Friday, November 7, 2014

A Tax Cut in Name, a Tax Increase in Reality

Much has been made of the Harper Conservatives' new income-splitting tax cut. It's actually called the Family Tax Cut. The schedule on the federal income tax return will actually be called Schedule 1-A: Family Tax Cut.

While Conservative supporters came flying out of the gates praising the measures as putting money back in the pockets of Canadians, it is only doing it for a few, for those who need it least, and on aggregate, is actually increasing our personal income tax burden.

Changes impact few Canadians

54% of families in Canada with children under 18 will get no benefit from this. Another 12.8% will only get an extra $250, not nearly enough to pay for even one month of child care for one child. Of all Canadian households, only 10% will see some benefit from income splitting.

Benefits those who need it least

Who does benefit mightily? Families with one high income spouse and one low income spouse. There is a small segment of the population that will reach the $2000 cap for this program. Here is the family structure you must have to maximally benefit from this program.

1. 1 or more child under 18.
2. 2 parents
3. A combination of the following annual earnings for each parent
a. Parent A makes $75k or more and Parent B makes nothing
b. Parent A makes $150k or more and Parent B makes $25k or less.
c. Parent A makes $200k or more and Parent B makes $50k or less.

You see now why it's not so unbelievable that less than half of Canadian families will benefit.

The average income splitting benefit per couple doesn't get north of $600 until they're making more than $82000.

You can't even make the argument, as supporters of the Conservatives and this plan do, that this will be of most benefit to those who choose to stay home and care for their children. The median income of families with one breadwinner and a non-working spouse is $40000. Their benefit from this plan would be $38 or less.

It increases the personal income tax burden of Canadians

The Parliamentary Budget Officer crunched the numbers on this plan. And here is where it falls completely apart.

The Conservatives would have you believe this is putting money in the pockets of Canadians. And it is. For one whole fiscal year.

After 2014/2015 (an election year), this plan causes two things to happen.

1. The total personal income tax burden on Canadians increases.
2. Total government expenditures increase. A lot.

The government has introduced a tax cut that actually causes taxes to increase. But not enough to offset the cost of the program. 

Enough so that by 2018/2019, it will COST the government an extra $4.8 billion.

If all that were not enough to make you wince, they are taking some of your tax dollars to advertise this tax cut increase in their typical partisan fashion, even though it will not actually be a law until next year.

It eliminates the Child Tax Credit

A previous version of this post mistakenly stated that the Child Tax Benefit would be eliminated. This was untrue. Due to the similarity of the names and the reporting of both names in connection with the Family Tax Cut, it was confusing.

For the sake of clarity, the CTB is a monthly benefit paid to lower income families. The CTC is a tax credit claimed on your annual tax return that lowers your taxable income by a certain dollar amount per child under 18. 

Since the Child Tax Benefit essentially credits you $338 per child in the family, but the enhanced UCCB adds $1200 per year, it is a net benefit to taxpayers with children under 18 living at home. 

All of the above still applies. On aggregate, it will increase the total personal income tax burden of Canadians and increase federal government expenses by a substantial amount. In fact, in Budget 2014, they project growing surpluses over the next four years. This plan is evidence that a budget is only good as those who try to keep on it. This plan instantaneously wiped out almost all the surplus they were on track to record this year. And it spent 50% of the surplus for the next 4 years. Increased taxes and expenditures to give a handout to a small portion of Canadian households. 

I thought tax-and-spend was a Liberal thing? 

And I'm far from the only one to consider this plan economically and politically foolish.

Income splitting and social engineering
Income splitting is bad politics...
Income splitting won't help those who need it
Harper's family tax cut isn't great policy, or good politics
Income splitting: Huge tax cuts for rich families
Wealthy husbands will cash in big time...
7 facts about Harper's family tax plan
Did Ottawa announce a tax increase last week?

Wednesday, May 7, 2014

Where are we going?

If you ask me, the glory days of Canada as a world leader in quality of living have sadly passed.  That does not mean they will never return, but we are certainly at a lower point than we have been at any time in my living memory.

