Mammograms

Several studies have disputed the efficacy of mammograms. I, being a man, of course ignored these when they hit the news last year. Some friends were discussing it, which got me thinking, "How could getting mammograms not help?"

Here are two articles which discuss the changing science on mamography:

• http://www.hsph.harvard.edu/news/features/vatten-mammography-screening/ (link) 
• http://well.blogs.nytimes.com/2012/11/28/ignoring-the-science-on-mammograms/ (link)

The first indicates that screening does not correlate with reductions in breast cancer mortality rates. Also, screening tends to find cancers that "would not have harmed them". The second reinforces that "that screening mammography doesn’t save lives" and "the number of cancers diagnosed at the advanced stage was essentially unchanged".

I thought about this for a while. How could screening mammograms, which find early stage cancer, not reduce advanced stage cancers or cancer deaths? I came up with five reasons:

1. The early cancers detected would not have become malignant, so finding and treating them doesn't affect mortality rates.
2. The early cancers that may have become malignant would have been caught at a later time. Treatments are now so advanced that the delay doesn't appreciably affect the mortality rate.
3. Other screening methods are finding cancers so mammogram screening is less effective at finding cancer. Maybe women who do self exams find more cancers compared to women who wait for their yearly mammograms. This would strangely lead to a correlation between mammograms and increased mortality rates.
4. The treatments may negatively affect mortality. Getting surgery or radiation or chemotherapy on early cancers or benign cancers may damage health enough to outweigh any benefits. I couldn't find a clear answer whether the mortality rates were just due to cancer, or due to anything (I'm guessing the latter).
5. The advanced cancers appear very quickly and are very deadly. This makes some sense because cancer is uncontrolled growth of previously normal cells. Fast growing cancers would seem to be the most deadly. In this case, the mammography screening rate might have to be monthly to have a hope of finding these advanced cancers in time to make a large difference in mortality.

I decided to actually read the original New England Journal of Medicine article, so see if I could understand what was going on.

• http://www.nejm.org/doi/full/10.1056/NEJMoa1206809

It enlightened the situation, and also showed the difference between scientists and science journalists. Here are some quotes for the NEJM study Discussion section:

• "Over the same period, the rate of death from breast cancer decreased considerably. Among women 40 years of age or older, deaths from breast cancer decreased from 71 to 51 deaths per 100,000 women — a 28% decrease. This reduction in mortality is probably due to some combination of the effects of screening mammography and better treatment. Seven separate modeling exercises by the Cancer Intervention and Surveillance Modeling Network investigators provided a wide range of estimates for the relative contribution of each effect: screening mammography might be responsible for as little as 28% or as much as 65% of the observed reduction in mortality (the remainder being the effect of better treatment). Our data show that the true contribution of mammography to decreasing mortality must be at the low end of this range."
• "As treatment of clinically detected disease (detected by means other than screening) improves, the benefit of screening diminishes"
• "Women now widely recognize the significance of a new breast lump and the need for diagnostic mammography. Ironically, increased awareness confers less opportunity for screening mammography to reduce the incidence of advanced cancer. ... We agree that women should understand that screening raises their risk of becoming a patient with breast cancer and that there is uncertainty about the benefit of screening. The assessment of how to cope with that uncertainty, however, remains a value judgment that we believe should be left to women and their doctors." - Authors response in Letters section

It should also be noted that the study did not follow women to see what they were doing, but looked at general statistics. It did not look at a woman's family risk of breast cancer, or whether they did self exams. Also, some fairly large adjustments had to be made to account for hormone-replacement therapy's effect on cancer rates.

What I take away from this is screening, in all forms, is useful, but results should be reflected on before health-affecting treatments are begun to make sure they are necessary. But this is a complicated subject, and my heart goes out to anyone who has to deal this these issues.

Diet and exercise ... and diet

Just in case you weren't convinced that About.com  is full of idiots, along comes Jennifer R. Scott with this "nugget" of wisdom:

Experts agree that it's easier to exercise than to cut the same number of calories that exercise shaves off. In other words, it's just plain easier for us to be a little more active than to do without more food to achieve the same calorie reduction.

I'm sorry, but W.T.F.A.Y.T.A? Not one sentence above, we get this:

For example, a 180-pound person who walks at a brisk 3 mph will burn just over 250 calories in 45 minutes.

Guess what else is 250 calories? A chocolate bar. How long does it take to eat? A few minutes. So what is more effective for losing weight? Jennifer, put your hand down. Let the adults answer.

Why is exercise associated with weight loss? The two have very little to do with one another. For example, whenever they show ads for The Biggest Loser, they show an obese person jogging on the beach and then chowing down on a sub. The only thing that jogging will do for an obese person is destroy their knees. The only reason the two are linked, that I can think of, is very active people tend to be skinny. But correlation does not equal causation.

