Tag Archives: breast cancer

July 2015 in review: part 1

There have been a good number of tweets on the #WDDTY hashtag highlighting bonkers claims in the July 2015 edition of WDDTY, so lets take a quick whistle-stop tour through its pages.

We dealt with the cover stories yesterday. Page 2 is (as usual) a full-page “we’ll never take advertising” advert for Altrient, which appears to be in competition with homeopathy as their strapline is “nothing compares to Altrient”. They lead with a “33% increase in skin firmness” cream, high dose vitamin C (perfect for enriching your urine) and “high performance” glutathione, which, you will be pleased to hear, may support optimal overall health (quackvertising code for: there is no credible evidence that it does), supports a number of fad diets, and contains no gluten or GMOs. WDDTY seems quite happy for the drugs it likes to be oversold with vague and inflated claims, it seems. Continue reading July 2015 in review: part 1

July 2015: the firehose of stupid at full blast

Your challenge: guess how much of this is valid information that doctors don't tell you.
Your challenge: guess how much of this is valid information that doctors don’t tell you.

The July 2015 issue of WDDTY is out.  You can tell from the cover that it’s going to be a cracker. HPV vaccine: new dangers revealed! Why low-cal sweeteners make you fat! Recipe for better breast health! How I beat Lyme disease! Staying sun-safe naturally! And the headline: 10 minutes to stronger bones.

Based on these I predict: an anti-vax diatribe based on misleading presentation of data with no balancing reference to the benefits of preventing cervical cancer; anti-aspartame conspiracist whacknuttery; pimping some refuted nonsense about breast cancer; favourite quack fake disease “chronic Lyme” cured by some quack nostrum; anti sunscreen bollocks; and something doctors already told you.

Let’s see how I do. Continue reading July 2015: the firehose of stupid at full blast

Evil ASA 1: Medical Thermal Imaging

This is one of a short series on the examples highlighted in January 2015’s issue of WDDTY as “proof” that the ASA is fundamentally flawed, and as justification for replacing it by a body run by practitioners commercially vested in the claims under evaluation.

Medical Thermal Imaging

An advertisement in WDDTY from Thermal Imaging claiming “100% safe breast screening … thermography can detect active breast abnormality before it’s possible with nammography” was challenged by the Nightingale Collaboration (NC).

But as thermography was used as a complementary screening method alongside mammography until the late 1980s-and is still routinely used by a major London hospital-the company
was able to produce 1,24 7 scientific papers, including studies authored by some of the world’s leading experts in the field. The ASA lost some of the papers and deliberately excised relevant sections from others before deciding the evidence was not’robust’.

First, please read the adjudication. It is not very much like what Bryan describes, is it?

Now, about breast thermography. I don’t know all the history of its development and testing in the medical world, but the critical fact to focus on here is that this is a relatively cheap instrument that could, if it actually worked, be used by any medical facility. Radiographers could use it without significant additional training.

Bear in mind also that there are significant ongoing concerns about false-positives and radiation exposure in mammography.

If breast thermography were as good as mammography, it would be universally used. If it were better, as proponents claim, then there would probably be massive scientific prizes for the inventor.

No rationale is advanced for why this test is “alternative”. You can probably guess the rest.

From the American Cancer Society:

Thermography has been around for many years, but studies have shown that it’s not an effective screening tool for finding breast cancer early. Although it has been promoted as helping detect breast cancer early, a 2012 research review found that thermography was able to detect only a quarter of the breast cancers found by mammography. In other words, it failed to detect 3 out of 4 cancers that were known to be present in the breast. Digital infrared thermal imaging (DITI), which some people believe is a newer and better type of thermography, has the same failure rate. This is why thermography should not be used as a substitute for mammograms.

From the US Federal Food and Drug Administration:

Certain facilities, websites, and mobile units are promoting the use of thermography as a stand-alone evaluation tool for screening and diagnosing breast cancer, claiming that is a substitute for or superior to mammography. They also claim that thermography can detect pre-cancerous abnormalities and diagnose breast cancer long before mammography and that compressing the breast during mammography will cause or spread cancer by pushing cancer cells into additional locations in the body. The FDA is concerned that women will believe these misleading claims about thermography and not receive needed mammograms. [emphasis in source]

From a news report by the Canadian broadcaster CBC:

Two provinces have issued cease and desist orders against medical clinics that promote the benefits of thermography, a diagnostic test for breast cancer that medical experts say is useless.

From the Australian Government Department of Health:

Studies have shown that a tumour has to be large (several centimetres in diameter) before it can be detected by thermography (Homer 1985). Screening mammograms have the ability to detect breast cancer at a much smaller size, and therefore to reduce deaths from breast cancer. Less than 50% of breast cancers detected by mammography screening have an abnormal thermogram (Martin 1983).

There is no current scientific evidence to support the use of thermography in the early detection of breast cancer and in the reduction of mortality.

Cancer Research UK:

In 2012, researchers pulled together all the research that has been done on heat scans. This is called a systematic review. They found that there is not enough evidence to show that thermography is reliable enough as a screening test for breast cancer. There is not enough evidence that it can help to diagnose breast cancer when used with mammograms in screening. And there is not enough evidence that it can help to diagnose breast cancer when there are signs that a breast cancer might be there.

Until we have research evidence to show it is reliable, thermography is not recommended as a screening test or to try and diagnose breast cancer.

A PubMed search shows what’s actually going on. Thermography may be useful as an adjunctive diagnostic tool in breast cancer (the jury is still out), but it is definitively not useful as a primary screening tool.

Women frightened by the prospect of X-rays may well fall for the seductive claim of non-contact, radiation-free screening, but it simply is not reliable for this use,. and there’s already a problem even with the dramatically more reliable mammograms currently in use.

And in saying that there may be some value as an adjunctive approach, we are giving the vendors the benefit of the doubt.

Let’s remind ourselves of the actual text complained about:

100% Safe BREAST SCREENING …Thermography can detect active breast abnormality before its [sic] possible with mammography …  Medically recognised

 

Two claims:

  1. It can detect abnormality before mammography;
  2. It is medically recognised.

The 2012 review to which the ACS alludes says this:

CONCLUSIONS: Currently there is not sufficient evidence to support the use of thermography in breast cancer screening, nor is there sufficient evidence to show that thermography provides benefit to patients as an adjunctive tool to mammography or to suspicious clinical findings in diagnosing breast cancer.

So the two claims on which the ASA adjudicated are categorically false. The evidence shows that breast thermography is dramatically less sensitive than mammography as a screening tool, which is exactly as expected given how they both work, and the medical community, charities, regulators and governments all seem to be unanimous in saying that it is not accepted.

It leaked its decision to the Daily Mail, which ran a misleading story under the headline ‘Clinic found guilty of misleading women by claiming it could detect breast lumps through thermal imaging’.

Not true. ASA Adjudications are sent out under embargo. They are released on a Wednesday, and by a curious coincidence I happen to have the ASA press release in my mail archive still.

Subject: ASA weekly rulings published
Date: Wed, 9 Jan 2013 08:49:16 +0000
Reply-To: ASA press office <[email protected]>
Message-ID: <[email protected]>
To: [my email address]
From: Press <[email protected]>

[...]

Advertising Standards Authority

Adjudications alert

Weekly adjudications published

This week's adjudications have now been added to the ASA website. The following advertisers have been subject to ASA rulings:

[...]
Medical Thermal Imaging Ltd
[...]
Regards

ASA Press Office

The Daily Mail’s online story went up at 10:57 GMT on 9 January 2013, two hours after the press release. ASA embargos allow release on  the same day so if it was in the same day’s print edition it also did not violate the embargo. No leak, it seems, just a press release (ironic, given that recycled press releases form a substantial part of WDDTY’s content).

Yet another schoolboy error, by the looks of it.

The company’s proprietor Phil Hughes became ill as a result and suffered catastrophic organ failure, and had to be treated in intensive care where he also suffered cardiac arrest.

Very sad. He should have done the smart thing and removed the advertisements when ASA first contacted him. Perhaps he should have read his own hype: he seems to think thermography can detect heart disease as well.

To be fair, I think he might have his thermal imaging cameras confused with the X-ray specs they used to sell in comics.

Vasectomy raises prostate cancer risk by 10 per cent

Some issues in medicine are complex – sufficiently complex that they actively invite Mencken’s famous expression: for every complex problem there is a solution which is simple, neat and wrong.

Other things are relatively straightforward. This October 2014 story on prostate cancer risk is straightforward, but that doesn’t stop WDDTY turning it into an alarmist anti-medicine dog’s breakfast.

