Jumping to conclusions

It seems I may be guilty of the very thing I continuously rail against: jumping to conclusions. Although I do not do this often enough to warrant the use of a jumping to conclusions map (see Office Space), I am a frequent enough offender. The most recent offence relates to a previous post of mine in which I state that the name America originates from Amerigo Vespucci, a cartographer that tailed along with Columbus. Although the origin of a name such as America likely has a great deal of uncertainty attached to it, I stated it as though it were fact. Thanks to the wonderful book I received for Father’s Day, The Book of Origins by Trevor Homer, I realized that this “fact” was actually far from it. A quick note on this book. For any man who spends inordinate amounts of time on the toilet, even when you are not actually producing anything worthy of a toilet, this book is a must-buy. It is all about the origins of everything you can imagine from ancient empires to languages to communications to art forms etc.
In the chapter on origins of nations it talks about the genesis of America, including the controversy surrounding its name. Apparently there is a good deal of evidence supporting America being named after Richard Amerike, a frequent sponsor of exploratory voyages at the time. It is thought that he sponsored voyages on the condition that whatever was discovered was to be named after him (talk about a narcissist). His most famous sponsored voyage was that of Giovanni Caboto (AKA John Cabot). Upon discovering Newfoundland, he then hopped the short distance to America and claimed the land in the name of his sponsor.
The most interesting thing about this whole theory is the resemblance of Amerike’s family coat of arms to that of the current American flag. Apparently the coat of arms consists of a series of stars and stripes. Interesting.

Media frenzy

Before I ramble on about this, if you want the short version, check out this good summary by Dr. Michael Evans in the Globe and Mail.

I received a fax from my head office imploring me to call all of my patients on Avandia to discuss recent concerns raised in the lay press about this drug. I decided that before I called them all and freak the hell out of them I should look into the original article.

The article was published June 14 in the New England Journal of Medicine. The first thing that set me off was that the media coverage emerged May 22, meaning that information was released to the public before health professionals even had a chance to access the information to critically appraise it. Now that I have access to it, let us discuss the problems with this study and why you should not stop taking your Avandia.

First of all, a prelude to the study. Avandia is also known as rosiglitazone, a thiazolidinedione, a group of drugs that increase sensitivity of the body’s cells to insulin, thereby improving glucose uptake and reducing the signs and symptoms of diabetes and their ensuing consequences. When Avandia first came onto the market, it was recognized that it increased cardiovascular risk slightly, specifically in patients with congestive heart failure (CHF), a condition in which the heart can not efficiently pump blood often leading to fluid buildup and consequences of insufficient blood supply to the organs. Accordingly, Health Canada specifically states that Avandia should NOT be used in patients with severe CHF.

Furthermore, Avandia is not approved for use in combination with certain other diabetes medications, namely sulfonylureas (glyburide and gliclazide) and insulin.

So this is the first problem with the study. Since it is a meta-analysis it analyzes the results of studies already performed and so the populations used in these studies are known and tabulated in this study. In 17 of the 42 trials studied, the treatment group was receiving a rosiglitazone/other drug combination not approved for use in Canada.

Now this is where it may get boring for some of you, but as God as my witness, I love this stuff.

One of the key features of a quality meta-analysis is a comprehensive literature search. If you do not include all the possible studies on the subject, you are running the risk of your study results reflecting publication bias. This is one place in which this paper failed. They did not do literature searches of the major electronic databases, nor the Cochrane collaboration, two very important sources of quality medical literature. Furthermore, they did not scour the reference lists of the studies used to find other relevant studies that may go unnoticed in a literature search. The real problem with this study is that it relies almost entirely on studies done by the manufacturer, GlaxoSmithKline, all garnered from their website. In total, 26 of the 42 studies used were unpublished in peer-reviewed medical literature. This is a huge problem as the quality of the studies, and therefore the validity of their results, is brought into question. Only 2 large well done studies were used in the entire meta-analysis.

One huge problem I have with their selection of studies is that they provided no measure of agreement among authors as to which papers should be included and which should not. This is mathematically expressed as a kappa statistic, something conspicuously absent from this paper. They also did no test for publication bias, that is, did the studies they include miss out on a big chunk of the available literature on the subject and therefore skew the eventual conclusion.

