Your Facebook Friends Are Wrong

 

Scientific studies can be difficult for a lay person to interpret, so it is not surprising that we rely on intermediaries - news outlets, social media, well meaning friends - to help us understand them. Every field has its own specialized technical jargon and the design and execution of the studies themselves can be complex. Unfortunately this leaves a lot of room for misinterpretation, both accidental and intentional. News media cherry pick studies and misrepresent their meaning, typically through ignorance. Organizations will search for studies and data that support their agenda and ignore any that don't. Critical context is often lost in the rush to post a great story. And the technicalities of statistical significance and study design are often just ignored.

Would you like to get better at interpreting the news of medical studies and new developments? Would you prefer to be a more critical and informed consumer of social media without having to get a medical degree?

Here is an option. A free course that explains how study design works and what questions to ask to intelligently interpret the results. "Understanding Medical Research: Your Facebook Friend is Wrong" will give you the basics you need to sort through all the noise and separate fact from wishful thinking, or worse. The instructor is from Yale University and knows his stuff.

Four Lifestyle Tips to Lower Cholesterol

 

 

Healthy cholesterol levels are pretty much the same for all adults. These are a Total Cholesterol under 200mg/dL, LDL (Bad) Cholesterol under 100mg/dL and HDL (Good) Choesterol at or above 40mg/dL (50mg/dL for women). The LDL and HDL numbers are the more significant ones for assessing your hearth health, along with keeping Tiglyceride levels under 150mg/dL. Do you know your numbers?

Whatever your levels, the following four lifestyle factors, taken together, will improve your cholesterol levels and lower your overall risk for heart disease.

Eat Smarter. Limit your consumption of red and processed meats, fried foods, sodium and added sugar. Focus on whole grains, poultry, fish and healthy fats.

Get Off Your Butt. Move more. Exercise like brisk walking is ideal but at least get on your feet and move. Aerobic exercise can help raise your HDL levels and resistance/strength training helps lower LDL.

Lose the Extra Weight. If you are overweight even a little - and 70% of us are - lose the excess. What is a healthy weight for you? It's less than you think it is. While it is complex and different for everyone, here is a calculator that will get you in the ballpark.

Stop Smoking. Seriously. Do you still need to be told this? And don't delude yourself that vaping isn't smoking.

There are effective medications for optimizing your cholesterol levels but they all come with unpleasant and potentially serious side effects. So why not try these things first?

Happy Thanksgiving

 

For me Thanksgiving is a day to take a deep breath and remind myself of all the things I have, the ways in which I am fortunate and everything that there is in my life to be grateful for. 

I do an exercise each Thanksgiving Day of sitting down in a quiet place and making a list - with pen and paper - of 100 things that I am thankful for. It is a great thing to have at hand throughout the year for whenever I am feeling sorry for myself or get caught up in thinking about all the things I don't have.

It is also the perfect day to pause to give some thought to those people who are no longer with me to celebrate it - more and more of them every year. 

Whatever your family traditions may be, however you celebrate Thanksgiving Day, I want to wish you a happy, healthy and special holiday. Be well, do good works.

 

Rolling the Dice on Social Media

 

Long gone are the days of people getting most of their news from a local TV station, their local newspaper or the national newscast from one of the networks. Increasingly, people turn to social media for news and information. Facebook leads with 36% of social media consumers using the social media giant for consuming news. Instagram news consumers were 11% of the social media population. Twitter was statistically tied at 12%. YouTube had 21% of social media users looking at news on the popular video site. WhatsApp had 16%. This is so even though, according to reports from Gallup and the Knight Foundation,  Americans believe that 65 percent of news on social media is made up or can’t be verified as accurate.

So increasing numbers of people are relying for their news and information on sources that they view as increasingly unreliable. Besides being just goofy, this has serious implications for our health and wellness too.

A recent study published in the Journal of the National Cancer Institute looked at the quality of cancer treatment information available on social media and the results were not encouraging. The researchers found that 32% of articles on Facebook, Pinterest, Reddit and Twitter giving advice on cancer treatment contained "misinformation and potential for harm". Generally the errors prompted readers to postpone therapy or try ineffective or inappropriate remedies. 

This is not simply being misinformed. It is potentially life threatening.

There is nothing on the horizon to suggest that the information you glean from social media is becoming any more reliable. Perhaps it is time to restrict your social media time to cat photos and catching up with family and friends and find your news and information elsewhere.

