Archive for category Angst

Should You Ice Your Boo-Boo? More Studies Necessary, Says Meta-Analysis.

IMG_5789

IMG_5789 (Photo credit: creativevictuals)

If you don’t care about the discussion, just skip down to the boo-boo in bold.

In my recent post about most scientific studies being wrong, I began questioning the very basis for evidence-based medicine.  How can we know what we know?  When we do a large scale human study, we have to trust the results.  We can’t run off to a lab and have them do it again.

So I thought a quick check into alternative medicine advances might be in order.  As expected, most studies are small and underfunded compared to the massive studies produced by drug companies.  And it is those massive  drug studies that are in question for their ability to give us truthful answers about what will work.  If they cannot be reproduced in a consistent manner, then what chance does alternative medicine have?

There is another avenue for medical knowledge, largely disregarded by current researchers but widely used by the public.  It is the school of what works.  One of the basics, something we are taught from the school yard, is that ice helps boo-boos.  In more medical terms, cryotherapy is largely regarded at efficacious for the treatment of minor acute trauma.  But is it true?

Do Boo-Boos Get Better With Ice? 

 

According to the Cochrane Meta-Analysis entitled:  Does Cryotherapy Improve Outcomes With Soft Tissue Injury? (free full article here) the researchers concluded:  “no authors have assessed the efficacy of ice in the treatment of muscle contusions or strains.”

That’s right, mothers across America.  You are applying ice to those boo-boos without a shred of scientific evidence that the ice is effective.

Until medical researchers address this ” large void in the literature,” you could be harming your child, or engaging in a worthless placebo effect.

Yes, icing has been shown to be effective after: “ligament repairs and knee and hip replacements. The results of these studies cannot be generalized to muscle strains and contusions.”

But ice works?  You’ve seen it work?  Mere anecdotal evidence.  Unreliable and prone to patient bias.  The researchers tenatively regarded ice as possibly helpful for pain, but concluded that: “Many more high-quality studies are required to create evidence-based guidelines on the use of cryotherapy.”

So until they do that, don’t waste your hard-earned health care dollars on ice cube trays and washcloths.

Let’s all wait until definitive studies conclude that ice does indeed help with boo-boos.  It may not happen anytime soon, because ice is not patentable (although you know they keep trying).  So we may need to create the “Boo-Boo Foundation” to fund ice research.  Get ready to march in “Stop the Boo-Boos” marches and send your dollars in.  Who knows?  In a few decades we might just be able to apply ice to those bumps with the knowledge that it actually works.

Or, if you’ve been following the discussion about studies, we might conclude that good-hearted researchers might want to spend a little less time in the lab and a little more time in the playground.   If they banged themselves on the monkey bars, they might just ask for a little ice.

Some things, because they work consistently and well, do not have research.  Giving a hug and a kiss are also tried-and-true, unscientific, aids for boo-boo relief.

 

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Study Concludes: Most Studies Are Wrong.

The Scientific Method

The Scientific Method (Photo credit: afagen)

As the number of scientific studies exponentially mount, surely we are advancing scientific inquiry at an ever increasing rate.  But perhaps we are simply increasing the scientific “noise.”

Enter the Reproducibility Initiative, which will try to reproduce your findings for you by an independent lab.  Yes, we’ve come to a point where you will need to pay to have the results you think you have confirmed by someone else.

Consider the NewsDaily’s article that “Bayer Healthcare reported that its scientists could not reproduce some 75 percent of published findings in cardiovascular disease, cancer and women’s health.” Or that “Amgen reported that when the company’s scientists tried to replicate 53 prominent studies in basic cancer biology, hoping to build on them for drug discovery, they were able to confirm the results of only six.”

How is that possible?  Don’t we have scientists dedicated to publishing whatever results occur?

Anyone who remembers science class knows the answer.  When you got the results you expected, you didn’t go over the equipment and the method with a fine toothed comb.  You assumed you did the experiment right and turned it in.  Only when you got wildly odd results that didn’t agree with what you were looking for in the slightest did you go back over your method and equipment to find the error.  Even if you had the highest ethics, it would be perfectly possible to miss some error as long as the results fell into a “reasonable” outcome.

Having more people do the same testing can lead to better results, but if you are all testing in the same area and watching one another’s results, chances are good that you started looking for the same results in your experiments.  A friendly classmate might even help you by telling you how to change your equipment to get a desired result.  So more tests do not necessarily lead to more accurate results.