Men who have had a vasectomy are more likely to develop prostate cancer and particularly the more aggressive form that’s likely to kill.

Or, to summarise as the authors did:

Our data support the hypothesis that vasectomy is associated with a modest increased incidence of lethal prostate cancer. The results do not appear to be due to detection bias, and confounding by infections or cancer treatment is unlikely.

Support the hypothesis. This is not proof of a causal link, but it is plausible. One paragraph in, then, and WDDTY have talked up “a modest increase” in a context of “conflicting reports”.

The procedure increases overall risk by 10 per cent, and the chances of developing an advanced or lethal form are even higher-compared with the general population-with an up to 20 per cent increased risk.

This is where WDDTY engages in one of its signature tactics. The paper discusses the relative risk. The difference between relative and absolute risk is very straightforward. Let’s say that you’re going to walk to the shops. You have, say, a one in a billion chance of being run over. However, on icy days, your chances of being run over are doubled, to one in half a billion. A large increase in a tiny risk is still a tiny risk. Or, to use the language of the authors, modest.

In this study, WDDTY tell us that you are 10% more likely to die of prostate cancer after a vasectomy. But the risk of lethal prostate cancer in this cohort is 1.6% : your chances of getting lethal prostate cancer (where the risk ratio is actually 1.19, not 1.1 as WDDTY simplistically state) is actually less than half a percentage point greater.

Not quite so scary now, is it?

The greatest risk was among men who had a vasectomy at a younger age of 38 or so, say researchers from the Harvard School of Public Health, who analyzed the health of 49,405 men over a 24-year period. In that time, 6,023 men developed prostate cancer and a quarter of those had had a vasectomy.

Again, the number developing prostate cancer sounds scary, but you have to put this in the context that current medical thinking is that any man who lives long enough, will probably have prostate cancer. Most men with prostate cancer die with it, not of it: they actually die of something unrelated.

Vasectomy is one of the most popular forms of male contraception in the US and UK, with around 15 per cent of men undergoing the procedure.

It is indeed. It is popular because it works, and because it is unobtrusive and allows women to stop taking the Pill, which has a higher failure rate and some side effects.

WDDTY, in its reliably inconsistent  hatred of all things medical, also fulminates against the Pill. Indeed, the same issue includes a story claiming that the Pill increases risk of breast cancer threefold.

Perhaps the editors subscribe to the idea of abstinence as contraception? The evidence is that this does not work. Or maybe they are Catholics. The evidence shows that the rhythm method is one of the least effective.

In fact, vasectomy is one of the most effective forms of contraception available. Any judgement based on the balance of risk v. benefit is likely to be favourable to vasectomy.

J Cl in Oncol, 2014; doi: 10.1200/JCO 2013.54.8446

Contraceptive pills increase breast cancer risk threefold

Bad news, girls. WDDTY wants you pregnant, barefoot and in the kitchen (albeit preparing raw food and none of those evil tomatoes). McTaggart is probably religious and has appeared on media promoting “sacred stewardship“, so this is not much of a surprise.

October 2014’s issue contains two pieces fulminating against two of the most effective forms of contraception. vasectomy and the Pill.

This article is based on a paper in Cancer Research, thus qualifying as something doctors do tell you.

Birth control pills high in oestrogen increase the risk of breast cancer by nearly three times. The risk seems to be highest in women who have only recently started taking the Pill and during the first 12 months of taking it, say researchers at the Fred Hutchinson Cancer Research Center in Seattle.

This is another case of abuse of risk ratios. The risk of breast cancer among all women in the cohort is not easy to compute form the abstract data, as the study looks only at those women diagnosed with cancer. Cohort risk then is not known, but the average lifetime risk of breast cancer in the US is currently stated to be 12.4% – this is high enough that a small percentage change in risk may be significant in absolute, not just relative terms.

The study finds that the relative risk varies from zero for some formulations, to 2.7 for the high dose oestrogen pill.

If only there were a thoroughly researched analysis available online to help unpick this complex issue. What’s that, you say? There is? I wonder why WDDTY did not bother reading this.

A large analysis of most of the studies carried out worldwide into oral contraceptives (the pill) and the risk of breast cancer, showed that women using the pill have a slight but significant increase in breast cancer risk. But the evidence suggests that the risk starts to drop once you stop taking the pill and 10 years after you stop your risk of breast cancer is back to normal.

There’s also a small increase in cervical cancer risk but this is vulnerable to confounding by levels of sexual activity. However:

The combined contraceptive pill protects you against ovarian cancer. This is particularly important if you have ovarian cancer in your family. The protection comes from the pill suppressing hormones that naturally stimulate the ovaries. It seems that the longer you take the pill, the lower your risk of ovarian cancer.

And the same goes for cancer of the uterus and the bowel.

So the reality-based take on it is:

The pill does increase the risk of some cancers, but lowers the risk of others. Any increase in cancer risk from taking the pill seems to go back to normal once you stop taking it.

Odd that WDDTY did not say this, since it’s undoubtedly what their readers need to know.

The risk is highest for high-dose oestrogen pills, which increase the risk of breast cancer by 2.7 times, while moderate-dose oestrogen ones raise the risk 1.6 times. Pills containing ethynodiol diacetate are also dangerous, raising the risk 2.6 times.

Not three times, as WDDTY says (amazing, talking up the risks, that has literally never happened in every single WDDTY story about non-quack treatments ) but not far short for one type of Pill.

High dose oestrogen is not the most common form of the Pill – in fact the most common is one of the low risk types discussed in the article (Boots has a really good comparison of Pill formulations).

All Pills are not equal. And WDDTY makes this clear in the article headline doesn’t it? Oh, wait, no, it implies the exact opposite.

In an analysis of 1,102 women who had developed breast cancer, the researchers found that most had only recently started taking the Pill, and had been using it for less than a year. Recent use increased the cancer risk by 50 per cent, irrespective of the type of contraceptive pill used.

Do you see the bit where they mention the fact that risk declines once you stop taking it? No, neither do I.

So as usual, WDDTY has engaged in scaremongering and missed an opportunity to leave its readers actually better informed about a relatively complex issue.

One can only speculate on which alternative the editors think women should use. Homeopathy, perhaps?

100 ways to live to 100: Your healthy lifestyle

Part of a series on WDDTY’s “free” advertorial report “100 ways to live to 100

Your healthy lifestyle

Oh good, lifestyle advice. We all love to be told what to do, if only so that we can feel appropriately virtuous when it’s what we would do anyway.

91 Don’t shield yourself from the sun’s rays

The sun is our best source of vital vitamin D, which to protect against numerous diseases and conditions. Most of us in the northern climes are vitamin D-deficient. Opt instead for sensible sun exposure by supplementing with antioxidants like selenium, lycopene, beta-carotene, and vitamins C and E, which offer natural sun protection without the need for potentially harmful chemical sunscreens.

One of the most baffling things about WDDTY is that they tell you things like WiFi cause cancer (which they don’t) then promote not only exposure to the sun (which irrefutably does cause cancer), but unprotected exposure, asserting (falsely) that sunscreens cause cancer.

In fact, that the Skin Cancer Foundation’s Francisca Fusco MD tells you exactly why doctors don’t tell you that sun exposure is the best way to get vitamin D or that sunscreen causes cancer: it’s utter bollocks. Dangerous bollocks at that.

92 Get at least seven hours of sleep

This amount of sleep may “significantly” reduce your risk of cancer, says recent research.60 Lack of sleep alters insulin levels, contributing to overweight and even diabetes. Seven hours seems about right while nine is too much; women sleeping more than this have the highest risk of stroke.

Reference 60: Cancer. 2011 Feb 15;117(4):841-7. Short duration of sleep increases risk of colorectal adenoma. Thompson CL, Larkin EK, Patel S, Berger NA, Redline S, Li L.

All together now: Correlation is not causation. How do you know that those who sleep less are not rampant caffeine addicts? How do you know they’re not heavy drinkers? Alcohol intoxication seriously impacts quality of sleep, after all.

The answer is, you don’t, and you certainly don’t from a study whose 95% CI is 1.05-2.06, meaning that either it makes no difference or it doubles your risk. The study is underpowered to draw any firm conclusion about a causal link.

WDDTY did suggest that a lie in could cure diabetes. If that’s the level of rigour at play here, then perhaps it explains the sloppiness of the argument.

