Sunday, April 29, 2012

Odds and Ends

Surviving Cancer - For some time now, researchers who study cancer recurrence and survivability have been suggesting that weight control and regular exercise are key factors for both.  Two years ago and times before and since, I also noted that the days of telling cancer patients to rest and eat are long gone.  This past week, the American Cancer Society went a step further - they made  official recommendations and are asking physicians themselves to promote the guidelines with their patients.  An article by Mike Stobbe from the AP is really well written and explains the research both simply and accurately.  Take a look.  Remember as well, what prevents recurrence and reduces fatality also reduces the risk of primary cancer diagnosis.  I.e. may reduce ones odds of getting cancer in the first place.

ROS - It is hard to believe that it has been a year since I attended my first Ride of Silence.  It was such a powerful experience that I wrote about it that evening.  This year it takes place on May 16 - this is an international event. It is a very low key bicycle ride (7-8 miles, 10 mph pace) that is done in complete silence.  It is in honor of cyclists who have been killed or injured.  Please visit this link to find where the ROS is taking place in your state (in your country).

Nutella - Well you probably heard that the company that makes this spread has been charged with false or misleading advertising and has agreed to a settlement.  There was a label claim that using the spread was healthier than using another product.  The lawsuit was triggered by some astute NFP (nutrition facts panel) readers who couldn't understand why something so high in sugar and fat would be better for you.  I checked out a jar at the store today.  It is so, though it may be made with hazelnuts, the first ingredient is sugar.  I also noticed on the label a statement that went something like this, "A balanced breakfast would include nutella on toast, orange juice and skim milk."  Yeah - ok.  I am not a fan of the spread, but let us say it is ok - and sure, calcium (in the skim milk) is good.  But the OJ is overkill and just adds more sugar... maybe an orange or other piece of FRUIT would be best - but NOT a banana.  One of my friends told me she liked nutella on a banana - sugar on a high glycemic starchy fruit = blood sugar spike.

WOTN - I almost started this one off by saying if the USA did not have an obesity problem I would not be in the doctorate program at UNC or writing this blog.  But that is not true - because I love both (blogging and school)- I would just be focusing on tobacco again.  We do have a weight problem though.  A serious and substantial one that has led to a great collaboration between some high level folks.  Beginning next month, HBO will air a 4 part documentary titled, Weight of the Nation.  I was able to get a free screening kit from the CDC (well, they tell me it is in the mail) and I hope to set up some community/university showings.  Here is the press release on the shows.

Cost of Healthy - For the first time that I recall, I saw a hummus that was fat free. In other words, the food maker did not add oil to it when pureeing the chik peas. The store where I saw this was having a sale on this particular humus brand, 2 for 2.99.  There were lots of flavors, but only the original came in FF.  I made sure that the sale tags covered all the flavors/versions.  When it was scanned at the register it did not come up as on sale.  There was a manager helping to bag the groceries and when I said that the price was wrong she said, "Oh I don't think the sale includes the fat free one."  OF course NOT - right?.  But I did get the sales price because of the tags.

Now - I hope I don't do bad on my exam tomorrow because I stopped studying to write my blog... but it was a nice break......

Saturday, April 28, 2012

Purposeful Aging

Something led me to think of the Andy Rooney quote I have mentioned more than once, last on November 2011, .  You know the story… Bill O’Reilly made fun of him over something and his retort was, “ I didn’t get old on purpose, it just happened.”  

When I recalled the quote yesterday it finally hit me – NO, that is not right at all Andy (he died last year).  People do NOT get old by accident at all.  So that led me to the post today.

I want to (and I will) link you to articles that were written or cowritten by the same author, John Rowe. One was written in 1987 and the other in 1996.
I love them both.  One is more technical as it discusses ways to intervene in the life course and how to test those interventions. I will summarize the abstract of the 1987 one in a moment.  Every time I talk about this article I am surprised that it was written so many years ago.  I was a young adult in (undergrad) college at the time and aging was not on my personal or professional agenda.

I returned to school in 2000 to get a  post baccalaureate certificate in Gerontology.  I did end up working with an older population after seven years in the child abuse/neglect field.  It always seemed to me that we (the country, public health) started to talk about aging then (greying of America) – the year 2000, and in the decade that followed the conversation switched to successful aging.  It seemed to me.

But Rowe began this dialogue long before and it is high time we started to listen.  I consider this blog as having everything to do with aging – but not like Andy Rooney said – not by accident.  This is purposeful aging.  I live my life now and encourage others to do the same, so that if accident and irony escapes me, I will be one of those very active 90 year olds!

