Map of life expectancy at birth from Global Education Project.

Wednesday, February 27, 2013

The world's most ignorant idiot

That's a little bit more specific than "Worst Person in the World," but probably too kind.

New Hampshire state representative Mark Warden.

The Republican Party must have a highly sophisticated search strategy to find these psychos.  But then people actually vote for them.

People used to wonder why people -- mostly women -- stay in abusive relationships. But now we understand that is a really stupid question. They're abusive, get it? One person is controlling another through intimidation, threats, psychological manipulation, and physical violence actual or latent. You can't just leave because the person has power to hurt you. You are not just "free to go, that's the whole point.

That is not a "love hate relationship," it's exploitation, assault, violation, oppression, and yes, the government and the law, as the embodiment of the expressed will of society, has a right and a responsibility to combat it and help abused people get free.

Mark Warden, schtick dreck.

Tuesday, February 26, 2013

Yes, this really is a breakthrough study

You may have seen coverage of this in the corporate media, but I'm going to give you a bit of value added. A randomized controlled trial finds that the so-called Mediterranean diet results in fewer strokes and heart attacks, not to mention fewer deaths, in people at high risk for heart disease.

Now here's why this is a big deal. Most of what we know about nutrition and health comes from observational studies. It's very difficult to sort out the effects of nutrition on human health because, among other problems:

  • People's diets are obviously very complex. You can't easily or convincingly sort out the effect of one dietary component or characteristic from all the other features of diet;
  • People's diets tend to be correlated with all sorts of other facts about them, including socio-economic status, where they live which is associated with all sorts of other exposures, their culture, their consumption of health care and all sorts of health-related behaviors from smoking to physical activity to how often they have sex;
  • There is confounding by indication. People who are overweight, or diabetic, or otherwise have been told by their doctors that they are at risk or believe they are for whatever reason may already be trying to modify their diets.
  • Doing long-term, randomized controlled trials is extremely difficult because people don't stick to the diets they are assigned.
These Spanish investigators overcame these problems by, first of all, deliberately selecting people who are at high risk -- who have been diagnosed with diabetes or overweight, with a median age of 67 years. They included smokers, and people who are taking medications for hypertension and cholesterol. They randomly assigned them to a low fat diet group, and two Mediterranean diet groups, one of which got free olive oil and one of which got free nuts in addition to nutritional counseling.

Finding #1: People could not stick to the low fat diet. We already know that: diets are very hard to stick to. So this group ended up being basically a control group of people who eat whatever. BUT, people could stick to the Mediterranean diet group. They got to eat all they wanted -- there was no attempt at calorie control. They were allowed to drink alcohol (encouraged to be in the form of red wine with meals). They didn't have to stop smoking or lose weight or do anything else. This diet is satisfying to eat, and allows all kinds of great tasting food. So unlike all the other diets out there, it's actually possible: you can do it.

Finding #2: No, the people didn't lose weight, but they didn't gain weight either, even though they were actually encouraged to eat a lot of fat, consisting of nuts, olive oil, and fatty fish. What they also didn't do was have as many heart attacks or strokes. The big win was stroke, which was statistically significantly less likely to happen with the Mediterranean diet after three years than the regular diet. That probably drove all of the results, but everything else got at least slightly better or no worse, including death, particularly with the olive oil supplementation, although this didn't hit the arbitrary p<.05 level of significance. Still, who wants a stroke?

So no, we don't know exactly what pieces of this were most important, but it confirms what I've been saying all along. It's not how much fat you eat, it's what kind of fat. Olive oil and nut oils are what you want. Also lots of veggies, legumes, and fish. (Alas, fish are not generally a sustainable food. We'll have to figure something out in that department.)  Skip the red meat and go very easy on the dairy fat. (Some Mediterranean cuisines have more goat cheese than cow cheese, which probably also helps since it's lower in fat.) Tomato sauces with olive oil are jes' fine, as are birds. You can do that!

Sure, you should also quit smoking and maintain a healthy weight and all that, but the news here is, even if you don't do that, you still benefit. Really. It's not a mystery.

Monday, February 25, 2013

Too obvious to study?

Yes, but sometimes you need to prove the obvious before anybody will do anything about it. Believe it or not, some U.S. medical schools still don't have policies to stop drug companies from brainwashing their students. They do this by sponsoring talks in which a corrupt physician or company flack pitches their products, often accompanied by free lunch; and by handing out gifts, including not only tschochkes but also school supplies and devices of significant value. Since the American Medical Student Association, to its credit, is against these practices, and has started grading medical schools on their policies restricting marketing to students.

