News and Studies

Opinionated analysis of news stories and studies, as well as how to understand study data. NEWS ANALYSIS zone.

Nov 062015
 

Relative versus absolute risk is a vital concept for you to understand in a discussion with your doctor.

Any recommendation from your doctor will probably have some expected benefit. Usually, expected benefit is framed as a percentage. For example, “This Wonder Pill will reduce your risk of cancer recurrence by 50%.”

That sounds awesome.

(Cool tip: You know what else can reduce your risk of breast cancer recurrence by 50%? Exercise! Specifically, three to five hours of moderate exercise such as walking per week. More info from Dana Farber at this link.)

It’s easy to hear this and imagine 100 people who have had breast cancer, 50 of whom will be saved by taking the Wonder Pill (or by exercising). That would be a 50% absolute risk reduction.

But that’s not true. It’s a trick your brain plays on you when it hears the words, “50 percent.”

The Idea of Relative Risk

What does that 50% risk reduction really mean? Well, it depends on your starting point — what your risk of recurrence is to begin with, at the moment before you begin taking the Wonder Pill (or exercising!).

For cancer patients, that varies based a huge number of variables, including the type of cancer, the stage of the cancer, the aggressiveness of the cancer, what prior therapy you’ve had (e.g., surgery), and so on. So you need to know your current starting point in order to understand what that 50% means for you.

The Key Is Absolute Risk

Let’s look at two examples.

Patient A has an aggressive cancer. Therefore, Patient A has a 30% risk of recurrence even after surgery, chemotherapy and radiation. This is called the residual risk. The Wonder Pill will reduce Patient A’s risk of recurrence by 50%. That means after taking the Wonder Pill, Patient A will have a 15% risk of recurrence.

Fifty percent is the relative benefit (the relative risk reduction) that Patient A will get from taking the Wonder Pill. The absolute benefit to Patient A is 15% (30% – 15%).

Now let’s turn to Patient B.

Patient B has a less aggressive cancer. Therefore, Patient B has a 10% risk of recurrence after surgery and radiation (no chemotherapy was prescribed, due to the cancer’s low aggressiveness). This is Patient B’s residual risk. The Wonder Pill will reduce Patient B’s risk of recurrence by 50% — the same relative benefit Patient A received. However, the absolute benefit is very different.

After taking the Wonder Pill, Patient B will have a 5% risk of recurrence. The absolute benefit to Patient B is 5% (10% – 5%).

As you can see, the difference between relative risk (or relative benefit) and absolute risk (or absolute benefit) is very important.

Make sure you understand which one you’re talking about when your doctor presents risk reduction figures.

Case Study: Absolute Benefit of Statins

For a real-life discussion of relative versus absolute risk, you can read this article about statins for heart disease:

http://www.thennt.com/nnt/statins-for-heart-disease-prevention-without-prior-heart-disease/

This article focuses on a medium-risk population (with a 25% risk of heart attack, stroke or death in the next 10 years). Even given those risk factors, the authors question the absolute benefits of statins. Here’s a key quote from the article (the 1.6% and 0.37% risk reductions referenced below are absolute risk reductions):

“It takes 5 years of daily statin therapy to achieve a 1.6% chance of avoiding a heart attack, and a 0.37% chance of avoiding a stroke. Most disappointing, statins seem unable to prevent death in this group. And most concerning, the drugs may increase diabetes, a serious and life-altering disease.”

How to Ask Your Doctor About Relative vs Absolute Risk

The complexities of relative versus absolute risk can get intricate. But you can understand the basics enough to have an informed discussion with your doctor. In fact, it’s vital that you understand what you are actually gaining from any medical (or lifestyle!) decision.

Here’s how to phrase the question:

“Is that a relative or absolute risk reduction?” or, “Is that a relative or absolute benefit?”

If you don’t understand the implications of the answer you hear right away, don’t worry. Write it down, research it later, and then ask any follow-up questions to your doctor. You have time to become informed, and you deserve to understand the decisions you’re making.

Nov 032015
 

First, the good news: Consumers’ demand for organic food is getting recognized by food companies! Chipotle has removed GMOs from its food, so even fast food can be real food. Juice bars abound. Regular supermarkets often have organic produce racks and aisles dedicated to healthier food. That’s awesome! It makes life so much easier.

Now the bad news: More food than ever before sounds healthy and great for you, but isn’t. It’s a war of labeling.