So to summarize the points John Rowe makes:
(speaking in 1986) Research focuses on the ways in which old age brings about disease and loss of functioning and refers to this as the usual course of life. There is a great difference on the individual level and successful aging does not include such a level of infirmity at all.
Rowe even claims that others have exaggerated the effects of aging.  Instead, the behaviors that people engage in or avoid in the preceding years impact how one ages and at what rate.  He calls for research that will give us the information we need to assist people in their life transitions so that they maintain the highest level of functioning possible. 

In the second article, nearly ten years later, he talks about some of those findings and then adds, Successful aging is multidimensional, encompassing the avoidance of disease and disability, the maintenance of high physical and cognitive function, and sustained engagement in social and productive activities.” 

 Do let us all take this to heart and do what we can to age with our faculties (mental and physical) intact.  That is my plan!

Friday, April 27, 2012

Prevention and Public Health Fund

The Prevention and Public Health Fund which was established through the PPACA - Patient Protection and Affordable Care Act is in the news today.  It is in jeopardy of being cut or the funds reallocated to pay for the money that will be lost if the student loan interest rate does not double as it is set to do.  

A bill keeping that from happening, the interest rate part, passed the House today (US govt) but may be vetoed because of the issue with the Fund.

The language in the fund, much like language in tobacco settlement laws, allows for the money to be used in ways not originally intended by the statute.

So what is the fund supposed to do and what will we give up if we lose it?

I found this two page handout about the fund, and page two is the interesting part so do check that out.  The group that put the handout together is NOT part of the government or affiliated with the White House.  It as a public health association and members do stand to benefit from the money.
I like that the document offers a link at the end so that people can see how funds are being spent or are set to be spent in their own states. 

You can click on this link to see a map of the USA and click on your state or a state you are interested in to see what the goals for the money are in your area.  For instance, many states are addressing obesity, tobacco use, food safety, immunizations, and work force training, etc. 

I am much more concerned about losing this money than I am about the student loan interest rate rising.  This is for two reasons and YES one is biased because the funds can help me.
1a) I am interested in obesity and tobacco use
1b) I am a student and "in training"
2) The problem with student loans is NOT the interest rate (as I suggested in a recent past post)

Most importantly - please do not let who you like or do not like in politics be the measure of whether or not a program or policy is good for the country.  Do YOUR homework.

(for instance, this cut is not targeted at women - the funds help everyone and will hurt everyone if they are taken away!)

Thursday, April 26, 2012

How Sitting Matters

Not how you sit but that you sit.

I have never missed an opportunity to remind my readers, friends, students, family and faculty of the research results (such as the two listed and linked below) that suggest sitting is harmful.

Screen-Based Entertainment Time, All-Cause Mortality, and Cardiovascular Events Population-Based Study With Ongoing Mortality and Hospital Events Follow-Up

Sitting Time and Mortality from All Causes,Cardiovascular Disease, and Cancer

The results and the take home message that I frequently share is that regardless of age, gender, race and exercise level, people who sit more have higher numbers of heart attacks, more cancer diagnosis and die more from any cause of death (during the research study period).  The risk can be 50% higher in some instances and 2 time as great in others.  The point being, even if you exercise every day - if you sit continuously, without taking stretch or walk breaks, you are more likely to have adverse health outcomes than if you do NOT sit for extended (more than 60 minutes) periods of time.

The reason I bring it up today relates to a comment I made yesterday when I was in a 3 hour workshop.  That comment catapulted me back to my childhood. At the workshop, we did not have scheduled breaks but were told to get up as needed for the bathroom or refreshments.  When I did stand up, I said to the learners at my table, I am not leaving, just stretching, followed by these words. "I am not a sitter."

"I am not a sitter."  That is what got me.  I smiled - almost laughed out loud because it is something that my mother would always say and I said it exactly as she would have said it.  I am one of those girls who does not want to be reminded of how much she is like her mother - regardless of how much I adore her.  I am me.

But indeed, she did say, "I am not a sitter." As well as, "I can't sit around like they do." OR, "I don't like all that sitting."  These words were uttered at almost every one of our family get togethers or when we had visitors.  Because in my family, on both sides, our entertainment involved lots of coffee drinking, cigarette smoking and card playing, OR alcohol drinking  cigarette smoking  and cards playing or just alcohol and sitting and talking all night.

The alcohol drinkers gave up the cigarettes in the 1970s, the coffee drinkers held out longer and a few still smoke.  Mom didn't smoke after 1965 and for every two drinks the others had she had one. They had lots of drinks.