I remember as a child being so proud to say that Canada topped the UN Human Development Index year after year after year.  So as I've been watching Stephen Harper's Conservatives slowly erode what I consider to be fundamental Canadian values it has made me more and more nostalgic for that bygone era.

Many people will challenge this assertion and that, of course, is their democratic right.  A right protected by the Charter of Rights and Freedoms, to me as quintessential and fundamental a guiding document to Canada as the Constitution of the United States is to that nation.  A document conceived and created in a time and by a government so fundamentally different from today that it seems more like a fairy tale than factual history.

The fact remains though, that for better or for worse, Stephen Harper has completely changed the Canadian political landscape and, in doing so, he has completely changed Canada's guiding principles, our economy, our way of life, and our global reputation.  And, as far as I'm concerned, not for the better.

I've already established that by pretty much every measure, despite popular assertion to the contrary, Conservatives are not better at fiscal management than Liberals.  In fact, at the very best they are just as good and an honest interpretation of the numbers would suggest they are worse.

But what about our global stature?  One cannot quantitatively measure our global reputation, but we can certainly measure our quality of living.  And the United Nations has thankfully been doing that since at least 1990.  And as far as Canada is concerned, the data does not paint a pretty picture.

In 2002, Stephen Harper and his party became Official Opposition in Canada.  In 2006 they formed the government.  And in 2011, they formed a majority government.  Coincidence?  Maybe.

But is the HDI ranking everything?  No, of course not.  How have we fared when compared to other wealthy nations?  Certainly our HDI as a raw number has increased over time.  But we've been left in the dust by many of our counterparts.

Compared to the US, Norway, Australia, Belgium, Denmark, Finland, France, Germany, Iceland, Luxembourg, Netherlands, New Zealand, Norway, Sweden, Switzerland, and the UK, we have not grown much in our HDI.  In fact you can see we started out on the top and have slowly migrated toward the lower half of these nations, being left behind mostly by Scandinavian and Northern European nations.  Norway is a great comparator as it is a northern nation with great resource wealth.  They've gone from an HDI of 0.804 in 1980 to 0.955 in 2013, a 19% increase.  Canada on the other hand has gone from 0.825 to 0.911, an increase of only 10%.  

But surely the UN HDI is not the only measure of quality of life or social progress.  That is true.  There are many others.  None have been calculated as long as the HDI, so you cannot see trends, but we can see where we stand today compared to other nations.

Social Progress Index: 7th; surpassed mostly by Scandinavians and Northern Europeans; NZ tops the list

Human Poverty Index: 8th; all Scandinavia and Northern Europe above

World Happiness Report: 6th; yup.  Scandinavia and N. Europe above.  Again.  

And, just in case you still think our health system is a bastion of perfection, the WHO World Health System Rankings: 30th.  That's right.  30th out of 191 nations.  Morocco, Saudi Arabia, and Colombia are a few of the nations ahead of us that don't traditionally appear near the top of other rankings.  

Don't get me wrong.  I love Canada.  I still think it's the greatest country in the world and I hold great hope for our future.  But our current government is taking us down the wrong path.  And I look forward to 2015 when, hopefully, we make a major course correction, and my children can live through a 7 year unbeaten streak atop the UN HDI as I did in the 90s.  

One can hope.  

Saturday, January 25, 2014

This Facebook graphic is full of shot

I saw the above image posted on Facebook.  Under the image, below where it says "Protect yourselves with knowledge!", is a laundry list of "knowledge" from such reliable academic sources as Natural News, run by anti-medicine, anti-science conspiracy theorist Mike Adams, and Joseph Mercola, purveyor of quackery and recipient of multiple warning letters from the FDA to stop making misleading health claims.

Normally I don't even bother with this sort of reckless disregard for science.  But this image is so wrong in so many ways, I couldn't help but try and counter the mis- and dis-information it attempts to dangerously spread.

Why is it that someone can post this and, without any valid factual references whatsoever, people start sharing it all over Facebook as though it were true?

This is a long post.  But something this complex requires detail and referencing.  I can't just post a bunch of statements and say they're true.  Unfortunately that is how people consume their health information these days.

