POLLS UNDERESTIMATE RACIAL BIAS FACTOR

THE BRADLEY EFFECT, RACIAL BIAS UNDERESTIMATED

With the elections less than 2 weeks away, everyone is talking about the likely fact that polls have not reached Democratic voters that harbor racial prejudice.  A fraction of these people may vote for Sen. McCain or not vote at all.

Are the polls capturing all that bias?

One voter model attempts to factor in hidden racial bias that was published this month suggests it might drag down the numbers for Obama by 6%. 

The hidden factor is commonly called the “Bradley effect’ dating back to 1982 when Tom Bradley, an African American lost the California governors race despite being in the polls on Election Day.  A similar pattern in Virginias governors race by Douglas wilder, an African American had a 15% lead but won by a half percent.

Many African Americans have won mayoral, state, and congressional elections since.  Racial attitudes have certainly changed.  Dan Hopkins, a Harvard political scientist examined every gubernatorial and senate race since 1989 which had either an African American or female candidate, on rationale that a woman could also experience voter prejudice.  Of 133 elections only 18 had an African American.  There was no Bradley effect in any of them since 1996.  He does not expect a Bradley effect.

Kohut, president of Pew Research Center, which performs public opinion polls does not think people polled are dishonest when asked if they will vote for Obama.  But he thinks there are reluctant responders that refuse to be polled.  They have a less favorable attitude toward racial minorities and the polls may miss their intent.

Nine groups published their models this month in PS: Political Science & Politics and only one, Lewis-Beck from the Univ. of Iowa adjusted his model to take race into account.  He fine-tuned his model on voting patterns in the primaries and on how honest people are in saying they will support an African-American presidential candidate.

Beck's prediction:  Obama will get 50.1% of the popular vote but lose the election in the Electoral College.  When he did not take race into account Obama would get 56% of the vote.  It’s a feel good thing: people don’t want to admit race is a factor.  In the past he has been 1.5% off in his predictions.

It’s hard to detect hidden bias, since polling is done on the phone and involves a one on one interaction.  You really will not tell a stranger you have racial prejudice.

A study by Krysan in 1994 asked Detroit residents if they would vote for an African American.  Face to face 11% said no, while in a mail survey 22% said no, privately.

In 2007, sociology students at New York University asked three groups related race questions that were hidden and statistically the groups were all similar.  They found 14% of the people lied.  Democrats were more likely to be dishonest than Republicans, as were those with less education.

Racial bias is clearly visible, and it has shown in preference polls.

The bottom line is Mc Cain still has a shot at the White House.

Sources: Science Oct 10, 2008,Political Science & Politics Oct, 2008

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NEW BREAST CANCER RISK TEST AVAILABLE

NEW BREAST CANCER TEST AVAILABLE

An Icelandic company, decode Genetics has released a breast cancer risk test.  It promises women a chance to take a more aggressive breast screening.

The test cost is steep, $1625, and includes just seven genetic variants out of the 300 scientist expect to soon find.

This test is a no brainier. The science behind the test is solid.  All seven genetic variants, called SNPs, for single nucleotide polymorphisms, are linked to an increased risk of breast cancer, primarily in women of European descent.  Being in the public domain, companies can incorporate them into new products.

The more SNP links, the higher your breast cancer risks.  The risk of this test is meaningful.  But we are basing someone’s risk on the basis of a small subset of variants.  It’s like having a poker hand and you don’t know what the whole hand is. 

About 5% of you who take the test will find you have a 20% risk of breast cancer, compared to the average risk of 12%.

Many epidemiologists feel that any test, even based on the best SNP will probably misclassify a large number of women.  As more variants are found, the risk estimates might actually change.  A high risk now may be one that isn’t so bad or vice versa.  It is estimated that there will be 300 SNPs to make the whole hand.  But why wait till you discovered everything about breast cancer.

How would you react to learn you have a 20% chance of breast cancer ? How would you communicate this explosive information? Some of you  might freak out or even commit suicide if they tested positive. It might also raise your risk of heart disease. It certainly is very sensitive information.

Has the test reached its time?  Do you have $1625 lying around to find out that your chance of breast cancer is higher than the general public?  And how will this change your life in a positive way?