If common sense wasn't enough, how about some studies. After a brief 24.8 second search on the Internet, I found this link which outlines several studies, all of which show that exercise "is not a major factor" in weight loss. I would look further, but I'm losing Rant Energy.

So next time you see an ad or a news story on weight loss and they show people exercising, do what I do, shake you fist at the TV. And think about how dumb Jennifer is.

P.S. I don't know Jennifer and the quality of her other post. She may or may not be an idiot*.

*Note: she is an idiot.

Sugar is poison

Those latest adds by the Corn Refiner's Association which are trying to "rebrand" high fructose corn syrup (HFCS) as the same as sugar scare me. Why would they spend so much telling me it is "safe" if it were actually safe? I know, I'm a skeptic.
Last night, I thought I'd try and educate myself about this. Here is what I found out.
Sucrose is normal granulated sugar, the stuff we put in coffee or on cereal. Sucrose is made up of two other sugars in equal proportions -- Glucose and Fructose -- which are bonded together. When you eat table sugar (Sucrose), your body breaks it down into Glucose and Fructose.
Glucose is the energy of life. It is in rice, pasta, grains, etc. It can be metabolized (used) by muscles, but is mostly broken down in the liver and stored until you burn it off (or, if you don't burn it off, it is turned into fat). Fructose, on the other hand, can only be metabolized by the liver. But there are a bunch of other nasty things that Fructose does.
Fructose is found mostly in fruit (but fruit contains fibre which mitigates some of its bad effects). Fructose does not create an insulin response, which is why it is used by diabetics as a sweetener. Fructose creates uric acid which causes gout and hypertension. Fructose is more readily turned into fat than Glucose. A good analogy for Fructose is another carbohydrate, Ethanol, or booze. Ethanol is fine in small quantities but in large quantities, it causes toxic effects on the liver and your body. Fructose acts in exactly the same way, but without the buzz. Fructose, like Ethanol, is a poison! With all poisons, it is dosage that determines toxicity.
Okay, so what is High Fructose Corn Syrup (HFCS) and why is it so bad? Well, HFCS is just Glucose (corn syrup) and Fructose, typically in exactly the same proportion as they are found in Sucrose (table sugar). They just aren't bonded together, which really doesn't mean anything because as soon as Sucrose hits your small intestine, it is broken apart. Look at the image above. The top (Glucose Fructose) is HFCS and the bottom (Sucrose) is table sugar. They are the same. Your body treats them the same. So what is the big deal? Here's the thing: it isn't that HFCS is worse than sugar, it is that sugar is really bad and HFCS is the same as it.
The real problem is HFCS is really cheap so it is put in everything to make it taste better. Here is a good analogy. Image table sugar is rat poison. In the past, it used to sit in a bowl on your table and you'd put it in coffee or on porridge or in baking. But if you didn't put it in stuff you wouldn't eat it. You could control your intake. But now, the rat poison is in everything: bread, juice, pop, cereal, anything processed. So if you don't put rat poison in your coffee, who cares, because you are getting it in everything else you eat. That is what makes HFCS so dangerous, is that there is no escaping it.
Sugar is poison, whatever the form.

Hospital - Part I - Crohn's

I spent a few weeks in the hospital due to my Crohn's disease. Being an engineer, I kept notes and have some interesting observations which I'll try and relate over the next few posts.

Crohn's disease is when your immune system attacks your intestines. It causes swelling which can be treated by anti-inflammatories (e.g., steroids) or immune suppressants (e.g., remicade). Crohn's symptoms read like a Pepto ad; it mainly causes pain and diarrhea.

The swelling eventually leads to scaring called strictures. Unlike the swelling, strictures can only be treated with surgery (usually a resection). I've had about 3 feet of small intestine removed (we have about 22 feet of small bowel total ... thanks Maxim!). Strictures can clog up with food and cause partial blockages, which is why I went into the hospital.

I've been to the hospital 3 times for partial blockages. Most times it happens late at night when the pain and nausea become too much for me to handle. The wait time in emergency has been between 2-5 hours before I get in, the nurse starts an intravenous line, and they give me pain-killers (usually Fentanyl). They always ask you to rate your pain between 1 and 10, with 10 being the worst pain in your life. I usually am at a 9 before I get the pain-killer, and have vomited several times.

Given that Crohn's is related to your immune and digestive systems, there are several lifestyle changes that will help reduce problems. Avoid weakening your immune system by not getting enough sleep, working too hard, drinking alcohol or coffee, or smoking. It is best to avoid difficult to digest foods like nuts and popcorn. I have found steak is particularly difficult to digest, and almost all my blockages have been preceded by eating steak (and Caesar salad ... thanks Earl's!).

In the next few blogs I'll try to go over some of the crazy roommates I had in the hospital, and essential things you should bring if you are going into the hospital.