Wednesday, May 13, 2015

Keeping blood pressure among the elderly at a high enough level

Alan Cassels talks about the dangers of keeping blood pressure low among the elderly.
People who talk about prescribing in the elderly call it an 'evidence-free zone.' ... [B]lood pressure makes a very poignant example of the kind of care the elderly can often be subject to.... The problem is that trying to get blood pressure that low for someone who is 80 is almost totally irrational. Why? Because the physiology of old people is different and most blood pressure studies have specifically excluded people aged 80 and over. Those few studies that have focused on the elderly find something terribly surprising: the patients in the trials who had lower blood pressure had a higher risk of death.
This gets my goat. Because some doctors treat the elderly like they're middle aged and drown them in antihypertensives to keep their bp within the range appropriate for half century old individuals. Hence adverse effects can kick in. As in dizziness and light headedness in my mom's case. Seemingly unable to think out of the box, these doctors (hopefully in the minority) treat their now septua- and octogenarian patients as if they were still in their 50s. And worse, patients have been indoctrinated into believing there is an unquestionable Goldilocks zone for bp which is true for everyone and for all ages. And so they happily go along with their physicians' recommendations.

False positives, incidentalomas, overdiagnosis

"More testing leads to more false positives and incidental findings (abnormalities that don't pose a risk to your actual health). That leads to a higher probability of treatment. And treatment carries side effects." --Charles Ornstein

And from Dr. Gilbert Welch:
The more tests you do, and this is only the statistical process, the more likely one of them will be falsely abnormal. And the more times you do it, the more chance that something will be falsely abnormal.

The problem is you'll always be catching things out of what we would say is normal. This is anticipatory medicine at its worst, where you're really focused on what could be going wrong in the future and you're trying to pick up [a] signal.

The problem is there's so much noise — because the human body is a living organism. Variation is the very essence of life. People will start reacting to this data. I also think it's really important to label it what it is: data. To me it only becomes information to the extent that it accurately predicts something will happen in the future, and it only becomes useful knowledge — a higher level piece of information — if we can do something about it.

Tuesday, May 12, 2015

Breast cancer overdiagnosis due to screening mammography

Daniel Kopans says, "Overdiagnosis is a myth that has been created by a handful of individuals who provide no care for women with breast cancer."

And yet according to one of the latest studies the cost of overdiagnosis from screening mammography in the United States alone is $1.2 billion annually.

Really difficult to put much stock in what someone with vested interest in mammography says, specially when there are others (without conflicts of interest) producing evidence to the contrary.


Web of corruption in clinical trials

Peter Wilmhurst shares his experience of the web of corruption involving industry, doctors, researchers/trialists in the following Evidence Live 2014 talk. Treatment efficacy and patient welfare were the least of their concerns.

Cholesterol Drug War

Watch the 2013 Australian Broadcasting Corp. documentary on statins.

The lone doctor interviewed in favor of statins almost sounds like a pharma shill. Makes one wonder whether he has conflicts of interest to declare.

Epidemic of diagnosis of thyroid cancer

Incidence of thyroid cancer has been going up. Steeply. But the mortality rate has been as flat as the Bonneville Salt Flats. Ergo, either we have an excellent treatment regimen for thyroid cancer or we have an epidemic of thyroid cancer diagnosis. It's the latter.
Currently, there is no way to confidently predict which incidentally detected thyroid nodule may be the precursor to a more aggressive process. Predictions such as these would require more accurate characterization of the biology of individual thyroid cancers than is currently possible. With time, we might prove our ability to confidently differentiate low-risk from high-risk thyroid cancers, but until that happens, routine screening for thyroid cancer by imaging billed as a “health checkup” should not be performed

Dr. Gilbert Welch explains this lucidly in his cancer screening video (@11 min.)

Antibiotics-bacteria chart

Finally, someone made a quick guide

Statins linked to diabetes

While the study is retrospective in nature, evidence is apparently mounting that there is a significant correlation between statin use and diabetes.

Saturday, May 9, 2015

Quality of life

Longevity is not the be all. Being isn't just a matter of continuing to be alive and staving off death as much as we can. What's more crucial when the medical community and the patient and his/her family feel they're facing the final curtain is quality of life, or more to the point, the quality of remaining life. In the contest between mere quantity and marked quality, the latter surely must trump the former. Life extension makes sense only if the additional days, weeks, months that we can buy aren't spent in unremitting pain and suffering, in unending rushes to the ER, or in being incarcerated to the very end in a hospital with a welter of wires and tubes dangling off our face and body. Life is worth prolonging only if we are not consigned to living out the rest of our days in a hell on earth. We must rage against the dying of the light. And old age should burn and rave. But only if there is still a life worth living.

Friday, May 8, 2015

Science Babe on the Food Babe

Yvette d'Entremont exposes Vani Hari's breathtaking ignorance.
Reading Hari's site, it's rare to come across a single scientific fact. Between her egregious abuse of the word "toxin" anytime there's a chemical she can't pronounce and asserting that everyone who disagrees with her is a paid shill, it's hard to pinpoint her biggest sin.

Atul Gawande on overdiagnosis

In his New Yorker article Dr. Atul Gawande talks about--among other things--overdiagnosis:
More than a third of the population turns out to have these tiny cancers in their thyroid, but fewer than one in a hundred thousand people die from thyroid cancer a year. Only the rare microcarcinoma develops the capacity to behave like a dangerous, invasive cancer.