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Science Skepticism

 

“You can’t tell whether I’m lying, delusional, ignorant, or simply incompetent. Sometimes even I don’t know!”

I ran across a 2016 article by Callie Joubert that summarizes skeptical ideas I’ve read about for years, but most people and physicians don’t know about. Bottom line: scientific research and medical studies aren’t nearly as reliable as you think.

Read the whole thing, but here are some excerpts:

We tend to think of science as a dispassionate (impartial, neutral) search for truth and certainty. But is it possible that we are facing a situation in which there is a massive production of wrong information or distortion of information? Is it possible that certain scientific disciplines are facing a crisis of credibility? Mounting evidence suggests this is indeed the case, which raises two questions: How serious is the problem? And what could explain this?

***

The title of an editorial in the prestigious medical journal The Lancet, dated April 6, 2002, asks the question, “Just How Tainted Has Medicine Become?”4 The article states, “Heavily, and damagingly so, is the answer.” Among other things, in 2001, researchers completed experiments with biotechnology products in which they had a direct financial interest and doctors did not tell their patients that others had died using these products when safer alternatives were available. In the same journal, dated April 11, 2015, Dr. Richard Horton stated the gravity of the problem as follows: “The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue . . . science has taken a turn towards darkness.”

In 2004, under the heading of “Depressing Research,” the editor of The Lancet had this to say about antidepressants for children: “The story of research into selective serotonin reuptake inhibitor (SSRI) use in childhood depression is one of confusion, manipulation, and institutional failure. . . . In a global medical culture where evidence-based practice is seen as the gold standard for care, these failings [i.e., of the USA Food and Drug Administration to act on information provided to them about the harmful effects of these drugs on children] are a disaster.”6 After being editor of the New England Journal of Medicine for 20 years, Dr. Marcia Angell stated that “physicians can no longer rely on the medical literature for valid and reliable information.”7 She referred to a study of 74 clinical trials of antidepressants that indicates that 37 of 38 positive studies were published. In contrast, 33 of the 36 negative studies were either not published or published in a form that conveyed a positive outcome. She also mentions the fact that drug companies are financing “most clinical research on the prescription drugs, and there is mounting evidence that they often skew the research they sponsor to make their drugs look better and safer.”

In 2011, researchers at Bayer decided to test 67 recent drug discoveries on preclinical cancer biology research. In more than 75 percent of cases, the published data did not match their attempts to replicate them.8 In 2012, a study published in Nature announced that only 11 percent of the sampled preclinical cancer studies coming out of the academic pipeline were replicable.9

In the prestigious Science journal, in 2015, the Open Science Collaboration10 presented a study of 100 psychological research studies that 270 contributing authors tried to replicate. An astonishing 65 percent failed to show any statistical significance on replication, and many of the remainder showed greatly reduced effect sizes. In plain terms, evidence for original findings is weak.

***

A discovery in physics, the hardest of all hard sciences, is usually thought of as the most reliable in the world of science. However, two of the most vaunted physics results of the past few years—“cosmic inflation and gravitational waves at the BICEP2 experiment in Antarctica, and the supposed discovery of superluminal neutrinos at the Swiss-Italian border—have now been retracted, with far less fanfare than when they were first published.”

***

Parker here again….

The science skeptic best known to physicians is John P.A. Ioannidis:

Empirical evidence from diverse fields suggests that when efforts are made to repeat or reproduce published research, the repeatability and reproducibility is dismal.

Another quote form Ioannidis:

There is increasing concern that most current published research findings are false. The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias.

Ioannidis again:

Most physicians and other healthcare professionals are unaware of the pervasiveness of poor quality clinical evidence that contributes considerably to overuse, underuse, avoidable adverse events, missed opportunities for right care and wasted healthcare resources. The Medical Misinformation Mess comprises four key problems. First, much published medical research is not reliable or is of uncertain reliability, offers no benefit to patients, or is not useful to decision makers. Second, most healthcare professionals are not aware of this problem. Third, they also lack the skills necessary to evaluate the reliability and usefulness of medical evidence. Finally, patients and families frequently lack relevant, accurate medical evidence and skilled guidance at the time of medical decision‐making.

If you like videos, here’s Ioannidis on YouTube.