Fast forward to 2012 - very few of the people to whom I refer are still alive.  Many of them who are are not able to do much more than sit.  They are arthritic actually, one of them quite severely.
My mother is in her 80s, rides a bicycle, works as a waitress, goes bowling and well - must I go on?

Sit less  - it sure made a difference in this personal story. 

(BTW, we, in the 2000s have become a much more active family,thanks to a few of the (then) youngsters who live a different lifestyle than their elders had.)

Wednesday, April 25, 2012

Debt and Health

I have used the term financial health in past blog posts.  I am not sure how I defined it then.

I think of it today in my reaction to student loan debt and the concern about an increase in interest rates. This is what I define financial health to be.

I am describing it based on my own circumstances.
Income: I would not say that I have an income but I do have a stipend.  It is enough to pay my rent and monthly bills. I do not go without anything that I need.  I am not able to add money to a savings account, so that would be a point against me.
Debt: I do not have any debt.  I do not have a loan.  I do not have a mortgage.  I do not carry a balance on my credit cards.
Assets: I do not own property (which at one time might have cost me a point, but that view is changing).
I own my car and it is relatively new so it is dependable.  I must pay insurance and upkeep.  I am able to do so.
I have money in a savings account.
Credit: I have good credit.
Future: I have a very small but still tangible retirement account.

I consider myself to be financially healthy and I do not have stress associated with money.

Young persons graduating from college with an average of 25K and an upward range into the 100ks are not financially healthy.  They are starting their careers, if they can start them at all, saddled with debt, lacking a means to address it and destined for poor credit histories.

However, reducing the interest rate, or keeping it from doubling does nothing to address the cause of the debt.  Some factors I see, and I am sure I have not captured them all, are:
  • high cost of tuition
  • high cost of materials needed to learn (books, PCs, software, etc)
  • direct to student loan offers or predatory lending
  • students being offered and accepting far more money than they need for their education (multiple loans)
  • students not learning how to live without every thing they want, and therefore being inclined to accept those extra loans
Our solutions then, should address the above issues. 
 I understand that universities are beginning to make some budget workshops mandatory, but this may need to take place in the high schools as well - specifically related to loans and debt.

Tuesday, April 24, 2012

Age as Health Determinant

I spent about an hour I didn't have looking for statistics to back up the argument I wanted to make today.  I didn't really find what I expected (so that refutes the theory that you can make numbers say whatever you want!), but as I've learned this year - Just because you don't see it or find it doesn't mean it isn't there.

My quest was triggered by ire.  My university offers health care coverage because are all required to be covered.  I am fortunate to have my premium waived by my assistantship.  There has been some talk of raising our costs and in an email that summarized the process and outcomes of the discussions, it was said that one of the options considered was varying costs by age.

Here is my point - which may end up in a well crafted letter to some high muckety muck.
Age is not a reliable measure of health status.  Blood assays, lung function tests, health risk appraisals, waist to hip ratios - even the BMI - would all be more accurate in predicting chronic disease.  
I assure you that my 40 something self is healthier than many 20 something undergraduates.  I have no chronic disease conditions and no 'pre' conditions (whatever that means). 

Nationally, the stats don't back me up - yet.  I blame overweight and obesity for my assumption that the 20 year olds are not the yard stick of health.  The levels of obesity in our children have tripled since the 1970s and that is going to show up in our diabetes, hypertension and cancer numbers. You can see at this CDC page that the consequences of overweight and obesity are as I indicated. This is not good.  It would be much better if chronic disease went down for all age groups.  
(by the way - most of the percentages on these conditions are offered within these categories 20-43, 44- 65 and so on - that is one of the reasons I couldn't find what I was looking for.  I couldn't separate myself from them!)
The closest thing I could get, and not necessary from the best source of data was this link here.  There are two charts on this page and you can see the much higher numbers in the older group. 

Health care costs have risen because we have more treatment options for more diseases which more people (Americans) have.  Being over 30 is not what causes diabetes, high blood pressure, cancer, or being overweight.  Many factors work together for these diseases to occur.  Some of the factors are controllable and are controllable to varying degrees based on circumstance. 

A person's age is 1) not controllable and 2) not causal.
Thanks for listening - I almost feel better. 