Next one must consider the test of heterogeneity. This is a test that determines the variation in results between the different studies. Variation will always exist, but the test of heterogeneity determines whether this variation is likely due to chance or if the studies are so varied in their results that we must question whether they can be combined into a pooled result. A HUGE problem here is that trials in which the subjects had no cardiovascular events were not included in the analyses. Consider that for a minute. You are trying to determine whether the medical literature out there supports the hypothesis that a certain drug causes cardiovascular events (heart attacks, strokes, etc.) You want to see if the studies you’ve included vary so much as to prevent them from being combined. Unfortunately, you do not include any study in which patients DID not have cardiovascular events. So of course your results will show a relative level of homogeneity, because you removed all the studies that stray from your hypothesis. Hmm.

When meta-analyses combine results of their individual studies, they use either a fixed-effects model (FEM) or a random effects model (REM). The FEM assumes that if all studies were infinitely large, the effect would be identical. For this to work, the test for heterogeneity needs to show very little variation. This study showed little variation, but not little enough. The REM, however, assumes that all study results will be randomly distributed around the true value. The researchers in this case used FEM which biases away from the null hypothesis: that is it will push toward the notion that there is an effect. The REM is more appropriate in most cases, because it is most conservative and biases toward the null: there is no effect.

Finally, let us look at the results. This is where the real problem arises. The article listed at the beginning touches on the distorted reporting of these results in the media. They reported all about relative risk and nothing on absolute risk. See, we shall now.

The odds ratio reported was 1.43, ranging anywhere from 1.03-1.98 with 95% confidence. So the truth lies somewhere between those receiving rosiglitazone being just as likely to 2 times as likely to have a heart attack than those not on rosiglitazone. However, if you look at the absolute risk increase, something entirely different emerges. It is incredibly small. First of all, the rate of heart attacks in both groups (treatment and control) rounds off to 0.6%. The most understandable value I can provide from this is the numbers needed to harm: 4854. This means that 4854 people would need to be treated with rosiglitazone versus controls in order for 1 heart attack to occur.

The biggest problem I have with the above is that the study authors did not even identify the total rate of heart attacks in both groups. Of course, having done so would have made their fancy odds ratio seem very silly.

So, if your neurons are still active after all of this, take the following home with you: be careful what you read in the papers. Most health journalists are not trained in the intricacies of epidemiology. Did you understand any of what I just said? Unless you are a pharmacist, physician, or other highly-trained healthcare professional, probably not. I took a whole semester in university just on learning how to analyze medical literature. Do you think the leading health journalists took that course?

Sure, information is a good thing to have, but careful what you do with false and misleading information, and almost more importantly, incomplete information. Please, for the sake of your health, do NOT stop taking this drug without having a serious discussion of the risks and benefits with your pharmacist and your physician. The last person you should be taking medical advice from is a journalist.

PS-On a side note, I have no connection to any pharmaceutical manufacturer that would bias my views in any way. I am heavily supported by Reason, Science, and Rational Thorough Analysis. Although these companies are publicly traded, not many people out there seem to be buying. Oh, and for the record, I will not be calling my patients to unnecessarily worry them. If they ask me about it, I will give them the short version of the above.

Walrus wins

Who would have ever thought such a lumbering beast as a Walrus could win a race? Oh wait, it wasn’t a real race, but the Walrus magazine, possibly the greatest magazine to ever emerge from Canada (Maclean’s used to be good but it now seems more like a soapbox placed firmly on the right side of the spectrum). Every year the National Magazine Awards Foundation holds the National Magazine Awards, a celebration of excellence in magazine journalism. And the Walrus kicked everyone else’s ass. It won 50 awards, including 6 golds, the most of any competitor. It beat the next best competitor, Toronto Life, by 27 awards. If you are a person interested in current events and political affairs, you have to subscribe to this magazine. It is not for the lighthearted, but man is it amazing. The writing is incredible, and they can make the most seemingly uninteresting subjects completely entrancing. Check it out.

Atheism: Is it the only truth?

So it seems society has settled on its new favorite reading material. For at least 6 weeks now, two books have shared top spots on the Globe and Mail’s bestsellers list. The books in question are God is Not Great by Christopher Hitchens and The God Delusion by Richard Dawkins. Both of these are essentially pugilistic diatribes against the whole concept of religion (in the case of the former) and the idea of the existence of God (in the latter case). The notion that those who believe in God or practice religion are somehow delusional is prevalent in our society. So allow me to be the first to admit that if this is so, I am one super delusional nutjob.

