I am only vaguely aware that South Africa, in which I lived for more than 20 years, is hosting the soccer world cup. Apparently, New Zealand drew their first game and this is somehow a good thing? I thought the plan was to score more goals than your opponent, but clearly I know nothing.

Back to Peter Snell and his dicky heart. While it is no surprise to me that a 71-year-old man has heart disease, it is even less of a surprise that a competitive athlete has serious heart disease. I clearly recall a study done in South Africa 20 years ago in which the investigators took blood from Comrades marathon runners after the event (the Comrades marathon is a 90km ultra-marathon run between Durban and Pietermaritzburg every year). Every participant in the small study had significantly elevated heart enzymes – the same ones we use to diagnose heart attacks. It is thought that this was caused by diffuse hypoxic damage (heart cells dying from lack of oxygen all over the heart). Call me chicken if you like, but that news extinguished any desire to do any long-distance running. Admittedly, there wasn’t a great deal of desire there in the first place.

That early South African study has been backed up many times. There is little doubt that athletes who train intensely are at increased risk of sudden cardiac death immediately after their training (I cite only one article here, there are plenty of others). There is also some evidence that the increased amount of oxidative stress (free radical production) caused by intensive exercise does cause long-term damage to the arteries, resulting in additional plaque formation (I am not aware of any particular definitive study on this, though).

Moderate exercise is good for you. The body apparently easily copes with the additional oxidative stress, producing higher levels of anti-oxidants. These higher levels of anti-oxidants are then useful for mopping up the extra free radicals we produce from eating junk and being generally stressed out of our minds. At least, that’s the theory. But competition-level athletes pay a price for their extreme conditioning, both in physical form, with injuries, and in physiological form with potential heart damage (and possible other organ damage – particularly kidneys).

Once again the old adage is true – too much of a good thing is bad for you.

Related posts:

1. Spam Journalism #68
2. Just Don’t Look at My Liver
3. Cut Short

PCV type 1 was found as a contaminant in the Rotarix vaccine in March and a temporary halt was placed on its use. Last week PCV type 1 and 2 were found in the rival vaccine RotaTeq. Clearly this is a manufacturing process problem. We have absolutely no idea whether these viruses could be harmful, although we do know that they do not appear to cause any immediate diseases. In the face of large numbers of unknowns, it is usually clinically prudent to stop the use of the vaccines altogether until the manufacturing problem can be solved or the PCV virus proved definitively harmless.

Apparently not for the FDA. Such a decision only calls into question the known incestuous links between the FDA and the pharmaceutical manufacturers. In case you think I am being a bit harsh in my judgement, take a look at the decision process of the advisory committee. they base their judgement on:

It seems unlikely that the FDA’s warning to avoid Rotarix will stand given that no data indicate the virus is harmful to people and that Merck’s vaccine also contains the virus.

GlaxoSmithKline scientists presented data to the panel indicating the PCV1 virus is not harmful to humans, at least in the short term.

“PCV1 infection is widespread but does not cause any disease in pigs or other animal species including humans,” X.J. Meng, MD, PhD, of GlaxoSmithKline, told the committee.

There was less information on PCV2, but an FDA official said it has been known to cause illness in pigs, although not in humans.

The argument runs that the other vaccine is contaminated, so lets un-ban the first one. Logically, we should be stopping use of both vaccines. The statement “PCV1 virus is not harmful to humans, at least in the short term” means only that it does not cause immediate disease. But what about recombinant effects? We spent weeks worrying about Swine flu mutating into a more deadly strain and seem completely unconcerned about injecting our children with a xeno-virus. How about long term slow-virus effects? I do not know enough virology to know if that is a concern, but it seems that the GSK virologist seems a little blase about the whole deal. The very fact that this is a virologist from the actual drug company is a concern. Is this not a little like taking assurances from the tobacco company researchers that smoking does not cause lung cancer? Why is there not an independent risk assessment from a virologist with no Big Pharma interests?

But this is not the only dangerous part of their logic. Recall that this is the FDA. They are only setting approval for drug use in the US. That makes the statement below a particularly stupid argument:

RotaTeq and Rotarix are administered orally to millions of infants worldwide to prevent rotavirus, which can cause severe diarrhea and dehydration and is deemed responsible for the deaths of more than 500,000 infants each year, primarily in low- and middle-income countries. [emphasis mine]

It seems to have escaped the attention of the advisory committee that the US is a first world country. Deaths from Rotavirus infection are relatively rare. It is therefore by no means certain that use of this vaccine outweighs the risk.