Monday, April 23, 2012

Cancer Killers

Because it is finals week (another semester and three courses nearly behind me) and I hardly have time to track down interesting stories, I offer you two words and their brief definitions.  I saw these in an article that I read a year ago and am re reading now.  You see, it made very little sense to me a year ago and is much more helpful now.  The article is not about cancer treatment, but research designs.  The words were just used to provide an example of when a drug worked in one condition but not in another. 
Before I came back to school, many of my posts were related to disease causes and medications to treat them.  I know that I talked about drugs that target tumors - and the different class of drugs that do so.  With that back story, you might get why the example provided in the chapter was a "oh that's cool": moment for me.

Here are the two words as drug types and what they mean:


Now that I have read the definitions and I look at the words - I can almost guess the meaning - maybe you can too. Here is a clue - 
Cyto stands for cell (in biology speak)
Both drugs address tumor growth but in different ways...

Ok - well toxic - pretty much anything that is toxic will kill you, so cytotoxins kill tumor cells

Think of the word static - if you are static - it means you are not moving or growing -
cytostatics stop cells from growing - or delay their growth by manipulating the environment (fluids etc) around them.

That was fun for me!  Hope you enjoyed it too - now back to that assignment......

Sunday, April 22, 2012

Odds and Ends

ABA and Self Regulation
The American Beverage Association is airing promotional messages in which they highlight efforts to limit sugar consumption.  I imagine that this is a strategy to push back against SSB taxation.  The ad I saw mentioned more "no" and "low" calorie beverage offerings as well as reduced sizes.

Subway at the 7-11
A friend texted me in disgust yesterday afternoon.  She had just eaten an "800 calorie monstrosity."  She made her choice without the benefit of a menu label and once she got home and looked it up, she realized why I was so passionate about them.  I do not know why there were not labels at the Subway, unless the convenience stores are exempt from the legislation and franchise owners can decide whether or not they are going to participate.  I told my friend that her lunch was half the calories I eat in a whole day when its a high exercise day - AND I eat no less than 7 times a day! (LED)

Gaming and Mental Health
A study which needs replication, showed that youth who played special video games vs youth who received "talk" therapy, did as well or better in reducing their depression.  I would love to see this study used to compare video games and medication because the side effects of psychotropic medications are pretty significant.  Of course, we already have evidence that exercise works as good as medicine for some people, but I guess video games are more enticing.

5 Hr Energy Drink
These commercials are everywhere. I see them when I am watching TV shows on line, when I watch the news, listen to Pandora and even NPR!  Today I heard another which specifically promoted a contest for work sites that use 5 hour energy.   Let me just say - caffeine in coffee has been found to have health benefits, but it's a dose response that is not linear.  In other words, caffeine to a certain point is helpful and over that point, it starts to cause harm.  There is NO research on the benefits of these caffeine drinks.  Also - if one wants to improve work performance - activity breaks should be policy!

Alzheimer's and Exercise 
Guess we can't say it enough this week.  Get Moving.  Not only does what you eat matter, so does what you do.  Persons who exercise on a regular basis (several times a week) appear to be less likely to suffer from Alzheimer's Type dementia than those who do not exercise.  My theory would be that exercise increases oxygen flow which helps to transport free radicals and cholesterol out of the system.  This could reduce plaque build up in the brain- which is one suspected cause of AD.

Saturday, April 21, 2012

Keep the Breast - Lose the Cookie

 I want to put this into context but to be fair, the details are sketchy.  I do not know where the actual awards show took place only that this particular "mock" advertisement was created in Korea.  I do not know if many food companies were involved or only Kraft.  The contest and ad were in reference to Oreo cookies which are made by Nabisco - a part of Kraft.  The Oreo cookie is celebrating its 100th birthday and this event could be part of the festivities regarding "milk's favorite cookie."

The ad of note was entered into a contest (with no expectation of becoming a true advertisement).  It showed an infant breast feeding.  It showed the child sucking from a woman's nipple.  The infant was holding an Oreo cookie.
The public outrage is over the display of breast feeding and I suppose, the showing of a woman's breast. 
To this, once again, I must say...."REALLY?"  That is what's wrong?!! 

Breastfeeding for most mothers and children is health promoting and natural.  It provides numerous benefits to both parent and child.  One of these benefits deserves specific mention here, breast fed infants are at less risk of becoming overweight or obese as children AND adults.

So what do I find scandalous?  Giving an infant a sugar laden, highly processed cookie.  The misplaced outrage (over a breast) might explain why the USA has an obesity problem. I am not saying that children should never have cookies, but I am saying that if sugar addictions or food preferences are real and started in childhood - is this the message we need to send parents?

Some information on breast feeding:
Breast milk is widely acknowledged as the most complete form of nutrition for infants, with a range of benefits for infants' health, growth, immunity and development.
-- Healthy People 2010, Centers for Disease Control and Prevention, Atlanta, Georgia

Link to a nice brochure that was put together by the California Department of Public Health.

