I frequently hear the claim that “doctors have just stopped prescribing opioids”. The truth is that U.S. doctors prescribe fewer opioids than they did 5 years ago, but the U.S. still dwarfs the world in its per capita prescribing even among the heaviest prescribing nations. For details, see my latest piece at The Washington Monthly.
Cat asthma as a political argument to Republican pet owners.
This is about public policy, promise.
My elderly cat Hobbes now has a respiratory problem, as I do. It’s probably feline asthma. Cats get asthma like humans, while dogs don’t. One cause, say vets, is air pollution.
Credit: MeowValet on YouTube
The literature seems stronger on indoor air pollution than outdoor. Second-hand tobacco smoke is a culprit, as are wood fires and incense. I found a serious controlled Taiwanese study on indoor pollution making the link. The effect of outdoor pollution has been less studied for animals. One Mexican study creepily found similar lesions in the brains of big-city dogs to those found in humans with Alzheimer’s.
It seems safer just to rely on the parallelism in the symptoms and mechanisms of cat and human asthma, and the massive literature connecting the human form to air pollution, to conclude that all air pollution is bad for cats too. The effect is reinforced by the height difference: cats and dogs breathe in air at car exhaust level.
This hypothesis suggests a political strategy. In the USA, there are said to be 49.2 million households with a cat. There are 50.4 million with children under 18. That’s 39% each. I couldn’t find a combined breakdown, but let’s assume that the two are independent. That would give 30 million childless households with a cat. The real total will be different, but it’s still a very large number.
This demographic skews old, white and therefore Republican. It cares for its cats. It strikes me as a good argument to make to this group in favour of the energy transition and the GND that the policy will protect the health of their pets.
Some will say: this is ridiculous. Are there really a non-trivial number of voters who will be swayed by the health of cats but not the health of children? If there are, surely they are either “low-information voters” – idiots – or moral imbeciles, and lost causes in either case?
My answers are (a) quite likely and (b) no.
Let me make the case for the defence. The questions are linked by the broader issue of moral myopia.Continue reading “Feline asthma”
the hot dog horror, and the salami scare. This story in the NYT quotes a source:
“We see a 4 percent increase in the risk of cancer even at 15 grams a day, which is a single slice of ham on a sandwich,” said Dr. Nigel Brockton, director of research for the American Institute for Cancer Research.
Eating a more typical serving of 50 grams of processed meat a day would increase the risk of colorectal cancer by 18 percent, a 2011 review of studies found.
What does this really mean? Lifetime risk of colorectal cancer is about 1 in 23, or a little over 4%. Now, does that slice of ham double your risk (4% to 8%), or merely increase it from 4.3% to (1.04*.043 = .045), 4.5%? Do a full fifth (18 + 4 = 22) of the 50-gram noshers get these specific cancers? Of course not. The quote, and the story, are completely ambiguous, but if you follow the link, you find that the data are relative risk values, which is the second interpretation. 50 grams a day entails about a 1% extra risk, and that’s not even counting all the people already in the 4.3% who eat deli meat and get cancer. If you do, and you stop, your risk of these cancers goes down from about 4% to…a little more than 3%. Perhaps Zabar’s should sue the Times over this alarmism.
Eating a reasonable amount of these exceptionally yummy foods seems to me a good deal, at the price of being 1% more likely to get this type of cancer before I get one of the other kinds or a heart attack. YMMV, of course. Everyone dies of something, so a much more useful statistic would be the average number of [quality adjusted ?] life years I’m putting at risk from a ham habit, and from an occasional indulgence.
The lesson here is that any statistics involving percentages have to be stated carefully to make it clear whether an increase adds to an existing rate or multiplies it, and “X% added risk” simply doesn’t cut it. Dr. Brockton and the reporter are equally at fault here, along with the Times copy editor. Students and colleagues: don’t make this mistake, especially when you’re explaining science to the public. What Dr. Brockton meant to say is that “the 15g pigout habit raises your lifetime risk from 4 to 5%”. There’s no escaping the additional words. Or reporting base rates: something that “quadruples your risk of contracting the gleeps” is not a big deal if the incidence of gleeps is a fraction of a percent.
Lessons of the great row in the Cochrane collaboration.
Want a change from watching the turds circle the drain in the Kavanaugh confirmation circus? Let me bring you a nasty academic spat between high-minded medical researchers. This is how learned gentlemen stab each other in the back! With a couple of serious morals. Everybody named below is a highly credentialed professional; I leave the titles out to avoid repetition.
The milieu is the Cochrane collaboration. Inspired by and named after the epidemiologist Archibald Cochrane (d. 1988), the Cochrane people promote evidence-based medicine through meta-analyses of randomised clinical research trials using methods as rigorous and objective as they can make them. (Our own Keith Humphries has been a Cochrane reviewer.) [Update] The very solid proposition is that if you can analyse correctly a handful of properly conducted trials, you are in effect adding the sample sizes, so you can draw much more statistically reliable conclusions than by cherry-picking one. There is of course a lot of art here behind “correctly”, “properly”, and “in effect’. [/update] They are not the only researchers carrying out meta-analyses, but a Cochrane review is widely regarded as the gold standard. Depressingly often, the answer is “we don’t know”.
One recent Cochrane review (lead author Marc Arbyn) was on vaccines against human papilloma virus (HPV), which causes much cervical cancer among women and lesser numbers of anal and penile cancers in men. This is not a trivial health issue. Fortunately there are vaccines sold by Merck (Gardasil) and GSK (Cervarix). Do these work? Short answer: yes. Are they dangerous? Short answer: no. (Please DO NOT quote me, read and cite the report, they do provide a summary for dummies.)