In the new BMJ, King et al look at the results. It turns out that for 2 of the 3 drugs they studies, graduates of medical schools that had policies restricting drug company marketing to their students were less likely to prescribe these drugs after they completed their residencies. The drugs were new, brand name drugs that weren't any better than older, cheaper generics. It's not clear why there wasn't an effect with the third one, desvenlaxafine, which by the way has not been approved for use in Europe and for which very weak evidence of efficacy exists. The authors say this appeared to be due to fairly high prescribing by the early cohort in the group less exposed to marketing as medical students, which suggests it may have been other marketing efforts that obscured the effect. Anyway . . .

There is no excuse whatsoever for any medical school to allow drug companies anywhere near its students, in any way. Drug company representatives and drug company sponsored talks or other events should be totally banned. 100% of the education medical students get about pharmaceuticals and prescribing should be provided by people with no financial interest of any kind in anything they will do once they enter practice.

Bring on your counterarguments, please. I will destroy them.

Thursday, February 21, 2013

Cleaning out the inbox

I've gotten a couple of press releases lately, which I usually ignore because I don't like to be told what to write about, if you know what I mean, but these I do commend to your attention.

This Time Magazine article by Steven Brill has gotten some coverage in the blogosphere, but it won't hurt to link it here as well. The general idea is that hospitals and other health care provider institutions don't tell you ahead of time what prices they will charge, and a lot of those prices end up looking totally outrageous. They also vary enormously, and seemingly arbitrarily. Insurance companies, which you would think would have a lot of leverage, really don't when it comes to the prestigious hospitals, which the insurers' customers demand access to and which are usually regional monopolies. Medicare and Medicaid pay less, but their prices are set through the political process and you know how that works -- powerful interests prevail over consumers and taxpayers. Medicare isn't even allowed by law to negotiate over drug prices.

It is a fact that one of the main reasons health care costs so much more in the U.S. than in  civilized nations is simply that we pay more for the same goods and services. Single payer national health care would mean the payer has real bargaining power and can get those prices down. It does not, however, guarantee that it would happen given the political process in this country.

Meanwhile, Choosing Wisely has released a new list of procedures that usually aren't indicated but are often done anyway. This also has gotten some press coverage. They sent me the release on Monday but embargoed the info until today. Since I don't usually blog at 12:01 am, I was behind the curve on it. Anyway, that's another reason why we pay more here for health care -- we don't have an equivalent of the UK's National Institute on Clinical and Health Excellence that issues guidelines on what the National Health Service will pay for because it's worth it, and won't pay for because it isn't. Congress won't allow that either.

Here are a few examples:

   Don’t use feeding tubes in patients with advanced dementia. Studies show that percutaneous feeding tubes do not result in better outcomes for these patients. The recommendation states that assistance with oral feeding is a better, evidence-based approach. (American Academy of Hospice and Palliative Medicine; American Geriatrics Society)
Don’t perform routine annual Pap tests in women 30 – 65 years of age. In average-risk women, routine annual Pap tests (cervical cytology screenings) offer no advantage over screenings performed at three-year intervals. (American College of Obstetricians and Gynecologists)
·   Don’t automatically use CT scans to evaluate children’s minor head injuries. Approximately 50 percent of children who visit hospital emergency departments with head injuries are given a CT scan. CT scanning is associated with radiation exposure that may escalate future cancer risk. The recommendation calls for clinical observation prior to making a decision about needing a CT. (American Academy of Pediatrics)
But insurance, whether public or private, will pay for all of the above, no questions asked. (BTW CT to diagnose appendicitis is also questionable in many cases, but there's no systematic review or guidance on that as yet. Maybe some day . . .)

Here's something you definitely should not pay for. (No link!)

As with any computer, it is imperative to occasionally reboot, refresh or restart your body. Unbeknownst to most, your body has its own CTRL ALT DEL function that can be set into motion by a trained physician practicing a lesser-known form of therapy called Cranial Osteopathy. This technique is capable of literally resetting, restoring and recharging our bodies and minds, to operate at optimal levels by improving the health of the cervical spine . . . .