Friday, April 20, 2012

The High Price of Whole Foods

I made dinner for a group this week.  My goal for the meal was to highlight a nutritious low calorie vegetable - prepared in a way the maintains the nutrition, tastes good and does not add calories.

My choice this month was kale, fresh kale.  I discovered kale about a year ago when my sister steamed it for me with some fish.  It was delicious.  Its a meaty green - but less 'meaty'  than chard.  It needs to be fresh or it does not taste the same.

My preferred method of preparation, after rinsing it well in the sink and cutting off several inches of each stem, is to season with cumin and simmer with a bouillon cube (vegetarian or chicken).

I have purchased kale at Walmart, but it scares me a little (enough not to want to risk it when serving to others).  I have also bought it at an upper end grocer, Harris Teeter.  (I would buy it at a farmer's market in a second if one were near by).

I was headed to Harris Teeter Tuesday when I noticed that the new Whole Foods store had opened.  I went in  to get my vegetarian proteins (usually cheaper) and also scoped out the kale.  It was locally grown, as it is at the other store, and was being sold in bunches.  The kale was priced at 2.49 a bunch.  I had to feed 25 people.  I couldn't do it, too expensive.
I went over to Harris Teeter and the kale was loose and priced at 1.99 a pound.  I filled two huge bags which cost less than one bunch at Whole Foods.

That my friends - is ridiculous.

Thursday, April 19, 2012

First I would like to direct anyone who missed it back to the 4-18-12 post (yesterday).  The slide show presentation that is accessible here  describes low energy density and the creation of my You Tube channel.  The channel teaches people how to apply the Dietary Guidelines for Americans to real, every day life.

Second, I want to share two of my recent actions/activities with you.  I do this to encourage you to be the one - wherever you are - to speak up, get involved, be the change agent.

1st Scenario:  I am continuing to use the indoor pool on campus.  This semester I have been able to swim once a week.  The other day I finished up a bottle of shampoo and didn't want to put it in the trash can.  My university is pretty forward thinking about sustainability and our chancellor has committed to becoming carbon neutral.  It seemed that a recycling bin in the locker room would be expected. I searched around on our website, not sure which department or person I should contact.  I found the recycling department and here are the emails that followed:
I am writing to request a recycle "can" in the Rosenthal Pool locker rooms, esp the women's.  There is no place for us to recycle our plastic shampoo, body wash, etc etc bottles.
Thanks so much

Sorry for the delay, busy time of year for us.  A recycling container for each locker room will be delivered by the end of the week.
It was there today!  Isn't that cool? I made that happen - I have agency.  I am empowered.  Feels good.

2nd Scenario: I belong to a campus listserv (a listserv is basically an email bulletin board. A group that shares an interest sends out email updates about upcoming events, speakers, opportunities etc).  The listserv to which I refer is for the Office of Leadership and Student Learning, OLSL. Last week the 'mail' included a call for volunteers for the OLSL plots in the campus community garden.  I offered to help - why not!?  Today I planted sun flower seeds, Brussels sprouts, spinach, okra (yuk), squash and more.  This summer I will be around to help water the plants.
I was easily 20 years older than the 3 or 4 others that showed up to help today.  The thing is, I did not have the confidence and self esteem to volunteer for anything (without knowing that my friends would be there too) when I was young.  I am making up for that now. I embrace opportunity. I hope that you will do the same.  If your young, don't wait.  If your older, don't wait. :)

Wednesday, April 18, 2012

You Tube and the Dietary Guidelines for Americans

I am attempting to embed a power point presentation into my blog.  Consider this a test.  I am using a hosting site call Scribd.  Using the blog or the host site means that you do not have to download the presentation or have any special program to view it.
The power point itself - the slide show - has links to the internet that you can click on while viewing. 

 [I do not think the presentation will show up in an email message so if you receive this blog in email format, you will have to come to the Your Health Educator website just click on the hyperlink in your mail message].

Below is the presentation I entered in the Graduate Student Creativity Expo at my university .  If the slide show is not here - or fully operating (there are over 20 slides) then click on the You Tube for Weight Control link above it and that should take you to the hosting site.  That is If you want to see the presentation.  IF you don't care to see it just come back tomorrow and I will have found something else to talk about :)

You Tube for Weight Control

Tuesday, April 17, 2012

Hazardous to all Living Things

Have you seen the commercial where a person is going to put flea and tick treatment on his dog so he dresses up in a plastic suit and puts on a face shield and gloves?  I believe the 'wife' comes home and gives him a flea and tick product that comes in a special tube.  This tube allows the treatment to be directly applied to the dog's skin without one drop touching the human.

