Of Mice and Men - reading about medical "breakthroughs"

Researchers want people to appreciate their work and to get funding for more research, so they and the institutions for which they work want favorable publicity.

Reporters want to get bylines and publishers want readers, because more readers mean more advertising dollars. Thus, news outlets have every incentive to trumpet research results as big news, breakthroughs that will attract “eyeballs.”

Combine these aligned incentives with the fact that very few reporters have much background in science and you have a recipe for over-hyping minor advances or preliminary results as big news.

How can you critically read a story about a supposed major medical advance and know if it is truly important?

First, accept that mice are not humans. What works in mice may or may not work in people. Some 5% of initial promising results in lab rodents end up being similarly effective in humans. Even those that do cross over take a very long time before being useful – an average of 17 years between the first trial in mice and an approved human product.

What about human studies?

Be VERY skeptical of association as proving causation: the observational trial Researchers live in a “publish or perish” world and look for associations between habits or exposures and diseases or longevity that can form the basis of a published paper.

Good medical science depends on a controlled clinical trial, in which people are randomly assigned to the treatment being studied and are generally otherwise very similar. Observational trials may suggest linkages but almost never prove them.

The fact is that people who do one thing, like drink coffee, may do many other things differently. Coffee drinkers may be more likely to smoke, or eat donuts or work in offices than those who do not drink coffee. Unless the researchers have been able to match the people who do the thing studied with those who don’t, and can be sure that is the ONLY difference between them, the outcome may be due to something completely different.

Good trials, in addition to randomly assigning people to the treatment(s) being studied are double blinded. This means that neither the people being studied nor the researchers know which treatment or placebo they are getting. Other than death, few outcomes of a trial are absolutes. There is a strong placebo effect for most conditions, and if people know they are getting the active drug, many will feel better for that reason.

If researchers are heavily invested (emotionally or financially) in drug A being better than drug B, they will be tempted to ignore side effects or encourage feeling better in the group given A.

Finally – be careful not to assume that “statistically significant” is always the last word. Statisticians devise ways to tell if trial results are purely due to chance. This is given as a “P value.” A P of 0.05 means there is only a 5% chance that the results were just luck; the lower the P value, the more likely there really was a difference between groups.

Small differences in outcome may be called statistically significant when their clinical significance is minor. When a study result says that people given A lived significantly longer than those given B, look carefully to see how much longer.

This is particularly common with trials of new cancer drugs. You may read a headline saying that cancer patients given X lived significantly longer than those given Y. Buried deep in the story may be the facts that those given X lived 6.5 months and those given Y lived 5.3 months – and that those given X had many more side effects and had to pay $50,000 more out of pocket. It is not so clear that you would always want to choose X.


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The last diet advice you need to read

Paleo, Keto, Carnivore, Intermittent Fasting , Whole30 – each diet purporting to solve all your health problems. None are terribly healthy and none solve all your health problems.

What do we know, based on lots of observation and backed by science, about what constitutes healthy eating?

First, make plants the foundation of your diet. Whole grains, fresh fruits and fresh (or frozen) vegetables should make up much of your food intake. Use legumes as a healthy source of protein. Use nuts or minimally-processed nut butter as a snack food. A plant-heavy diet reduces inflammation, reduces coronary disease and cuts your cancer risk.

Eat fatty fish, preferably wild-caught, 2-3 times a week to get more protein and omega-3.

Use red meat sparingly and do not eat processed meats such as bacon, hot dogs or salami. Despite the new USDA guidelines, heavy consumption of red meat adds to coronary risk and may be carcinogenic.

Avoid highly-processed foods. If you look at the label and see items you cannot pronounce and that are not found in normal kitchens, don’t buy it or eat it.

Get adequate dairy for calcium. Best are fermented dairy products such as yogurt, kefir and cheese.

Limit your alcohol intake. Modest (1-2 drinks/day for men, 1/day for women) alcohol intake probably reduces heart disease a bit and increases cancer a bit – sort of a wash. If you enjoy an occasional glass of wine, you do not have to stop, but you certainly do not have to drink for health reasons.

For coffee-drinkers, the news is good – 2-3 cups/day may lower dementia risk, reduces the risk of atrial fibrillation and seems to have no harmful effects. Do not drink it at night if it causes insomnia. Regular or green tea (but not herbal) probably has similar benefits.

Finally, loosen up occasionally. Very few foods are dangerous in small quantities; it is the day-to-day that matters. If you are taking your grandchildren to an amusement park, have an ice cream cone. If your boss has you over for a cook-out and serves hot dogs, eat one. You can get back on your normal healthy diet tomorrow.