 

The Food Labeling Wars Continue

 

 

One has to wonder why every time food labels are enhanced to include more accurate and complete information about what is in it, the food industry shrieks as though bitten in a tender place by a very angry dog. You might almost think they oppose pretty much any change in labeling regulations because they are hiding something.

The Food Labeling Modernization Act (HR4917) was recently introduced by Congressman Frank Pallone, Jr. of New Jersey and is presently in the House Energy and Commerce Committee. The proposed bill would mandate several changes to required food labels including nutrition summary labels on the front of food packages and warnings of excessive amounts of substances such as added sugar and sodium. If a food package highlights a specific ingredient, say, "whole grains", "fiber" or "real" fruits or vegetables, it would be required to list how much of it the product actually contains. Finally, food manufacturers would be required to list complete nutrition and ingredient information for their products on their web sites.

Food manufacturers are not amused and are fighting hard to spare us the "confusion" that the new labeling requirements would cause.

Meanwhile, Brian Ronholm, Director of Food Policy for Consumer Reports, points out that under present rules "claims about healthy ingredients are sometimes used even if the product has only a very small amount." For example, in a recent Consumer Reports review of 56 breads touting "whole grain" and "multi grain" content nearly all contained little else than refined wheat flour. "The bill would make labels simpler, clearer and more informative," Ronholm says, "and reduce the chance that consumers will perceive food as being more nutritious than it really is." Sounds confusing to me!

This would be an excellent time to let your Representative know that you want his or her support on this bill.

Foods Better Frozen Than Fresh

 

It may seem counterintuitive to use frozen ingredients instead of fresh. In fact, in some situations frozen can be better than the fresh alternative. This can be true for a number of reasons. 

There is essentially no nutritional difference between frozen and fresh fruits and vegetables, and frozen fruits/vegetables retain their nutritional value while fresh ones have decreased levels of nutrients after being stored for a few days.

Frozen foods will not spoil for months and with vegetables and fruits that are prewashed and cut, you can reduce your meal prep time and add more healthy foods to your meals.

Frozen foods are often less expensive than fresh ones, especially if you’re thinking about fresh organic foods. Frozen vegetables give you the option to pull some out only when you want them and then put them back until later. With fresh fruits and vegetables, you typically need to consume them all soon after purchase. So frozen reduces waste.

One study looking at the impact of fruit and vegetable storage options discovered that frozen fruits and vegetables can have more antioxidants than their refrigerator-stored counterparts. It turns out that freezing them preserves the antioxidants, and letting the fruit sit in a refrigerator causes some of that free radical fighting power to be leached away.

Finally, frozen can actually be "fresher than fresh". Modern ‘harvest-to-freeze’ technology has evolved so much that fresh fruits and vegetables are picked when they’re ripe, full of flavor and nutritional value, and then quickly frozen. Whereas the fruits and vegetables you buy in the grocery store that are purported to be fresh have actually been picked prematurely and spent days or even weeks in transit.

Here are five foods that you should consider buying frozen rather than fresh.

Shelled Peas.

Peas taste amazing in the spring, when they’re fresh and filled with nutrients, and not so great anytime after that. You can capture that healthy flavor all year long by cooking with frozen peas. As a bonus, they’re already shelled so they’re easier to cook with, too!

Berries.

When berries are in season, you should definitely seek them out at the farmers market. The rest of the year, choose frozen berries. They’re picked and packed at the peak of freshness, and they won’t lose their antioxidant-rich properties in the freezer either.

Spinach.

If you are making a salad by all means stick to the fresh stuff, but use frozen spinach for any cooked dish. Frozen spinach lasts longer and is typically less expensive than the fresh stuff. Plus, freezing spinach actually makes it more nutritious, increasing its concentration of thiamine and beta-carotene.

Corn.

(Yes, I know corn is a grain. Humor me.) Corn is not only expensive when it’s out-of-season, but it also doesn’t taste that great. Frozen corn, on the other hand, is packed at the peak of the season, so it’ll taste sweet and delicious any time of year.

Bell Peppers.

Bell peppers lose their nutrients super fast. In fact, the vitamin C found in peppers starts to oxidize as soon as the peppers are chopped! Freezing the peppers stops the process, preserving the nutrients more efficiently. Plus, you won’t have to worry about de-seeding the peppers if you buy them frozen.

