Category Archives: Medical and health

Doctoring Data

DD_Front_Hires_FinalThomas Jefferson famously said “If people let the government decide what foods they eat and what medicines they take their bodies will soon be in as sorry a state as are the souls who live under tyranny”. It’s a good quote to start a book with and one which rings true in Dr Malcolm Kendrick’s new book, Doctoring Data. I thought The Great Cholesterol Con was a cracker but this time has taken his scalpel to the world of medical research and properly dissected it for our inspection.

Kendrick is by his own admission a sceptic on all things medical but sceptics can be a force for good in guiding us through the mire of health messages we are bombarded with on a daily basis.

Take just a few he mentions – Will sausages give you cancer? What should you avoid eating? Sugar, fat, salt or all three? Should you have a smear test? A mammogram? What about statins? The sheer volume of information and statistics is enough to bamboozle the more mathematically challenged among us.

Kendrick has ruthlessly dissected the statistics for us and shows how drug trials are hyped and data manipulated to make minute risk seem enormous. He explains succinctly the difference between absolute and relative risk. He sheds light on the difference between “observational” studies and randomised controlled trials where statistics actually mean something. He illustrates the importance of language when describing the results of clinical trials.

For example, loud warning bells should sound when a study claims that treatment X would save 50,000 lives a year. “In medical research we have to be a little more scientific” he explains. “A more pertinent question would be “How much longer does this intervention allow people to live?”

He debunks long held and deep rooted notions about subjects like screening which is seen as “a good thing” by asking what do we really know about the risks and benefits?

For example did you know that there has never been a randomized controlled study on the benefits of cervical cancer screening done anywhere-ever? So why does nobody challenge it? Kendrick does and argues that the public needs well balanced information rather than propaganda to make informed choices.

Of course in the world of medical research, those in positions of power do not take kindly to anyone who dares to question the established order. That does not stop Kendrick criticizing the pharmaceutical companies who have vested interests in ensuring their drug gets to market.

By the time you finish this book you could feel hard pressed to know who to trust. A good start has got to be sceptics like Kendrick who refuse to simply accept current dogma and go digging for the truth.

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More fun at Queen Square!

Why do people who have strokes feel fatigue? Well on Friday I went back to Queen Square for more tests to try and discover exactly that. I was met at the door of No 33 by the lovely Anna who took me to the special room where the testing takes place. First off she asked me how tired I felt on a scale of 1-10 at that precise moment. I felt slightly ashamed to say I was totally knackered. I had had no lunch and had traipsed round the shops for over an hour. Not only that but I had been fighting off a virus which had been trying to take hold for more than two weeks. So I guess I should not have been surprised I didn’t feel 100%. Anna explained what I was going to do and that it required a lot of concentration. The idea was to measure strength and whether I could tell how much energy I needed to perform a task. In typical high tech fashion that I am getting used to at these sessions,  I had to hold my forefinger against a slightly Heath Robinson contraption involving a piece of metal and a pencil. The metal was linked up to Ann’s computer to record measurements. Anna would then press the end of the pencil twice against my finger and record on the computer how hard she had pressed and how accurately I guessed the pressure of the pencil was on my finger. Next she pressed the pencil and handed the pencil to me to press at at exactly the same pressure (I told you the test was high tech!) I could see why you needed concentration as it’s vital to remember exactly how it felt when she pressed the pencil into my forefinger so as to try and match the pressure as accurately as possible. The whole test took around an hour. As ever we had a good laugh about the strange set up and the fact that of course I couldn’t be told whether I had got the answers right or not! All that data will now be put into the study which hopefully will help answer the question why so many stroke survivors suffer fatigue.

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The myth of saturated fat and heart disease

ImageAn article in the BMJ today by leading cardiologist, Dr Aseem Malhotra of Croydon University Hospital in the British Medical Journal today states that it is time to “bust the myth of the role of saturated fat in heart disease”.

In the article he also blames the food industry for lowering saturated fat levels in food by replacing it with sugar which also contributes to heart disease.

He believes that saturated fat has been “demonised” and the link with heart disease is not fully supported by scientific evidence.

“Adopting a Mediterranean diet – olive oil, nuts, oily fish, plenty of fruit and vegetables and a moderate amount of red wine – after a heart attack is almost three times as powerful in reducing mortality as taking a statin” he writes.

The saturated fat link to heart disease was first put about in 1953 when a respected US physician Dr Ancel Keys published a paper comparing saturated fat intake and heart disease mortality.

Keys looked at six countries in which higher saturated fat intake correlated with high rates of heart disease.

However, what Keys conveniently ignored was that data from 16 other countries did not fit his theory. This tenuous link between saturated fat and heart disease became enshrined in the public consciousness and has remained so ever since.