You should indeed protect with yourself with knowledge.  But the image does not qualify as such.  It is misleading and dishonest fear-mongering.

And here's why.

1.  There is no longer an H1N1 flu shot.

There is a seasonal flu shot.

Every year, over 100 monitoring centres in over 100 countries around the world monitor active strains of influenza.  Based on all of this information, the World Health Organization makes a projection as to which strains are most likely to be active in the upcoming influenza season.  From this, the vaccine strains are decided.  It is not perfect.  If the prediction matches more than 80% to the actual circulating strains, you only have to vaccinate about 40 healthy, working age adults to prevent one case of influenza.  If the match is poor, that number doubles, and it may not be more effective than placebo.

This year those strains are Influenza A H1N1, Influenza A H3N2, and Influenza B.  There are different types of vaccines made in different fashions.  I will cover the three publicly funded in Alberta.

Agriflu: This is made by growing the selected viral strains in hens' eggs.  This process alone weakens the virus as it adapts to growing in a galline environment, making it less able to replicate in human cells.  But as a safety measure, it is inactivated using formaldehyde (Note: the amount of formaldehyde in a single flu shot is less than would be consumed by eating a single pear).  Then the viral particles are removed through a purification process and only the hemagglutinin is left behind, a protein that occurs on the surface of the influenza virus.  This protein allows the virus to attach to human cells and also causes the immune response to the virus.  So you can remove the virus and isolate the protein itself (also known as a "surface antigen") and still get the desired immune response.

Fluviral: The strains used are the same for this vaccine but it is manufactured slightly differently.  The whole virus is first inactivated using UV light, then formaldehyde, then purified, then disrupted using sodium deoxycholate.


Flumist: This is slightly different.  It is mostly used for children or individuals under 60 who would prefer a nasal spray over a needle.  The virus is replicated in eggs just like the others.  However, it is not inactivated.  It is attenuated, meaning the virus is weakened.  They adapt to grow at 25℃ and cannot replicate efficiently at body temperature.  They also cannot cause influenza.  They replicate efficiently in the nasal passage and thus induce an immune response.

There are also Intanza, Influvac, Fluad, and Vaxigrip, but they are all made with one of the above methods.

It bears repeating that not one of them ONLY contains H1N1.

They all contain the same three strains as above.

2.  Forgiving the creator of the above image for their error, and assuming "H1N1 Flu Shot" means "Seasonal Trivalent Flu Shot", let's see if they contain all of the things they mention and, if they do, if we need to be worried about it.

a.  Beta-propiolactone

i.  Is it in any of the above vaccines?
Nope.  Not a single one of the seven vaccines above contains this ingredient.

ii.  What is it?
It is a sterilizing agent that is NO LONGER USED in medical procedures or for food.

iii.  Is it a carcinogen?
It is considered "reasonably anticipated to be a human carcinogen".  Read this as "We've done rodent studies on it and found it caused tumours in rodents but have absolutely no idea whatsoever if it has an impact on humans because those studies have not been done"  But proving that the medical establishment is not a giant killing machine intent on propagating cancer, it was removed just to be safe.

b.  Neomycin sulfate

i.  Is it in any of the above vaccines?
Vaxigrip, Intanza, Fluad, and Agriflu all contain it as non-medicinal ingredients, usually as trace amounts.

ii.  What is it?
It is an antibiotic, found in topical creams, ointments, and antibiotic eye drops.

iii.  Is it an immunotoxin?
Well, considering that immunotoxin isn't even a real word in the way it is used here, the answer is no.  It is toxic to bacterial cells, which is why it is effectively used as an antibiotic.  Not using it or some other antibiotic would risk dangerous bacterial contamination of our vaccines.

An immunotoxin in the truest sense of the word is a therapeutic molecule created through genetic recombinant technology.  An immune molecule is attached to a toxin.  The targeted cell takes up the combined molecule, upon which the toxin kills the cell.  It is investigated for its use in killing certain cancer cells and viruses.

Neomycin is not one of those things.