What do you think?  Your comments are always appreciated.

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Source: Science Oct 17, 2008

 

 

 

THE PRESCRIPTION CRUNCH

ARE YOU TAKING ALL YOUR PRESCRIPTIONS?

Patient prescriptions are down 13% this year.   Americans now spend $286 billion dollars a year on prescription drugs.  This is 10% of health care costs that amount to 2.26 trillion dollars.  They take over 12 prescription drugs a year.  There are 3.8 billion prescriptions filled annually since the paid medical prescription plan went into effect.

With loss of jobs and loss of senior savings, people are cutting down on which drugs they will continue to take and which they will not buy.  Pain medicines are a must, but cholesterol drugs that don’t leave an impact that the patient sees are forgotten.  Even the generic drugs are not affordable.  Groceries and housing necessities take precedent and some drugs will have to wait.

The trend, if it continues, could have potentially profound medical implications.  Controllable disease conditions will get out of control and our nation’s health care bill will certainly sky rocket. 

People are screaming for regulation of prices.  They are cutting pills in half and playing doctor by how they feel.  There is probably over prescribing in the United States anyway, but we after all in a drug culture.

 As long as you can get it free, why not fill all your prescriptions.  For every complaint, the doctor prescribes a drug.  Sometimes this leads to a new disease.  A cortisone tablet helps inflammation, but now it causes indigestion, an ulcer, or sugar problem.  All these things need new prescriptions, which leads to new side effects worse than the original problem.

We also need our left over pills from last year in our medicine cabinets in case we get diarrhea, an infection, or a headache.  Lets play doctor!

There is no free lunch.  We must pay for all this someway.  Universal health care may be the answer.  But where will the money come from?  We spend $286 billion on pills now, what will it be when everyone can go to a doctor, anytime, and get a prescription for what ails them at the moment.  TV drug advertising tells us what we need.

  And the doctor visit, the Cat scans and MRIs, and heart monitoring costs certainly will not go down.  We lost 2 trillion dollars in the market recently and we spend 2.6 trillion on health care now.  Lets just print more money.

Perhaps our standard of health care might improve if we went back to 8 prescriptions a year like we did ten years ago.  If the doctor talked to us, we might forgo some of these prescriptions.  But talking takes time and who in medicine has that luxury today?   We all need prescriptions but folks do we all need 12 a year?

Perhaps this recession will contain this growing monster.  Lets evaluate how effective all our drugs really are.  Maybe we can really get by with less than the 12 prescriptions we now take annually  Source NY Times Oct 22, 2008

What do you think?  Your comments are appreciated.

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CONFUSED WITH TOO MANY MEDICATIONS

CONFUSED WITH TOO MANY MEDICATIONS?

 

When I ask patients to bring all their medicines in a bag to my office, it is usually double what they told me.  The sicker the patient, the poorer they can count.  There is mass confusion.  Some duplications, interactions of drugs, inappropriate off label uses of drugs, and inability to know the reason why they take each drug.  Every year grandma and grandpa should spread out all the bottles on the table and look at them.  If there are over 10 bottles, usually something is wrong.

Iron and Calcium tablets can interfere with thyroid absorption.  Two products containing amphetamine may cause liver damage.  Many drugs have expired or are no longer needed, but are saved, just in case.

Your parents should know the name of the drug they are taking and what it is for.  They may have memory problems or difficulty comprehending.  If they understand the reason for the medication, they will take it correctly and also know what to expect from it. 

Many times they stray from their doctor’s medication plan and the doctor is not aware of it. Their blood pressure soars and the doctor thinks the medication is not working, and in reality they are not taking the medication.  So the dose in increased or a second medication is added.  Have their doctor talk to them to insure they comply.  Often they can’t afford the medication or are worried about the side effects.  This intentional noncompliance occurs because the plan is too hard to keep up with.  Switching to a medicine once a day versus three times a day often works, or make the schedule simpler by treating two problems with one medication.  Medication charts on the refrigerator, pillboxes, or taking certain meds with other meds help.  Often getting rid of the childproof capsules can help.