But don’t believe me.  Have a gander at the most read PLoS article ever, entitled: Why Most Published Research Findings Are False.

In this appetizing little mathematical jaunt, the author takes us down the reality that false positives are far more likely than finding the truth.   Even before we add in publication bias, tenure track pressures, and financial incentives, it is just too easy to find the results you’re looking for.  The author Ioannidis states:  “manipulation could be done, for example, with serendipitous inclusion or exclusion of certain patients or controls, post hoc subgroup analyses, investigation of genetic contrasts that were not originally specified, changes in the disease or control definitions, and various combinations of selective or distorted reporting of the results. Commercially available “data mining” packages actually are proud of their ability to yield statistically significant results through data dredging.”

So just how many of us are taking drugs created for an illness, supported by studies created to support that drug’s ability to treat that illness, and prescribed by doctors who believe that the drug will effectively treat our illness despite all of our claims that the drug really isn’t working?  Meanwhile we as patients want to have something that works for our illness, so we spend a lot of time giving the drug “time to work” when it really never does anything to help us.

As someone who works in the alternative healthcare field, I don’t know whether to laugh or cry.  It feels like the rug just got pulled out from under all the work we’ve done to start bringing the field up to the standard of scientific inquiry.  Suddenly what was clinically relevant information is in question, and the standard drugs that we’re trying to compare to the alternatives are also in question.  How do we know what works?

Fortunately, I’ve got an ace up my sleeve.  I’ve been working with ornery, independent minded patients for years who don’t mince words when things don’t work.  So I’ve got an ongoing practice based on what is working in the field, using my patients as my resources.  Maybe it is time for all doctors to use their patients, rather than the drug reps, as their resource for what really works.

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A Dark Knight Indeed: The Colorado Shooting Spree.

English: Memorial for the victims of the spree...

English: Memorial for the victims of the spree shooting in Urfahr 1995 Deutsch: Denkmal für die Opfer des Amoklaufs 1995 am Bezirksgericht Urfahr-Umgebung (Photo credit: Wikipedia)

As the reports pour in, we all hang our heads and send our thoughts and prayers to those involved.

http://www.eonline.com/news/331806/the-dark-knight-rises-horror-gunman-kills-12-injures-38-at-colorado-screening

What can we do to prevent these from happening?  What is it about our culture that allows this to take place again and again?  There is no single, simple solution, but we all need to examine this most recent tragedy and look to our own communities about how to prevent it in the future.

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Alas, Stephen Covey Did Not Write Seven Habits of Effective Bicycle Riding Before He Passed.

Professor Stephen R. Covey

Professor Stephen R. Covey (Photo credit: Wikipedia)

When I heard that Stephen Covey had died at the relatively early age of 79, I wondered if he’d had some sort of long-standing illness.  Surely someone so efficient and so directed in his life would not allow his health to slip away.  Then I heard he died of complications after a biking accident.  At a time when others are busy in rockers, he was still rocking it a little too fast and furious.

We never think anyone like Stephen Covey will pass.  In my mind he has joined others like Cary Grant who may have passed but still live on as part of our collective memories.  Somewhere in heaven, he is making things more proactive.

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We All Need Statins, STAT!

Rafael Statin [6685Crop]

Rafael Statin [6685Crop] (Photo credit: Juan N Only)

English: Statin Pathway from WikiPathways

English: Statin Pathway from WikiPathways (Photo credit: Wikipedia)

Family Medicine – Focus on… News Article | The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials |4075225.

In a stunning analysis, researchers found that the healthiest among us do as well or better on statins than the sickest.

The results found that:  “Reduction of LDL cholesterol with a statin reduced the risk of major vascular events (RR 0.79, 95% CI 0.77–0.81, per 1.0 mmol/L reduction), largely irrespective of age, sex, baseline LDL cholesterol or previous vascular disease, and of vascular and all–cause mortality.”

In other words, we all need statins, STAT!  Everyone should take them, because they are good for everyone.  Forget all those silly risk factors, and above all, forget that life could possibly be lived without taking prescription medications.

All this brings up another question:  wouldn’t we be better off taking everything?  Hypertension meds, anti-diabetic meds, statins, anti-depressants, etc.?

These are the answers to life’s ailments and gosh, they would all individually be good for our statistical lives.  But somewhere in all that goodness is a creeping uncertainty.  We just haven’t done the studies on the interactions between all these miracle pills.