It does bear mentioning that some people are allergic to neomycin so should choose one of the vaccines not containing it.

c.  Polymyxin B
This is my favourite one.  It's actually outright hilarious.  This is the ingredient that made me decide I needed to respond to this ridiculous image.

i.  Is it in any of the above vaccines?

ii.  What is it?
It's an antibiotic.

It's one of the most commonly used antibiotics in the world.

Some people would know it better as Polysporin.

iii.  Is it a neurotoxin?
Well let's hope not.  Because there would be literally millions of people walking around being slowly poisoned by the little tube of cream in their medicine cabinet.

d.  Potassium chloride
i.  Is it in any of the above vaccines?
Influvac (100mcg), Intanza (20mcg), Fluviral (trace), Fluad (100mcg), and Agriflu (100mcg)

ii.  What is it?
Potassium chloride is one of those things that is both incredibly necessary and potentially incredibly toxic.  Potassium is crucial to human body function and is commonly supplemented orally as potassium chloride.  If given in high doses it can be toxic, causing cardiac conduction failure.  However, the highest dose in any of the above vaccines is 100mcg.

Is this of concern?

One banana contains roughly 400mg of potassium, 4000x the amount contained in a single vaccine.  The LD50 of potassium (the dose at which it would kill 50% of people consuming it) is 2.5g/kg (keep in mind table salts LD50 is 3.75g/kg).  So if you weighed 75kg (165lbs), that'd be 187.5 g.

This is 187.5 million mcg of potassium.

You would need to get 1.875 million vaccines at once to kill you from potassium overdose.  Even at the IV LD50 of 30mg/kg, you'd still need to receive 22500 vaccines.

So if you plan on being immortal, maybe it should concern you, but for us mere mortals it is of no concern beyond needlessly scaring people.

iii.  Is it a neurotoxin?
At the doses above, maybe.  At the doses in vaccines?  Absolutely not.  If you want a poignant example of the impact of dose on biological effects, read the Material Data Safety Sheet for table salt.

e.  Sodium taurodeoxycholate
i.  Is it in any of the above vaccines?

ii.  What is it?
It is a chemical used for isolation of membrane proteins.  It is also a naturally occurring bile acid in human bodies.

iii.  Is it a carcinogen or immunotoxin?
Well, we've already established that immunotoxin is a made up word in this sense.  What about a carcinogen?  Nope.

f.  Thimerosal
Whole books have been written about thimerosal, so I'll just stick to the focus here.

i.  Is it in any of the above vaccines?
Vaxigrip (2mcg), Fluviral (50mcg/shot).

ii.  What is it?
An organic mercury compound used as a preservative.  It is a form of ethylmercury which is broken down by the body much more quickly than mercury occurring in nature, methylmercury.

If you want to argue about one carbon atom, I ask you to consider this.

Ethyl alcohol (2 carbon groups) is consumed in mass quantities around the world every Friday and Saturday evening.  Methyl alcohol (1 carbon group) causes rapid poisoning and death.

Propylene glycol (3 carbon groups) is a relatively harmless solvent used for medical and food purposes.  Ethylene glycol (2 carbon groups) is used to keep your coolant lines from freezing and is also extremely poisonous if consumed orally.

iii.  Is it a neurotoxin?
I refer to Paul Offit's incredible book, Vaccinated, for this answer.  Yes mercury can be neurotoxic in high doses.  But in the doses and form used in vaccines, it has never been linked to neurotoxicity.

Also consider that a human child ingests about 360 mcg of methyl mercury from breast feeding in the first six months of its life.  So even the Fluviral contains less than a quarter of the mercury that a baby gets just from drinking mommy's milk.

A study done in Canada provides some of the most conclusive evidence that thimerosal is not linked to autism, one of the most common neurotoxic outcomes attributed to its use in vaccines.  Between 1987 and 1991, vaccinated children in the study received 125 mcg of thimerosal, between 1992 and 1995 225 mcg, and after 1996, 0 mcg.  The incidence of autism was actually higher in those children vaccinated after 1995 than those before.  This is likely due, as is the case with most other things thought to cause autism, to a broadening understanding and diagnostic definition of the disorder.