Your parents wait for a half an hour for three prescriptions to be filled and just want to go back home.  Their doctor never told them about the reason for each drug and its instructions.

He may speak quietly and fast and this may be a challenge to your parents who still did not get their hearing aids.  Your kind parents feel intimidated and don’t ask question because the doctor looked busy and seemed to have no time to answer questions.

Side effects your parents have should not be chalked up to old age, and should not be treated with more drugs.  Older people have compromised livers and kidneys and all the drugs affect how the drugs are broken down and excreted.

Your parents  may experience  dry mouth, drowsiness, depression, insomnia, nausea and vomiting, dizziness and may fall.  Sedating antihistamines can be disastrous to them.  They often take over the counter sleeping aids, Tylenol pm, cold and allergy medicines as Benedryl.  Since the medications last longer, they may be confused in the morning and fall.  If your dad has prostate trouble, he may end up with urinary retention.

Parkinsonism drugs, and Neurontin can cause hallucinations.  Antipsychotic medications for depression or dementia can cause them to have more heart and lung problems and also a higher death rate.

The starting dose for elderly may be too high compared to one for you.  Start slow and go slow! Medicines must be monitored for side effects.  The labels and inserts must be read.  Someone should go with them to the doctor so questions are asked and answers are given.  The doctor should know about every OTC drug they are taking.

Make a point to clean out their medicine cabinet every year of expired or old medicines.  Make a medication list for them and give a copy to their primary doctor every time they make a visit.

Your comments are always appreciated.

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SMOKERS, SHOULD YOU GET YOUR CAT SCAN?

SMOKERS, GET YOUR CAT SCAN

The push is on for smokers and non-smokers to get a CAT scan.  The message is that it will catch tumors when they are small, and they can be removed before they spread.

Lung cancer kills over 160,000 of us a year.  If more tumors can be caught early, many lives could be saved.  Every one of you 45 million Americans is a prime candidate for this lung imaging.

Most  people agree on how good a CAT scan has become since 1995 when CAT scans were created.  The detectors now spin and slice through the body in 5 seconds.  An image can be taken in a single breath.  A computer can tune some densities in and out and make a 3D view of tissue and bone.  A scan might have 256 slices and a 0.3 mm square can be well visualized.

What happens after your initial scan?  If you have a nodule 5mm or a cyst 8mm you would probably get a biopsy and then possibly surgery.  At least you will be asked to come back in 3 months for another scan.

The logic is hard to argue with.  If you can find a small cancer at an early stage, why not go for the CT screening.  If you don’t treat it, you will die.

PROBLEMS

All this is based on a screening study on 32,000 people 40 or older, called I-ELCAP.  The study is riddled with flaws.  There never was an outside audit of their data. 

The procedures are very lucrative.  The initial CAT scan may be about $300, but that’s just the down payment with much more to come.  This results in all kinds of medical business.  There will be follow-up scans, biopsies, and other tests.  Since the people in the study were not picked at random, but  were smokers, it is markedly twisted.  The intense screening can flag many non tumors  or slow growing tumors as dangerous,when in reality they are nothing.  Over diagnosis can boost the number of people diagnosed with cancer and appear to recover from it when they don’t even have cancer. 

Another study, by Bach published in JAMA last year, this one  a random study, found no evidence that screening reduced the risk of death from lung cancer in 5 years. 

Biopsies were done 3 times more often than needed and lung surgery 10 times more than needed.

The basic principle of CT screening is wrong, says Bach.  Most of the lung cancer that kill come like a meteor, out of nowhere and is everywhere.  Screening is not going to catch them.

Random studies?  Is it ethical to recruit normal non-smokers with a promise of a high quality diagnosis and then give chest x-rays?

There is a fierce battle between a patient advocacy groups, Lung Cancer Alliance funded by GE the makers of Cat Scanners, and the National Lung Screening Trial by the federal government and the National Cancer Institute. 

The tobacco industry is fighting annual screening and feels it would set a precedent.  The tobacco industry gave $3.6 million to Weil Cornell Medical College in New York city to speak about the uncertainties of CT screening and the potential risks to people who might sign up for the study.