I might be excessively paranoid here, but it seems to me that the interests of the pharmaceutical companies are being considered ahead of medically prudent safety measures. That is unconscionable from a government organisation that is supposed to ensure the safety of medicines for public use.

Related posts:

1. Bad Jab? (UPDATED)
2. No Magic Bullet
3. Attack of the Vaccine Nazis

Major research finds link between multi-vitamin pills and breast cancer

Women who regularly take multi-vitamin pills face a much higher risk of breast cancer, a study has found.

The Swedish study, which looked at more than 35,000 women aged between 49 and 83 during a 10-year period, found that women who take daily multi-vitamin pills are nearly 20 per cent more likely to develop breast cancer.

Let’s try a slightly more truthful headline “Somewhat flakey cohort study suggests there may be a vague link between breast cancer and multi-vitamins supplementation but authors would like to do a lot more research before saying anything as inflammatory as the above headline”.

It is probably just as well that the MacDoctor runs a blog rather than a newspaper.

This article is not completely contentless, so it can’t join my spam collection. On the other hand, the redoubtable Mr Lincoln Tan manages to misunderstand almost every aspect of the study – partially assisted by the study’s authors who say:

“These results suggest multi-vitamin use is associated with an increased risk of breast cancer. This is of concern and merits further investigation,” researchers told the American Journal of Clinical Nutrition.

Medical authors should know better than to couch their abstract in such alarmist terms. Sometimes it seems to me that the term “peer-reviewed” cannot possibly mean that someone with a modicum of sense read the paper. While I know that getting funding for further research is difficult, I do think that scaring women witless on fairly slim evidence is not particularly ethical. It also allows journalists to be “authoritatively” alarming, even though the facts of the study do not support the conclusions.

Firstly, the overall risk of women developing breast cancer is fairly low (even though it is a relatively common cancer) so a 20% increase in overall risk is not “much higher” , just slightly elevated. In addition, during their attempts to identify and account for confounding factors (other things that might cause breast cancer) they identified so many possible ones that their eventual 95% confidence limits are so wide they virtually encompass the null hypothesis. Translated into non-statistics jargon: There were so many other possible contributing factors to developing breast cancer that they were not able to tell for certain if multivitamins made a significant contribution.

But the largest failure of the study was that vitamin usage was determined by questionnaire virtually on a yes/no basis. Any multivitamin use above 1 tablet a week for a year was counted. In Sweden the choice of multivitamins is limited and most carry 300-400mcg of folate (a reasonably solid dose). Unfortunately, the study also established that women who took multivitamins were 4 times more likely to take folate supplements as well. Readers will recall the controversy over the fortification of bread with folate. There is some evidence that excessive folate supplementation may increase the incidence of several cancers. Failure to eliminate excessive folate supplementation is therefore a fatal error in this study, as it may well be a major confounding factor (especially given the wide margin of error).

While I would certainly agree that the findings in this study would suggest further research is needed, I tend to view cohort studies like this with some suspicion. There are dozens of similar studies in the US that say the exact opposite of this, including the famous Nurses’ Health Study. One has to take this sort of information in context and wait for more detailed prospective studies that can address confounding factors without guesswork and creative statistics. I would certainly not recommend that all women stop taking vitamin supplements simply on the grounds of a single study of this nature.

Related posts:

1. Vitamin D and the Big C
2. Folate Folds (updated)
3. Medicating the Masses

The trouble is, nicotine is registered as a drug in this country (in most first-world countries actually) and, as such, any delivery system needs to go through the normal registration process. This may seem silly, since you can buy a nicotine hit in the form of a cigarette quite legally, but then tobacco does not purport to have health benefits or to be a way of quitting smoking.

In order for a nicotine delivery system to be approved, the company would need to provide evidence of health benefits (less cancer, less lung disease) or that it does help people to quit smoking. Neither of these things have been demonstrated for the e-cigarette. In addition, the company would have to show that their system delivered the same amount of nicotine each time, within reasonable limits. They would also need to show reasonable clinical safety standards in their manufacturing processes.