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Supplements - What are they good for?

Supplements are a multi-billion-dollar business. Pushed by TikTok influencers and TV personalities, they cover everything from vitamins and minerals to a variety of gummies, powders and pills.

Supplements are not regulated the way pharmaceutical drugs are, meaning the FDA does not assess them for efficacy or safety before they are marketed. Only if serious side effects show up does the FDA get involved.

An important consequence of this lack of regulation is that many of these products do not contain what they claim to contain, and there have been many reports of seriously tainted products. A popular protein powder was found to contain lead.

While touted to solve all human ills, no supplement has been found in a scientific trial to prolong life. Resveratrol was all the rage until trials showed no benefit.

Many of the products pushed on-line or on-TV are expensive. I know of people spending hundreds of dollars monthly on supplements, most of which were useless.

Are there any that you should consider taking?

A standard multi-vitamin is safe and inexpensive. There is evidence that it has a modest effect on reducing dementia. The B12 and D included in multivitamins can make up for the reduced B12 absorption that is common is older adults and the lack of sunshine-produced Vitamin D that is common in winter.

Omega-3 is healthy for the circulatory system. The best way to get this is by eating fatty fish 2-3 times a week. If you don’t eat fish, an omega-3 capsule may be useful.

Even safe and useful products can be harmful in large doses. Vitamin D in excess causes elevated serum calcium, which in turn can cause nausea, constipation, kidney stones and bone pain. While 1 multivitamin daily may be good, 5 or 10 are likely to be bad.

When you see a product pushed by a celebrity or “influencer,” remember that they are usually either selling the product or being paid to tout its benefits. Keep your money in your pocket.


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Can we make healthcare affordable?

On January 15, President Trump announced a “great healthcare plan” that seemed to have three components. It would formalize his push for pharmaceutical companies to lower their prices, send funds to individuals to help pay their insurance premiums and mandate price transparency for any hospital or other provider who participates in Medicare.

Will this do any good? Given the sparsity of details, analyzing this “plan” is analyzing air, but probably not much.

Going back to President Nixon, U.S. presidents have decried the high cost of medical care. In 1971 Nixon pronounced health costs as a crisis when healthcare consumed 7% of the Gross Domestic Product (GDP). In 1992 President Clinton said that “healthcare costs are increasing at unsustainable rates.”

Well, here we are in 2026, and healthcare now consumes 18% of the U.S. GDP, roughly double the cost in peer-countries.

In 2025, the average premium for a family plan was $26,993 - roughly 40% of the average worker’s salary. Even though much of this cost is borne by the employer (for those lucky enough to work for a company that offers health insurance), workers contributed an average of $6850 towards the cost.

Moreover, as insurance costs have skyrocketed, employers have tried to slow this by offering plans with high co-pays and deductibles, meaning that out-of-pocket costs have risen dramatically.

Keeping drug costs down is a start, but drug costs make up only 9-10% of healthcare spending.

When it costs $27,000, sending people $2000 to buy health insurance would not allow most lower income people to come anywhere near being able to afford it.

We have had mandated price transparency in law since 2021, and hospitals have proven very adept at making prices visible only to those with a PhD in computer science.

Yes, we MUST make healthcare affordable to all Americans, but this will require bold steps, with some pain for those currently getting rich off our dysfunctional, adminstration-burdened system, not “a concept of a plan.”


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The liver disease no one talks about

If you have diabetes, are overweight or have bad lipids, you may have MASLD: metabolic-associated steatotic liver disease – or fatty liver to be brief.

Most of us know that heavy alcohol use is bad for your liver, and years ago, most patients with cirrhosis (advanced liver damage with scarring and loss of function) were alcoholics.

In 2026, with the world-wide epidemic of overweight and obesity. MASLD has become the commonest cause of liver disease that can progress to cirrhosis. Up to 38% of adults have this! If you have Type 2 diabetes, that rises to 65%!

The first stage is fatty infiltration of the liver. If nothing is done, scarring and replacement of functioning liver tissue with fibrous (scar) tissue can follow. Eventually the liver loses much of its function, and the complications of a scarred non-functional liver ensue. These include jaundice, swelling of the legs and abdomen and bleeding.

Untreated MASLD is also the number one cause of liver cancer.

How can you prevent this cascade of catastrophes?

First, if you fit the risk profile (diabetic, overweight and/or high triglycerides), ask your doctor to check your liver. While most doctors know they should check your eyes if you have diabetes, many do not think about the liver.

Standard “liver function tests” are not routinely done and are not always abnormal in early stages of MASLD. While elevated liver enzymes may offer the first clue to the problem, 20-25% of people with biopsy-proven fatty livers have normal liver blood tests.