A massive review in the British Medical Journal concluded strongly that thimerosal does not cause autism.  Of particular interest, autism rates have risen in Denmark since 1991, the year they banned the use of thimerosal in vaccines.

Case closed.

Onto the next claim.  Here it is not that the claim is ridiculous, it is more that it is overstated.

Have vaccines actually been linked to the diseases mentioned?

1.  Narcolepsy
Here is one that is not too ridiculous.  There was an observed association between the pandemic H1N1 vaccination program in 2009 and increased cases of narcolepsy.  However, at this point it is an observed association, like ice cream consumption being associated with swimming pool drownings.  One association study suggested an increased risk of 4 additional cases of narcolepsy per 100000-person years (that is, in 100000 people over the course of one year, 4 additional cases may be associated).  However, further immunologic research has called causation into question and suggests this is likely just a fluke association.  More research is required.

2.  Guillain-BarrĂ© Syndrome (GBS)
The best research suggests the excess risk may be 1-2 extra cases per 1 million people vaccinated.  In contrast, by vaccinating 1 million people with flu vaccine, you would prevent roughly 25000 cases of influenza.

3.  Autism
So thoroughly debunked and refuted by real science it is barely worth arguing about.  See above on thimerosal.

4.  Paralysis
This is a repeat of GBS above.  Let's think of synonyms for the same disease and put them in multiple spots so people think the shot is even more scary.

5.  Dystonia
Nope.  Could find no research supporting this association.  Not even epidemiological evidence.

6.  Rheumatoid arthritis
Only correlational, not causative, associations found.  Whenever controlled studies have been performed, association disappears.

7.  Multiple Sclerosis
No increased risk from Hep B, Influenza, MMR, polio, or typhoid immunization.  Diphtheria and tetanus vaccination potentially PROTECTIVE against MS, not causative.

8.  Lupus
Nope.  No research to support this notion.

9.  Cancer
Vaccines don't cause cancer.  If anything, they prevent it.  Hepatitis B vaccine can prevent liver cancer induced by hepatitis B.  HPV vaccine was developed for the sole purpose of preventing cervical cancer in women.  And although only a concern in chickens, Marek's Disease is prevented by a vaccine against the oncogenic virus that causes it.  (All taken from Offit's book)

I'll get to death last.  But first I will tackle the other two statements in the picture.  The H1N1 shot may have been banned in some countries.  Who knows?  But it doesn't matter because IT IS NOT USED ANYMORE.  Nor could I find any supporting documentation regarding the H1N1 vaccine makers not taking their own vaccine.  However, I find it very hard to believe, given that early vaccine makers often tested their experimental vaccines on family members and drug company executives before bringing them to clinical trial (an obviously unethical practice that would not pass muster today).

10.  Death
Yellow fever vaccine has 10 reports of death associated with its use. The risk is incredibly low.  Millions upon millions of people have received this vaccine.  Risk of serious reactions is less than 1 in 1 million to 1 in 8 million.  Death from those reactions is even less common.

For other vaccines in current use, there is no conclusive links to death.

To quantify the number of deaths PREVENTED by vaccines would require a whole other article.  However, I will use the most poignant example.

Before the vaccine was commonly given, smallpox ravaged populations around the world.  In the 20th century, it is thought to have killed 300-500 million people.  In the 18th century, in Europe alone, it killed 400 000 people per year.  It almost completely destroyed indigenous populations in the Americas upon arrival of European settlers.

Some experts estimate smallpox was responsible for more deaths than all other infectious diseases combined.

Because of Edward Jenner's vaccine, humanity actually eradicated the virus from circulation.

And in case you think influenza is some annoying seasonal pest that causes mild misery, here is a history lesson.  Spanish influenza killed upwards of 100 million people in 1918.  In 1957 Asian flu killed 2-3 million people globally.  And in 1968, Hong Kong flu killed over 34 000 Americans.

Infectious disease is still the second most common cause of death worldwide.  They cause 45% of deaths in low-income countries, 63% of deaths among children, and 48% of premature deaths.

A study in the New England Journal of Medicine published in November suggests that vaccines have prevented 100 million deaths in the United States alone.

