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…

What your gym teacher never told you about stretching before exercise

By Julia Belluz - Wednesday, August 10, 2011 at 6:05 PM - 15 Comments

Photo by Pensiero/Flickr

You don’t need to look very far to find advice about stretching and exercise: the oft-cited wisdom is that they should go hand-in-hand, like peanut-butter and jelly or Bonnie and Clyde. You’ve surely heard that a little stretch before and/or after a work-out helps muscles warm up, keeps injuries at bay, and stress and muscle tension away. Continue…

Is the war on salt justified?

By Julia Belluz - Thursday, August 4, 2011 at 4:39 PM - 9 Comments

Photo by somethingstartedcrazy/Flickr

The Statement: “People who eat a high-sodium diet can be putting themselves at risk of high blood pressure that can lead to heart attack and stroke.”—The Chronicle Herald, 08/03/2011

After decades of attempts by policy makers to wean people off the white stuff, it is now taboo to grab the salt shaker at a restaurant and pour it like snow on your dinner. The wisdom that salt is bad is often reinforced in the media. Just this week, the Chronicle Herald ran a piece about how to “shake your salt habit,” as if sodium were akin to tobacco or cocaine. The Globe and Mail also published on a new scare study, which revealed that 70 per cent of infants consume too much salt. Parents were warned that side-effects could be “more serious than having bloated babies… too much salt in an infant can lead to poor kidney development (and kidneys are the organs that help us skim salt from our blood).” Continue…

Antioxidants: Can they save you or kill you quicker?

By Julia Belluz - Thursday, July 28, 2011 at 1:35 PM - 10 Comments

Photo by gabster_ro c/o Flickr Creative Commons

The Statement: Antioxidants for “building strong bones and teeth” and  “protection and healing while improving memory function.”— Cafeteria signage, 07/28/2011

Like many of you, dear readers, on my way to lunch every day I am met with a barrage of well-intentioned signs in my workplace cafeteria that extol the benefits of antioxidants. According to these colourful posters, antioxidants do everything from build strong bones and teeth to protect and heal the body (whatever that means) while also improving memory function.

These signs ring bells: naturally, Science-ish is skeptical of any life-preserving miracle cures. So we asked: what are antioxidants and what do they really do for the body?

First, we must begin with free radicals, which are molecules that have at least one unpaired electron and therefore can be unstable and highly reactive. The theory goes oxidation (or oxygen metabolism), which is a natural process needed to sustain life, also causes the formation of free radicals, and the free radicals can age and damage your cells, leading to diseases such as cancer.

That’s where antioxidants come in. Found in many foods—from fruits and vegetables to wine, chocolate, and tea—antioxidants are thought to interact with the free radicals, stabilize them, and prevent some of the damage they would otherwise cause. In other words, they protect the body’s cells from the sometimes harmful effects of those wild free radicals.

So it would seem to make sense that consuming more antioxidants—drinking pomegranate juice and eating carrots at lunch, topping up with vitamin supplements C and E—leads to more health benefits, which is probably why the thinkers behind the lunchroom signage encourage cafeteria-dwellers to dive in.

But the science shows that more antioxidants, particularly those derived from vitamin supplements, have no health benefits and, what’s worse: they can kill you early.

A 2008 systematic review of the literature on antioxidants found no evidence to support the seemingly widely accepted use of antioxidant supplements, such as vitamins A and E, and beta-carotene. Instead, the researchers concluded, these substances may increase mortality. “Antioxidant supplements need to be considered medicinal products and should undergo sufficient evaluation before marketing,” they wrote.

Similarly, a comprehensive evidence report out of Johns Hopkins University stated: “With few exceptions, neither beta-carotene nor vitamin E had benefits for preventing cancer, cardiovascular disease, cataract, and age-related macular degeneration.” Beta-carotene supplements actually increased the risk of lung cancer in people at risk (smokers and those exposed to asbestos).

Though I’ve pointed to some of the newer and more comprehensive evidence, it by no means tells a different story from what the scientific community has known for years about antioxidants.