Those researchers doing the current CT study have a financial interest in the CT invention to be used with CT screening and have 27 patents for lung screening.   They receive royalties from General Electric who makes the CAT Scanners and have licensed the patents to GE.

 The National Cancer Institute has spent over $200 million on this Lung Screening Trial, which will be finished in 2010. 

Perhaps the air will clear by then.  In the mean time, could we spend some of this money on curbing smoking?  After all, this is the major cause of lung cancer.

Sources: Bach @ Memorial Sloan Kettering Cancer Center,  Science, May 2, 2008

What do you think?  Your comments are always appreciated.

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AUTISM FEARS ABOUT VACCINES

VACCINES AND AUTISM

In April 2008, the National Vaccine Advisory Committee asked the general public to help set up its safety research agenda for the next 5 years.  Can you imagine asking us to help the advisors?

There is still a lot of fear that vaccines might cause autism.  This has been fuel recently by a lawsuit involving a 19-month girl named Hannah who got 5 vaccines and two days later became lethargic and febrile.  Ten days later she got a rash seen in vaccine induced varicella.    Months later she developed neuralgic signs seen in autism.  Her parents believed the vaccines triggered her problems. She sued the Dept of Health and Human services who made a concession in the Federal claims court.

The government created in 1982 a Vaccine inquiry act, the VICP, to compensate families quickly who got paralysis after the polio vaccines, thrombocytopenia after the measles vaccine, Reye’s syndrome, transverse myelits, mental retardation and epilepsy.  This dropped dramatically the number of lawsuits.

It seems the VICP has recently turned its back on science.  In 2005, they ruled that if someone proposed a plausible biologic mechanism in which a vaccine could cause harm and a logical sequence of cause and effect, they would grant a financial award.

This resulted in many claims that MMR vaccine caused fibromyalgia and epilepsy, hepatitis B vaccine caused Gullian Barre syndrome and demyelinating polyneuropathy, and the Hib vaccine caused transverse myelitis.

In 2006, the VICP granted awards in Hannah’s case, and also for a hepatitis B vaccine causing multiple sclerosis.

SCIENCE AND DRUG COMPANIES  FIGHT BACK

Children, who have deficiencies, as Hannah, with mitochondrial enzyme deficiency, are more susceptible to infections and they should on the contrary get all the vaccines available. 

Multiple vaccines can overcome and weaken the immune system.  Thanks to advances in protein purification and DNA technology, the 14 vaccines given young children only have 150 immunologic components compared to 200 years ago with just the small pox vaccination.

Development of fever and varicella vaccine rash after getting 9 vaccines can put stress on mitochondrial enzyme deficiency, as in Hannah’s case.  They are a miniscule contribution to this ‘antigenic’ challenge.

Kids with mitochondrial enzyme deficiencies might have a lower risk of exacerbation if they did not get the vaccination, but the change would come at a price.  Pneumoccocus, varicella and pertusis are still common in the U.S.

THE GOVERNMENT SPEAKS

Center for Disease Control spokesperson Julie Gerberding, makes no statement indicating that vaccines are a cause of autism.  Since autism is a clinical diagnosis, children are labeled autistic because of a collection of clinical feature as difficulty speaking and communicating.  In Hannah’s case, what was considered autistic was really a part of a global encelopathy caused by a mitochondrial defect.  Other disease also has autistic features as tuberous sclerosis, fragile X syndrome and Down’s syndrome.

CONFLICT OF INTEREST

Dr. Offit who authored the above paper gets royalties for vitamins, and vaccines.  He serves on the advisory Board for Merck and is chief of infectious diseases @ Philadelphia children’s Hospital.  Who better to right an impartial analysis of autism?

COMMENTARY

Why not have the drug companies run a double blind study of kids not getting vaccines and those getting all 14?   In a couple of years we would have all the answers.

Most kids who get measles, whooping cough, and chicken pox recover with no ill effects.  It sounds like everyone who gets these viral infections will die.     HOGWASH.

Source; Science 5.15.08

Your comments always appreciated.

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YOUR FACE SHOWS YOUR INNER FEELINGS

YOUR FACE SHOWS YOUR INNER FEELINGS

 

Patients ask me why their face gets flushed, why they blush, and how can they hide their feelings.  Your face can show your inner feeling and can cause changes in your feelings as you talk, its not the words, it’s the dance of emotions, that trigger a particular emotion in the other person.  