Staying skeptical,

Steve Parker, M.D.

h/t Vox Day

 

Mediterranean-Style Diet Improves Symptoms of Depression In College Students

Spaghetti squash “spaghetti”

Study participants at the outset were judged to have a poor diet as compared to the Australian Guide to Healthy Eating. Here’s the intervention diet:

The diet was developed by an Accredited Practising Dietician and was based on the Australian Guide to Healthy Eating (2003) [18], with additional recommendations to increase concordance with Mediterranean-style diets known to be associated with reduced risk of depression (2) and diet components (e.g. omega-3 fatty acids, cinnamon, turmeric) that have beneficial effects on neurological function (e.g. see [19] for a review). Participants were instructed to increase intake of vegetables (5 servings per day), fruits (2–3 per day), wholegrain cereals (3 per day), protein (lean meat, poultry, eggs, tofu, legumes; 3 per day), unsweetened dairy (3 per day), fish (3 per week), nuts and seeds (3 tablespoons per day), olive oil (2 tablespoons per day), spices (turmeric and cinnamon; 1 teaspoon most days). Conversely, they were instructed to decrease refined carbohydrate, sugar, fatty or processed meats and soft-drinks. Participants were provided a sample meal plan and recipes, a handout answering frequently asked questions and troubleshooting solutions.

Source: A brief diet intervention can reduce symptoms of depression in young adults – A randomised controlled trial

Click for New York Times coverage of the study.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

Testosterone Supplementation May REDUCE Risk of Prostate Cancer

…which is contrary to what we’ve been told for years.

From Nature:

The relationship between testosterone therapy and prostate cancer continues to challenge historic and current beliefs. A new cohort analysis revealed a ~33% reduction in prostate cancer incidence in men with increased testosterone use. The mechanisms underlying this protective effect are unclear, but these findings challenge current paradigms and warrant further investigation.

Source: Challenging beliefs of testosterone therapy and prostate cancer | Nature Reviews Urology

Ramen Linked to Higher Fatal Stroke Risk in Japan

I rarely eat ramen, but understand it’s fairly popular among young adults in the U.S, particularly among college students because it’s cheap, quick, and tasty.

Click for details of the study in Nutrition Journal. Some background from the article:

Ramen is one of the most popular foods in Japan, despite being of Chinese origin [11]. Since its original introduction in Japan, ramen has been adapted and now consists of wheat noodles served in broth topped with sliced pork, seaweed, or menma (a Japanese condiment made from lacto-fermented bamboo shoots; Additional file 1). Being tasty and inexpensive, ramen became a popular food that was available from street food stands in Japan after World War ΙΙ. Although the number of ramen stands has decreased markedly, ramen remains highly popular in Japan. High dietary sodium content was recently reported to be a risk factor for stroke [12]; ramen has a high sodium content. However, the relationship between stroke and ramen consumption remains unclear. In this study, we investigated the association between the number of ramen restaurants in each Japanese prefecture and stroke mortality in that prefecture.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

 

Have You Been Wiping Your Ass Wrong All These Years?

This is a topic I’d never run across online until recently. In the anal hygeine department, it looks like the Europeans and Japanese—with their bidets—are ahead of us in North America.

From Insider:

To keep your backside happy, Goldstein [a rectal surgeon] recommended using a patting motion rather than a wiping motion and being as gentle as possible. Ideally, he added, you should use a bidet to clean yourself and then pat the excess water dry with a bit of toilet paper if need be.

From MF (Mental Floss):

Asbury [a dermatologist] is an advocate of the standalone or add-on toilet accessory that squirts a spray of water between your cheeks to flush out residual fecal matter. While bidets are common in Europe and Japan, the West has been slower to adopt this superior method of post-poop clean-up; others might be wary of tapping into existing home plumbing to supply fresh water, even though DIY installation is quite easy. For those patients, Asbury has developed an alternative method.

TRY PAPER TOWELS AND WATER

“What I tell people to use is Viva, a really soft, thick paper towel made by Kleenex,” he says. “You get a squirt bottle and you leave it near the toilet and moisten the paper towel.” Regular toilet paper is usually too flimsy to stand up to a soaking, while normal paper towels are too harsh for rectal purposes. Viva is apparently just right. (And no, Asbury is not a brand ambassador, nor does Kleenex endorse this alternative use.)

This advice does come with a major caveat: Viva wipes are not flushable and might very well clog your pipes if you try to send them down the drain.

From Shape:

When it comes to wiping, less is more and not just because it keeps you from replacing the toilet paper roll every other day. “Overwiping can irritate the perianal skin and lead to small abrasions that trigger inflammation and itching,” Sheth [a gastroenterologist] says. One or two wipes are all it takes, he says. If you need to wipe more than that you may not have completely emptied your system or you could be constipated (in which case, up your fiber and water intake like you would to prevent hemorrhoids). If you still require more than a few wipes, consider switching to wet toilet paper or unscented baby wipes. “Moist wipes decrease the friction of wiping and cause less irritation,” Sheth says.

The first two links recommend against baby wipes.