93 Ensure you are breathing through your nose

Breathing incorrectly can contribute to asthma,61 and even attention-deficit/hyperactivity (ADHD)-spectrum problems. If you aren’t breathing correctly, try the Buteyko Breathing Technique or the breathing exercises (pranayama) practised in yoga.62

Reference 61: BMJ, 2001; 322: 1098–100 Prevalence of dysfunctional breathing in patients treated for asthma in primary care: cross sectional survey Mike Thomas, general practitioner, R K McKinley, senior lecturer, Elaine Freeman, primary care research coordinator, and Chris Foy, medical statistician.

Reference 62a:  J Asthma, 2000; 37: 557–64; A clinical trial of the Buteyko Breathing Technique in asthma as taught by a video. Opat AJ, Cohen MM, Bailey MJ, Abramson MJ.

Reference 62b:  J Asthma, 1991; 28: 437–42 Effect of yoga training on exercise tolerance in adolescents with childhood asthma. Jain SC, Rai L, Valecha A, Jha UK, Bhatnagar SO, Ram K.

The first reference concludes:

About a third of women and a fifth of men had scores suggestive of dysfunctional breathing. Although further studies are needed to confirm the validity of this screening tool and these findings, these prevalences suggest scope for therapeutic intervention and may explain the anecdotal success of the Buteyko method of treating asthma.

This qualifies as blindingly obvious, as does the second paper, because bronchospasm is self-reinforcing: teaching breathing techniques that help recover normal breathing rhythm, will minimise the symptoms of bronchospasm. But Buteyko does not claim to be merely palliative, it claims to cure asthma. The second reference shows this not to be the case – there are improvements in quality of life and reduced bronchodilator use, but no evidence of cure.

Wait, isn’t it medicine that’s only supposed to treat the symptoms?

Here’s what Asthma UK say:

Buteyko

  • There has been little research published in medical journals about the Buteyko technique. This makes detailed comment difficult.
  • A Cochrane Review of breathing exercises found no improvement in lung function. However, four clincial trials have suggested that breathing exercises can lead to a reduction in asthma symptoms and reduced use of a reliever inhaler.
  • In 2003 (Cooper et al) Asthma UK funded research into the clinical effectiveness of the BBT as a complementary addition to conventional asthma treatment. This study showed that for some people with asthma, the use of the BBT helped to reduce their asthma symptoms and to reduce their use of reliever inhaler; although no effect on the underlying condition itself was found.
  • The BBT may help people with asthma to feel more in control of their breathing and may be worth trying for those who are willing to give it a try and commit the time required to learn the technique.
  • More research is needed to identify if certain people with asthma benefit more than others.
  • BBT can be expensive and this should be taken into account when considering it as an option.

Yoga

  • Yoga is an ancient Hindu discipline that uses a variety of postures and breathing techniques to help to increase fitness and aid relaxation.
  • One aspect of yoga, Pranayama uses breathing exercises, and has been studied with regard to asthma. These breathing exercises were found to be beneficial, with participants showing fewer asthma attacks and a higher tolerance to certain triggers.
  • Simple relaxation techniques, which do not incorporate the philosophical aspects of yoga, have also been shown to have some benefit.
  • It’s uncertain whether yoga and breathing exercises help asthma by reducing stress (which can be a trigger) or by other physical effects. More research is needed to establish this.

So, breathing techniques help the symptoms of bronchospasm, it probably doesn’t matter much which one you use, in both cases you’re dealing with “brands” that have a side-order of claptrap so go in with your eyes open and don’t succumb to the usual woo.

Remember that the appeal to tradition is fallacious, that starting with a treatment and then generating evidence to support your business is always a red flag, and never give your money to anyone unless they can prove they are fully qualified with proper degrees from accredited colleges.

94 Walk

Especially if you’re a woman, walking at even a moderate pace (3 miles per hour) provides every benefit that running does for staving off degenerative diseases and cardiovascular events. Power walking will even burn more calories than running at a similar speed with no harmful effects on your joint cartilage. Use a Swiss ball to work your ‘core’—the muscles of the trunk, front and back—as this will strengthen the abdominal muscles that support the spine, hip and buttocks. Opt for free weights over machines, which are less effective for strengthening the body holistically.

Free weights also carry a higher probability of injury, because they are less controlled in the axis of movement and have no mechanism to control release on muscle failure.

Here’s a simple and easy fact about exercise: the type you enjoy most is the type you will keep up. Running, walking, rowing, cycling, on crosstrainer, climber, stationary bike or treadmill, on the road or on singletrack. Whatever you enjoy, you will be motivated to do.

The single best piece of advice is probably to exercise as part of a group who have healthy attitudes to their bodies and what they want to achieve. A cycling club, or a group of ladies who meet for half an hour on the treadmill followed by a skinny latte. Whatever gives you pleasure. 

Regardless, this advice is precisely what your doctor will tell you.

95 Sleep in the very dark dark

Too much light at night interrupts our body’s production of melatonin, the hormone that regulates our internal sleep–wake cycle; working at night and sleeping in a too-bright bedroom have also been linked to an increased risk of cancer.63 Get yourself a sleep mask or blackout curtains, particularly for the bright summer months.

Reference 63: J Natl Cancer Inst, 2001; 93: 1557–62 Night shift work, light at night, and risk of breast cancer. Davis S, Mirick DK, Stevens RG.

Yes, night shift work adversely affects your health. Remember to thank the nurses and juniors and buy them biscuits and chocolate next time you’re in a hospital, they do it for you. Now what does the study actually say?

RESULTS: Breast cancer risk was increased among subjects who frequently did not sleep during the period of the night when melatonin levels are typically at their highest (OR = 1.14 for each night per week; 95% CI = 1.01 to 1.28). Risk did not increase with interrupted sleep accompanied by turning on a light. There was an indication of increased risk among subjects with the brightest bedrooms. Graveyard shiftwork was associated with increased breast cancer risk (OR = 1.6; 95% CI = 1.0 to 2.5), with a trend of increased risk with increasing years and with more hours per week of graveyard shiftwork (P =.02, Wald chi-squared test).

CONCLUSION: The results of this study provide evidence that indicators of exposure to light at night may be associated with the risk of developing breast cancer.

That was in 2001, over time the evidence that prolonged night shift work is associated with higher cancer risk has firmed up. Sleep masks and blackout curtains? Not so much. These studies refer to long-term shift workers (nurses, in fact) and don’t establish any causal link between levels of darkness in normal sleep and cancer.

96 Seek out the new

Keep your brain active, stay curious and maintain goals—even physical ones. Routine is not only deadening to the senses, but can actually make us ill. According to Bowling Green State University psychologist Jaak Panksepp, one of the most important basic human instincts is the ‘seeking’ mode, a nature that remains intensely engaged in the search or the puzzle, or is simply curious about what’s new. Every study of longevity shows that those who live to a ripe old age set themselves goals and stay curious. An interest in new things and change and, most of all, a “pioneering spirit” seemed to be the longevity elixir of a group of long-lived Civil War nurses.64 Vary your activities and ensure that you engage in ones that involve problem-solving.

Reference 64: Nurs Forum, 1991; 26: 9–16 New Surprises in Very Old Places: Civil War Nurse Leaders and Longevity, Wendy Woodward

Just when you think the Weird has peaked…

While the average woman in the U.S. Civil War times lived to the age of about 40, a group of 17 extraordinary nurses–including Louisa Mae Alcott, Dorothea Dix, and Clara Barton–survived to much older ages. A variety of possible reasons, from social and marital status to altruism and religion, is explored. More than any tangible factor, however, the presence of a “pioneering spirit” seems to be at the root of their longevity.

 Is this genuinely the best source supporting this claim?

97 Love your work; work to serve

Don’t settle for anything less than work that makes your heart sing, and do it with gusto. People at peace with their lives and life’s work live longer than those at war with the world. One of the most fulfilling types of work is living a life of service to others.

Doctors, for instance? Oh, wait…

We hope our public service in debunking WDDTY’s egregious nonsense will indeed confer long life, but we don’t put money on it because the actual evidence for positive attitude making the blindest bit of difference is pretty thin.

If you live to be 100, you’re likely to be pretty chipper about it, but you can be the Duracell Bunny and still die aged 30 from a heart attack.

98 Find your tribe

Various studies have revealed that the root emotions of stress are a sense of helplessness and loneliness, and anything that can help re-establish connections—with family, with the community, with God—is a potent healer. Joining just one group this year will halve your chances of dying; connecting also protects against heart disease and stroke. If you don’t have a close community, then assemble one either through your church, or through work or leisure organizations. Meet and share regularly.