My problem is not with these gentlemen espousing their ideas nor with consumers buying their books. My problem is with the wholesale rejection of the opposing view by these authors and those who share their opinions. My biggest problem is with their assertion that atheism is somehow the default worldview, that it is the only one that makes sense, and that any other view should not be entertained for fear that we will only encourage the development of intellectual retards.

What these authors and many other thinkers do not accept is that their worldview is as much a leap of faith as mine. The belief that there is no God and that there is no place for religion in the world is no less based on objectivity than the alternative. One of the main arguments made by atheists such as Msrs. Hitchens and Dawkins is that believers in God and proponents of religious life are taking the easy way out and hiding behind a belief that cannot be empirically tested. Of course, this is an absurd argument because no cosmological belief as broad as this can be either proven or falsified but that does not make it any less of a valid view. Atheists cannot possibly test their view either, but somehow belief in nothing is more psychologically responsible than belief in something. So I will not sit here and commit the same faults as these thinkers by purporting that my worldview is correct, but I will say that ones mind must be open to exploring all views.

And that brings me to some alternatives. A new book was recently published by Pope Benedict XVI, AKA Joseph Ratzinger, called Jesus of Nazareth. In it he seeks to explain both the historical Jesus and the spiritual one. It is said to be surprisingly measured for a man commonly thought to be an ultraconservative polemicist. Now, while I have not read any of the above books yet, I am a believer in reading books that both challenge my worldview and confirm it, and I recommend the same for all of you out there.

I plan to read all three of these books in due time. Of course, I will most likely agree with the Holy Father, and most likely disagree with Msrs. Hitchens and Dawkins, but I find it incredibly refreshing to read the views of those who do not share mine.

For example, I once read Critiques of God, a collection of essays by many of today’s top thinkers on why the idea of a God creates dissonance with reason. While I really questioned some of the thoughts put forward, it was a very intriguing book and mind opening to read. In full fairness of disclosure, I will admit that more of the books I read on ontological philosophy are in support of my view, but I do try to intersperse them with those challenging my views, and I recommend the same for you. The next book on my list after the above two is Atheism: The Case Against God. If everyone in the world could embrace intellectual discovery, we wouldn’t have so many ridiculous squabbles over ideas.

Allow me for a moment to deal with one favorite of atheists: war and death in the world is all due to religion. While this may seem so on the surface, is it not equally likely that it is not religion itself causing the “Holy Wars” around the world, but instead the intellectual rigidity of those following these “religions”, which, equally likely the cause of these wars, are often not the true religions they have been named but distortions of the original concepts used by those leading the fight to bring followers to their side. Is it not also possible that if people were to just open up to other worldviews that the whole problem wouldn’t exist, that if the atheist mantra that there is only one true ontology and all others are to be spoken out against, that the problem would go away? Maybe it is in fact a poor grasp of the true meaning of spirituality and religious teaching that leads people to recklessly take the name of God in vain in pursuit of their twisted ideologies. Maybe Rosie O’Donnell was a bit emotional about it, but the Bush administration’s war against Islam is very much a part of the distortion of Christian belief held true by Bush and his followers, and although not overtly so, somewhat terroristic in nature. It is an extension of Manifest Destiny still held by many in the upper echelons of American political society.

Let us take a moment to reflect on a potent diatribe against the “Christian” theology of the Bush administration. This I take from John Tirman’s excellent 100 Ways America is Screwing Up the World.

The following are distortions of Christian belief taken up by Bush’s soldiers:

1. “How hard it will be for those who have riches to enter the kingdom of God!…It is easier for a camel to go through the eye of a needle than for a rich man to enter the kingdom of God.”

Mr. Tirman goes on to point out that Mr. Bush and his family are exorbitantly wealthy and most of the policies put forward by Bush Jr and Sr favored the rich and punished the poor, quite the opposite of Christian teaching.

2. “If anyone strikes you on the right cheek, turn to him the other also.”

There is no escape clause for 9/11. Retaliatory and preemptive strikes are not the purview of Christ.