The term polypharmacy applies to an ever increasing portion of the population.  At five or more medications (and yes, we include your multi in that mix)  no expert in the world can truly tell you what’s going on in your body over time.

I wonder if they factored that into the glowing report that statins are great for everyone.

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Bath salts, drug alleged “face-chewer” Rudy Eugene may have been on, plague police and doctors – Crimesider – CBS News

A senior police officer of the Hamburg police ...

A senior police officer of the Hamburg police on assignment at Hamburg city hall, Germany. Français : Capitaine de la police de Hambourg en faction devant l’hôtel de ville de Hambourg, en Allemagne. (Photo credit: Wikipedia)

Bath salts, drug alleged “face-chewer” Rudy Eugene may have been on, plague police and doctors – Crimesider – CBS News.

If you’ve looked at my previous post on face eating people (just use Zombie-B-Gone), I called this one right.

People selling bath salts should be sued for truth in advertising.  They need to tell people that they will go insane, rip off their clothes and be a terrible menace to themselves and their friends until they are sedated and held down by eight police officers.  Hoo boy, what a great trip?  Why would you do that to yourself?

If I was a police officer, I would seriously be asking for maximum penalties for anyone selling this stuff.  It turns a human being into a berserker.  That’s what we need to change the name to:  Berserker Salts.  Then people at least know the kind of “high” they’ll be experiencing.

Truthfully, if you want to live in hell for a few hours, get a round trip ticket to any of the world’s slums or conflicts.  You can walk around in the slum, get beat up and shot at, and bring post cards back.  It’s just like bath salts but you can skip the whole “Satan whispering in my ear” soundtrack.

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How Not To Help Your Hypertension. Just Kill The Nerves!

English: indirect blood pressure measurement i...

English: indirect blood pressure measurement in a cat, oscillometric. Deutsch: indirekte Blutdruckmessung bei einer Katze, oszillometrisches Messverfahren (Photo credit: Wikipedia)

In a very disturbing article, frustrated doctors are now recommending destroying the nerves of people unresponsive to blood pressure medication.

How does it work?

Let’s let them explain the procedure first.  (From Huffington Post)

“If there was a snake in the room, all of our blood pressures would go up, appropriately so,” explained interventional cardiologist Dr. Manesh Patel of Duke University.  But sometimes those nerves stay switched on when they shouldn’t be. The hope is that destroying a small number of the nerves could calm an overactive system, relaxing arteries and lowering blood pressure.”

Ok, let me recap.  Stress causes our blood pressures to rise.  It is a necessary part of staying alive.  But in some people, this stress continues to be a problem.  Make that all people, but some of us have more resilient arteries.  So the “new” solution is to cut off the nerve response so your body cannot respond to stress by producing nasty blood pressure raising adrenaline.  Why not just severe the spinal cord and be done with it?  Probably on next year’s list of options:  “you’ll need help to breath, but boy, that blood pressure sure dropped.”

How well does this severing of the nerves work?  In small studies, it takes about 33 points off the upper range, as long as you stay on all your other medications.  And does it work long term?  We don’t know, because we’re just starting larger trials.  And we have no long term results.

I’m going to go out on a limb here and say, yeah, cutting your nerves will work short term in some people.  But long term you keep up that stress, and you’re going to see that blood pressure rise back up.

Heck, you know what really drops blood pressure?  A newsectomy.  Let’s do a side-by-side trial of the people who get this lovely procedure with people who cannot look at the news for thirty days.  I bet you that the newsectomy is twice as effective.

What gets me about blood pressure is that we haven’t shown that lowering blood pressure prolongs people’s lives overall.  A slight decrease in stroke risk, and yes if you’ve had a heart attack.  But take your healthy eighty-year-old with slight hypertension, and you’re not going to see any more life if you control it with six meds.

But that doesn’t matter.  For this procedure, they’re getting fourteen thousand dollars in Europe.  That means about thirty thousand here in the U.S.  So it’s going to be rolled out.

Here’s a truly radical idea.  Let’s give the patients the thirty thousand dollars.  I’m betting that would bring down their blood pressures.  It might even lead them to take a holiday or get out of the situation that is causing the blood pressure elevation.  Let’s do a study testing the procedure versus giving the patients the cash.  I volunteer for the control group!

 

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