A classic confusion of correlation with causation. Does going to church make you live longer? It would be nice to think so, but nobody has successfully unpicked this from a general attitude of acceptance of the world, rather than perpetual angst. 

Oh, we believe chocolate works as well. Also probably gardening, certainly cycling, and who knows what else. It’s likely that anything that gets you out of the house and makes you happy, works. Which doesn’t explain the longevity of Victor MeldrewW, and although it’s definitely true that Tom Good has outlived Jerry Leadbetter, we reckon Margot Leadbetter is wearing the years more gracefully than Barbara Good.

99 Erase your old inner emotional tapes

Try one of the new energy psychology methods like  Thought Field Therapy (TFT) or the Emotional Freedom Technique (EFT), both of which are ‘needlefree’ forms of acupuncture in which the therapist or patient ‘taps’ on various meridians of the body while making a series of statements. In one study of patients suffering from post-traumatic stress—considered extremely difficult to treat—TFT reduced such stress by more than half.65

This message was brought to you by our sponsors.

Reference 65: Traumatology, 1999; 5: 1, article 4 – reference unclear (see contents)

This kind of bullshit makes professionals who deal with PTSD very angry. There is an immense body of research into PTSD, much of it centred on combat veterans. CBT and other techniques have an effect, as does EMDR, but it is a complex and long-lived disorder that is likely to require a lot of intensive effort from well-trained professionals.

Thought Field TherapyW is ideologically acceptable to Lynne McTaggart, author of many pseudoscientific discussions of similar concepts, but there’s no credible evidence it works.

Emotional Freedom TechniqueW is also purest hogwash.

Both are practised mainly by hippy-dippy New-Age quacks who believe that the body is regulated by the flow of an empirically unverifiable life force whose balance is vitally affected by meridians and acupoints that have no known associated biological structures.

The evidence that these points exist is, to put it mildly, not compelling. Nobody has yet succeeded in proving that tapping them (or sticking needles in them or anything else) has any differential effect over doing the same thing in the “wrong” place. Oh, and Chinese and Japanese versions are different, so if you’re a Chinese and get sick in Japan, be sure to let them know.

100 Cultivate a readiness to empathize and forgive

One of the greatest antidotes to stress is heartfelt forgiveness and empathy. Learning to forgive can help overcome depression and stress.66 Gratitude and generosity are powerful, health-promoting game changers.

Reference 66: Explore [NY], 2006; 2: 498–508 Positive emotional change: mediating effects of forgiveness and spirituality. Levenson MR, Aldwin CM, Yancura L.

Opinion masquerading as fact, basically pure new-age hogwash. But what the hell, to err is human, to forgive divine. However, it does require that the sinner first repents. When WDDTY apologises for some of its egregious errors, we’ll start to forgive them for their decades long anti-health crusade.

100 ways to live to 100: 10 bits of medical advice you should question

 

Part of a series on WDDTY’s “free” advertorial report “100 ways to live to 100

10 bits of medical advice you should question

In general, it’s always fair to ask for the evidence supporting any proposed medical intervention.

In general, WDDTY does this for you by quote-mining and cherry-picking to suit its anti-medicine agenda.

What WDDTY does not do is to provide any actual evidence that this information is anything other than a routine part of the normal process of informed consent, especially in the UK. For example, discussion of radical prostatectomy is dominated by a test that has been deprecated in the UK for over twenty years and an operation that never reached a quarter of its peak level in the USA.

81 Lower your blood cholesterol levels

The theory that high-fat foods—like meat and dairy—build up fat in our arteries has never actually been proven. After people eating high-fat diets were followed for 10 years and not one suffered a heart attack, researchers concluded that “the evidence is not there” to support a high fats–heart disease connection.48 In fact, high levels of the ‘bad’ LDL cholesterol may actually be good for us, especially as we get older.49

Reference 48: Nutr Metab Cardiovasc Dis, 2012; 22: 1039–45 Biomarkers of dairy intake and the risk of heart disease. Aslibekyan S, Campos H, Baylin A.

Reference 49: J Gerontol A Biol Sci Med Sci; 2007; 62: 1164–71 Statins and dietary and serum cholesterol are associated with increased lean mass following resistance training. Riechman SE, Andrews RD, Maclean DA, Sheather S.

The first reference is specific to dairy, noting:

Dairy product intake as assessed by adipose tissue 15:0, 17:0, and by FFQ is not associated with a linear increase in the risk of MI in the study population. It is possible that the adverse effect of saturated fat in dairy products on cardiovascular health is offset by presence of beneficial nutrients.

This is a great point against WDDTY’s anti-dairy agenda, but not really a point for the argument that cholesterolW is good for you. The second source finds:

These data suggest that dietary and serum cholesterol contribute to the skeletal muscles’ response to RET in this generally healthy older population and that some statins may improve this response.

A great point against WDDTY’s anti-statin agenda, but not much of a hit for the promotion of cholesterol either since this applies to people undergoing “12 weeks of high intensity resistance exercise training (RET) with post-exercise protein supplementation”. Few 60-69-year-olds do this, and the overall evidence is taken from the largely sedentary general population not from atypical sub-populations like this.

WDDTY seems to be disputing the lipid hypothesisW but without actually tackling it head on, still less addressing the evidence base behind it. In fact both the lipid and the chronic endothelial injury hypothesisW are converging over time to a single hypothesis which puts LDL front and centre in the mechanism of hypertension.

The Centers for Disease ControlW are blunt: “Having high cholesterol puts you at risk of developing heart disease, the leading cause of death in the United States”.

82 The mercury in your fillings is permanently locked in and harmless

Dentists have been saying this for years, but the European Commission’s BIO Intelligence Service (BIS) begs to disagree. The group recommends that a total ban on amalgam fillings be fully implemented in five years’ time, and the use of mercury fillings virtually eliminated throughout the EU.

No, the EU does not say that your fillings are a problem. It has a rather technical document detailing measures to reduce usage and pollution from mercury in the environment. It puts the report by Bio Intelligence Service S.A. (which is,a s the name suggests, a commercial entity and not an EU body) into context. Its principal argument is that dental use of mercury represents an environmental, not a toxicological, problem.

The report does not say that amalgam fillings in-place are a significant source of concern, instead it discusses the pollution caused by the mixing and installation of amalgam, and the disposal of amalgam after teeth are extracted or the patient dies.

Overall, you’re probably fine as long as you don’t heavily chew nicotine chewing gum. A controversy that has raged for a century without any consensus forming or any concrete and damning evidence of significant biological effect – a “smoking gun” – is evidence of philosophical differences, not provable harm.

83 Go for angioplasty

Balloon angioplasty and stents were to be medicine’s ‘miracle’ treatments for blocked arteries, but around one in 10 heart patients returns to hospital for emergency treatment following the procedures, and nearly a third of non-emergency ‘drug-eluting’ stents are also likely to cause potentially fatal harm.50 Patients given a cocktail of generic heart drugs instead do just as well .51

Reference 50: Arch Intern Med, 2012; 172: 112–7 Factors associated with 30-day readmission rates after percutaneous coronary intervention. Khawaja FJ et. al.

Reference 50b: N Engl J Med, 2007; 356: 1009–19 Long-Term Outcomes with Drug-Eluting Stents versus Bare-Metal Stents in Sweden Bo Lagerqvist et. al.

Reference 51:  N Engl J Med, 2007; 356: 1503–16 Optimal Medical Therapy with or without PCI for Stable Coronary Disease William E. Boden et. al.

This is a particularly pernicious piece of misinformation. It is very easy to find cases where people are readmitted not long after surgery for coronary heart disease: the reason they have had the surgery is often because they are very sick. Unsurprisingly, they are a poor surgical risk and a high risk for post-surgical complications. In other words, even with surgery, doctors may not be able to save them. That’s a great reason for keeping your heart in good shape and a truly terrible reason for refusing heart surgery if it’s indicated.

WDDTY say that nearly a third of drug eluting stents are likely to cause potentially fatal harm. The source absolutely does not support this.

Drug-eluting stents were associated with an increased rate of death, as compared with bare-metal stents. This trend appeared after 6 months, when the risk of death was 0.5 percentage point higher and a composite of death or myocardial infarction was 0.5 to 1.0 percentage point higher per year. The long-term safety of drug-eluting stents needs to be ascertained in large, randomized trials. (emphasis added)

 WDDTY have been caught before confusing relative and absolute risks, but rarely this blatantly.

The final study also doesn’t support WDDTY’s statement:

As an initial management strategy in patients with stable coronary artery disease, PCI did not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to optimal medical therapy.