Vaccines don't kill people.

Ignorance does.

Incidence of vaccine preventable diseases

Friday, December 27, 2013

One a Day Keeps Nothing Away

Vitamin use is ubiquitous in Canada.  50% of women and 35% of men take a daily vitamin or mineral supplement.  They are so commonly used that few question their necessity.

James Lind was an 18th century Scottish physician tasked with finding a cure for scurvy, a greater threat to the Royal Navy than enemy arms.  Instead of relying on anecdotes as his colleagues did, he conducted the first known clinical trial.  Citrus fruit was so obviously effective that supply of lemon juice was made mandatory on all British ships.

It took 100 years to discover that vitamin C in citrus fruits is what cures scurvy, but Lind’s rational approach nonetheless identified the best treatment and saved lives.  

Contrast this with the approach taken by Linus Pauling and his countless followers.

Pauling was an American scientist who won the Nobel Prize in Chemistry and the Nobel Peace Prize.  Then he met Irwin Stone.

Stone convinced Pauling, just by saying so, that if he took 3000 mg of vitamin C daily, he would live a long life.  Pauling was so excited about vitamin C he increased his daily dose to 200 times the daily limit and published a book about it. Shortly after, 50 million Americans were following along.  

He eventually promoted other vitamins to prevent and treat every disease known to modern medicine, including cancer.  His pronouncements became so outrageous that he lost his scientific credibility.

The public didn’t notice and the use of vitamin supplements grew unabated.

Pauling based his treatment on anecdote, Lind based his on evidence.  

Who was right?

Vitamin C is useless in treating colds.  It may slightly reduce the duration of colds if used daily, but not the number of colds.  

As for multivitamins, there is no currently available evidence that daily use in the general population has any impact on reducing cancer, cardiovascular disease, or mortality.  

Beta-carotene, selenium, and vitamins A, C and E warrant special mention.  Not only do they have no impact in preventing disease but there is reasonable evidence that beta-carotene and vitamin E may actually increase risk of death.  

“There is no scientific basis for recommending vitamin-mineral supplements to the healthy population.”-Dr. Benjamin Caballero, MD.

4.  Offit PA. Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine. New York:HarperCollins; 2013.


Friday, December 13, 2013

Something's Fishy Here

First published in the December 6, 2013 issue of The Vault Magazine.  

If you research ice cream sales and drownings in swimming pools, you will find they are correlated.  That is, as ice cream sales increase, so too do drownings in swimming pools, and vice versa.  To say that ice cream causes people to drown is of course absurd.  More likely, heat waves cause both variables to increase.

This logical fallacy is common in population studies.  Researchers look at large groups of people and analyze their lifestyles.  They then look at the health of this population and try to determine if certain lifestyle factors are associated with poor (or positive) health outcomes.  

When they find relationships it often leads to pronouncements of causation which quickly spread. 

The ubiquity of omega-3 fatty acids is testament to the problems this can cause.  

Omega-3 fatty acids (AKA omega-3s, EPA, DHA, fish oil, etc.) occur most commonly in fish.  They represent a $25 billion global market, mostly in infant formula, fortified foods, and supplements. 

From this one would think the evidence is conclusive that they improve health.  

Sadly, this is not the case. 

It all started in the 1970s when Danish researchers looked at Greenlandic Eskimos, a population with extraordinarily low rates of heart disease.  Their diet consisted almost entirely of marine animals and their blood showed massive levels of omega-3s.  

Assuming correlation equals causation, they attributed the low rates of heart disease to the high rates of omega 3s.

The notion spread.  Study after study showed that high rates of fish consumption correlated with lower risk of heart disease.  

Today omega 3s appear in every form imaginable, from pills to yogourt.  They are promoted for infant development, intelligence, autism, ADHD, heart disease, Alzheimer’s and more.  

Dr. Oz says they are 1 of 5 "critical" supplements every woman should take, and good for "just about every single part of your body".  

To determine causality, researchers conducted randomized controlled trials, the gold standard in medical research, on omega 3 supplements.  

The Cochrane Collaboration reviewed many of these studies and the conclusions are clear.  