Dr. Stephen Sinatra, a US cardiologist who’s been practicing for over 30 years and is the author of The Great Cholesterol Myth, does not believe cholesterol is the bad guy in the heart disease mystery. “Cholesterol may be at the scene of the crime for heart disease, but it’s not the perpetrator,” he says.

Sinatra is among a growing number of doctors who believe that inflammation rather than cholesterol is the real villain of the piece.

Inflammation is caused by a number of things but sugar in our diet is a major factor-particularly high fructose corn sugar which is present in so many fizzy drinks. “Sugar damages arteries, increases blood pressure, and ages your organs” he explains.

Yet still doctors are prescribing more statins than ever. Cholesterol-lowering has become a huge global industry, generating at least $29 billion each year.

More and more health professionals are beginning to believe we have been focusing too hard on cholesterol and may be missing the point. If we have spent the last fifty years chasing the wrong demons the greatest sadness is the lost opportunity to tackle heart disease.

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Aluminium-the silent visitor

ImageNew research shows that some types of baby formula contain 100 times more aluminium than breast milk. Experts like Dr Chris Exley, Professor of Bioinorganic Chemistry at Keele University are now calling on the government to take action. 

Their study, published in the journal BMC Pediatrics, examined 30 types of formula sold in the UK, including infant first milks and toddler milks. ‘It is widely recognized that aluminium is a neurotoxin and that it can cause cognitive deficiency’ says Exley.

Study leader Professor Chris Exley, who raised the alarm three years ago with a similar study, said some formulas have aluminium levels 100 times higher than the same amount of breast milk. He said ‘We believe this is too much aluminium to be subjecting a human to at their most vulnerable stage of life.

‘What we don’t know is whether aluminium is accumulating in the bodies of formula-fed babies. If it is, aluminium has no biological function at all, you have no requirement for it. ‘Simply the fact we don’t have experiments showing that it’s either safe or not safe in humans certainly doesn’t mean it’s not an issue.’

Dr Exley’s concern about aluminium is the lack of research into safe levels at which it can be tolerated in the body. ‘Aluminium has no function in the human body and there are hundreds of publications which demonstrate that it is not safe. Yet nobody is doing any research in this area-least of all the people who should be protecting us like the WHO and FSA’ says Dr Exley.

Most people remember that aluminium was linked to early onset Alzheimer’s many years ago. In fact, the earliest link between Alzheimers disease and aluminium was published in 1921 by J Spofforth in the Lancet where it was suggested that aluminium poisoning caused memory disorder in humans.   Then in 1976 D R Crapper et al showed aluminium was associated with plaques and tangles in the brains of people with Alzheimer’s disease.

More recently Rondeau et al demonstrated that high daily intake of aluminium correlated with an increased risk of dementia or cognitive decline in a 15 year follow up French cohort study known as PAQUID.

There is no doubt that aluminium is toxic. During the 1960/70s kidney dialysis patients used to have their blood flushed out with ordinary tap water. ‘In areas where there was a high level of aluminium in the water these patients got extremely ill and some of them died from the neurotoxic effects’ says Dr Exley.

Aluminium is the most common metal on our planet forming 8% of the Earth’s crust so needless to say it is naturally absorbed by many plants and foodstuffs we grow to eat. However it is also added in almost everything else we come into contact with. All of us consume it daily-often without realizing it.

For example, Aluminium sulphate is added to our water to improve its clarity. All foods which need raising agents or additives such as cakes and biscuits contain aluminium. Children’s sweets contain aluminium-enhanced food colouring, it is in beverages such as tea, cocoa and malt drinks, in some wines and fizzy drinks and is also in most processed foods.

It is in a variety of cosmetics including sunscreens and antiperspirants. It is used as a buffering agent in aspirin and in a wide range of antacids. It is even used in vaccines. And now we know it is in extremely high levels in certain types of infant formula.

You might wonder why we have not adapted to deal with aluminium in the body. But Exley points out it was only 100 years ago we learned how to make aluminium metal from the stuff locked up in the Earth’s crust.  ‘This heralded the advent of the Aluminium Age and 100 years of humans being exposed to a burgeoning concentration of biologically available aluminium. So all the aluminium in our body is a silent visitor’ he says.

Toxic effects of aluminium are dependent upon the amount we consume, tissue distribution and excretion rate. When the amount of aluminium consumed exceeds the body’s capacity to excrete it, the excess is then deposited in various tissues including nerves, brain, bone, liver, heart, spleen and muscle.