WDDTY recommending intensive pharmacologic therapy. That’s a turn-up for the books.

84 You don’t need your womb anymore

A University of California committee of gynaecologists once concluded that three-quarters of all hysterectomies done are not necessary.52 Except for genuine indications like uterine cancer and life-threatening bleeding during childbirth, some 90 per cent of referrals for hysterectomies can be treated with conservative surgery, medication, alternative medicine, nutritional supplementation or just waiting until menopause.

Reference 52: Obstet Gynecol, 2000; 95: 199–205 The Appropriateness of Recommendations for Hysterectomy, Michael S Broder et. al.

This is an US study. One in three US women will undergo hysterectomy, compared with one in five in the UK. The US removes ovaries in 73% of cases, the UK in 20%.

WDDTY editor Lynne McTaggart is American. Sometimes she forgets which side of the pond she’s living.

Sometimes she also forgets that the anecdotal claims of quacks to “cure” endometriosis, fibroids and the like are a long way short of being evidence that they actually can do this.

85 Have ‘catch it early’ surgery for prostate cancer

Men in the early stages of the disease are often offered radical prostatectomy, where the entire gland is removed. At best, it’s a trade-off, mostly because of the high risk of permanent impotence and incontinence. Unless you’re under 55, you’re more likely to die with the disease than from it.

That’s why the standard of care for indolent prostate cancer is “watchful waiting”. Who are these doctors who supposedly “don’t tell you” this? I suspect they may be American again, though even there it’s been in decline since the early 1990s. The UK has deprecated screening since the 1990s and the UK’s rate of radical prostatectomy never reached 10 per 100,000, a quarter of the peak rate in the US.

Bottom line: if your doctor recommends radical prostatectomy, it’s probably the conservative option.

86 Have a radical mastectomy to ‘catch it all’

This mutilating operation involves removing the breast, the chest wall, the lymph nodes and much of the skin, but it confers no advantage over other, less aggressive forms of mastectomy, including the simple removal of the lump with radiotherapy.53 Also, some 70 per cent of double mastectomies—where both breasts are removed following a diagnosis of breast cancer—are unnecessary as the cancer was never likely to have spread, say researchers.54

Reference 53: Ann Surg, 1986; 204: 136–47 Treatment of primary breast cancer without mastectomy. The Los Angeles community experience and review of the literature.

Reference 54: J Clin Oncol 30, 2012; suppl 34: abstr 26 [Medline does not find this reference]

This advice is literally decades out of date. Radical mastectomy no longer involves routine axillary clearance, instead the lymph nodes are staged, often in real time. Prophylactic mastectomies will only be advised for women who already have cancer, or who, like Angelina Jolie, have both genetic and family history indications.

WDDTY were among the strident chorus of natural-woo promoters who denounced Jolie for her decision. Jolie showed grace and fortitude in the face of this torrent of bullshit, pointing out that the risk for her was in excess of 80% given family history and evidence of specific expressed genetic mutations.

Lumpectomy is the standard of care for small, well-defined tumours; radical mastectomy is not recommended lightly.

The moral of this story is, listen to oncologists, not cranks who hate the entire world of medicine on reflex.

87 Let’s fix your inguinal hernia

The wise doctor will delay surgery until the patient is in pain or discomfort—partly because he knows that surgical repair carries a long-term risk of recurrence and can itself cause more groin pain than the hernia, as it does in a quarter of patients.55 When more than 700 men with hernias underwent watchful waiting instead, the vast majority carried on with their everyday lives without a moment of pain and without the need for surgery.56

Reference 55: Ann Surg, 2001; 233: 8 Groin Pain After Hernia Repair, Robert E. Condon.

Reference 56: JAMA, 2006; 295: 285–92 Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. Fitzgibbons RJ Jr, et. al. 

Once again, WDDTY recommends the standard of care. Well done for telling your readers what doctors already do tell them.

The only problem with WDDTY’s commentary is that it seems designed to deter anyone from undergoing repair, based on a speculative finding from 2001 (“Could it be that the major change in the technique of hernia repair that has evolved over the most recent two decades—the widespread use of implanted prosthetic mesh, whether needed or not—is a cause?”) and a report based on minimally symptomatic patients.

The 2001 paper refers to what is now termed post herniorraphy pain syndromeW, a recognised complication that leads to – guess what? – the standard of care being “watchful waiting” for minimally symptomatic patients. The problem does not seem to be caused by mesh itself, but by damage to the nerves, which may be consequent from the original injury

So as usual it’s safe to follow WDDTY’s advice as long as you’re not actually ill…

88 Let’s cut out your gall bladder

This procedure (cholecystectomy) may increase the risk of colon cancer, according to a review of 33 studies.57 Surgery can often make matters worse by injuring the bile duct, releasing gallstones and causing more digestive issues. Stones can usually be sorted out by avoiding processed food and sugar, eating less red meat and eschewing HRT, which doubles the risk.

Reference 57: Gastroenterology, 1993; 105: 130–41 A meta-analysis of cholecystectomy and risk of colorectal cancer. Giovannucci E, Colditz GA, Stampfer MJ.

CONCLUSIONS: Because the risks varied substantially by study design and because time since cholecystectomy or potentially confounding factors were often not considered, we could not firmly quantitate this risk. However, the findings are consistent with other evidence that suggests some characteristic of bile acid metabolism increases the risk of cancer of the proximal colon.

CholecystectomyW became much more common in the 1990s after laparoscopic techniques were devised which made the surgery effectively a day-case. Yes, like any surgical procedure, it has potential complications, and those should be (and are) taken into account when considering surgery.

The accuracy of WDDTY’s commentary can be demonstrated pretty simply:

WDDTY: Surgery can often make matters worse by injuring the bile duct, releasing gallstones and causing more digestive issues

Goldman’s Cecil Medicine (24th ed.): The most serious complication of cholecystectomy is damage to the common bile duct. This occurs in about 0.25% of cases.

Often… 0.25%. I think this might be a problem of perspective.

WDDTY: “Stones can usually be sorted out by avoiding processed food and sugar, eating less red meat and eschewing HRT, which doubles the risk”

NHS: “There are several non-surgical ways to break down gallstones, but they are only effective in around less than 1 in 10 cases and are rarely a viable option.”

Perhaps WDDTY has been mistaking the claims of its advertisers for fact.

89 Sort your overactive thyroid with surgery

Nearly a third of all cases will resolve on their own. Even when just part of the thyroid is removed, only 30 per cent will have normal thyroid levels after eight years, a whopping 41 per cent will have a permanently underactive thyroid and 12 per cent will still be hyperthyroid.58

Reference 58:  J Endocrinol Invest, 1993; 16: 195–9 Follow-up evaluation of patients with Graves’ disease treated by subtotal thyroidectomy and risk factor analysis for post-operative thyroid dysfunction. Sugino K, Mimura T, Toshima K, Iwabuchi H, Kitamura Y, Kawano M, Ozaki O, Ito K.

Grave’s diseaseW is the commonest but not the sole cause of hyperthyroidismW, and it’s not the sole indication for thyroidectomy. In fact, it’s been considered debatable for some time:

Operation is indicated mainly when the disease is severe with a larger goitre or in younger age groups (below 40 years) where radioiodine may not be advisable. For preoperative treatment the use of antithyroid drugs in preferred, although iodine perhaps in combination with beta blockers may be used safely as well at least for moderate cases. In the presence of alternative means of treatment surgery should not exceed an operative risk of 0.5-1.5% with virtually no mortality

It’s unlikely that any patient will be offered surgery for management of hyperthyroidism without first excluding non-surgical approaches. WDDTY seems to think partial thyroidectomy is common, in the UK at least this is not the case. As the NHS says:

Surgery to remove all or part of the thyroid gland is known as a total or partial thyroidectomy. It is a permanent cure for recurrent overactive thyroid.

Your specialist may recommend surgery if your thyroid gland is severely swollen (a large goitre) and is causing problems in your neck.

Other reasons for surgery include:

  • a person is unable to be treated with radioiodine treatment as they are pregnant and they are unable or unwilling to take thionamides
  • a person has a severe form of Graves’ ophthalmopathy
  • the symptoms return (relapse) after a previous successful course of treatment with thionamides

It is normally recommended that the entire thyroid gland is removed as this means there will be no chance of a relapse.

See that word “specialist”? In the UK you will not get anywhere near thyroidectomy for Grave’s disease without seeing a specialist endocrinologist and exhausting the alternatives.

It’s almost as if doctors know what they are talking about and WDDTY don’t.