One of the words most often used to make a food sound healthy is “natural.” Food packaging also may use varieties like, “All Natural.”

The truth is, natural means (almost) nothing in the U.S.

The Definition of ‘Natural’ in Food Labeling

To be exact, there is a definition for “Natural,” at least for U.S. meat and poultry products. The USDA states that “Natural” means: “A product containing no artificial ingredient or added color and is only minimally processed. Minimal processing means that the product was processed in a manner that does not fundamentally alter the product. The label must include a statement explaining the meaning of the term natural (such as ‘no artificial ingredients; minimally processed’).”

This definition applies only to meat and poultry. It also says nothing about antibiotics, GMO feed (which is not considered an artificial ingredient), or hormones.

Antibiotics, Hormones and Free Range?

So what really means “no antibiotics”? The answer is, “No antibiotics.” Here’s the USDA on that: “The terms ‘no antibiotics added’ may be used on labels for meat or poultry products if sufficient documentation is provided by the producer to the Agency demonstrating that the animals were raised without antibiotics.”

Similarly, “no hormones” means no hormones (but only for beef, since hormones are prohibited in pork and chicken). And “free range”? All that means is that the animal had access to the outside. It doesn’t necessarily mean happy cows wandering around a pasture.

“Natural” doesn’t mean any of these things. To cut through the jargon, essentially, natural means very little.

It’s Not Just Meat and Poultry

The FDA, too, tap-dances around the issue: “….FDA has not developed a definition for use of the term natural or its derivatives. However, the agency has not objected to the use of the term if the food does not contain added color, artificial flavors, or synthetic substances.”

So, all “natural” seems to mean is a lack of artificial colors and flavors — and I’m not sure who enforces that stricture. An animal product labeled “natural” can be treated routinely with antibiotics and hormones, caged indoors for most of its life, and given genetically modified feed. A processed food product can contain byproducts from these animals or genetically modified ingredients that were originally sprayed with dangerous pesticides.

That doesn’t sound very natural, does it?

Organic for the Win: Definitions, Standards, Inspections

What does mean something?

Organic.

Organic means:

  • A lack of most synthetic pesticides and fertilizers
  • Animals raised in more humane conditions and often allowed to graze
  • Animals that ate 100% organic feed (which is not genetically modified)
  • No antibiotics or hormones
  • Documented processes and annual inspections to confirm compliance (actual enforcement!)

More detail is available from the USDA. Notably, they state that products labeled as “made with organic” ingredients can contain about 30% non-organic ingredients — but can’t carry the USDA organic seal. So the USDA organic seal is really the quality marker that means a product is truly organic. (For fruits and vegetables, look for a “9” in front of the four-digit product ID number on the sticker.)

(Note: There’s a controversy about whether sick animals should be permitted to receive antibiotics. I believe they should be permitted to receive them, although under current organic guidelines, they are not. But I do NOT believe routine antibiotic use should be permitted, in either conventional or organic animals. I do buy organic animal products, because I believe it’s the lesser of two evils.)

So keep an eye out when shopping, and remember that “natural” food can be pretty far from the idyllic image that word evokes.

Go organic!

Oct 062015
 

A recent article on Mercola.com got me thinking about the Buteyko breathing method.

I first read about the Buteyko method in 2010, when I was diagnosed with cancer. I made a short-term effort to learn it based on Internet tutorials and then abandoned it in favor of other tactics.

But I’m reconsidering it as a long-term, sustainable therapy. Not only does Mercola cite general health benefits like lower blood pressure and reduced stress, but a study showed the Buteyko method reduced three-year breast cancer mortality from 24.5% to 4.5%. That’s amazing for an hour or two of breathing per day!

I strongly encourage you to read the original study here (translated from Russian):

http://www.normalbreathing.com/nb-word/A-Paschenko-ENG.pdf

In addition — and this is really awe-inspiring — the study seems to state that Buteyko breathing also eliminated lymphedema in the test group. Almost nothing works for lymphedema! (Caveat: I’ve found a few things that helped me).

So if the Buteyko method helps lymphedema, then it shouldn’t matter that the study was originally published in Russian: Therapists should look into it!

Here’s the source from the study:

“Seven (13.2%) of the patients in the control group suffered from edema in their upper extremities. The same symptoms were present in 9 (13.4%) patients of the main group. However, unlike the control group, their edema disappeared with the elimination of deep breathing.”