The company that manufactures e-cigarettes has declined to do any of this. We therefore don’t know if their product is either safe or useful. Certainly, it is not legal in this country, and rightly so.

Even if the vendor, Full Life, actually did research in this area, I suspect that they would find their product does not help anyone to quit smoking. By no means all of the addictive properties of smoking is to do with nicotine addiction. There is also a strong element of psychological addiction associated with it. The e-cigarette merely acts as an alternative to smoking rather than a way of giving up smoking. Worse, it does not remove the oral habit, meaning that relapse rates will almost certainly be very high. In the very few limited trials on these products I have seen, precisely this effect was noted. This may explain why the manufacturer is not interested in legalising his product.

As a healthier alternative to smoking, the e-cigarette may have a place. Unfortunately, it’s main market will almost certainly be to those who could potentially give up smoking altogether, if offered a more suitable product. Instead, they may wind up hooked on psuedo-smoking. The relapse rate into proper smoking is likely to be horrendous. These people would be far better served with a proper, registered product that we know has demonstrable results.

Some researchers have suggested that “e-cigarettes could produce an alternative route for teenagers to nicotine addiction”. I suspect this is nonsense. Teenagers get hooked on tobacco through peer pressure. the e-cigarette would almost certainly be viewed as suitable only for pansies. No self-respecting teenager would be seen smoking anything less than a cigarette. The “soft drugs lead to hard drugs” has always been a highly suspect argument. Doubly so in this context.

MacDoctor’s advice to those wanting to stop smoking: avoid this product like the plague.

Related posts:

1. The Regulation of Tobacco
2. Spam Journalism #6
3. Force Quit

This is in keeping with what we know about neurophysiology. The frontal lobe of the brain starts to develop at around 16 years of age and is only fully developed by about age 23 (age 20 in girls). This is the area of the brain in which we assess risk, so it is hardly surprising that a 16-year-old boy makes reckless decisions. Medically speaking we should probably be extending the driving age to around 25, but this is not particularly practical.

Most parts of Australia now have graduated licenses that start at age 17 or 18. It should come as no surprise that Australia has about 60% of our youth fatality rate per kilometer driven. That is more that a third less teenagers slaughtered on our roads. New Jersey has had a graduated license system since 2001 offering a restricted license from age 17 for a minimum of a year (full license from 18 years). The fatal accident rate for 16-year-olds has halved and there have been substantial reductions in 17 and 18-year -old fatalities. Clearly the system works.

Interestingly, the increase in the driving age, somewhat immobilising 16 and 17-year-olds, has also been shown to reduced drug and alcohol use in these age groups, as an added side benefit. So when you hear 15-year-olds arguing that their freedom is being trampled on by raising the driving age, just remember that the freedom they are talking about is the one that entitles them to get slammed out of their minds on a Friday night and then wrap their car around a tree at high speed.

My idea of fun does not encompass digging bark out of the skull of a teenager in the early hours of Saturday morning.

Mr. Joyce should have ignored the ill-informed twitterings of Federated Farmers and raised the driving age immediately to 17. He will now have to engage in the same battle in a couple of years time, when it becomes crystal clear that this is what he should have done the first time.

Some journal references (sorry, only links to abstracts)

Voas, Robert and Kelley-Baker, Tara(2008) ‘Licensing Teenagers: Nontraffic Risks and Benefits in the Transition to Driving Status’, Traffic Injury Prevention, 9: 2, 89 — 97

McCartt, Anne T. , Mayhew, Daniel R. , Braitman, Keli A. , Ferguson, Susan A. andSimpson, Herbert M.(2009) ‘Effects of Age and Experience on Young Driver Crashes: Review of Recent Literature’, Traffic Injury Prevention, 10: 3, 209 — 219

Williams, Allan F. , Chaudhary, Neil K. , Tefft, Brian C. andTison, Julie(2010) ‘Evaluation of New Jersey’s Graduated Driver Licensing Program’, Traffic Injury Prevention, 11: 1, 1 — 7

Williams, Allan F.(2009) ‘Licensing Age and Teenage Driver Crashes: A Review of the Evidence’, Traffic Injury Prevention, 10: 1, 9 — 15

Related posts:

1. Too Young to Die
2. Fit To Drive
3. Pushing the Limit