90 You need a blood transfusion

This routine medical practice suppresses the immune system, increasing the chances of infection, pneumonia—and cancer. Patients who received a transfusion during cancer surgery are 42 per cent more likely to develop cancer again, say Johns Hopkins University researchers.Transfusions should be reserved for emergencies like trauma or haemorrhage, when they can be a lifesaver.59

Reference 59: Anesthesiology, 2012; 117: 99–106 Variability in blood and blood component utilization as assessed by an anesthesia information management system. Frank SM, Savage WJ, Rothschild JA, Rivers RJ, Ness PM, Paul SL, Ulatowski JA.

CONCLUSIONS: The use of data acquired from an anesthesia information management system allowed a detailed analysis of blood component utilization, which revealed significant variation among surgical services and surgical procedures, and among individual anesthesiologists and surgeons compared with their peers. Incorporating these methods of data acquisition and analysis into a blood management program could reduce unnecessary transfusions, an outcome that may increase patient safety and reduce costs.

Needless to say, this does not support WDDTY’s statement. The article proposes spreading of best practice in the context of the US health system (where interventions may risk being profit-driven).

Yes, transfusions might indeed have negative effects, especially in the US where payment for blood donors has led in the past to contaminated supplies. However, cancer surgery tends to be at the upper end of things that are not considered “emergencies” even by WDDTY’s rather arbitrary standards, and some people might consider that the chances of being offered a transfusion just on the off chance when you’re not in mortal danger is probably pretty low. Especially in the NHS.

100 ways to live to 100: 10 drugs to avoid whenever possible

Part of a series on WDDTY’s “free” advertorial report “100 ways to live to 100

10 drugs to avoid whenever possible

WDDTY frame this with a truly staggering statement of faith:

After 24 years of publishing WDDTY, we’re still searching for one single drug out there besides antibiotics that actually cures something. We still haven’t found one. Virtually all drugs are for maintenance—that is, they manage, ease or suppress symptoms, but they do not cure. In spite of assurances from the pharmaceutical industry that drugs can target certain receptors in the body with laser-like accuracy, the fact is that many unrelated systems in the body have identical receptors—which is why drugs invariably affect other parts of the body indiscriminately and cause side-effects.

There is a better, alternative solution to virtually every chronic health problem except emergency medicine, which is where orthodox medicine comes into its own. If you’ve been shot, stabbed or run over, or suffer a heart attack or stroke, then modern Western medicine is without parallel for fixing you. In those cases, get to a hospital without fail. Otherwise, here are the10 drugs you might be better off avoiding. In no particular order:

We’re pleased to be able to help WDDTY out here. Again, since this is not the first time WDDTY have made this claim.

  • Tetanus antitoxin cures tetanus.
  • Antimalarials cure malaria.
  • Chemotherapy cures liquid tumours especially in children.
  • Antivenins cure venomous bites.

But why exclude antibiotics? Not only are they the best known and least ambiguous example of drugs that cure, but WDDTY also disputes their utility. The exclusion of this class of drugs seems to be capricious and specifically designed to assert that, excluding the vast number of illnesses they can cure, doctors can’t cure anything. Of course, unlike quacks, doctors don’t claim to cure disease unless they actually can, but n the end this reminds us of something:

But ultimately this is a categorical fallacy. Think for a moment: what is the definition of a chronic disease? It’s one that cannot presently be cured. A hundred years ago, syphilis was a chronic disease. Now it’s not. So WDDTY are taking a class of diseases defined by the fact that medicine cannot currently cure them, and asserting that, shockingly, medicine cannot cure them.

Is maintenance and management of symptoms necessarily a bad thing? Ask a type I diabetic or an asthmatic. 

Are there better alternative solutions to “virtually every chronic health problem”? No. Minchin’s Law applies: these things are alternative because they have not been demonstrated to be better. In most cases they haven’t been demonstrated to be as good. Many of them don’t work at all, and several are actively harmful.

71 Statins

These can cause cancer and definitely cause muscle weakness.

So they might, but the benefit outweighs the risks according to large studies.

A meta analysis of randomised controlled trials found:

Conclusion In patients without established cardiovascular disease but with cardiovascular risk factors, statin use was associated with significantly improved survival and large reductions in the risk of major cardiovascular events.

WDDTY has a long-standing agenda against statins, leading to its promotion of the idea that cholesterol is OK as long as it’s the “good” kind, but this is mainly arguing backwards from ideological opposition to statins. As always, the NHS has more nuanced and more accurate information.

72 Prozac and other antidepressants

These can cause rebound anxiety, suicide and addiction, and have been sold to us on a faulty premise—there is no brain chemical imbalance to fix.

This is pure propaganda. Antidepressants and antipsychotics have a role in the management of acute disease, and trying to tough it out without them can and does lead to suicide.

Epidemiological analysis shows that SSRIs reduce suicide rates. There is a specific problem with use in children, but it’s uncertain whether this balances out or not – however, this does not undermine the conclusion that:

[T]he strongly positive results of the TADS study indicate that medication treatment is vital for effective treatment of adolescent depression. With the confusing results of studies to date, fluoxetine is a good first choice for antidepressant treatment of adolescents. However, there may be reasons that clinicians choose to start other antidepressants instead. For instance, adolescents with a good prior response to another antidepressant, who are currently on another antidepressant with good response, or who have a history of poor response to fluoxetine, would probably be started or stay on another antidepressant.

In other words, follow the data not the dogma.

73 Tumour necrosis factor (TNF)-blocking drugs

Meant to replace painkilling COX-2 inhibitor drugs, they’ve been linked to tuberculosis and cancer.

Having “been linked to cancer” is a standard WDDTY weasel phrase. Yes, there is a plausible link between TNF inhibitor|TNF inhibitorsW and cancer. This applies to both synthetic drugs and natural TNF inhibitors such as curcuminW, catechins and canabinoids.

As with any effective treatment, it’s a question of risks versus benefits.

74 Atypical antipsychotics

These next-generation drugs, classed as the ‘new’ antipsychotics, include olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal). Studies show they’re no better than the older variety, and may cause Alzheimer’s disease and hasten mental decline in the elderly. They also cause sexual dysfunction and depression, and so make any psychiatric condition worse.44

Reference 44: Clin Neuropharmacol. 2005 May-Jun;28(3):111-4. Use of ziprasidone in parkinsonian patients with psychosis. Gómez-Esteban JC, Zarranz JJ, Velasco F, Lezcano E, Lachen MC, Rouco I, Barcena J, Boyero S, Ciordia R, Allue I.

A source at last! So what does it say?

Twelve patients with Parkinson disease and psychosis were included in an open-label 12-week trial of ziprasidone. Two patients withdrew from the treatment because of adverse effects. The remaining 10 patients reported a significant improvement in psychiatric symptoms. Altogether, there was no deterioration of motor symptoms (UPDRS III score: basal 40.4 +/- 11.1, first month 41.1 +/- 10.8; final visit, 37.7 +/- 13.3). Two patients (20%) suffered a slight deterioration in motor symptoms and another patient suffered deterioration of gait. No analytic alterations or serious adverse effects that could limit the use of ziprasidone were observed. Although controlled trials are needed, the findings suggest that ziprasidone may be effective in parkinsonian patients with psychosis.

Is it just me, or does that say pretty much the opposite of what WDDTY claim? Be in no doubt: ziprasidoneW is an atypical antidepressant, the fifth such to be licensed by the FDA.

This is unusually dishonest even by WDDTY’s standards: the paper supports the use of the drug in Parkinson’s sufferers, but this is spun as a recommendation against it.

75 Anticholinergic drugs

These have a long list of side effects, including dementia.

This is not specific to anticholinergicW drugs, but to anticholinergics generally, including plants of the solanacae family, henbane and mandrake.

They also have a long list of beneficial effects. They suppress muscle spasms, for example, so are often used in gastritis and ulcerative colitis. But the major source of adverse reactions appears to be in recreational drug users, not least because medical use tends not to be long-term. One of the better known anticholinergics is butylscopolamineW, marketed under trade names such as Buscopan, which is used to control stomach cramps. It tends to be used episodically and not chronically.

76 Bisphosphonates

These osteoporosis drugs can halt bone loss, but they’ve also been linked to high rates of atrial fibrillation, a heart-rhythm disorder that can lead to stroke.45

Reference 45: N Engl J Med, 2007; 356: 1809–22: Once-Yearly Zoledronic Acid for Treatment of Postmenopausal Osteoporosis, Black et. al.