If this is true, it could be a revolution for lymphedema patients worldwide. If I had lymphedema (I don’t, but I struggle with high altitudes and believe I’m at risk for it), I’d be trying this right now, today, starting this second.

Have you tried the Buteyko method? Let me know in the comments or via private message.

Jun 062011
 

Some tempered good news: The U.S. Court of Appeals for the Ninth Circuit ruled last month that the USDA must produce an Environmental Impact Statement (EIS) for genetically modified sugar beets, prior to granting them permanent approval for commercial use. A full press release is posted at the Center for Food Safety website.

However, GM sugar beets planted last winter are still in the ground. Moreover, the USDA on April 7 announced a pilot program that could allow agribusiness firms to directly influence the content of Environmental Impact Statements. The Federal Register notice states:

“The pilot project will explore two voluntary mechanisms: (1) A petitioner-submitted environmental report based upon which APHIS would develop an EA or an EIS; and (2) an EA or EIS prepared by a contractor, funded by a cooperative services agreement between the petitioner and APHIS.”

(Note: The “petitioner” is the firm seeking approval for a product.)

So, although the court ruling mandating an EIS seems like progress, the independence of the EIS itself does not seem assured.

In the meantime, until full, independent, objective safety studies are available that counter the limited animal studies showing negative outcomes such as liver and kidney damage, I strongly believe that the best defense against GM foods is to avoid them whenever possible. Buying organic is one way to avoid GM foods, but if that’s not possible, avoidance of processed foods or careful label-reading can help.

No, GM foods are not specifically labeled as such. But the main GM components of the food supply — what I like to call the Four Horsemen of GMOs — are:

  • Corn
  • Soy
  • Cottonseed
  • Canola

That damns a lot of processed foods right there, because they may contain all sorts of derivative products: high-fructose corn syrup, cornstarch, soy lecithin, soybean oil, canola oil, and cottonseed oil are among the most common. If a food package lists any of these ingredients and doesn’t say non-GMO, chances are that it contains GM ingredients.

Other GM products may include papayas, alfalfa sprouts, and, yes, sugar beets. It’s a jungle out there. But there are ways to make a difference.

Apr 122011
 

Worthwhile reading today on page 1 of USA Today. The cover story is titled ‘Girls hit puberty earlier than ever, and doctors aren’t sure why.’

Here’s a brief excerpt with the grim stats:

About 15% of American girls now begin puberty by age 7, according to a study of 1,239 girls published last year in Pediatrics. One in 10 white girls begin developing breasts by that age — twice the rate seen in a 1997 study. Among black girls, such as Laila, 23% hit puberty by age 7.

“Over the last 30 years, we’ve shortened the childhood of girls by about a year and a half,” says Sandra Steingraber, author of a 2007 report on early puberty for the Breast Cancer Fund, an advocacy group. “That’s not good.”

I give this article credit for hinting at the reasons why puberty is starting earlier. It addresses rising rates of childhood obesity; endocrine disruptors such as pesticides, phthalates in water bottles, and BPA in cans; and reduction of melatonin levels triggered by overexposure to computer and TV screens. It also mentions stress and premature birth rates (up 18% since 1990, according to the article) as possible causes. What it doesn’t mention — and what I rarely see in articles of this type — is an acknowledgment that many of the problems and diseases of modern life are interlinked, so early puberty cannot really be viewed in isolation.

One indication that the problem is modern life and not genetics is mentioned in the article:

Studies consistently show that black girls in the USA go into puberty earlier than whites, suggesting a possible genetic difference. Yet Steingraber notes that, 100 years ago, black girls actually matured later than whites. And she notes that black girls in Africa enter puberty much later than those in the USA, even when their nutrition and family incomes are comparable.

Since we can’t turn back the clock to the year 1900, how can we fight back against the onslaught of contaminated food, water, and environmental surroundings? I discuss some ideas in the 10 Changes section in relation to general health, but this is what I would do if I had a daughter:

1. Choose organic dairy. Conventional dairy products may contain recombinant bovine growth hormone (rBGH) and/or recombinant bovine somatotropin (rBST). These hormones stimulate increased milk production by cows, but that milk also contains higher than normal levels of insulin-like growth factor 1 (IGF-1). What is IGF-1? A trigger of puberty in mice, according to recent research from Johns Hopkins. 1 I look forward to the human studies — in the meantime, organic milk is unlikely to contain such high levels of IGF-1. Plus, it is free of antibiotic residues, and the cows cannot be fed genetically modified corn. Honestly, I might go easy on dairy in general, since most mammals in nature don’t consume it after they’re weaned.