3. “Blessed are the peacemakers, for they shall inherit the Earth”

Gandhi and his teaching of nonviolent resistance hit this one on the head, but Bush seems to have missed that sermon. “He who taketh up the sword shall perish by the sword. Think ye that evil can be overcome by evil or violence by violence? The way of peace requires courage and patience, but it will prevail.”

4. “Mortals go to war so that they can inherit dust. It is because their vision is distorted by the followers of the lie that they value that which is nothing. In destruction there is no victory but for darkness. The power of victory is not force but Love.” ‘Nuff said.

5. All the over-the-top public promotion of Christian beliefs, prayer breakfasts, etc.?

“And when thou prayest, thou shalt not be as the hypocrites are: for they love to pray standing in the synagogues and in the corners of the streets, that they may be seen of men. Verily I say unto you, they have their reward. But thou, when thou prayest, enter into they closet, and when thou hast shut thy door, pray to thy Father which is in secret.”

What a great piece.

Finally, to wrap it all up, I present to you a list of books I have read on the above topic for your perusal. Since the atheist books are quite high on the list right now, this may be welcome to believers in both views looking for some balance.

1. The Case For Faith, The Case for Christ, and The Case for a Creator, a series by Lee Strobel, a former atheist.

2. Seven Story Mountain, by Thomas Merton, a former atheist turned ascetic monk.

3. Science & Religion: From Conflict to Conversation, by John F. Haught

4. What Faith is Not, by Mitch Finley

5. Why God Won’t Go Away: Brain Science & the Biology of Belief, by Andrew Newberg, Eugene D’Aquili, and Vince Rause

This is a short list. I have numerous others on my Amazon wishlist that I have not read. If you would like more ideas, let me know.

I leave you with the following. While all worldviews differ in some way, I like to think that they are all intricately tied together by the big picture known as The Golden Rule: Do unto others what you would have them do unto you. See comparisons of this statement in numerous world religions at this site. And remember that everytime an atheist stands on his soapbox shouting that religion is the cause of all the world’s problems remember this: do not blame Christ or Allah or God, for their teachings are not the problem; blame their followers and then seek to teach them peace, love, and understanding.

Fill up my cup with Ducks

Fill it only 86.7%, in fact. So at the beginning of the NHL postseason I sat down and attempted to reason out the somewhat unpredictable outcome of the ensuing playoffs. I am an armchair statistics buff so I used what I had, combined with some good old rational thought, and attempted to devise a method to predict the outcome of the Stanley Cup Finals. Here is how my thought process worked.

In the playoffs, nothing matters but wins. Overtime losses don’t matter. Points don’t matter. So I wanted to find out what statistics correlate significantly with number of wins achieved during the regular season. I used the statistics from every NHL team to expand the sample size. From these calculations I found that 3 statistics significantly positively correlated with winning (goals per game, 5 on 5 goals for and against ratio, power play %) and 1 significantly negatively correlated with winning (goals against per game). However, all of them had at least some correlation, although not above 0.5. So I developed two separate scores based on a summation of the 4 stats, or a summation of all. What I did was take the correlation coefficients for each statistic and multiplied it by the actual statistic achieved by each team. I then added the products and arrived at a sum that I called the All Score, or the 4 Score. I then ranked the teams by descending all score or 4 score. I predicted the outcome of each series by comparing the scores of each competing team. By doing this, both of these scores correctly predicted the outcome of 13 of the 15 Stanley Cup playoff series, an 86.7% success rate. However, the truly amazing outcome was the prediction of the all-score. From the get go, before the playoffs even started, I used the all-score to predict the outcome of the entire tournament. It predicted an ANA v OTT final with ANA being victorious. Holy shit. The only series I predicted incorrectly were the first round DAL v VAN series, and the second round BUF v NYR series. So, we’ll will see if I am as successful next year!

Got gas?