As science writer Ben Goldacre outlines in his book Bad Science, a large 1994 study—published in the New England Journal of Medicine—investigated the then-promising notion that diets rich in carotenoid-rich fruits and vegetables, as well vitamin E and beta carotene, were associated with a reduced risk of lung cancer. Nearly 30,000 Finnish people with a high risk of lung cancer were recruited for the study, and the findings dashed the hopes of researchers when it was revealed that those who received beta-carotene supplements had more deaths overall—from lung cancer and heart disease—compared to those who received a placebo.

The well-documented Beta-Carotene and Retinol Efficacy Trial (CARET) was similarly alarming: it looked at the effect of daily beta-carotene and vitamin A on the incidence of lung cancer, other cancers, and death in over 18,000 people at risk for lung cancer, and had to be stopped ahead of schedule in 1996. The reason? Those assigned to receive the vitamins were found to have a 28% increase in incidence of lung cancer, a 17% increase in incidence of death, and a higher rate of cardiovascular disease mortality compared with the control group.

Where does this leave us? Since there’s no scientific evidence to back the use of supplemental antioxidants, sticking to the old commonsensical balanced diet plan with fruits and vegetables should do the trick.

*Thank you to reader @helenspitzer for requesting a post on antioxidants.

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

How do you know when to get screened for breast cancer?

By Julia Belluz - Monday, July 18, 2011 at 2:22 PM - 14 Comments

The Statement: “The benefits of mammography are going to depend a lot on what your underlying risk is, and the current guidelines look only at age… I think that, other things being equal, it’s reasonable for a patient and their doctor at that point to say, ‘we’re going to put off the next mammogram until age 50.’” (Dr. John Schousboe, 07/06/2011)

Dr. John Schousboe, of the Park Nicollet Clinic in Minnesota, is speaking here about a new health- and cost-effectiveness analysis of mammography (breast x-rays) he co-authored, which was published in the Annals of Internal Medicine. The study suggests that risk factors other than age—breast density, family history, and history of breast biopsy—should also be taken into account when determining who should be screened regularly. Continue…

Will those genetically modified soy beans make you sick?

By Julia Belluz - Monday, July 11, 2011 at 2:56 PM - 52 Comments

Photo by Karen Eliot/Flickr

The Statement: “To date, Health Canada has not identified health risks associated with GM foods that have been approved for sale in Canada.” (Stephane Shank, Health Canada spokesperson, 07/05/2011)

Codex Alimentarius Commission—a group of the world’s food safety regulatory agencies—reached consensus last week on new guidelines that will make it easier for food makers to label products with genetically-modified ingredients. The new guidelines are voluntary, though, so don’t expect advertisements about GMOs on the box of your favourite breakfast cereal anytime soon. And part of the reason Canada has not moved to mandatory labeling of GM foods is because, as Stephane Shank put it, “To date, Health Canada has not identified health risks associated with GM foods.”

So, is GM food really safe?

We called Dr. Sylvain Charlebois, a researcher in food distribution and safety at the University of Guelph, to find out. He told Science-ish, “There is no scientific evidence out there that would suggest GM seeds or foods that contain GMOs have health risks to consumers.” Dr. Charlebois did add this note of caution: the key phrase in Shank’s statement was ‘to date.’ “GMOs have only been accessible or readily available to consumers since 1994, so that’s 17 years ago. That’s not a whole lot of time for us to fully appreciate the risks around GMOs.”

Discourse around genetically modified organisms—defined by the WHO as “organisms in which the genetic material (DNA) has been altered in a way that does not occur naturally”—has been a political and scientific battlefield. As a 2009 Nature news feature pointed out, “No one gets into research on genetically modified (GM) crops looking for a quiet life. Those who develop such crops face the wrath of anti-biotech activists who vandalize field trials and send hate mail… [Those] who suggest that biotech crops might have harmful environmental effects are learning to expect attacks of a different kind. These strikes are launched from within the scientific community and can sometimes be emotional and personal…”

There’s also the knee-jerk reaction by the public—often reflected in the media—that these food items are borderline ghoulish, unnatural, and therefore potentially harmful to human health. Just think about the coverage of the transgenic “Frankenfish” salmon. The fish was developed decades ago by AquaBounty Technologies to grow faster than naturally occurring salmon, and has been waiting for a final seal of approval from the Food and Drug Administration for years. (Just last week, House lawmakers in the U.S. voted to bar the regulatory body from okaying the Franken-salmon for mass consumption, though the bill still needs to pass through the Senate.)