A better test is the “FIB-4” value, which is calculated from your age, two simple liver enzyme tests and the count of your blood platelets. If this is abnormal, an ultrasound test should be done to look for any scarring.

The good news is that getting your lipids and blood sugar under control and losing weight will reliably reduce fat in the liver and prevent you from going on to worse liver disease.

The GLP-1 drug semaglutide (Wegovy) has been proven to improve MASLD and is FDA-approved for this use. Though not studied for this use, the other GLP-1 agents would probably be equally effective.

You cannot live without your liver, so look after it!


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Who will care for me at home?

As birthrates fall and we live longer, western societies are aging. In the U.S., Canada and Britain, almost 20% of the population is over 65, while in Western Europe it ranges from 20 to 25%. Indeed, as baby boomers age, the fastest growing demographic is projected to be those 85+.

While today’s seniors are healthier than the elderly were a generation ago, aging eventually leads to the loss of some ability to live independently.

If an elder can no longer safely take a shower or grocery shop by themselves, what are their options?

As the last resort, moving to a nursing home is an option but, when asked, most seniors strongly prefer to age in their own home.

Besides being unappealing, nursing home care is expensive! In Massachusetts, a high cost of living state, the median cost of a semi-private room in a nursing home is $12,600 per month. Nationally, the median cost is $9555, which translates to $114,660 per year.

Staying at home instead of a nursing home means that help in the home will be needed. This can be provided by some combination of friends, family and paid caregivers.

Long-term, the U.S. must make policy decisions about how to cope with its aging population. In the immediate future, we need to provide more, and more affordable, help at home.

In 2024, some 3.2 million people worked as home health aides and personal care aides. To meet the demand, experts say that another 750,000 will be needed over the next decade.

Who are these people caring for our frail elders? Not surprisingly, almost 90% are women. About 30% are foreign-born, many from low-income countries such as the Dominican Republic, Jamaica, Haiti and the Philippines.

Home health workers are poorly paid, averaging $17/hour, and there is very high turnover. At the same time, the cost to care-recipients is high, averaging $34/hour. The difference is the money made by the agencies that employ the workers.

The agencies play a key role in vetting the home care workers. Given the possibility of physical abuse or theft by unknown individuals in the home of a dependent elder, hiring someone “off the street” is risky, yet keeping half of the cost seems excessive. If you or a loved one needs help at home, what are your options other than going through an agency?

The ideal option would be word of mouth. If a friend or neighbor has had a home aide that has been reliable, hiring them directly is an option. You can pay them more than they would get from an agency and still save money.

A better option would be for your state to set up a registry of vetted home health and personal care aides that individuals could access. The state could assume the responsibility for doing background checks and listing any complaints.

Massachusetts has such a registry, but it is only accessible to employers, not the public. Ask your state legislators to open the registry for public access.

The best fallback would be to call your local Visiting Nurse agency. They will either provide vetted home health aides or be able to direct you to a trusted local agency


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Are you taking too many pills?

90% of Americans 65 and older take at least one prescription medication. Half take 4 or more and 15% take 8 or more. The number of medications taken rises with age.

Add to that the many over-the-counter (OTC) pills such as pain relievers, acid suppressors and supplements that people take, and we are talking about a lot of medications.

While most of these are probably needed, some are not and some are harmful to your health.

There are many reasons people take medication they should not be using. A common reason is that we see many doctors, and each may be unaware of what the others are prescribing. This can lead to duplication – two pills with very similar actions – or to harmful interactions between medications.

Many medications are particularly dangerous to older people. These include muscle relaxants, sedatives and antihistamines, which can lead to dizziness and falls and/or confusion. A very valuable resource in this area is the Beers list of medications that may be harmful to older individuals, maintained by the American Geriatrics Society. It is easily available on-line – just Google “Beers list.”

While medicine has very few “always” or “never” rules, if you find that you are taking medication(s) on the Beers list, ask your doctor about this. You may be healthier stopping them.

I often saw patients taking two different strengths of the same medication. Clearly the dose was changed but the person did not know they were to stop the original pill, and the pharmacy kept refilling both.

There are numerous drug-drug interactions, many dangerous. One pill may affect the way the body handles another, leading to higher than safe levels of one or both. When they are prescribed by the same practitioner, a good electronic record will pick this up, but this will not happen if the prescribers do not share a common record.

If you have a primary care doctor, a valuable visit is the “brown bag visit.” Put ALL your medications, including OTC pills, in a bag and let your doctor review what you are taking. You may be surprised to find how many should be stopped.


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