiny. A close second would be: “My notions have not been proven wrong, so they might be correct.”

Q: What are some of the direct risks associated with alternative medicine that people need to consider?

A: Chiropractic neck manipulations can injure an artery that supplies the brain. This can cause strokes or deaths.

Q: Can you give me an idea of the absolute or relative risks related to complementary medicine?

A: Risks of alternative medicine are under-researched and under-reported. We know of some 700 serious complications after chiropractic. We also know that under-reporting is such that this figure could be larger by one or two orders of magnitude.

Q: Do you think regulating this industry would help? If so, what kind of regulation would you like to see?

A: Yes, regulation is essential. But it must be regulation according to accepted standards. If not, regulation will just be a way of giving credence to people or products that do not deserve it.

Q: Have you looked at whether alternative medicine can lead patients to postpone seeing conventional health professionals? If so, what are the dangers here?

A: Even homeopathic remedies, or other treatments which are pure placebos, can kill someone if they are used as an alternative to effective therapies. The most recent, tragic example is Steve Jobs.

Q: Are there any good, trustworthy references for patients who want to learn more about the risks or benefits of alternative therapies?

A: Because there is so much misinformation and so much unreliable information, we have decided to write Trick or Treatment. I recommend it as an honest attempt to summarize the evidence.

Q: A lot of people use acupuncture, yet high-level studies show that sham acupuncture is just as good as ‘real’ acupuncture. What does this tell us?

A: It shows how important the placebo effect can be, particularly if expectations are high. But we do not need bogus treatments to benefit from a placebo response. Any effective therapy also comes with a free placebo effect in addition to its specific therapeutic effects, as long as it is administered with compassion and empathy.

Q: Taken as a whole, your research shows that only five per cent of the therapies you have studied have rendered a benefit above and beyond a placebo or hint that further research might be warranted. How do evangelical alternative-medicine users or practitioners react to this finding?

A: The 5 per cent figure is based on the evidence we evaluated for our book Desktop Guide. For that, we pre-selected the most promising areas. Thus, the five per cent figure is a gross over-estimation. Across the board, the true percentage is probably one dimension less. Believers react with disbelief in such data. You cannot easily disprove a religion.

Q: What do you say to people who argue that conventional medicine kills more people than alternative medicine and that the latter is even more dangerous, so we should focus on this threat to public health?

A: I say it’s true but misses the point. Treatments must be judged by their risk-benefit balance. If a therapy causes some harm but, at the same time, saves thousands of lives, it still might be worth considering. Very few alternative medicines generate a lot of benefit. This means even small risks can affect the risk-benefit balance significantly.

Q: Any final messages for consumers who are considering alternative medicine?

A: If it sounds too good to be true, it probably is.

The haunting spectre of energy drinks

By Julia Belluz - Tuesday, November 1, 2011 at 2:36 PM - 0 Comments

Last month, federal Health Minister Leona Aglukkaq unveiled reforms to the way the government regulates energy drinks, including a change in the classification of these caffeine-filled beverages from “natural health products” to “foods.” This means the feds can better control the ingredients the drinks contain and mandate that they carry labels listing their contents and related health warnings. Health Canada will also cap the concentration of caffeine per 250 ml at 100mg, require labels that indicate total caffeine content, and force manufacturers to include a warning that the drink shouldn’t be mixed with alcohol.

But just exactly how bad are energy drinks for the body? Continue…

The truth about vitamin D

By Julia Belluz - Wednesday, October 12, 2011 at 5:30 PM - 35 Comments

Shattered Infinity/Flickr

The Statement: “If your skin is super pale, you’re already well aware of your must-have items: sunscreen with a high SPF, and a hat (for shade). But a new study suggests you might also need some vitamin D supplements.” Huffington Post, 10/04/2011

The claim about vitamin D making the rounds right now is that pale people should top up on the supplement du jour because they may not get enough from the sun. Doctors already prescribe it for various reasons, from preventing falls among the elderly to easing chronic pain and boosting levels of the vitamin—produced in the skin after sunlight exposure—in anyone living in a cloudy climate.

Testing of vitamin D levels is now widespread, as is the idea that everyone needs more of the stuff. At last count, the Nutrition Business Journal reported that sales of vitamin D in the U.S. made the leap from $40 million in 2001 to $425 million in 2009. But is this notion that vitamin D should be a fixture in most medicine cabinets justified? Continue…

Do school-based obesity interventions really work?

By Julia Belluz - Wednesday, October 5, 2011 at 3:45 PM - 20 Comments

Alan Cleaver/Flickr

We’re fatter than ever and efforts to reduce our ever-expanding waistlines are failing, according to a new report by the Community Foundations of Canada.

Between 1981 and 2009, obesity roughly doubled across all age groups and tripled for youth (age 12 to 17) in Canada. This translates to a rate of obesity that’s close to 25%.