We are also exposed to aluminium by other routes such as our skin, nose and lungs which may be just as important as our exposure via the gut.  Eighty per cent of vaccines contain aluminium which acts as an adjuvant to boost the immune response. ‘If you think most infants get around 14 vaccinations before the age of 13 then we believe the aluminium load is unacceptably high’ says Exley.

Dr Exley has been working in the field of aluminium for more than 25 years. Not for nothing has he been affectionately dubbed Mr Aluminium-a nod to his remarkable expertise in a field which does not traditionally attract plaudits or huge research funds.

‘Everyone has some aluminium in their bodies but infants below the age of six months are more susceptible because their gut, kidneys and blood brain barrier are immature so they are especially prone to absorbing it and not so good at getting rid of it’ he says.   The FSA does not provide a ‘safe’ limit for aluminium in formula milk but Dr Exley wants manufacturers to lower the level or print it on the label so that parents can make an informed choice.

Diane Benford, Head of the Chemical Risk Assessment Unit at the Food Standards Agency, is confident that babies are not at risk. She does concede however, that children may be consuming too much aluminium, simply because they eat more than adults.

‘Some small groups of the UK population may now be consuming more than the safety guideline amount of aluminium. This may particularly affect children who consume food with higher amounts of aluminium such as bread and bakery products, cocoa and cocoa products, and some leafy vegetables.

There is a Tolerable Weekly Intake which was recently set by the European Food Safety Authority’s Scientific Panel on Food Additives. ‘The TWI is not an estimate of people’s intake but an expert opinion of an amounts that EFSA considers can be safely consumed every day over a whole lifetime’ explains Benford.

So how do consumers know how much is safe? ‘There is no way an individual can actually check because aluminium is everywhere and can be found in so many different foods. In 2008 EFSA estimated that some people would exceed the TWI. However the available data do not show an increase in intake and because the TWI was increased by the WHO to 2mg per 1kg fewer people will now exceed it’ says Benford.

Yet Exley takes issue with their science. ‘To put out these ‘safe tolerable levels’ suggests we know something we do not. More scientific research is desperately needed’ he says.   ‘Our research demonstrating the vulnerability of infants to early exposure to aluminium serves to highlight an urgent need to reduce the aluminium content of infant formulas and no longer use aluminium as an adjuvant in vaccines agains childhood diseases’ he says.

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Neurofast Trial a bundle of laughs!

When I agreed to be part of the Neurofast Trial at UCLH I could never have known what a hysterical couple of hours I would have.

The Neurofast Trial is a study funded by the Stroke Association looking at 142 people who have had a stroke and trying to discover why some people have fatigue and others don’t. The idea is that the way in which the brain controls the muscles in the body is different in those with and without fatigue.

The boffins in Queen Square have devised a cunning plan. By stimulating the region of the brain that controls the fingers while performing certain tasks they can work out how ‘fatigued’ that particular region of the brain is.

I had already watched a YouTube clip of what the trial involved and immediately warmed to Anna the therapist who would be conducting the research. As I watched, however, I felt more and more uneasy about what I was about to undergo.

In the clip Anna looked very serious as she took what appeared to be a huge clockwork key and placed it against the head of her unsuspecting subject. The ‘key’ then delivers a magnetic stimulus to the brain which makes the muscles of the hand react.

On the appointed day I arrived at 33 Queen Square and first of all discovered nobody on the desk knew I was coming. The place is a maze of different neurological specialisms. I hadn’t realized that the research section was very separate but I eventually recognized Anna’s beaming smile as she arrived to collect me.

First I had to be wired up with electrodes attached to my fingers and hand. Next I had to have a sort of trial run to see how much brain stimulation I could take. To say it was a weird sensation would be a total understatement.

Luckily Anna has a great sense of humour and as she cheerfully pressed a pedal on this huge machine and hovered over my head with her clockwork key, each time my hand jumped up off the pillow we both got a fit of the giggles.

The only way I can describe the sensation is like someone flicking your scalp quite hard and then getting a tingling after effect. The really weird thing is how the fingers and hand on the other side to where the ‘key’ is placed twitch involuntarily in time with the tapping. It was very spooky but somehow incredibly funny.

The second test was even more hysterical. I had to sit bolt upright in a chair and place my arm on a table in a contraption where I had to pull as hard as I whilst Anna zapped the other side of my head with a slightly different machine.

At one point I was asked to pull the lever as hard as I could and Anna got very excited shouting and hollering “Go go go!’ at me as if I was in a race. Then suddenly I was zapped out of the blue and my arm flew up and nearly threw me out of my chair. We then dissolved into helpless laughter again.

ImageI have to say I have never enjoyed any ‘medical’ experience as much as I di this particular trial. I would happily go back and get zapped again. I know they use this technique to help people with depression and I certainly felt on top of the world when I left. Enough anyway to go shopping all afternoon and spend a small fortune on new clothes! Thank you Anna!