Here is the question.  If the stuff is so toxic it requires a hazmat suit,why in the world would you put it on your pet?

Monday, April 16, 2012

Drug Trial Information

I attended a brief lecture today that was presented by a statistician who works for a pharmaceutical company.  The statistician was Dr. Imogene Grimes.  

As I have mentioned the FDA and its UK counterpart in several posts, as overseers of new drug applications and approvals, I wanted to share a couple of highlights from today's talk.

This is not all new information (I have talked about the different phases before, for example) but it may be a more detailed explanation or in one case, a correction of past postings.

I will start with the correction.  I thought in order to have a new drug approved, the new drug had to treat a condition that was not being treated at all, or treat a condition better than an existing drug, OR treat the condition similarly but with less side effects or less inconvenience.  That is NOT true - in the USA.  I do think that Europe has a different rule.  Dr. Grimes did say that one deterrent for not creating a new drug just to add it to the market is because doctor's don't like to switch patients to new drugs for no reason.

What IS true is that the new drug has to show a benefit. The benefit has to be measurable.  This measurement has to be identified in the protocol.  The drug company has to say how the effect will be measured and what outcome from the drug is considered success.  For example, a new drug will lower cholesterol by at least 3 mg/dL which will be determined by a blood test.  Or a drug will reduce depression as measured by the average score a person gets on a test that measures feelings.

The research has to include a risk to benefit analysis and proof that it is safe and effective.  

We have talked about phase 1-3 trials before - but I think I left out a stage.  Actually I referred to Phase 1 as the non human participant part, but the stage that does not include human subjects is called the Pre Clinical phase.

In the pre clinical stage, the drug is created and tested in the lab with test tubes, petree dishes and animals.

Clinical trials are the ones that include people.
Phase 1 includes healthy volunteers who do not have the condition that the drug is supposed to treat.  The scientists just want to know how the drug works in the body and what happens when different doses are tried.

Phase 2 is the main efficacy stage - does it work?  Risk is also assessed in this stage, but efficacy is the main concern. The drug is tested in people who have the condition.

Phase 3 is the large full scale trial that is specifically intended to capture the risk profile.  As Dr. Grimes said - chemicals always DO something - the drug does things we want it to do and things that we do not want.  

 Before a drug can be approved, the scientists also have to prove adequate exposure.  There have had to have been enough people in the various phases to assess the effect and risk.  There is a standard. 
  • At least 100 people have had to been on the drug for at least a year,
  • between 300 and 600 have had to been on it for 6 months, and 
  • 1500 people have had to have had at least one dose.
Monitoring of the drug continues as long as the drug is on the market.
 The process of testing - pre clinical, phase 1-3 and FDA assessment can take 12-16 years and cost a billion dollars.

New term:
"biocreep" - the term for when less effective drugs get approved - some fault of the system when a drug does not have to be compared to a placebo.

Types of Studies:

A superiority study attempts to prove that the new (investigative) drug is better at treating a condition than a placebo.
A non inferiority study is intended to show that the investigative drug is at least as good as an existing drug (for that condition).

Sunday, April 15, 2012

Odds and Ends

I certainly do not have 3 days worth of O&E this week - just 4 blurbs (finals are approaching and I have been writing papers for days).

Cashing in on Diabetes - I read an article in which a stock analyst recommended that people consider investing in companies that will be treating diabetes.  In the article, it was noted that countries outside of the USA may not be in as much health care debt and will be spending money to treat this epidemic rise of diabetes (related to obesity) in their populations.  In other words, the rates of diabetes are going up everywhere, and in emerging markets the governments haven't had to try and get a grip on spending, so there is a profit to be made.  Scandalous.

Swinburn Speaks - I always listen.  He is my hero. He gave his thoughts in regards to the goal of dietary interventions, programs and policies. Dr. Swinburn said that a change in behavior, not a change in weight, should be the focus.  Especially, he said, in regards to youth.   I strongly agree.  The behavior change I would like to encourage is choosing foods that are lower in calories and higher in nutrients.  If a person fills their plate with items that are low in energy density, a healthy weight should follow.

Robots for Our Own Good - Ford Motor Co is using robots in its plants to do things that human cannot do well, cannot do safely, or cannot do efficiently.  The use of robots will also reduce environmental pollution.  This is a plus side of automation.  I understand there is a downside.