I read an interesting article forwarded to me by my blog-happy sister. You can read it here, which I would suggest or the following will make no sense. I find a few things interesting about this article. First of all, Americans should not complain. They are paying $4 a US gallon, which works out to $1.05/L, less than I am currently paying ($1.18/L). In fact, one of the reasons American energy & environmental policy has lagged so far behind the rest of the world is the absurdly cheap cost of energy in America. There is literally no financial incentive to be green in the United States. The subsidies handed out to the oil and gas industry keep the prices artificially low. Furthermore, they pay almost no tax. 18% of the price of gas?! HA! We’ve got you beat Uncle Sam. Taxes make up roughly 35% of the cost of Canadian petroleum. Second, Americans have only themselves to blame for the increasing cost of fuel. As supply diminishes in any commodity, the price will always rise. The production peak of oil occurred in the US in the 1970s and so ever since, demand has steadily overtaken supply. The remainder of the worlds oil is in the confines of shaky nations run by autocratic or theocratic governments. They are also conjoined through OPEC, so at the flick of a switch they could cut off supply to the rest of the world. However, they usually play nice, except when the US develops bogus foreign policy like the war on terrorism, trade embargoes against Cuba (a supplier of highly-trained physicians to Venezuela in exchange for oil; see below), and hate-filled slandering of Venezuelan president Hugo Chavez (Venezuela has one of the world’s largest oil reserves). Third, numerous independently funded studies have failed to prove that oil companies collude to keep prices high. In fact, quite the opposite is true. Governments have kept prices artificially low, and have only compounded the problem, as people then use energy recklessly, thereby further diminishing supply, and therefore, further raising the price of oil. The average gasoline price in Western Europe is currently over $6 per gallon, or roughly $1.60 a litre. Why do you think they all drive around in tiny little cars and mopeds? Why do you think they have walkable cities and mass public transit? Make sense? Americans can bitch all they want about the high price of gasoline, but little do they know they have it pretty damn sweet. (Qualifier: When I say “Americans” I refer not to the American people as a whole, but to those running the country.)

Metal gardener

Last night I was a walking paradox. Here was a man in his “Mr. Cool” T-shirt and second-hand snap pants, using cheap gardening tools and his wife’s gardening gloves, pulling weeds from his lawn and garden, while listening to death metal on his iPod. Out in the serenity of Mother Nature, all by my lonesome, plucking earthworms gently from the soil to save them from my garden spade-induced swath of destruction, while simultaneously enjoying a cornucopia of death metal. I was ripping some fairly pathetic perennials out of my garden as they were contributing nothing but living space for snails. I also trimmed back some dead leaders on my other plants as they were sapping precious nutrients from the other branches that were actually producing something useful, namely, foliage. Who wants to spend their hard-earned money on worm poop and city water just to have it used up by zombie branches? Finally, I tackled the dandelions. Dandelions really piss me off. Anyone who ever does them the honor of making a salad out of them is kicking every weed-pulling fool like myself square in the nuts. I have slaved over my little herb garden to grow actual edible plants, only to watch them die before my eyes. Yet these plants that I did not even plant thrive and spread despite my best efforts. Screw you dandelion. See, that is where the metal comes in. I need the incessant thrashing of DevilDriver, Killswitch Engage, Unearth, Trivium, Becoming the Archetype, August Burns Red, Chimaira, et al. to muster the aggression and strength I need to eradicate the herbaceous scourge of Taraxacum officinale, the common dandelion. I worked up more of a sweat in those 3 hours I spent in my yard pulling weeds and mowing then I have in numerous manufactured workouts. No wonder our society is so fat. We don’t get on our knees and get dirty often enough. We just pay the Weed Man to take care of it. Man did it feel good. Rhythmic death metal. Destroying and creating life at the same time. Learning about the organism that is my yard. Awesome. If you want a killer website about gardening techniques more in line with nature, check out EarthEasy. Everything from how to attract beneficial insects to your yard to kill unwanted pests (who would have ever thought a species known as parasitic wasps could at the same time be considered beneficial?) to how to use corn gluten to kill weeds while rejuvenating your lawn. Who would have thunk it? Speaking of corn, if you find yourself in a bookstore, pick up Omnivore’s Dilemma, by Michael Pollan. If you don’t want to buy it (although I am not endorsing this), just read the first 25 pages. Apparently, North Americans are very corny. Literally. We are full of corn. Everything we consume apparently contains corn in one form or another. No joke. But I digress (I do that a lot, don’t I?) Conclusion: There is no better way to unwind, get your aggression out, enjoy nature, and get a great workout, all at the same time, than gardening while pumping some thrash metal. Try it out!