Cranial osteopathy encourages the release of stressors and sources of tension throughout the body – especially within the head and neck region. Osteopaths utilize their finely honed sense of touch to detect and restore the Cranial Rhythm and elicit a therapeutic response.

This is probably the most ridiculous, manifest bullshit I have ever seen. There is no such thing as "cranial rhythm" and there is no such thing as "rebooting" your body, and anybody who falls for this crap is an idiot who deserves to be relieved of his or her money. That is all.

Tuesday, February 19, 2013

Men are scum

A visitor asks whether it might be more appropriate to attribute the problem of gun violence in the U.S. to the male of the species, than to the weapons.

Our friend is certainly reality based when it comes to numbers. Men are about four times as likely to kill themselves as are women. (Although, of considerable interest and puzzlement, women are more likely to think about it, and to make unsuccessful attempts, or at least gestures.) Men are also about four times as likely to kill other people than are women, and women who do kill often kill an abusive partner, just as women who are murdered are likely victims of intimate partner violence.

So yep, men are more violent than women, and this is pretty much true throughout history and across cultures, as far as I know. People engage in a great deal of feckless (in my view) argumentation about the extent to which this may be an innate human trait, or subject to cultural modification. To me this is a false dichotomy -- all phenotypes result from the interaction of genetic inheritance with environments. The greater proclivity of the male of the species to violence exists in just about every culture we know of, so in that pragmatic sense it is as innate as the tendency for men to be taller, and to die sooner, than women.

On the other hand, the absolute level of violence, perpetrated by males or otherwise, varies a lot among cultures and, as Steven Pinker argues, has generally been declining in recent centuries. The greater lethality of available technology, including firearms, cuts against this trend, but I'm nevertheless fairly convinced that it is real.

So I would say our friend introduces another false dichotomy. Whatever the demographic profile of the killers of self or others, they'll succeed less often if the available means are less effective. Furthermore, a culture that glorifies or condones violence and fetishises weapons is going to have more violent deaths given a specified prevalence of effective means. In other words, the strategies are not mutually exclusive.

Seems like an easy question.

Monday, February 18, 2013

Energy Medicine

I changed my usual policy and left a spam comment on my previous post, because it links to an utterly outrageous fraud.

I don't spend a lot of time trashing quackery because there are plenty of people doing it with more time and resources, and a bigger readership, than me. (Viz., Science Based Medicine.) But I am curious about why so many people are attracted to so much hooey, and how is it that these malignant clowns manage to relieve said people of their hard earned cash.

One can discern a taxonomy of quackery. There is the herbalist/supplement group, which generally hews close to the scientific worldview but just doesn't bother with the facts. The claims are intrinsically plausible: that the nostrums do in fact contain biologically active chemicals which either fill nutritional needs or correct one or another form of bad chemistry in the body, just like pharmaceuticals. But they are purportedly better because they are "natural," "gentler," have fewer side effects, whatever. Big Pharma doesn't want you to know it because they aren't patentable and therefore don't bring in the big bucks.

You know what? This might be true. Sometimes it is true. Aspirin is a slightly modified form of a compound found in willow bark, which was known to the ancients. Statins are versions of a compound found in a fungus which was used by the Chinese to treat heart disease. Presumably you know about morphine, etc. Lots of drugs are derived from plant compounds. But you don't make willow bark tea, you buy aspirin, for a good reason -- you know exactly how much you are getting of a pure compound. And most of the junk on the shelves of the GNC doesn't do any good. It's almost all a ripoff. But that can be determined on a case by case basis -- the claims aren't inherently nonsensical. People have good reason to distrust pharmaceutical companies and it isn't that hard to see why they fall for the blandishments of the supplement industry.

Energy medicine is another matter. This encompasses Reiki, therapeutic touch, and acupuncture, along with some more obscure or localized shamanistic systems. It derives from a category of pre-scientific belief called vitalism, essentially the idea that life is a kind of energy or mystic force that imbues living things. In acupuncture, it is said to flow through specific channels in the body called meridians, which connect organs and locations in the body with others. These flows become blocked or diverted, and sticking in the needles is supposed to correct them. In Reiki, the practitioner "realigns" forces with his or her hands.