Despite the political battles and the public’s wariness about these foods, Dr. Douglas Powell, a professor in food safety at Kansas State University who sat on the Canadian Biotechnology Advisory Committee (CBAC) in the early 2000s, was even less cautious than Charlebois when talking about the potential of GMOs to harm to humans. “(The CBAC) reviewed everything that was out there and there was nothing to show GMOs present a risk to health.” In fact, Dr. Powell has since moved away from researching the subject because, he says, “I got tired of talking about hypothetical risks.”

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

Review: Beggar’s Feast

By Julia Belluz - Thursday, July 7, 2011 at 10:05 AM - 0 Comments

Boyagoda’s novel follows the sprawling life of Sam Kandy, who begins as a nobody in a village in Ceylon (now Sri Lanka) and ends up a self-made shipping magnate with three marriages and 16 children. When he is seven, an astrologer tells Sam’s low-caste parents that their son will ruin them, and his father later abandons him at a monastery. Through vast ambition and predatory instincts, however, this “no one from nowhere” manages to escape the temple by selling on the streets of Colombo, then hopping on a ship to Australia to work for a wealthy man, whose dog, he notes, sleeps on a rug thicker than his father’s mattress.

Sam Kandy (a name he invents) is propelled by an early promise: if he ever goes back to his ancestral village, he’ll “return like it had never been done before.” Through relentless work and the trading opportunities afforded by the world wars, he manages to climb the social ladder in Ceylon. But this beggar in a world that has given him nothing can’t seem to escape his early rejection: not through wealth nor through his upwardly mobile first marriage to Alice, daughter of the village headman. He sends his family clothing, toys, and cars, but remains indifferent to their emotional needs. His rough beginnings do not fully explain the extent of his cruelty. When a man mistakes Sam for Alice’s driver, and his wife does not console him about the error, Sam, “raging that the fate-roped world was holding his head in place,” kills her.

Boyagoda uses language as deliberately as a poet to depict the politics and lushness of colonial and post-colonial Ceylon. But there’s sometimes a gap with “historyless” Sam. His lack of an interior life renders him unknowable and, often, unlikeable. One is left wanting to know more about the motivations of a man willing to go so far to change his fate.

Continue…

Yogurt, the fermented panacea?

By Julia Belluz - Tuesday, July 5, 2011 at 9:36 AM - 15 Comments

The Statement: “Fermented milk products such as yogurt and kefir contain friendly probiotic bacteria that may help guard against disease… Yogurt’s active bacterial cultures can help stimulate the immune system, reduce symptoms of antibiotic-associated diarrhea and improve the absorption of lactose in people with mild to moderate lactose intolerance.” (Leslie Beck, The Globe and Mail, 06/23/2011)

Yogurt has been starring in the news lately for its panacea-like ability to do everything from “stimulate the immune system,” as Beck writes, to help aid weight loss, according to reports about a new 20-year Harvard study. Of the latter, the Toronto Star recently stated, “Vegetables and fruits helped keep weight in check, but nuts and yogurt were the most effective. Most of the test subjects ate no-fat or low-fat yogurt.”

But before you go stocking up on the fermented miracle food, know this: Continue…

How do you get a smoker to quit?

By Julia Belluz - Thursday, June 23, 2011 at 6:09 PM - 0 Comments

The Statement: “These labels are frank, honest and powerful depictions of the health risks of smoking, and they will help encourage smokers to quit, and prevent children from smoking.” (Kathleen Sebelius, U.S. secretary of health and human services, 06/21/2011)

On Tuesday, the FDA ramped up its war on tobacco by introducing nine new graphic warning labels for cigarette packages. This means that after decades of having only text caveats, America’s smoke packs will feature soot-stained lungs, rotten teeth, cadavers, and crying babies.

Given all the attention paid to labeling, Science-ish wanted to know: how much does packaging matter to smokers? And do non-smokers pay attention to the warnings? Continue…