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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