It is much more difficult for me to see why anybody falls for this nonsense. The "vital energy,"  the chi of acupuncture, do not exist. The meridians do not exist. These ideas are purely imaginary. Life is not in fact precisely definable, nor is the border between life and death sharply defined, but life processes are based on the same forms of energy found independent of living things. Chemistry and physics give a complete account of life. Of course we haven't filled in the innumerable details of every life process, but there is no missing or mysterious form of energy. Chemical bonds break and form, heat (and yes, a little bit of electricity) flows, gravity pulls down (to put it in vernacular terms, sorry Dr. Einstein), electromagnetic radiation strikes the cells and has readily describable effects. (Some life forms produce electromagnetic radiation, but as far as I know we don't. We do have a weak electrical field, but it doesn't particularly do anything.)

There is, to be sure, growing interest in using electrical stimulation for various healing purposes, from orthopedics to neurology. But that's plain old electricity, folks, not the mystic force field. You don't make it by waving your hands around or sticking in needles. The useful therapeutic inputs include chemicals, heat (or cold), light, physical manipulation (e.g. compression, immobilization, mobilization, stretching, surgery), electricity. The same old boring energy that pertains to dead stuff.

Okay, it's not boring. It's science. Why isn't that good enough for folks?

Friday, February 15, 2013

And while we're on the subject of supplements . . .

Last time, I mentioned that lots of people take calcium supplements for "bone health." Well, you might want to think again. The linked article presents very complex statistical analysis, but to make a long story short the authors have done everything they can to control for potential confounding in an epidemiological cohort study. (They took advantage of a cohort of Swedish women recruited originally for a study of the benefits [or lack thereof] of screening mammography.)

The bottom line is that the body regulates the level of calcium in the blood very closely. Unless you have a real calcium deficiency, more calcium won't make your bones stronger, it will just be excreted. Up to a point, that is. The basic conclusion of this study is that calcium supplementation at low levels -- say from a multivitamin -- is probably harmless, but doesn't do you any good either. However, once you get above a certain threshold, about 1400 mg/day, which you can get from taking a specific calcium supplement, it sharply raises your risk for heart attacks and death.

So once again, the same message. Eat a half decent diet. Skip the supplements, you're wasting your money and more likely to be harming yourself than helping yourself. If you have a specific nutritional deficiency, it may be a different story. Talk to your doctor.

On another subject, Merck has agreed to pay investors $688 million for keeping secret the results of trials showing that it's highly profitable blockbuster drug Vytorin doesn't reduce the risk of heart disease. The company previously paid out a mere $41.5 million to consumers in a class action suit, and $5.4 million to state attorneys general. You may remember the advertisements featuring people dressed up to look like various foodstuff, touting the useless snake oil.

Sounds like a big victory for the good guys, right? Not so much. It's chump change. In its heyday, Vytorin was being prescribed at the rate of 800,000 new scrips per week, bringing in $5 billion in one year (2007). They made a ton of money, and had to cough up a few percent. That's why they keep doing it.

Wednesday, February 13, 2013

Firearms policy on Earth 2

A couple of essays in the new JAMA on gun violence: one by Kellerman and Rivara on Republicans' successful efforts to defund public health research on the subject; the other by Mozffarian and colleagues on possible effective public health measures based on analogy with other health hazards. (And props to JAMA for making these available to y'all commoners.)

What is astonishing about both of these ruminations is that they are simultaneously the very paradigm of common sense; and so politically naive as to be risible. I expect the authors know that, but they figured, what the heck?

As K and R recount, Congress in 1996 tried to de-fund the CDC Center for Injury Prevention altogether, because they were figuring out that keeping a gun in the house makes you more, not less, vulnerable to violence and death. They ended up backing off slightly, but the amount of funding originally spent on gun violence was earmarked for other purposes, and language inserted in the appropriation that forbade funds being used  to "advocate or promote gun control." Not wishing to risk their agency's existence of their own careers, CDC employees have assiduously avoided the issue ever since. The restriction was later applied to NIH.

As always, Republican epistemology is "If evidence might show that we are wrong, make sure we don't get any evidence."  Reality has a well-known liberal bias.

So, what do Mozaffarian and the gang propose? Noting that 85 Americans are killed by guns every day, they look to public health successes in the areas of tobacco, unintentional poisoning, and motor vehicle safety. We have made major progress reducing harm from all of these sources.

So why don't we tax firearms and ammunition to incorporate their actual social cost in the price and fund gun safety programs, as we have done with tobacco? Riiiigght.

Why don't we require keyed or code locked security devices on guns, analogous to childproof safety packaging on drugs and chemicals? Ha!