Our padded figures have left governments scrambling to address the chronic condition. Carrying extra weight increases the risk of a range of health conditions (from Type 2 diabetes to high total cholesterol and several cancers), meaning health-care costs balloon with our waistlines. (The Community Foundations of Canada put the price tag on health spending related to obesity at between $4.6 and $7.1 billion each year.) Continue…

Is alternative medicine effective?

By Julia Belluz - Monday, September 26, 2011 at 11:34 AM - 54 Comments

Avi Paz/Flickr

The Statement: “Traditional Chinese Medicine plays an important and valuable role in the health and well-being of Ontarians as many are choosing this complementary and alternative approach to health care. It is in this spirit that we are committed to the regulation of this profession,” – Deb Matthews, Minister of Health and Long-Term Care, 01/09/2011

The field of complementary medicine is huge and growing. In Canada, recent estimates put out-of-pocket spending on alternative-care providers at $5.6 billion—a substantial amount, even when compared to the $31.1 billion spent on pharmaceutical drugs last year.

Governments have been making attempts to rein in the gargantuan industry. As Deb Matthews suggests, since Ontarians are turning to alternative care like Chinese Medicine, and it “plays an important and valuable role in [their] health and well-being,” we should regulate it. The Canadian Medical Association, however, argues that any guidelines for or regulation of alternative medicine “should respect the conviction of many physicians and clinical researchers, that [alternative medicine] has minimal scientific validity and that recommending it to patients achieves no clinical purpose and may be unethical.” In other words, warn the huddled masses about this quackery.

Given the face-off between politicians and the doctors, Science-ish wondered: does alternative medicine—the traditional Chinese variety, in particular—actually work? Continue…

Who’s afraid of a gay man’s blood? We are.

By Julia Belluz - Wednesday, September 14, 2011 at 12:11 PM - 9 Comments

Adam Piotrowski/Flickr

The Statement: “In our case, we’re absolutely certain that going from a lifetime deferral to a five-year deferral or even a one-year deferral … would absolutely make no difference in terms of the risk of HIV (transmission),” Marc Germain, Héma-Québec, 09/08/2011

Starting in November, the United Kingdom will join South Africa, Australia, New Zealand, Japan and other countries that have lifted the lifetime ban on blood donations from men who have sex with other men (MSM) and instead impose a 12-month deferral period after oral or anal sexual contact with a same-sex partner has occurred. This rule will apply whether or not a condom was used.

The policy change is based on the findings of the independent Advisory Committee on the Safety of Blood, Tissues, and Organs, which reviewed the evidence on donor selection criteria, taking into account improvements in blood testing, monitoring from countries with shortened deferral periods, and donors’ compliance with the ban. They concluded that the science “no longer support[s] the permanent exclusion of men who have had sex with men.” Continue…

Can hitting the gym cure the blues?

By Julia Belluz - Wednesday, September 7, 2011 at 5:26 PM - 5 Comments

Meredith Farmer/Flickr

The Statement: “On antidepressants but still in a funk? Try hitting the gym. [A new study] has found that exercise is just as good as a second antidepressant in conquering the blues.”—Toronto Star, 08/25/2011

Our collective bafflement at the tragic deaths of NHL players Wade Belak and Rick Rypien, whom both reportedly committed suicide recently, and Derek Boogaard, who accidentally overdosed on booze and painkillers in May, had Science-ish wondering about the link between depression and sports. As the Globe and Mail’s André Picard penned rhetorically, “Surely a trio of tough guys dying at their own hand in a short period can’t be a coincidence, right?”

Indeed, the notion that athletes in peak physical condition could succumb to what Winston Churchill used to call the black dog doesn’t square with what we thought we knew. Besides the fact that jocks (unlike artists) aren’t typically associated with depression, the well-documented health benefits of playing sports don’t seem to align with the blues. There are the mood-boosting physiological effects of working out—it raises endorphin levels and reduces the stress hormone cortisol. There are intangible benefits, too: the increased self-esteem that comes with feeling and looking fit. Being athletic in our society is virtuous, and some have even linked too little physical activity to depressive moods.

So it seems easy to believe that exercise would inhibit depression.

Those who have wrestled the black dog may have been interested in the news stories last week about a new study that supposedly found the “treadmill can act as second antidepressant,” as the Toronto Star put it. That a jog could help treat depression—with fewer side-effects and costs than blockbuster antidepressants—sounded immediately appealing, especially when considering people tend to have poor adherence to antidepressants (the dropout rate within the first weeks of treatment can run as high as 40%), and even when they stick to their treatment, they often just don’t feel better. (A 2003 Cochrane review found only marginal differences between antidepressant medications and active placebos.)

Naturally, Science-ish was inclined to look at the evidence behind physical activity as a treatment for depression. The most recent Cochrane systematic review on the subject—”Exercise for depression“—examined randomized controlled trials in which exercise was compared to standard treatment, no treatment, or a placebo in adults with depression. Exercise, the investigators concluded, seemed to improve depressive symptoms in people—but the effects were statistically insignificant when only methodologically robust trials were considered.