   Any stimulus can become emotional, as the financial crisis, and the upcoming elections.  Feelings are the subjective aspects of emotion.

 

The bottom of the face dominates the expression.  A sad mouth with smiling eyes implies sadness.  A smiling mouth on sad eyes implies happiness.  Why do you clench your jaw when you are happy?  See my blog "Your face tells it all' 12.01.07.

Emotional gestures help restore and regulate the vascular system of the head.  Your face can trigger many emotions. When you blush, there is danger of blood flooding the brain.  The blood is shunted away from the brain and hence the face gets flushed.

Body temperature affects all the biochemical processes.  The brain can’t tolerate variations in the brain temperatures.  The brain cools itself by heat exchange. Facial muscles can change venous blood flow.  This changes the blood temperature in the brain.  The temperature changes affect the neurochemicals of the brain. 

Nose breathing is not just to get air.  The cavernous sinuses can become severely restricted.  Blood that goes through these sinuses is warmed 0.3 degrees centigrade.  Your forehead is like a thermometer.  Its temperature is very diagnostic of your brain’s temperature. 

Thumb sucking is an unlearned action hard to break.  Sucking forces nasal breathing.  This effectively cools the brain.  Kissing also forces breathing through the nose.  Screaming release opiates that act as analgesics.  Weight lifters and tennis players scream to relieve pain.

CONCLUSION

Feelings, both good and bad, are a result of your neurochemical brain activity.  This emotional activity is temperature sensitive.

Brain temperatures control the neurochemical activity of your brain.  The brain makes a lot of heat and requires cooling.  The cavernous sinuses cool the arterial blood to the rain.  All the facial veins and nasal airway brains drain into your cavernous sinuses.  Your face muscles and your breathing patterns control the brain temperature.

Source: Robert Zajosc, Charles Cooley LSA lecture, 1989

Visit www.drneedles.com for more blogging on controversial medical subjects.  Your comments are always appreciated.  

IS IRRADIATED FOOD NUTRITIONAL?

IS YOUR FOOD NUTRITIONALLY IMPAIRED?

Are you buying nutritionally impaired foods? Most of you have heard of irradiation but know little about it.  Let's be honest. Chances are that you have probably already eaten irradiated food in some form during the course of your life, whether you knew it or not.

Over the past 12 years, the FDA has approved irradiation for most of our food.  Most meat, chicken, wheat, vegetables, fruits, sprouting seeds, spices and herbal teas are irradiated. Luncheon meats, salad bar items, and imported fruits and vegetables are now being considered.

Food irradiation is a process in which food products are exposed to a controlled amount of radiant energy to kill harmful bacteria such as E. coli Campylobacter and Salmonella. The process also can control insects and parasites, reduce spoilage, and inhibit ripening and sprouting.

What are the Benefits?

Food is irradiated to make it safer by destroying harmful bacteria, parasites, insects and fungi. Irradiation does not destroy all disease-causing organisms, which is why perishable irradiated foods must still be kept in the refrigerator or freezer. Nor does it cook foods; so irradiated meat is still not safe to eat raw.

Irradiation also reduces food spoilage. Like freezing, canning and drying, irradiation can extend the storage time of perishable food products. For example, irradiated strawberries stay unspoiled in the refrigerator for up to three weeks as compared to three to four days for untreated berries.

If you are worried about health risks, it was easy to avoid purchasing them, because the FDA required food to be properly labeled if it was irradiated.  The FDA has relaxed its rules on labeling of irradiated foods to allow some products zapped with radiation to be called pasteurized.  Foods soon will be labeled irradiated food only when the radiation treatment causes a material change to the product. The FDA defines a material change as an alteration in a food's characteristics caused by irradiation, such as extended shelf-life in bananas or changes in color, texture, or taste that exceed the normal range of variability for the food.  Other examples included changes to the taste, texture, smell or shelf life of a food, which would be flagged in the new labeling.

Irradiation supporters include: The American Council on Science and Health, which supports food irradiation as a science-based technology that has been proven to be safe and effective. ACSH supports informational—not warning—labeling requirements for irradiated food as approved by the FDA.

