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Does good research get buried?

We had a problem in our pregnancy forum today – there were so many forum posts submitted so quickly that people didn’t get the chance to answer a post before it was buried underneath an avalanche of other questions. This left the people asking the questions quite frustrated.

A few hours later I was peer reviewing an article for the AJNR. I did a Medline search as part of a background check for my review. I found 30 pages of research articles. I was reading through their titles when, glazing over on page 28, I realized that a very similar study had already been conducted… in 1979.

It suddenly occurred to me that good questions (and good answers) can be buried by time. They say that history is doomed to repeat itself… the Internet is beginning to help me understand why that’s so.

What do you think?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Sleep your way thin?

Yes my friends, I’m afraid it’s true… lack of sleep can pack on the pounds! In 2004 a couple of researchers were analyzing the NHANES database, and noticed that sleep deprivation was an independent risk factor for obesity. Since that observation, more studies have confirmed that sleep debt is associated with weight gain. It’s not completely clear how this works – but one writer summarizes:

“Sleep causes changes in the brain, leading to abnormal secretion of hormones which can result in several body disturbances that include excessive daytime sleepiness, mood changes such as depression or anxiety, altered hunger and eating patterns, and ultimately further sleep disturbances. It’s a vicious cycle!… Throw out the diet bars, and fluff up the pillows.”

I bet my sleep expert colleague, Dr. Steve Poceta, has some further thoughts on this. Let’s ask him!

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Homeopathy or Big Pharma – Choose Your Poison?

Wow, this was one of the best rants I’ve heard in a while (thanks to Kevin MD for linking to this article in his blog) – looks as if this writer is neither friend to homeopathy nor big pharma:

“Some homeopaths [say] that their cures are not amenable to scientific proof. That’s fine, if you want to call the multimillion dollar industry what it is: faith healing…

Homeopathy rests on three unproven tenets: First, ‘Like treats like.’ Because arsenic causes shortness of breath, for example, homeopaths prescribe its ‘spirit’ to treat diseases such as asthma. Second, the arsenic or other active ingredient is diluted in water and then that dilution is diluted again and so on, dozens of times, guaranteeing—for better and worse—that even if the dose has no therapeutic value, it does no harm. And third, the potion is shaken vigorously so that it retains a ‘memory’ of the allegedly curative ingredient, a spirit-like essence that revives the body’s ‘vital force.’

So what about the fact that some homeopathic patients get better? Part of the effect comes from the ritual of consultation with a practitioner who treats the patient like a person rather than a body part on an assembly line. And just taking anything can help; the placebo effect is real. In gold-standard, double-blind studies, placebos presented as possible cures sometimes rival pharmaceuticals for effectiveness, or beat taking nothing at all.

Nor are the effects simply psychological. When volunteers took a placebo that they were told contained painkillers, they experienced relief, while researchers watching PET scans of the subjects’ brains tracked increased levels of the body’s own pain-relieving endorphins. In other studies, research subjects given placebos instead of antidepressants also showed chemical changes in their brains. FDA data for six top antidepressants showed that 80 percent of their effect was duplicated in placebo control groups.

Which brings us to the patient’s dilemma: Have faith in 19th century magic or rely on a pharmaceutical industry that suppresses negative outcomes (including death), promotes drugs for nonexistent diseases, repackages old drugs in new bottles to circumvent patent expirations, bribes doctors with perks and cash and hires ghost writers to author favorable studies? Given the hype, toxicity, and expense of many drugs and Big Pharma’s snake-oil tactics, the side effects of water (laced with “memory”) start looking pretty damn good. If your condition is relatively minor, self-limiting or untreatable, you may be a lot better off drinking homeopathy’s Kool-Aid-less Kool-Aid.”

Ouch. What do you think of Mr. Allen’s remarks?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Conflicting research studies: how do I know what’s true?

Consumers often express frustration with new research findings reported to them by the media.  One day a medicine is being promoted on TV as the cure for arthritis pain, the next it is being removed from the market by the FDA, citing increased risk of death.  One day margarine is considered a healthy alternative to butter, the next day trans fats are being banned from entire states.  And so medical research is eyed with suspicion and people are left to wonder about the safety of their food, medications and treatments.

I sympathize with the confusion and frustration.   Here’s part of what fuels it:

1)  Clinical trials are designed to answer very specific questions under a set of limited conditions. They have to be designed this way in order to prove a cause and effect.  The results should be repeatable, given the same conditions.  Sometimes when a drug is used in a different way (like, at a higher dose or for a longer period of time, or in older patients) it has different or more frequent side effects.  It’s important not to generalize efficacy or safety to use cases outside those tested in a clinical trial.  What’s good for the goose is NOT necessarily good for the gander.

2)  Large observational studies can often pick up trends that might not have been noted in a clinical trial. This is why previously unknown (or rare) side effects are sometimes detected after clinical trials seem to indicate that a drug or treatment is safe and effective.

3)  We are all tempted to over-simplify research data, especially the media. How many of us would like to read a headline that says, “Drug X may reduce your arthritis pain by 10% if you are over 80, have no history of high blood pressure or diabetes, use it 3 times a day at 10mg doses and take it on an full stomach” versus “Drug X can cure your arthritis!”  Yup, we just want something easy to understand, and so we opt for statement #2, even though it’s not accurate.  Inaccurate statements generate a lot of confusion and lead to unwarranted hype.

So, what is a consumer to do? My opinion is that the educated consumer’s best friend is an educated physician.  Doctors are natural skeptics – they are formally trained (for a minimum of 7-10 years at good schools) to understand the limitations of research studies and effectively communicate all the caveats that are so critical for informed decision making.  If you’re having a hard time figuring out if a drug or treatment is right for you, ask your doctor (wow, did that sound like a TV ad!)  Or better yet, keep reading the physician blogs and medical news commentary at Revolution Health.  We are committed to translating research news into a format that you can understand and use.  We’ll do our best to cut through the hype and give you the real facts.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Scary virus revived by scientists

In 1918, a man died of a vicious strain of “Spanish Flu” and was buried in the Alaskan tundra. Almost a century later, scientists found his well preserved body poking through some permafrost and decided to take tissue samples to a Canadian laboratory to thaw out the virus that killed the man.

Sounds like the beginning of a made-for-TV, horror movie, doesn’t it? Well, I wish it were fiction. This is a true story.

So why did the scientists revive this infectious menace? To see what it would do to modern day macaque monkeys, of course.

The BBC news reports:

“Symptoms appeared within 24 hours of exposure to the virus, and the subsequent destruction of lung tissue was so widespread that, had the monkeys not been put to sleep a few days later, they would literally have drowned in their own blood.”

Um… gross?

The scientists say,

“This research provides an important piece in the puzzle of the 1918 virus, helping us to better understand influenza viruses and their potential to cause pandemics.”

The BBC continues:

“Analysis at the University of Wisconsin-Madison (UW-M) revealed that a key component of the immune system, a gene called RIG-1 appeared to be involved.

Levels of the protein produced by the gene were lower in tissue infected with the 1918 virus, suggesting it had a method of switching it off, causing immune defenses to run wild. This ability to alter the body’s immune response is shared with the most recent candidate for mutation into a pandemic strain, the H5N1 avian flu.”

There is a final word from Dr. Jim Robertson, a British virologist:

“Many influenza virologists remain nervous about creating and experimenting with a reconstructed 1918 Spanish flu virus.”

Yeah, I’m nervous too.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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