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June 25, 2013 · 11:05 am

Healthy gums mean healthy arteries

Discussions about the link between oral health and heart disease has been rumbling on for many years. A study of over 11,000 people in Scotland in 2010 showed that poor oral hygiene was associated with higher risks of cardiovascular disease.

And now, new research shows there may be a connection between serious gum disease (periodontal disease) and the build up of fatty deposits on the lining of artery walls which can lead to blood clots causing atheroscelerotic disease (ASVD).

There have been more than 50 studies looking into whether periodontal disease puts people at greater risk of ASVD. In a recent assessment of all the literature the American Heart Association stated that the relationship between periodontal disease and ASVD is potentially a massive pubic health issue of because of the growing prevalence of gum disease in the general population.

Dr Brian Clapp from Guys and St Thomas’ Hospital London says the gum disease/heart disease link is interesting and complex. ‘Some argue that it is a direct effect of bacteria being involved in both processes. Most people including myself think that this is an epiphenomenon or a secondary symptom which may be unrelated to the original disease or disorder’ he says.

‘Nevertheless, there is no doubt that poor dental health correlates with an increased inflammatory state within the body (probably by a causal relationship) and this increased level of inflammation which can be measured by the increased levels of C-reactive protein in the blood, leads to increased atherosclerosis’ says Dr Clapp.

New research from Bristol University has recently shown that dental plaque may actually trigger blood clots in other parts of the body. Researchers found that streptococcus gordonii which normally inhabits the mouth can cause problems when it enters the bloodstream via bleeding gums. The theory is that the bacteria mimics the clotting factor, fibrinogen which in turn activates platelets causing them to clump together inside the blood vessels.

Signs of gum disease include:

Gums that bleed when you brush your teeth

  • Blood in your saliva
  • Red, swollen gums
  • Bad breath
  • Wobbly or loose teeth
  • Abscessed teeth
  • Tooth loss

The good news is that brushing your teeth properly and looking after your gums can prevent and treat gum disease, improve your overall health and help reduce your risk of health problems, such as heart disease. It’s important to have a routine of brushing your teeth for a full two minutes twice a day with a fluoride toothpaste, plus cleaning between your teeth with floss or interdental brushes.

Chief Executive of the British Dental Health Foundation, Dr Nigel Carter, says: ‘The link between oral health and overall body health is well documented and backed by robust scientific evidence. Despite this, only one in six people realises that gum disease may place them at an increased risk of stroke or diabetes. And only one in three is aware of the heart disease link.’

Dr Carter recommends visiting your dentist and dental hygienist regularly for cleaning and check-ups. It’s especially important to look after your teeth and gums if you’re pregnant. NHS dental care is free for pregnant women and during the 12 months after you’ve given birth.

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Drink more slowly from a tall straight glass!

Maybe you haven’t given much thought to the shape of your glass on a night out in the pub. But recent research shows that you are more likely to drink more quickly from a curved glass than a straight glass.

Researchers at the University of Bristol took a group of 159 men and women and filmed them drinking either soft drinks or beer as part of their study. The glasses used were either straight or curvy and each contained around half a pint of liquid.

Those drinking soft drinks took around seven minutes to polish off their drinks whether drinking from straight or curvy glasses. However those drinking beer took four minutes longer to finish their drinks when quaffing from a straight glass.

The results showed that drinking time is slowed by almost 60% when alcohol is consumed from a straight glass compared with a curved glass. Researchers believe that curvy glasses make it harder to pace drinking because it is more difficult to judge how much was in the curved glass.

The study group were also shown a variety of pictures of partially filled beer glasses and were asked to judge whether they were more or less than half full. Researchers said they were more likely to get the answer wrong when assessing the amount in curved glasses.

The study backs up previous research published in the BMJ seven years ago which determined whether people pour different amounts into short wide glasses than into tall slender ones.

Aiming to pour a shot of alcohol (44.3ml) the study group poured more into short wide glasses than into tall slender glasses. In fact despite an average of six years experience bartenders poured 20.5% more into short wide glasses than tall, slender ones.

Angela Attwood, lead researcher on the Bristol study said: ‘Our research is the first to examine whether glass shape directly influences drinking behavior. Our data indicates that the shape of a drinking glass influences the rate of drinking of an alcoholic beverage, but not a non alcoholic drink’.

The drinkers on the study were unable to judge how quickly they were drinking so were unable to pace themselves. She suggested that altering the glasses in pubs could help ‘nudge’ people to drink more healthily by ‘giving control’ back to the drinkers.

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