Why don't we require mandatory gun safety classes and licensing, as we do with drivers? In your dreams.

Why don't we have a sustained media campaign to de-glamorize guns, as we did with cigarettes? Instead of being manly and cool, in other words, guys who have to go around armed all the time are wimps. Uh huh.

The fact is that of all the measures they discuss, only restrictions on large capacity magazines are under any sort of serious discussion, and that's not going to happen. (And in case you think we're talking about restricting rapid fire semi-automatic weapons, no we aren't. We're only talking about restricting "assault weapons," which just means rapid fire semi-automatic weapons that have a certain bad ass look about them. Tone down the bad ass look, and the president's proposal is inapplicable.)

If we did even half of the above, we could significantly cut down on the carnage. And in case you're wondering, so far the Supreme Court would have no problem with any of it. (The media campaign would have to be conducted by private organizations, presumably, although the government could fund more straightforward educational messages.) But should I be spending my bandwidth on a hopeless cause?

Tuesday, February 12, 2013

Not that the corporate media will notice . . .

or in any way change its conventional presentation of the "Tea Party" as a) a party of some kind and b) a grassroots movement of down home regular murkins who are fed up with big gummint because they believe in freedom, but it is of course a phony astroturf movement funded by the Koch brothers, which grew out of the phony smokers' rights movement with its associated science denialism funded by the tobacco industry.

As I have said here many times, in the United States we do not have public political discourse organized around competing value systems, or competing analyses of facts in evidence. We have competing sets facts, classifiable by people capable of evaluating evidence as true and false.


True: The federal budget deficit is not the cause of our recent economic collapse and current sluggish recovery. Federal borrowing is not "crowding out" private investment. We have a shortage of demand, the cure for which is more, not less, government spending.

True: Rich people do not "create jobs," and they do not create more jobs if they are taxed less. Jobs are created when it is worthwhile to produce goods and services because there are people who want to spend the money to buy them. Right now, giving more people to rich people destroys jobs, because they are not inclined to spend most of their money.

True: In the long run, the projected large federal deficits are not caused by big government or any form of discretionary spending. (In my opinion, most military spending is wasteful but for the sake of argument I'll stipulate that to be debatable.) In any event, projected growth in deficits is not based on growth in military or domestic discretionary spending. Nor are they caused by Social Security. They are largely a product of projected increases in spending on health care, and contingent on our having historically low rates of taxation by modern standards. But . . .

The reason we spend so much on health care is not because people have insurance, or we don't have a "free market." It's because we have too much of a free market. Countries with socialized health insurance spend half as much, and get more. Ideology can't trump that fact.

True: Human activity, principally burning fossil fuel but also cutting down trees, is causing the climate to change, increasing the frequency and severity of storms and droughts, making the seas rise, and otherwise wreaking havoc.

True: Sugary soft drinks and other heavily marketed elements of the U.S. diet cause people to have diabetes, and other diseases.

And so on. The only reason we pretend to have a "debate" over these issues is because rich psychopaths pay to create phony controversies. A truly independent, professional and competent journalistic establishment would tell that story, and only that story, to the American public.

Friday, February 08, 2013

Boring academic wankery

Our latest paper has been published on-line, and you can read the abstract here. If you really want to read the whole thing, which I doubt, send me an e-mail and I'll send you the PDF.

The abstract doesn't really do it justice. What we've done is break some outpatient visits into pieces -- all of the various issues that come up -- and keep track of how they are processed. It turns out, among other observations, that about half of them either don't require that anything be done, or there is in fact nothing that can be done. This isn't necessarily bad -- docs need to check in on stuff, people need to bring up stuff that's worrying them even if it turns out to be not a problem. It's just what it is.

Also, there are huge differences in the way the interaction looks depending on what task is being done. While we're trying to understand what's wrong or what's going on, the physicians ask a whole lot of closed questions and the patients give information in response. This actually takes up the bulk of most visits. There is also some patient education/information giving, during which patients ask more questions than do providers, no surprise, but not a lot more. When decisions are being made about treatment, doctors do most of the talking, patients seldom express their own wishes or ask questions, and doctors pretty much just say "This is what we'll do." So shared decision making or patient choice are quite scarce, at least in this data.