If, like me, you get tired of throwing away produce that has gone bad while waiting for you to use it, frozen provides a healthy, convenient and less expensive alternative for you to try.

It's Not Dead Yet!

 

I don't really talk much about Covid-19 because conversations usually become arguments where little information is exchanged and no minds are changed. But I recently read an article in the Bottom Line Health newsletter about what is likely ahead for us regarding Covid. Bottom Line publications are not always rigorous but they do provide timely information free of political bias and backed up by verifiable references, so I thought I would share the key points. Take them or leave them, I'm not looking for an argument.

The article was written by Dr. Joseph Feuerstein, a professor of clinical medicine at Columbia University and the director of integrative medicine at Stamford Hospital. Here is his take on what we can expect over the coming weeks and months.

Expect more variants. There are now more than a dozen variants of the original virus and we should expect more, possibly many more. Viruses always mutate and new strains continually develop when they are not held on check. Most variants are harmless but some will be more contagious or cause more severe symptoms.

Vaccines are safe. There is no question that vaccines were approved conditionally and rushed into production. Concerns about their safety were overblown but not unreasonable. But now there is a peer reviewed study of nearly 2 million people published in the New England Journal of Medicine that has concluded that the mRNA vaccines are both effective and extremely safe. 

Herd immunity is out of reach. At least any time soon. It was hoped that when enough people had been vaccinated that Covid would effectively run out of opportunities to spread. For better or worse, not enough people are getting vaccinated and it does not look like enough ever will. So the virus will continue to mutate and spread.

Get used to booster shots. The effectiveness of the existing vaccines appears to lessen after 9 to 12 months. So expect to be taking regular booster shots that will maintain your immunity as well as address the threats posed by new variants.

Keep your vaccination card safe and handy. The time is coming when you will need it to gain entry to many public places and events. This will vary State by State unless the Federal government establishes a national standard. You will certainly need it for any foreign travel so keep it with your passport.

Schools will continue to struggle with infections. The politicization of mask mandates and vaccinations mean that we will continue to see increasing infection rates among school-age children. There is no appetite for a return to virtual learning so the arguing will continue until mounting transmissions and outbreaks force localities to change, probably after the worst damage has already been done.

Effective treatments for the virus are on the way. Two new drugs for treating Covid are in clinical trials and may start to be available as soon as the end of 2021. More are sure to follow.

Is Obesity a Disease?

 

In June 2013, the American Medical Association (AMA) House of Delegates voted to recognize obesity as a disease requiring treatment and prevention efforts. A number of other medical societies had sponsored a resolution to support this idea, including the American Association of Clinical Endocrinologists, the Endocrine Society, the American College of Cardiology, the American College of Surgeons, and the American Heart Association. The National Institutes of Health had declared obesity a disease in 1998.

The AMA's decision remains controversial, since the AMA’s own Council on Science and Public Health in 2012 said that there was not sufficient data to support calling obesity a disease. So then is obesity a clinical condition or a behavioral problem?

Right now, 42% of the population of the USA are obese (a BMI of 30 or higher). Another 30% are overweight. And despite spending $3.7B on weight loss products and programs in 2020 more than 70% of us are overweight and the number keeps growing year after year. Being overweight is a risk factor for over 200 chronic diseases including cancers, hypertension, diabetes, arthritis and heart disease.

In designating obesity as a disease, the AMA recognized that it is not simply a matter of choice and willpower but of a complex set of factors that include genetics, socioeconomic status, education, medications that a person may be taking, sleep quality and more. This does not negate the timeless advice to "eat less and move more". But it suggests that it is a condition serious enough to merit the attention of doctors and other healthcare practitioners. 

The stigma associated with obesity is also an important factor. No one who is obese does not realize it. But, unlike a person hobbled by arthritis or insulin dependence, they are often shamed and told to "just stop eating so much". There is no shame in needing therapy to treat a cancer but many obese people are too ashamed of their condition to seek help.

Another mitigating factor is the lack of insurance coverage for weight loss support programs. Considering the the serious and widespread negative public health impact of obesity this may seem strange. But as long as it is seen as purely a matter of personal choice and willpower, insurance companies are reluctant to provide coverage.