IRRADIATION CONCERNS

Irradiation damages food molecules and creates free radicals.  These kill some bacteria but also damage enzymes and vitamins in the foods.  These free radicals combine with pesticides and other chemicals forming new chemicals called radiolytic products.  These are toxins like genzene, formaldehyde, and lipid peroxides.  What effect these new chemicals will have on our bodies will take years to find out. 

Irradiated foods lose up to 80% of many vitamins as A, C, E, K, AND B complex.  Irradiation damages the natural digestive enzymes found in raw foods.  This makes the bodywork harder to digest them.  The high-energy electron beam used can result in trace radioactivity in the food irradiated.

Irradiation doesn’t mean clean food.  It doesn’t kill all the bacterial in food, and the ones surviving may be radiation resistant.  Some like botulism, viruses and Mad Cow prions are not killed by current doses of irradiation.

Food producers now can cut corners on sanitation because the food is cleaned up just before shipment.   Since the food lasts longer, it can be shipped further and still appear fresh.  The giant farms are replacing the local small farmers. 

However, irradiation is not a substitute for proper handling procedures during manufacturing and at home. For example, perishable foods must still be kept in the refrigerator or freezer at all times. . Foods labeled “organic” may not be irradiated.  Studies on animals fed irradiated foods showed increased tumors, kidney damage and reproductive failures. 

Raw food that is irradiated looks fresh, but are like cooked foods, with less vitamins and enzymes.  The FDA allows these foods to be labeled fresh.  Irradiated fats tend to become rancid.

Sources FDA consumer reports,

It looks like irradiation is here to stay, as is aspartame.  Neither have had long-term safety studies, but our large food packagers can now grow at the expense of your local farmer. Our bodies can’t handle foreign chemicals and metabolize them.  The kidneys and liver become toxic and overload our bodies.  Our immunity decreases and we have a hard time overcoming disease.  When foods look fresh they are not necessarily fresh and wholesome.  Time will tell the story.  In the meantime, when in doubt,you might choose organic.

What do you think? Your comments are always appreciated.

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ALZEHIMER'S GENETIC TEST AVAILABLE

DO YOU WANT TO KNOW IF YOU WILL GET ALZEHEIMERS ?

A Pennsylvania company is marketing a genetic test to tell whether you are at increased risk for Alzheimer’s.  Fifteen years ago the critical gene APOE was linked to Alzheimer’s.

You give a saliva smear and $399 and learn if you have a risk of Alzheimer’s that is 3-15 times higher than normal.

The science behind the test is solid.  It differs form many other gene tests for common adult diseases. 

How would you react to learn you have the APOE genotype and how will you communicate this explosive information?

There are  mental health consequences of telling people you MAY get a disease that is neither preventable nor treatable and is fatal.  Most researchers feel the benefits of knowing your genotype are trivial and the emotional risks are huge.

This test might help the 2% of people with the worst APOE combination: two copies of the allele that gives one a 15 times increased risk for the disease.

But about 25% of us carry one copy of APOE4 and your risk is roughly three ties higher than normal.  It isn’t helpful and there is nothing you can do about it medically.

Until recently the test has been done by Athena Diagnostics in Worcester, Mass. And the only ones that qualified for the test were those with dementia.  Smart Genetics recently has licensed rights to the test from Athena. 

Some people might freak out or commit suicide if they tested positive. It might also raise the risk of heart disease. It might be very sensitive information.

Has the test reached its time?  Do you have $400 lying around to find out that your chance of Alzheimer’s is higher than the general public?  And how will this change your life in a positive way?

ADDENDUM

Two days ago, Oct 6, Smart Genetics has gone out of business.  The two-year-old company sold HIV Mirror and Alzheimer’s Mirror, DNA tests for HIV progression to AIDS and Alzheimer’s risk respectively.

Ironically, the CEO and cofounder Julian Awad found that his own personal lifetime risk of Alzheimer’s disease to be about 10% compared to the general population rate of 15%.

Looks like you will have to keep your $400 for now till the new company opens.

What do you think?

Source: Science Feb 22, 2008

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