So far so routine. But then an article was published in the journal BMJ – Evidence-Based Medicine by Lars Jørgensen, Peter Gøtzsche, and Tom Jefferson, alleging that the vaccine review was sloppy on several counts and hinting that it was influenced by pressures from the Big Pharma vaccine vendors. (Note that while they argue that the side-effects are greater than the review says, the critique does not recommend stopping or curtailing vaccination programmes.) This naturally provoked a rebuttal from the Cochrane management (David Tovey and Karla Soares-Weiser), saying the criticism is wrong on all counts.
It did not stop there. Gøtzsche is, or rather was, a member of the Cochrane board, indeed a founder member of the organisation. He could presumably have raised his concerns there first rather than publicly. After a presumably furious board meeting, Gøtzsche was expelled and four other board members quit. The great collaboration is now in existential danger. Will donors, including the Gates Foundation, keep the funding flowing? Will Gøtzsche set up a breakaway fitzCochrane, applying his own higher standards? Will anti-vaxxers and misogynists exploit the row to attack the vaccination campaign? Only 27 % of American men under 26 are vaccinated.
It’s important that the crisis be resolved quickly and the collaboration continue. There’s not much outsiders can do to help this in the short term, and I am quite unqualified to take sides. I have though one reflection and one suggestion for the future. Continue reading “Evidence-based catfighting”
Lenny Bernstein of Washington Post moderated this panel with Vanda Felbab-Brown, me, and Pagan Harleman. The audience and panelists had just watched the first episode of Pagan’s Showtime documentary series The Trade.
There’s been lots of chatter about the cannabis-opioid substitution question.
People whose background is medical research tend to distrust anything that’s not a randomized controlled trial. They point to the positive correlation between cannabis use and opioid use at the individual level, and the fact that opioid deaths continue to rise even where cannabis is most freely available. Their position is, “We don’t know anything about this. Let’s due the clinical studies before taking action.”
But “not taking action” now means continuing to criminalize even the possession of cannabis. If cannabis substitutes for opioids, those laws cost lives: lives that can’t be regained ten years from now, after the clinical-trial results are in.
Moreover, the relevant clinical trials can’t actually be done in the U.S. Continue reading “Does cannabis availability help prevent opioid overdoses?”
Two easy tips for better walking.
We all learnt to walk very young, normally in the second year of life. It’s completely automatic. Severely neglected babies in orphanages ( update – assuming they are physically normal, see comments /update) get up on their feet and walk (Bowlby, 1952, page 20) just as soon as the adored princelings of modern parents, who cheer on every step with praise and console with hugs after every fall. As with any self-taught skill, our methods are approximate, and we stick with what works.
Skills acquired like this can often be improved. Here is a tip sheet from British sports scientist and walking guru, Joanna Hall.
Ms Hall has a system to sell. If you can’t be bothered to wade through it all, here is the RBC tl;dr condensed version in two bullet points. Continue reading “How to walk: the RBC guide”
I grieve the loss of Sir Roger Bannister, whom I never got to repay for his kindness to me. But at least let me relate my favorite story about the great man.
Many people don’t realize that his achievements didn’t end after his famous athletic feat. He went on to become a prominent and respected neurologist who mentored a number of my London-based colleagues. One of them was training in internal medicine and Sir Roger was teaching a mini-rotation on neurology. She was struggling and he had to give her some feedback.
He: “You simply spend too long with each patient. You will never have as much time in everyday practice as you spent with that head injury case this morning. Just make an quick initial assessment and refer the patient on to neurology if you suspect serious damage.”
She: “I needed the 30 minutes to be sure.”
He: “In practice, you will have to do at least 15 of these screenings in an hour.”
She (getting irritated): “I can’t do a neurological screening in just 4 minutes!”
He (with a kind smile): “You might be surprised what you can accomplish in 4 minutes.”
Of course the gun nuts, their lobby, and the elected officials who have traded their souls for the money trot out the platitude that mass shootings demonstrate the need for better mental health care, not gun control.
On Saturday morning, a young man with a background full of warning signs walked into the public library in Winchester, Massachusetts, armed with a large knife, and fatally stabbed a young woman who was reading at a table. Bystanders, including a 77-year-old man, rushed to help and were able to keep the man at bay until the police arrived. One is dead, another injured.
It’s awful. But it’s not another 17 dead bodies. Jeffrey Yao lived in Massachusetts where it’s a lot harder to get a gun and there is much less “rah rah, we love guns” in the culture. When the madness seized him, he had only a knife.
Certainly we need a better system for dealing with mentally ill people who behave like Jeffrey Yao and Nikolas Cruz. Perhaps we could ask the psych experts instead of the police and courts to work on a system that protects the public and the individual. That will be a hard task. Gun control is not a hard task. Get it done.
Rick Snyder, the Republican governor of Michigan, set the Flint water crisis in motion by implementing his deeply-felt beliefs (I infer from his behavior, always the best evidence) that spending tax money, or exercising government regulatory power, for the benefit of poor people–especially poor black people who probably vote wrong if you let them grow up–is a moral offense.
He is also a very strong (not the strongest/rape-and-incest) abortion opponent, and we don’t have to infer, because he’s on the record about that.Â It turns out he and his gang of vicious, reckless, subordinates committed the biggest mass abortion episode in US history; lead in Flint’s water not only damaged thousands of little kids for life, but killed hundreds in utero.