2. Banish high-fructose corn syrup. Since obesity is a possible contributor to early puberty, I would seek out products unlikely to promote obesity. That means real, unrefined food — organic fruits, vegetables, nuts, seeds, lean meats and eggs, beans, and whole grains, ideally speaking. If that were not entirely possible, I would at least avoid likely contributors to the obesity epidemic, such as HFCS. 2

3. Dump the plastic water bottles and canned foods. I would use stainless steel water bottles (less breakable than glass) and fill them with filtered tap water, using a high-quality reverse osmosis or combination filtration system (such as Aquasana). And I would seek out food packaged in BPA-free cans, glass jars, or bags.

4. Encourage outdoors time. I would make sure the day included some active time outside in real sunlight. Humans aren’t built to live indoors 24/7.

5. Enforce screen-off time. I would install Flux on all computers. I would set the computer to shut down automatically about an hour before bedtime. I would turn off the television about an hour before bedtime. I would encourage the reading of old-fashioned paper books — not on-screen books — in that last hour before sleep.

Mar 172011
 

I was happy to see the recent UN report titled “Agroecology and the Right to Food,” mainly because it debunks a common argument of industrial farming promoters. That argument posits that without industrial farming, we could not feed Earth’s population. It would be interesting to conduct a review of published statistics to determine if that is in fact true, because this report implies the opposite.

The report states that in areas of Africa where small-scale sustainable “ecological agriculture” was implemented, average crop yields more than doubled within 10 years. Moreover, it states that sustainable small-scale farming creates jobs and increases crop diversity, promoting better nutrition.

In theory, this sounds like a slam-dunk — but I expect large agribusiness firms will fight it tooth and nail.

Here is the press release as well.

Mar 082011
 

Headlines in January covered the USDA’s unrestricted approval of GM alfalfa.

Dr. Joseph Mercola now has a scathing analysis on his site about potential long-term implications of the decision. He interviewed representatives from the Institute for Responsible Technology, Organic Valley, Whole Foods and the Organic Consumers Association — and then made some good points. The key highlight: Most alfalfa is not sprayed with pesticides now, so why would any need arise for a Roundup-resistant version?

Mercola (via his sources’ interviews) analyzes a possible ulterior motive as follows:

“‘The interesting thing about the way alfalfa has been grown up until now is that, according to Michael Pollan and other experts, 93 percent of the alfalfa grown in the United States right now is not sprayed with herbicides… alfalfa is pretty much an herbicide free crop!’ Cummins says.

“‘Now, what’s going to happen is that Monsanto is going to sell their alfalfa seeds all over the country which make this alfalfa roundup resistant. This means they’re going to spray the heck out of these 23 million acres of alfalfa fields.’

“How can anyone justify the planting of Roundup-resistant alfalfa when there’s apparently no need for it, and when emerging evidence shows that weeds are rapidly becoming increasingly resistant to Roundup as well, creating superweeds that are near impossible to get rid of?

“That seemingly nonsensical decision becomes clearer if you look at alfalfa’s role on a much grander scale, and helps explain why Monsanto appears to have pulled out all the stops to get it approved, despite the fervent opposition of the organic industry and hundreds of thousands of vocal consumers.

Alfalfa is the Perfect Choice if You Want to Contaminate a Wide Variety of Organic Foods!

“Alfalfa is a perennial crop, meaning it comes back year after year. In the case of alfalfa, farmers only need to re-seed about every seventh year. And as stated earlier, it’s a powerful pollinator.

“‘Basically, any organic alfalfa or non-genetically engineered alfalfa within a five mile radius will immediately get contaminated,’ Cummins says.

“‘Given the fact that alfalfa is a major food source for dairy cows across the United States, and organic alfalfa is a major food source for organic dairy cows, we’re going to see widespread contamination getting worse every year… by this GM alfalfa.

“‘So this is outrageous. It totally flies in the face of campaign promises that Obama made in 2008 when he was running for president. It totally flies in the face of what Hillary Clinton, who was also running for president at the time, made, which was that they would support mandatory labeling and safety testing of GMOs. They have gone back on their word…'”

What now? I highlighted this article mainly because Mercola outlines several ways to take action at the end of it. If you really care about this issue, take a few minutes to sign up to help stop GM food’s pervasive spread. This is one of those battles that can be won, because it’s not too late. Time is growing short, though.