So that's a lot of what I do. We're pressing on with these methods now in other contexts, and I'm actually hoping to learn something. Meanwhile, when you go to the doctor, don't be afraid to speak up, and ask for an explanation of why a particular treatment is recommended -- or just given to you -- and whether there are alternatives you might want to know about. It turns out, by the way, that when that happens, people tend to end up using less drugs and getting fewer procedures. Which is probably good for you.

Wednesday, February 06, 2013

A Good Death

Some of my colleagues have used Medicare claims data to track the trajectories of dying people in 2000, 2005 and 2009. The article in JAMA is a dense, hard to read recitation of numbers, basically, so let me just unpack it for you.

Superficially, it looks like good news: many fewer people died in acute care hospitals in 2009 than in 2000 (24.6% vs. 32.6%). Most people say they prefer to die at home, but failing that, a good quality nursing home is usually a much better environment than an intensive care unit. If you're shuffling off anyhow, you don't want to be hooked up to machines with weird noises and flashing lights and strangers shoving tubes into you and whatnot. And more good news: the percentage of people receiving hospice services at the time of death went up from 21.6% to 42.2%.

But, you knew there was a "but," right?

The problem is that despite what happened at the very end, more people were hospitalized, more often, during the last months of life, and many of those people who got hospice services got it for only a day or two. In other words, we're still putting dying people in the hospital, in fact more so than before, it's just that they don't stay there until the moment of death as often, they tend to get shipped out a day or two ahead. That isn't really progress.

Now it's not clear how many of these hospitalizations were "appropriate." It's hard to predict who is going to die soon and some percentage of them no doubt looked they had a chance to pull through. But most of them are people who were clearly dying, perhaps in a nursing home already, who got sent to the hospital to get an IV antibiotic infusion or emergency rehydration or some such essentially pointless treatment.

I don't mind telling you that my father could well be in this data. (It's a 20% random sample of all the deaths of people on fee-for-service Medicare in those years.) He died in 2009, in a nursing home, receiving only palliative care, and he was not hospitalized even once in his last two years of life. But it wasn't easy for my mother and I to achieve that. My mother had to write a letter (with my help) to the nursing home, stating that she did not want my father, who was severely demented, to be hospitalized or tube fed. She had to sit down with the nursing director and have a lengthy conversation in which the nursing director tried to talk her out of it.

There is, believe it or not, a financial incentive for nursing homes to hospitalize people. They get paid by Medicaid to hold the bed while the person is in the hospital, during which time they don't have to take care of the person; and then they may be able to get paid by Medicare for a period after the person returns, which is better money than Medicaid.

So until we straighten out our completely batshit crazy health care financing non-system, it's going to be very hard to fix this or any other problem.

We need universal, comprehensive, single payer national health care.

Tuesday, February 05, 2013

Why you are wasting your money

A couple of days ago I posted about the uselessness of dietary supplements for most people. Right on cue, some folks writing in JAMA Internal Medicine let us know what people think they are doing when they take the snake oil.

It turns out that 45% of all U.S. adults say they take dietary supplements -- mostly multivitamins -- "to improve overall health," while about 1/3 say they do it "to maintain health." Other prevalent reasons include "to prevent health problems" (20%), for heart health (15%) to "boost immunity" or prevent colds (14.5%), for healthy joints or to prevent arthritis, (12.4%), for enhanced energy, skin health, eye health, mental health, weight loss . . .

Reality check: it is all bullshit. Dietary supplements for the general public do none of the above. These authors are a bit coy about that conclusion. They review evidence, all of which is negative, and then call it mixed or unconvincing. It's convincing, folks. What has happened to you is that people on teevee lied to you, and you fell for it. Unless your doctor has identified a specific condition for which you require a nutritional supplement, there is no reason to take vitamin pills, or iron (which can actually be quite bad for you in excess!), or fish oil, or even calcium. (I delayed mention of the bone health motivation, which 1/4 of people, mostly women, give because some women have been told by their physicians that they should take calcium supplements. I doubt this really applies to 1/4 of all people, or 40% of women, however, and it's somewhat controversial anyway.)

There are a couple of other gray areas or open questions. Some people, those with dark skin in particular, might benefit from vitamin D, although this has been questioned. There is maybe a little bit of a fuzzy zone between some specific foods and dietary supplementation, olive oil, very high fiber foods like bran, there are other examples. Some foods are routinely supplemented -- e.g. folic acid and iron in refined wheat, vitamin D in milk -- which replaces what otherwise might be supplements that might reasonably be indicated for more people. But really folks. Talk to your physician, and unless there's something specific going on, you should probably save your money.