There is simply NO evidence that supplementation with omega-3 fatty acids causes any of the health benefits attributed to them.

Populations with high fish consumption have lower rates of heart disease than those with low fish consumption.  

This does not mean fish consumption causes low rates of heart disease.  

It is likely just one component of an overall healthier lifestyle.

To think that in the infinitely complex interaction between lifestyle and health that ONE chemical component of ONE food group is responsible for this effect is a leap of faith. 

To take that one ingredient and put it into every food and supplement we consume and think we will reap healthy rewards stretches the boundaries of reason.  

It’s a shortcut to health that rarely works.  

Next time: What multivitamins and the Nobel Prize have in common.  



Friday, November 29, 2013

The Cholesterol Conundrum

Originally published in The Vault Magazine, November 22, 2013.

On November 12, the American College of Cardiology and the American Heart Association released an update to their clinical guidelines for the management of high cholesterol.  Amid all the ensuing controversy and debate, the most remarkable facet of the guidelines was forgotten.

Previous guidelines promoted measurement of cholesterol and frequent monitoring for the purposes of “getting to target”.  Start treatment, measure cholesterol, adjust treatment if it needs to go lower, and repeat.  

The new guidelines suggest these numbers be almost entirely abandoned in clinical practice.  If a patient has excessive heart disease risk and it has not been ameliorated by lifestyle changes, they suggest you take a statin (eg. LipitorTM and CrestorTM) and be done with it.  The cholesterol measurement only remains important for determining risk. 

It’s about time.  These targets were always arbitrary.  They have no scientific underpinning and led to excessive treatment including unnecessarily high doses and use of drugs that have no proven benefits beyond lowering cholesterol.  

Wait a minute.  If a drug lowers cholesterol, isn’t that good for you?  

Not exactly.  And herein lies the public interest in this issue.  

Cholesterol is a “surrogate marker”.  If studies show lower cholesterol correlates with lower heart disease risk, then a drug developer might look at the impact of their treatment on cholesterol and assume any reductions in this number translate into reductions in heart disease.  Measuring heart attacks, strokes, and deaths in your research takes time and money.  Measuring cholesterol does not.

If A=B and B=C, in medicine at least, A does not always equal C.  

For example, many cholesterol drugs on the market reduce bad cholesterol but only statins are known to reduce heart disease.  

Not convinced?

Torcetrapib was a drug being developed by Pfizer which showed great promise as the next “blockbuster drug”.  Early small studies showed the drug raised good cholesterol by 60-100%.  This should, by extension, mean it reduces heart disease.

Shortly after, Pfizer’s large clinical trials were stopped early because the drug increased risk of death by 60%.  

Why should you care?  

Because the media, TV doctors, and internet snake oil marketers LOVE surrogate markers.

Dr. Oz’s most popular recommendation of the year has undoubtedly been raspberry ketones for weight loss.

Too bad they’re useless.

His website quotes all sorts of research on the topic to lend it credibility but it is useless for everything but hypothesis generation.  All the studies he quotes were done on animals or in test tubes and they studied things like markers of metabolic rate and fat metabolism.  

Not a SINGLE piece of research shows raspberry ketones do ANYTHING useful in humans, let alone cause them to lose body weight or body fat.  

THAT is why you need to know about surrogate markers and why from now on, you will know to ignore practically everything Dr. Oz says.  

Unless by some miracle he starts promoting products based on high quality medical research conducted on humans.

I can dream.

Next time: Why some would argue that ice cream causes swimming pool drownings.

Other Resources
A hilarious video on surrogate markers from my friend and colleague, James McCormack, PharmD.


Wednesday, November 20, 2013

The Problem with Origins

I was directed to this "enlightening" image by a Facebook friend.  I don't take umbrage with her sharing it with me.  I believe she only meant to guide me toward the origin of the word Pharmakeia.  However, after looking at the link, I have to take umbrage with the suggestion inherent in the text of the image.

Instead of writing a giant tirade of a comment on Facebook, I thought I would post it here.