The lead author on the study, Dr. Gillian Mead of the University of Edinburgh, told Science-ish, “There was also uncertainty about the optimum exercise prescription, which individual patients might benefit, how best to motivate people with depression to start to exercise, and how to optimize adherence.”

Dr. James Blumenthal (PhD), a leading researcher on exercise and depression at Duke University, weighed in, too. He has found that, while promising, there is no definitive link between exercise and depression. “Data are more limited in children, and most studies of adults have focused on aerobic exercise. But there is some—albeit limited—data supporting the potential value of anaerobic strength training,” he noted. Though, again, the exact dose of exercise needed to boost low moods is not yet known. (Duke research suggests 30 minutes three times each week for 16 weeks may be adequate).

As for the recent headline-grabbing study, “Exercise as an augmentation treatment for nonremitted major depressive disorder,” the researchers looked at people who had not responded to antidepressants, and split them into two groups: one went on a gentle exercise regime (walking ten minutes per day, for example) and the other took more vigorous aerobic exercise (a jog on the treadmill). All participants remained on antidepressants; but exercise—not another drug—was their co-treatment.

After the four-month trial, more people on the higher ‘dose’ of exercise experienced remission of symptoms than the gentle exercisers, but more of those on the brisk routine dropped out of the trial. Dr. Mead observed, “The difference between the two doses of exercise was not statistically significant. So while these data are not inconsistent with the literature that suggests that exercise is of benefit for depression, further research is still needed to answer important questions about how effective exercise might be.”

Still, in her systematic review, Dr. Mead and her co-authors did suggest physicians consider prescribing exercise for depressed patients. “It would be reasonable for doctors to give them the same advice that they would give healthy people about the long-term benefits of exercise. And also say that exercise may have short-term beneficial effects on mood,” she said. “As you know, there is a vast, robust literature on the benefits of exercise in the general population.”

So will we see doctors prescribe exercise for depression anytime soon? “Possibly,” said Dr. Blumenthal, “especially physicians who feel comfortable recommending exercise for their patients. However, if physicians don’t normally prescribe exercise—and many don’t—they will likely continue to prescribe what they usually do: antidepressants.”

Science-ish is a joint project of Maclean’s, The Medical Post, and the McMaster Health Forum. Julia Belluz is the associate editor at The Medical Post. Got a tip? Seen something that’s Science-ish? Message her at julia.belluz@medicalpost.rogers.com or on Twitter @juliaoftoronto

The end of hospitals

By Julia Belluz - Thursday, September 1, 2011 at 12:15 PM - 70 Comments

Luca Rossato/Flickr

For the last several years, there’s been a lot of apocalyptic chatter about whether the aging population—or “gray tsunami”—will overwhelm the health system. That, coupled with the fact that there seems to be a shortage of hospital beds, has politicians offering up home-care services as an alternative to hospital and long-term care, and health-policy wonks pondering what a system without hospitals would look like.

This week, Ontario Health Minister Deb Matthews was the latest such politico to announce the Liberal plan to invest $60 million in home-care for seniors and the disabled. Though details about the program were not yet available, Matthews said it would offer services ranging from a health professional’s house visit, to phone and online consultations.

The supposed benefits? Improved access, more cost-effective care, reduced visits to hospital, and less pressure on long-term care facilities. As Matthews’ campaign office spokesperson put it, a hospital stay can cost $1,000 per patient per day while long-term care rings in at $150 per day.

But is the suggestion that home-care programs are an efficient alternative evidence-based? Continue…

Do the health benefits of cycling outweigh the safety risks?

By Julia Belluz - Wednesday, August 17, 2011 at 2:58 PM - 13 Comments

Photo by helter-skelter/Flickr

The Statement:  “To be sure, cycling provides good exercise, but there are safer ways to get it. [...] Second, bike riding here is not as environmentally virtuous as it’s cracked up to be.”—Montreal Gazette, 08/11/2011

This Gazette story was prompted by a series of five very sad cycling fatalities in Montreal this year, “an unusually high death toll,” the writer lamented, before going on to list myriad downsides related to cycling in the urban environment. The Winnipeg Free Press published a similarly disturbing article, which noted that in the last 18 months, 29 people have died on Winnipeg streets in car crashes, and 18 of them were pedestrians or cyclists. The Winnipeg Free Press article’s message was as clear and pedantic as its title: “Walking, cycling can be deadly.”

Ontario doctors have likewise called for safer cycling. They note that while biking is good exercise, the government needs to invest in cycling infrastructure, such as purpose-built bike lanes, to make commuting on two wheels safer. The provincial NDP in Ontario offered another (seemingly unlikely and impossible to enforce) solution to the problem of cars and bikes mingling dangerously on the road: they suggested changing the Highway Traffic Act so motorists can be fined for crossing a one-metre buffer with cyclists.

But what is the evidence behind these proposed cycling policies? And if cycling is as dangerous as these news articles purport, do the health benefits of cycling outweigh the risks? Or should people refrain from biking on city streets altogether? Continue…