Monday, February 04, 2013

Guns don't kill people,

people kill themselves. With guns.

I haven't had a whole lot to say about the big gun safety debate going on right now in part because, if I'm going to be contrarian, I want to take the time to get my ground under me.

First, I actually find highly offensive the repeated calls by people who are ostensibly progressive and ought to know better that a priority should be to keep guns out of the hands of the mentally ill. As I have repeatedly discussed here, according to the American Psychiatric Association, half of the population is mentally ill at some point in their lives, and almost 1/4 of us are "mentally ill" right now. I actually think that's preposterous and largely consists of fake "diseases," but that's more or less beside the point. It does happen to be true that rampage killers are usually diagnosable with something, but that's pretty much tautological. The question is whether psychiatrists or anybody else can actually predict who will act violently and the answer to that is, the only really useful predictor of violent behavior is past violent behavior.

So no, preventing "mentally ill" people from buying guns is a) useless and b) offensively discriminatory. Keeping guns out of the hands of people who have been convicted of violent crimes is potentially useful, but that's already generally the law in most states as far as I know. Whether this is actually possible, however, given that guns already outnumber people in the U.S., is another question.

Second there is the nonsensical issue of assault weapons. An assault weapon is just a semi-automatic rifle with certain largely cosmetic features, such as a bayonet mount. There is something culturally repellent about them - the only reason people want to own them is so they can fantasize about being soldiers or committing mass mayhem. But they aren't functionally more dangerous than other semi-automatic weapons. Rifles in general are far more accurate at more than modest distance than are handguns, but handguns are actually responsible for most gun injuries and deaths in the U.S. I just don't see banning the sale of particular categories of firearms as being meaningful.

Large capacity magazines? Okay, those have no purpose other than killing large numbers of people in a short time. There's a perfectly good case for banning them, although again, it's probably too late to stop people who want them from getting them on a secondary market, given how many gazillions are already out there.

But now here's the real truth about gun violence. Congress has prevented the CDC or NIH from funding studies of gun injuries, because ignorance is patriotic, but people study the issue anyway. Most gun deaths in the U.S. are suicides, not homicides. If you have a gun in your house, I don't know exactly what the chances are that you will ever use it to defend yourself against an intruder. As we've seen lately in too many cases, the intruder you shoot is likely to turn out to be your own spouse or son, but that aside, I'm going to take an educated guess and say that the likelihood you will kill yourself with your gun is at least 4 orders of magnitude, i.e. 10,000 times as great, than the likelihood you will successfully defend yourself with it.

Most people who haven't studied the issue assume that people who commit suicide are determined and will spend time and effort to find a way. Mostly, that just isn't so. It's an impulsive act. It's also usually unsuccessful -- unless you use a gun. The reason is pretty obvious. The purpose of guns is to kill people. They work very well. And they work quickly. Grab the gun, point at your temple or put it in your mouth, and shoot. Badabing badaboom. You haven't been convicted of a felony, you haven't been committed to a secure mental institution as a danger to yourself and others, and the gun you're using is perfectly legal, probably a handgun with six rounds. You only need one. If you had been forced to take time to plan a way, or tried a less effective method, you would probably be alive.

That's the real truth about gun violence. The best way to keep yourself safe is not to have one; or failing that, keep it locked in a safe and unloaded in between bouts of shooting cans off the top of the fence. Really. Other than that, I can't see banning any particular products as making much of a difference.

Friday, February 01, 2013

Vitamin pills: Nothing will come of nothing

This meta-analysis in the new BMJ is the most zero finding ever. I mean to tell you, the bottom line is zip, zilch, nada, bupkis, totally nothing: taking vitamin supplements, be they specifically anti-oxidant vitamins or multi-vitamins or whatever you want absolutely, positively, does not prevent heart disease or the bad consequences thereof based on a huge amount of unusually consistent evidence.

Other reviews have found that vitamin supplements don't prevent cancer -- in fact certain vitamin supplements actually increase the risk of cancer in smokers. Taking vitamin supplements doesn't make you live longer, doesn't stop your hair from falling out, doesn't do a damn thing for you as long as you eat a half decent diet and don't have a specific disease (such as pernicious anemia) that requires supplementation.

These products are heavily marketed, you see them on teevee all the time. Ignore the advertisements. Save your money. Eat your veggies.

That is all.