No one is saying that a healthy lifestyle that includes whole, nutrient-dense foods, exercise, stress management and restful sleep is not the foundation of weight loss. But many people are not able to succeed at it. Failing to recognize it as a serious health condition, if not a disease, worthy of support and attention from insurers, doctors, the healthcare community and society at large seems likely to allow the alarming prevalence of obesity to continue to grow.

If I Can Do It So Can You

I talk a lot on here about weight. Where it comes from, why too much is bad and how to lose it. I base what I say on what I read (I'm a pretty critical reader) but more importantly I base it on my own real life experience. At the start of 2020 I was heavier than I had ever been in my life. So much so that I felt crappy, my joints hurt, I had no energy, was sleeping poorly and could not fit into my pants.

I'd been there before. I knew I could drop some weight just by eating less for a while because I had done it many times before. But this time I wanted to do it sustainably. I didn't want to gain it all back again. The graph above shows my progress from February 2020 to today.

No special diets. No weight loss programs. No gym membership. Just eating a better diet, exercising and burning more calories than I consumed. No tricks, no magic and if I could do it, anyone can.

If you would like more detail on exactly what I did, drop a comment and I am happy to send it your way.

The Aduhelm Fiasco

 

In June of last year, to great media fanfare, the FDA approved the new drug Aduhelm (aducanumab) to treat Alzheimer's disease. Six million Americans suffer from Alzheimer's, which is a horrific and ultimately fatal form of dementia, and available drugs typically delay cognitive decline by only a few months at best. So any new medication is eagerly welcome. If it works, that is. And if anyone can afford it.

Two clinical trials of Aduhelm had concluded that the drug was so unlikely to slow the progression of the disease that both trials should be stopped early. They were.

Six months later, Biogen, the manufacturer of the drug, announced that they had analyzed the data more carefully and that the study group receiving the highest dose had actually improved. Based on this new information the FDA convened an external advisory committee to examine the evidence. 

"The totality of the data does not seem to provide sufficient evidence to support the efficacy of the high does," the FDA's internal analysis concluded, noting that even the "favorable" results presented by Biogen produced only a 0.4 point improvement on an 18 point scale. The advisory committee voted 10 to 0 against approving Aduhelm.

Instead, the FDA approved the drug, justifying its decision by citing that it appears to reduce the amyloid plaques often seen in Alzheimer's patients - despite the fact that there is no proof that the plaques cause the disease, rather than just being a symptom of it. Three  committee members resigned in protest. Further, the drug was approved for all Alzheimer's patients, not just the early stage patients on whom it was tested. (Did I mention that the list price of Aduhelm is $56,000 a year?)

Fortunately, new leadership at the FDA is taking a new look. In July, 2021, the FDA changed its recommendation and said that only people with early stage Alzheimer's should use the drug. That same month, the FDA's Acting Director ordered in independent investigation of the agency's approval process, citing an "off the books" meeting between the head of the FDA's neuroscience division and Biogen executives.

So there you have it. An enormously expensive drug that is mostly ineffective and has side effects such as brain bleeds and swelling approved against the advice of the FDA's own annalists and independent advisors. Doesn't sound like anything is amiss here to me. How about you?

Shrinkflation

 

 

No one is going to be surprised to hear that prices have been going up lately. Post-Covid inflation is bringing price increases across a wide range of goods and services from gas for your car to food for your family. What you may not know is that food prices have been going up for years, long before the current bout of inflation. The cause? Shrinkflation.

Shrinkflation, also known as grocery shrink ray or contents downsizing, is the process of items shrinking in size or quantity, or even sometimes reformulating or reducing quality, while their prices remain the same or even go up a bit. You aren't paying more, but you are getting less. And unsurprisingly, manufacturers carefully disguise this from you. For example, packaging is usually identical, it just contains less. "New and Improved" often means nothing more than less product in a redesigned package.

Instead of increasing the price of a product, something that would be immediately evident to consumers, producers reduce the size of the product while maintaining the same price. The absolute price of the product doesn’t go up, but the price per unit of weight or volume has increased. The small reduction in quantity is usually unnoticed by consumers (at least that’s what the manufacturer hopes). Producers always indicate the weight, volume, or quantity of their products on packaging labels. So it’s not illegal – it’s just sneaky.

Some examples....

Coca-Cola: in 2014, Coca-cola reduced the size of its large bottle from 2 liters to 1.75 liters. The price did not change.

Toblerone: in 2010, Kraft slashed the weight of Toblerone bars from 200 grams to 170 grams. The price did not change.