From Sussex Surgery:

Many people cannot bear the thought of a dirty anus and they go to great lengths to keep their anus spotlessly clean using large amounts of toilet paper and vigorously washing the area, especially after defaecation.  Unfortunately this breaks down the fragile anal skin and then this usually effective barrier to bacteria lets in microbes to the surrounding tissues.  This is very irritating to local nerves and people then get in to a viscious cycle because they get itchy, feeling the need to clean the anus even more, which breaks down the anal skin barrier even further.  Therefore it is ironically and usually the cleanest people that end up in my specialist bowel surgery clinic rather than the dirtiest!

The first thing to do is to break the vicious cycle and I recommend that people tone down their anal cleaning routine.  Fingernails and abrasive materials such as rough toilet paper should be kept away from the anus.  Non-scented baby wipes or luxury toilet tissue are usually the kindest and most effective ways of wiping the bottom after opening the bowels.  Running water is the best way to wash the anal surfaces.

Often people think that they must keep on wiping their bottom with toilet paper until they do not see any more brown smears on the toilet paper but this can cause significant damage.  Instead people should stop wiping when the brown smears have lessened but before they rub their fragile anal skin raw.

From Atlas Obscura:

All of this provides a mixed view on the ideal material for wiping. Water is very good, because it’s gentle and won’t cause tears, but you want to stay away from residual moistness. Toilet paper isn’t bad, because it easily soaks up any moisture, but it also can be a little rough, which is bad. The ideal method would probably be a water bath followed by careful, gentle, and immediate drying, whether that’s with toilet paper or a jet of warm air.

For a history of anal hygeine and a tour of various cultures, visit Toilet Guru.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

 

Mediterranean Diet May Prevent Multiple Sclerosis

MRI scan of brain, commonly done to evaluate for MS and demyelination

Multiple sclerosis is a disease of unknown cause characterized by demyelination (loss of the protective coating around nerves) in the brain.

From The Journal of Nutrition:

A Mediterranean diet, including unprocessed red meat, was associated with reduced risk of [first clinical diagnosis of brain demyelination] in this Australian adult population. The addition of unprocessed red meat to a Mediterranean diet may be beneficial for those at high risk of [multiple sclerosis].

Source: Higher Mediterranean Diet Score, Including Unprocessed Red Meat, Is Associated with Reduced Risk of Central Nervous System Demyelination in a Case-Control Study of Australian Adults | The Journal of Nutrition | Oxford Academic

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com

Which Is Better at Reducing Insulin Resistance: Alternate-Day Fasting or Daily Calorie Restriction?

Horses, like Java, also get Metabolic Syndrome but it’s not quite the same as in humans. Java had to lose weight and change his diet.

Body tissue resistance to the effect of insulin is considered harmful by many experts. For instance, it may contribute to obesity, high blood pressure, type 2 diabetes, and cancer. BTW, if you have Metabolic Syndrome, you probably have insulin resistance. Regular exercise and loss of excess body fat are two ways  to reduce insulin resistance. Fasting also has an effect, but is it better than daily calorie restriction?

From the journal Obesity:

Abstract

Objective

This study compared the effects of alternate‐day fasting (ADF) with those of daily calorie restriction (CR) on body weight and glucoregulatory factors in adults with overweight or obesity and insulin resistance.

Methods

This secondary analysis examined the data of insulin‐resistant individuals (n = 43) who participated in a 12‐month study that compared ADF (25% energy needs on “fast days”; 125% energy needs on alternating “feast days”) with CR (75% energy needs every day) and a control group regimen.

Results

In insulin‐resistant participants, weight loss was not different between ADF (−8% ± 2%) and CR (−6% ± 1%) by month 12, relative to controls (P < 0.0001). Fat mass and BMI decreased (P < 0.05) similarly from ADF and CR. ADF produced greater decreases (P < 0.05) in fasting insulin (−52% ± 9%) and insulin resistance (−53% ± 9%) compared with CR (−14% ± 9%; −17% ± 11%) and the control regimen by month 12. Lean mass, visceral fat mass, low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol, triglycerides, blood pressure, C‐reactive protein, tumor necrosis factor α, and interleukin 6 values remained unchanged.

Conclusions

These findings suggest that ADF may produce greater reductions in fasting insulin and insulin resistance compared with CR in insulin‐resistant participants despite similar decreases in body weight.

Source: Differential Effects of Alternate‐Day Fasting Versus Daily Calorie Restriction on Insulin Resistance – Gabel – – Obesity – Wiley Online Library

It would be interesting to compare the compliance and drop-out rates between the two groups studied. Is a daily 24% calorie deficit easier to stomach than a 75% reduction every other day?

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com