Calorie Burn & Intensity - I just realized that I had a bit of data that could be used for an example - a teaching moment if you will.  It regards the intensity and duration of exercise within the same subject and the caloric expenditure difference between levels.  I.e. this controls for height and  weight because it is the same person - me.  
'We' know that running burns more calories than walking because it is of higher intensity, higher METs.  We think that if we walk twice as long as we run, the caloric expenditure will be the same (or close).  My little experiment is that I ran three miles and then I walked three miles - same route, day, and body!  (I went to meet my Saturday walking buddy, but I got there early and did this short run first. I kept my Garmin device on for both).  
Calorie monitoring devices are prone to inaccuracies so the amount that it says I burned for each activity is a broad estimate. The difference between the two amounts is the point of this post.  So the 30 minute 3+ mile run burned 238 calories and the 1 hour 3- mile walk burned 159 calories.  Not the same no matter how you look at it and I walked twice as long as I ran.

Side Effects that Make You Giggle

That isn't really fair, maybe not true - the side effects didn't make me laugh as much as the blog title from a Motley Fool post did.

In case you haven't heard, two drugs made by Merck - one for baldness and the other for an enlarged prostate - are getting label revisions.  Additional side effects that did not present themselves in the original drug approval trials appear to be common enough to warrant this label change.  Interestingly, the new message involves a sexual triple threat - loss of desire, premature ejaculation and erectile dysfunction.

I link you to an article from the AFP that gives more details and also the financial post that I thought quite clever.  In the latter, Brian Orelli notes the quandary related to Propecia, the male baldness drug.  Apparently, the drug does work with regard to preventing or reversing hair loss.  Mr. Orelli notes that men usually take the drug because good hair is a relationship plus thus the title of his post, "More Hair, Less Reason for It," and my giggle.

BTW - and again I say to you, we are an over medicated society and drugs have side effects.  Of course, you know what the drug industry and the doctor will say to the guy suffering from ED from his prostate or hair loss drug - "Here, take some Viagra." And what of those side effects?  
Well, There is a pill for that too and every thing under the sun.

Friday, April 13, 2012


I have just returned from a wake - saying goodbye to an outstanding community member who touched my life in a way that can never be forgotten -  or undone.  I am blessed by having known her.
She did not die of natural causes.  She died of Lung Cancer.  I do not know what "caused" her cancer.  We don't really know what causes anyone to end up with a disease because so many factors interplay.
A person can smoke and get lung cancer or not get lung cancer.  A person can not exercise and stay healthy or exercise and stay mobile into their very late years.  But it is not a crap shoot at all.
We have known risk factors and probabilities.  It is possible to stack the deck in ones favor.
 That being said:
  • maintain a normal weight
  • exercise daily (including strength training on 2-3 days)
  • limit saturated fats, sugars, salt and empty calories (and sometimes calories in general)
  • add fruits, vegetables, fish, whole grains and healthy oils to your diet
  • don't smoke
  • limit radiation (sun and medical)
  •  avoid environmental toxins
I want to add that we learn new things every day.  It may be that what we thought was a risk factor turns out not to be and vice versa.  I hope that you won't take that to mean that no one knows what they are talking about and instead take it as learning and getting better at things.  You can only act on the information available to you today, but that does not mean that it won't change.  You should act accordingly.

Thursday, April 12, 2012

Is 64 the right number?

The Robert Wood Johnson Foundation (RWJF) released a report today that suggests children need to reduce their caloric intake or increase their expenditure by an average (and not individual) amount of 64 calories or face a future where they are heavier by 4 pounds than the cohort that went before them.


Meaning that around 16% of adolescents were obese in 2007-08 and if things don't change, the obesity rate will rise to 20% for year 2020. 

Things must change - this is not an acceptable outcome.

Children who are obese tend to remain obese and the consequences of obesity across a life span are significant and disabling. 

Whether or not '64' is the magic number is questionable.  It is derived from population wide averages - meaning it looks at the weights of children in aggregate and finds the average number that all kids would have to lower to prevent the rise in obesity for the group.  However, some children are already obese and would have to lose weight before sustaining it (meaning a 100+ calorie deficit), and some children are NOT overweight (meaning a 0 calorie deficit).

Non white girls are heavier than white girls and boys are generally less heavy than girls.  Living in a poor neighborhood also increases the risk of obesity - i.e. living in a food desert that lacks access to affordable, lower calorie foods.