The origin of the word pharmakis in Ancient Greek did indeed mean "witch".  This makes sense as much of the origin of pharmacy came from experts in botany and translating that into medicinal uses.  Many early chemists were considered "witches" by the medical establishment at the time, which is funny given that the docs thought disease was caused by unbalanced humours in the body and treated everything under the sun with blood letting.

And yes, they were seen as potions and witchcraft, but only because the science hadn't caught up to their use.  Use of pharmacologic substances was much more advanced in the Arabic world early on than it was in Europe.  It is there that pharmacology as a science originated.  Meanwhile in the "modern" world of Europe, because the drugs they used were not understood, those making them were considered witches, sorcerers, and poisoners.  All drugs are really just poisons brought to a dose tolerable by the human body.  Anyone suggesting that this means pharmacists are poisoning everyone doesn't understand science.

As the science of pharmacy evolved, it always remained connected to medicine.  It is only recently that it evolved into an independent profession, and, in turn, it evolved into a more clinical profession than one focussed solely on drugs.  The word "pharmacy" today means something very different than it did even 25 years ago, let alone in the Middle Ages or Ancient Greece.

If we are going to take the word literally, the original practitioners that were labelled this way practiced something more similar to modern herbalists and "natural" practitioners.  If homeopathy, for example, actually worked, it would only be through witchcraft, given that there is no detectable active compound in homeopathic substances.

As well, the word "physician" comes from "healer", "sage" and even "physicist".  "Doctor" comes from the word meaning "teacher".  That doesn't mean they teach kids in classrooms about how to prove String Theory.

More etymology fun.  "Sycophant" originates from "showing the fig".  Figure that out.  Or "clue".  Originates from "ball of thread".

The point is that the origins of words are meaningless without historical context and evolution.

The poster of the image above sells essential oils for a living.  She actually promotes essential oils for weight loss.  Essential oils have absolutely no scientific evidence whatsoever of effectiveness, no less for weight loss.

I'm not going to comment on her use of Bible quotes to deride and debase modern medical science.  If she wants to believe that using products that have no scientific evidence to support their use means she has "knowledge", she can go on thinking that.

Or MAYBE, just MAYBE, she is making those arguments because, gee, I don't know, she sells essential oils through her website?  And yes, I know I'm a pharmacist, before someone points out the obvious and says I also have a financial interest in promoting drugs as safe.

Too bad I spend more time talking people OUT of taking drugs (which, no matter what way you slice it, "natural" products are also considered; as a dietitian once said "If you get it from food, it is a vitamin.  If you get it in a bottle, it's a drug.").

And that the majority of problems associated with medication use are due to inappropriate use or prescribing.  Roughly 7.5% of hospital admissions in Canada are due to adverse drug reactions.  Roughly 40% of those adverse drug reactions are considered preventable.

But none were likely due to natural products, right?  Wrong.  Natural products cause serious reactions too.  Unless you think that hepatotoxicity leading to market withdrawal is not serious.  Sadly, many of them go unnoticed because, despite appearances, they are poorly regulated and there is very little in the way of formal pharmacovigilance monitoring programs.

If someone wants to go back to the time before modern medicine, they can be my guest.  But I'd rather revel in the advances of modern medicine that have expanded the human lifespan.  It has not been universal by any means, but we are getting somewhere.  Estimates range from roughly half of the 7.5 years gained in life expectancy since 1950 being due to medical care to 25 of the 30 years gained since the early 1900s being due to public health measures (vaccines, improvements in sanitation, etc.).  And yes, some of these things, like pasteurization (this is a really good article; check it out), were discovered by scientists and not necessarily "medical" practitioners, but the scientific method underpins the discovery, as it does medicine, so the argument still stands.

Natural does not mean safe.  Synthetic does not mean dangerous.  I wonder if proponents of this notion would be willing to part with all of the other synthetic products in their lives?  Or if they knew some essential oils were extracted with solvents like methanol and hexane? Or if they knew stevia is manufactured using a chemical extraction process and marketed by such major players as Cargill?

If worshiping modern technology means that I adhere to the scientific method and refuse to condone anything that has yet to be proven effective or has actually been proven completely useless, than a witch I am.  Or warlock I guess.