RESULTS: Treatment with zoledronic acid reduced the risk of morphometric vertebral fracture by 70% during a 3-year period, as compared with placebo (3.3% in the zoledronic-acid group vs. 10.9% in the placebo group; relative risk, 0.30; 95% confidence interval [CI], 0.24 to 0.38) and reduced the risk of hip fracture by 41% (1.4% in the zoledronic-acid group vs. 2.5% in the placebo group; hazard ratio, 0.59; 95% CI, 0.42 to 0.83). Nonvertebral fractures, clinical fractures, and clinical vertebral fractures were reduced by 25%, 33%, and 77%, respectively (P<0.001 for all comparisons). Zoledronic acid was also associated with a significant improvement in bone mineral density and bone metabolism markers. Adverse events, including change in renal function, were similar in the two study groups. However, serious atrial fibrillation occurred more frequently in the zoledronic acid group (in 50 vs. 20 patients, P<0.001).

The question then would be: are you better off suffering a hip fracture due to untreated osteoporosis, or atrial fibrillation, which may or may not result in a stroke?

WDDTY claims to be all about informed choice, but by giving only a tiny subset of the information, they actively impede a properly informed choice. It’s about as much use as advising everybody never to leave the house in case they get knocked over crossing the road.

77Aspirin

It’s the ultimate just-in-case lifestyle drug, taken to ward off heart disease and stroke, but it actually increases the risk of stroke sevenfold.46 It can also cause serious gastrointestinal bleeding. Other NSAIDs now carry warnings regarding their cardiovascular and gastrointestinal risks—and guess what? They haven’t been proven to reduce inflammation.

Reference 46: Lancet Neurol, 2007; 6: 487–93 Change in incidence and aetiology of intracerebral haemorrhage in Oxfordshire, UK, between 1981 and 2006: a population-based study. Lovelock CE, Molyneux AJ, Rothwell PM; Oxford Vascular Study.

This is a long-term study of stroke risk which finds that in the over-75s long term use of antithrombotics (aspirin) is associated with an increase in stroke incidence. This is most likely to be based on a population with higher dosages, as the prophylactic dose recommendation has reduced over time.

Reliable sources support low dose aspirin as a prophylactic against heart disease and stroke, unreliable sources promote more aspirin (mainly out of date) or none (WDDTY and other natural-woo promoters).

The Mayo Clinic has a useful reference. One interesting point that WDDTY didn’t make is that if you’re already taking aspirin daily, stopping can cause a rebound effect and actually trigger a stroke. Let’s hope nobody suffers a stroke after following WDDTY’s advice and sues them.

The important thing to remember is that a paediatric dose confers most of the benefit, but most of the risk studies refer to an adult dose, two to four times as great. As always discuss it with your doctor, not some anti-medicine crank.

78 HRT and the Pill

Their cancer connections are finally indisputable, even though drug companies keep fighting the evidence.

We already covered HRT. The pill? WDDTY really are becoming more reactionary over time.

Here’s what Cancer Research UK say about the Pill:

  • There’s a small increase in risk of breast cancer, which reduces when you stop taking the pill and returns to normal by 10 years after you stop taking it.
  • There’s an association with cervical cancer, likely to be down to the fact that cervical cancer is rarely seen in women whoa re not sexually active.
  • There’s a reduction in the risk of ovarian cancer, and the longer you take the pill the lower the risk gets.
  • There’s a reduction in cancer of the uterus which lasts for around 15 years after you stop taking the pill.
  • There may also be a reduction in bowel cancer.

Oh, and you tend not to get pregnant.

Your doctor knows all this, it’s safe to take your doctor’s advice rather than the ideological nonsense form WDDTY.

79 Antiepileptic drugs

These can lead to suicide and also cause potentially fatal liver failure. Many of the newer ones like Keppra (levetiracetam), Topamax (topiramate) and Sabril (vigabatrin) increase the risk of depression and suicide or self-harm threefold.47

Reference 47: Neurology. 2010 Jul 27;75(4):335-40. Use of antiepileptic drugs in epilepsy and the risk of self-harm or suicidal behavior. Andersohn F, Schade R, Willich SN, Garbe E.

Once again, WDDTY misrepresents the source. Here’s what it actually says:

Newer AEDs with a rather high frequency of depressive symptoms in clinical trials may also increase the risk of self-harm or suicidal behavior in clinical practice. For the most commonly used other groups of AEDs, no increase in risk was observed.

So: older AEDs do not increase the risk of suicide. Newer ones might, so doctors should be on the lookout for symptoms of depression. Which may well be partly due to the well documented tendency of practitioners to be more conservative and report more adverse reactions in new drugs than for well understood ones, where they know that symptoms are unlikely to be directly related.  Nothing to see here, move along please…

It’s hard to express how inappropriate it is to issue a blanket warning against antiepileptic drugs based on a misrepresentation of early studies on an entirely new class of drug that’s only recently entered clinical practice.

80 Zetia and other second-generation cholesterol-lowering drugs

Not only do these drugs not work, but they’re also hard on the liver.

We totally understand: cholesterol is natural so trying to control it is evil. Heart attacks are natural too, as is dying by the age of 40.

NICE don’t endorse ezetimibeW other than in cases where statins are not well tolerated, or as an adjunct to statins where cholesterol remains stubbornly high. It’s a relatively new class of drug and the evidence base is changing fairly quickly. Your doctor should be reading up on this, so it’s worth discussing the findings of ENHANCE and, when published, IMPROVE-IT with your doctor. As always, the advice form your doctor is likely to be evidence-based not ideology-based like WDDTY.

Cholesterol levels are a proxy marker and the jury is still out on whether reducing cholesterol levels is a valid end in itself; however, the outcome of statin trials does indicate a significant reduction in cardiac events so it does seem likely.


Errata and corrections:

  • Thanks to Andrew Crysell for spotting a schoolboy howler in the first section, fixed on 27/12/2013

100 ways to live to 100: 10 situations that don’t usually require a doctor

Part of a series on WDDTY’s “free” advertorial report “100 ways to live to 100

10 situations that don’t usually require a doctor

If there’s one thing you can rely on doctors telling you, it’s when you don’t need a doctor. They are about as keen to see people with the common cold as WDDTY is to see evidence that vaccines are safe and effective. And in both cases, that doesn’t stop it happening, all the time.

61 Backache

Some 80 per cent of us suffer from back pain, but medicine doesn’t offer much besides potentially dangerous surgery (which leaves only a quarter of patients free of pain) and drugs. In most cases, an osteopath, chiropractor or Alexander Technique practitioner can sort you, as can exercise.

Let’s unpick that. If medicine cures back pain by surgery, that’s evil. If medicine gives drugs to manage the pain, that’s evil. If medicine recommends exercise and physiotherapy, that’s ignored because it would undermine WDDTY’s pretence that these are “alternative” and thus the sole preserve of quacks like their advertisers.

Why don’t doctors tell you that Alexander Technique works for low back pain? They do. They also recommend osteopathy and chiropractic, but there are severe problems with both these fields, due to the prevalence of crank ideas. Osteopaths need to discipline and exclude charlatans who practice “cranial osteopathy”, and chiropractors need to recognise that there is no evidence that chiropractic works better than evidence-based manipulation therapy, and substantial evidence of actively dangerous practices such as cervical spinal manipulation, potentially leading to stroke, bullshit claims to treat ear infections, asthma and other things unrelated to the musculoskeletal system, anti-vaccination propaganda, and of course the big scam: never discharging a cured patient, but instead trying to sell them an indefinite course of worthless “maintenance”.

If you have back pain, see your doctor, they will recommend the most appropriate treatment. Which might be surgery, drugs, exercise or some form of physiotherapy. Unlike WDDTY’s advice, this won’t be based on dogma or pleasing the advertisers, it’ll be based on the best currently available evidence.

62 Earache

Shout it loud: antibiotics just don’t work for earache. Nor does removing adenoids fix glue ear.39 Instead, try time, mullein oil, a woolly hat, a hot-water bottle, homeopathic Pulsatilla,40 osteopathy or auricular therapy (acupuncture of the ear). Before having grommets inserted in your child’s ear, cut down his fat and sugar, and investigate food or airborne allergies as the potential cause.

Reference 39a: JAMA, 2006; 296: 1235–41 Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial. Spiro DM, Tay KY, Arnold DH, Dziura JD, Baker MD, Shapiro ED.

Reference 39b: BMJ, 2004; 328: 487 Adenoidectomy versus chemoprophylaxis and placebo for recurrent acute otitis media in children aged under 2 years: randomised controlled trial. Koivunen P, Uhari M, Luotonen J, Kristo A, Raski R, Pokka T, Alho OP.