Tetley: in 2010, Tetley reduced the number of teabags sold in one box from 100 to 88. The price did not change.

Toothpaste: a tube of toothpaste used to contain 7.2 pounces of product. Now nearly all brands contain only 5 ounces... but the size of the tube, like the price, is unchanged.

Other common victims of shrinkflation include breakfast cereals, toilet paper, canned tuna, ice cream, coffee, peanut butter and canned anything.

There is not a lot that you can do about these ubiquitous hidden price increases. But you can at least be aware of them by checking the "unit cost" information that is posted by grocers along the edgers of their shelves.

Patently Ridiculous

 

Developing an effective new drug and then bringing it to market is an expensive process. A very expensive process. In an analysis of the drug development costs for 98 companies over a decade, the average cost per drug developed and approved by a single-drug company was $350 million. But for companies that approved between eight and 13 drugs over 10 years, the cost per drug went as high as $5.5 billion, due mainly to geographic expansion for marketing and ongoing costs for Phase IV trials and continuous monitoring for safety. Any way you look at it, that is a lot of money.

Drug companies often cite these high costs as justification for the often astronomical prices of drugs on the market. Most people would agree that investing in the development of important new drugs is a social good and should be well rewarded. But according to Andrew Witty, the former CEO of GlaxoSmithKline, one of the largest pharmaceutical companies in the world, the R&D costs cited by drug manufacturers are "one of the great myths of the industry". Why? Because of the patent system.

Patent protection allows a company to sell the product that it developed for over a decade without any competition. Its no secret that brand name drugs are more expensive than essentially identical generic versions of the same drug, and the difference is growing rapidly. In 2013, brand name drugs were about 6 times more expensive than generics; by 2017 - just 4 years later - they are 18 times as expensive. The patent system prevents generic drugs from even being sold so long as the patent is valid (about 10 years in most cases). Ten years of charging 18 times what a competitor would charge for a product people urgently need.

But wait! There's more!

Drug companies are constantly gaming the system by making insignificant changes to a drug as it comes out of patent protection - making it a pill instead of a capsule or changing the dosage or targeting it at a different condition - and then patenting the same drug all over again. And when a drug does come off patent protection, it is not uncommon for a drug company to simply pay generic manufacturers to not produce a generic version of a profitable drug.

There is much more behind the high cost of drugs than just the patent protection system. But do we really want to tolerate a system that lets us pay $200 for a drug that we could buy for $10 in Toronto?

What can you do to protect yourself? Often nothing. But here are a few things you can do.

1. Drugs do not cost the same everywhere. Shop around. If you have a chronic condition be sure to investigate online sources.

2. Do not assume that your health insurance will get you the best price. If can often be cheaper to use a pharmacy discount card or, if you have hefty copays, to just pay for it yourself. (Truth.)

3. ALWAYS ask you doctor if there is a generic or cheaper brand name version of what you need. Doctors tend to prescribe what they are familiar with without regard to the cost.

4. ALWAYS ask your doctor or pharmacist if a combination drug would be cheaper to buy as individual components. In some unusual cases this can reduce the cost as much as 96%.

5. Review your medications at every doctor visit and make sure you still need to be taking them. Doctors will rarely suggest stopping a medication.

Better yet, make the diet and lifestyle changes that will minimize or eliminate the need to tale medication at all.

Are You Confused?

 

The Department of Health and Human Services (HHS) recently proposed a new rule that drug manufacturers don't like. They don't like it a lot. In fact they are pulling out all the stops to prevent the rule from ever taking effect.

What is this controversial new rule? HHS wants drug companies to be required to reveal the "list price" of all medications they advertise on TV. The rule would apply to any drug costing more than $35 for a monthly dose. 

The $35 limit is laughable, but drug companies aren't laughing. Not when a monthly supply of Humira rheumatoid arthritis pens costs $5,684. Even that seems like a bargain compared to the common multiple sclerosis drug mavenclad, which will set you back over $60,000 a month. And many cancer drugs, while not usually advertised on TV and so not subject to the proposed rule, can cost over $100,000.

Why are the manufacturers so unwilling to share prices in their ads? Really, its all about protecting you! Because if they were to make their prices public, you, the consumer, might be "confused".

Or is it that with price information the consumer might decide to shop around for a better deal? Nah. That would be even more confusing.

Are you confused?