That being said - what is 64 calories?  It is easier to quantify as intake because expenditure depends on ones body weight, fitness, and intensity of exercise - so we really can't say -for instance, 63 cals= a 30 minute walk.  We can say how much 64 calories is in food.  For example, it is one and a half teaspoons of oil or pats of butter.  It is the extra calories in 2% vs skim milk.  Calories could easily be reduced if SSBs were cut out of schools (as RWJF suggests - NO SODA). 

Wednesday, April 11, 2012

What's Your Diet Style?

After just a few sentences, I am going to link you to a newsletter that I received from WebMD.  The newsletter gives an over view of research that was presented at a recent American Heart Association conference.

It appears that scientists conducted some type of survey research, but from the newsletter I do not know if this was on line, in person, through the mail or by telephone.  I only have this statement:

"21,000 adults aged 45 and older completed a questionnaire containing 110 food items"

In the article, the reporter suggests that there is strong evidence that links gender, race, age and region to certain dietary styles.  The research itself is not available - it has not been published, so it is hard to know what they consider strong evidence and whether or not I would also consider it strong.

We really need to know about the design of the study and who those 21,000 people were before judging or applying the evidence.  So that stated - get your grain of salt and read about the 5 most common dietary styles here. 

Tuesday, April 10, 2012

Odds and Ends (3 of 3)

Diet Pill Warning – why would ya??  I hope you wouldn’t.  A certain batch of diet pills from Japan are said to contain a cancer causing agent called phenolphthalein.

Measuring Fatness – The BMI is an inaccurate measure of fatness, especially for individuals. It is the best we have right now for tracking the weight status of populations.  Some researchers are calling for the use of a DEXA scan or a blood test instead.  The BMI is a math calculation based on height and weight - i.e. it is basically free. We can get height and weight by self report (it may be inaccurate, but most people can tell you their numbers). Otherwise, why not use WHR  - which tends to be more accurate than BMI. Here we would have to measure a persons waist and hip circumference because most people won't be able to articulate this in a phone interview.    I can’t believe researchers would suggest the routine use of  DEXA which costs 100s of dollars and offers some radiation exposure. Blood tests are also expensive and invasive.

What's the fuss – So Mary J Blige and BK got a lot of flack over her singing a song about chicken snack wraps, and the ads have been pulled, temporarily they say.  Are these the same snack wraps I already reviewed for calorie and fat content?  Not sure, so might as well do it again…Oh I think that was McDonalds.  Anyways, BKs wraps have about 400 calories and 6 grams of sat fat.  They are high in sodium also.  I have a feeling that the 400 calories is for one wrap.

Death in Old Age – One of my favorite sayings , by Richard Doll, is  "Death in old age is inevitable, but death before old age is not.”   I think of that when I hear absurd statements like , “he died of natural causes” when someone is in their 50s, like Thomas Kinkade.  It is much more likely that Mike Wallace died of natural causes at 93.

Monday, April 9, 2012

Odds and Ends (2 of 3)

Early Dx of Breast Cancer – If you are a person who had an early diagnosis of a disease that led to prompt treatment and the preservation of your life, than you are the exception – but you are alive and that is what matters to you..  New studies released this past week argue against early and frequent screens for breast cancer and possibly some others because on a population level, very little difference occurs in the outcome.  The outcome is survival.  Does early diagnosis change survival rates?  In many cases it does not, perhaps the difference is that one spends more time worried about the disease and being treated for it, than someone diagnosed later.

HPV Vaccine – Just another example of misleading words.  I don’t recall the story in full but it was about the two vaccines Gardasil and Cervarix.  The vaccines are recommended for men and women at increasingly, younger ages, i.e. before either one becomes sexually active.  My problem with the story was that the writer referred to the immunizations as cervical cancer vaccines, which they are NOT. 

Gene Mapping – Not helpful.  Really – there isn’t more to say.  Disease and weight, for that matter, have complex mechanisms for development and environment plays the predominant role.  Further, how can a gene map predict the exposures you are going to have??  Or the behaviors you’ll engage in?  Not gonna happen folks, you just have to take care of yourselves.

Radioactive Dye and Brain Imaging – A few years ago, I wrote about the President's Cancer Panel report which led to calls for reducing radiation, but I cannot remember what the risks associated with radioactive dye was.  I am curious because a pharmaceutical company has been approved to sell a special dye which can ‘light” up plaque in the brain – that may be associated with Alzheimer’s Dementia.
Here is the link to the report  - I refer you again to table 7 which lists the dose of radiation by medical imaging type (i.e X ray, CT and location) and includes nuclear medicine or radiopharmaceuticals - which is what this dye would be.  I feel that the consequences of the procedure, of similar procedures has not been adequately studied.