Reference 40: Ullman D. Discovering Homeopathy: Medicine for the 21st Century. Berkeley, CA: North Atlantic Books, 1991; AHZ, 1985; 230: 89–94

If you follow this advice, a repeat of a recent and particularly dreadful article,  you’ll have to “shout it loud” because your child may be deaf.

The standard of care is watchful waiting, but adenoidectomy may be indicated in the presence of both glue ear and persistent nasal symptoms. Antibiotics work as a primary treatment for bacterial ear infections. Most children will grow out of them in time, but leaving the infection untreated when treatment is indicated, on ideological grounds as WDDTY propose, is perverse.

HomeopathyW has three problems: first, there’s no reason to think it should work; second, there’s no way it can work; and third, there’s no proof it does work. Of all alternatives to medicine, it is the most thoroughly debunked. Its doctrines were refuted over a century ago and its only real value now is as a litmus test for lack of critical thinking. A test WDDTY fails on a truly epic scale.

Dana Ullman, the cited source, is a high priest of the cult of homeopathy, he is a proven liar who claims Darwin and Nightingale for homeopathy despite their well documented contempt for it, and is responsible for propagating the lies that Montagnier’s work proves homeopathy and that the Swiss Government found it safe and effective. His propagandising for homeopathy knows no bounds. Each new publication by a True Believer is presented as the final clinching proof of homeopathy, and when it’s shown to be flawed or fraudulent he merely moves on to the next, occasionally repeating the old ones if he thinks nobody will notice. His self-promotion and steadfast denial of reality got him banned from Wikipedia.  There’s even an eponymous law: the Dull-Man Law. In any discussion of homoeopathy, being Dana Ullman loses you the argument – and gets you laughed out of the room.

AcupunctureW is also nonsense, though it is only recently proven to be completely useless. Auricular acupuncture has absolutely no basis in fact and lacks even the marginal credibility of acupuncture. The ear looks a bit like a baby, therefore the bits of the ear correspond to the organs that would be there if it was a baby. No, not even vaguely sensible.

63 Infection

For common and non-serious infections, try Echinacea, essential oils like clove, lavender, lemon, marjoram, mint, niaouli (Melaleuca), pine, rosemary and thyme oils, and goldenseal, manuka honey, tea tree oil, good old garlic and cranberry, all of which are powerful alternatives to antibiotics.

Alternatives they may be. Effective? Not so much. There’s some evidence of manuka honey as a topical antibiotic but why on earth would you not use antibiotics? They work very well, are generally well tolerated, and they have saved countless millions of lives.

This references a May 2013 article, we’ve added it to the work list.

64 Just-in-case checkups, particularly if you’re aged over 50

If you have nothing particularly wrong with you, going to the doctor won’t necessarily protect but is likely to unleash the entire arsenal testing apparatus have you leaving prescription (or three) in your hands.

So let’s get this straight: it’s wrong to see your doctor in case he finds something wrong with you.

Er, right.

65 Menopause In most cases, holistic measures

In most cases holistic measures (diet, homeopathy, herbs) will help you through the change in a safer way than using hormone replacement therapy (HRT), which continues to be discredited, despite protestations by doctors, because of a link with breast cancer.41 Our medical detective Dr Harald Gaier has had greater success with Phytoestrol N (which contains rhubarb root) than most of the popular herbals for menopause.

Reference 41:  Am J Public Health, 2010; 100 [Suppl 1]: S132–9 Decline in US Breast Cancer Rates After the Women’s Health Initiative: Socioeconomic and Racial/Ethnic Differentials Nancy Krieger, PhD,corresponding author Jarvis T. Chen, ScD, and Pamela D. Waterman, MPH.

HRT was discredited years ago, when it was shown not to protect against coronary heart disease but instead to promote it. Well-informed doctors don’t push it unless the symptoms of menopause are extremely bad, or for very early menopause or occasionally hysterectomy.

Homeopathy doesn’t work. Herbs may or may not (remember that a herbal remedy is basically an unknown dose of a potentially pharmacologically active compound with unknown impurities). The source for Harald Gaier’s success stories is Harald Gaier – WDDTY seem to think that blatant conflict of interest is fine as long as the message is ideologically acceptable.

66 Chronic but non-life-threatening conditions

Eczema, psoriasis, non-life-threatening asthma, arthritis and the like generally respond better to alternative measures than drugs, which only suppress symptoms. Check out the alternatives before resorting to lifelong drug use.

Few things are more infuriating than the claim that medicine “only suppresses symptoms” so alternatives are better.

Alternatives do one of two things: suppress the symptoms less effectively and less predictably, or nothing.

There are no alternatives which cure chronic conditions. If there were, they would no longer be alternative (Minchin’s Law).

The easiest way to demonstrate how wrong this advice is, is with a simple case study of one of the “non-life-threatening conditions” listed: eczema.

A couple whose baby daughter died after they treated her with homeopathic remedies instead of conventional medicine have been found guilty of manslaughter.

Gloria Thomas died aged nine months after spending more than half her life with eczema.

The skin condition wore down her natural defences and left her completely vulnerable when she developed an eye infection that killed her within days of developing.

And it’s not the only case. It’s extremely clear that the very last thing you should do when faced with a chronic condition is to consult an “alternative” practitioner, who will follow an ideologically-determined path with no provable value to you, for profit.

67 Slimming

All doctors usually have to offer are drugs and calorie counting, which aren’t long term solutions, and numerous slimming drugs have potentially fatal side-effects. Look first for potential food intolerances, get your thyroid checked out, clean up your diet, and opt for low-GI foods and lots of fruit and veg.

The GI diet was developed by doctors. It’s recommended by doctors, who also recommend exercise and weight management clinics. Oh, and they can also refer you for lap band or other surgical interventions which have a reasonable success rate in the chronically obese who are not compliant with diet regimes. Doctors are also pretty good at spotting thyroid problems.

In the end, though, there is only one diet that is proven to work 100% of the time: the ELEM diet. Eat less, exercise more. Every reputable doctor in the UK, and probably the world, will tell you the same. WDDTY seem to prefer nutritionists who generally have no recognised qualifications whatsoever but nevertheless often sell miracle or fad diets.

68 Colds and flu

Unless you’re elderly and your immune system is compromised in some way, there’s nothing your doctor can give you (or your children) to end a cold or flu, which is usually caused by a viral infection (against which antibiotics mostly don’t work). Bed rest and plenty of fluids, plus zinc, Echinacea, Pelargonium sidoides, Andrographis paniculata, vitamin C and probiotics can all shorten the life of a cold (see WDDTY December 2013).

We’ve critiqued these claims recently. No reputable doctor prescribes antibiotics for uncomplicated viral illness. WDDTY’s view of current medical advice seems to be 20 years out of date and from another continent.

69 Fever

Heat is the body’s extremely clever method of killing foreign invaders of all varieties, and taking anti-inflammatories and other drugs to lower your temperature just hampers that process. Allow your body to self-help by not interfering with a fever unless it’s so high that it may cause permanent damage. Fevers for ordinary viral and bacterial infections won’t exceed 105 degrees F (40.5 degrees C), which generally isn’t dangerous. But see a doctor immediately if you suspect a serious problem like meningitis.

WDDTY don’t seem to know the difference between anti-inflammatories and antipyretic|antipyreticsW. As it happens, Clay Jones at Science Based Medicine recently wrote a much more nuanced piece on fever, in the context of acute cases in hospital, which seems to be the situation WDDTY are considering.

As it happens, Clare Gerada, chair of the Royal College of General Practitioners, recently tweeted a much more pragmatic piece by an actual doctor. Why would you allow your child to suffer the symptoms of fever, if a cheap and safe drug can bring them relief and let them at least get to sleep?

70 Acne

All your doctor can offer are drugs with horrendous side-effects; isotretinoin, marketed as Accutane and Roaccutane, can cause permanent damage to the cornea, impaired hearing, fatal pancreatitis, depression and even suicide.42 Try changing your diet, balancing your blood sugar and identifying any food intolerances first, then look to acupuncture, shown to help in 80 per cent of cases, or herbs like the Ayurvedic herb guggul (Commiphora wightii).43

Reference 42a: Arch Dermatol, 2012; 148: 803–8 Ocular Adverse Effects of Systemic Treatment With Isotretinoin Meira Neudorfer, MD; Inbal Goldshtein, MSc; Orna Shamai-Lubovitz, MD; Gabriel Chodick, PhD; Yuval Dadon; Varda Shalev, MD

Reference 42b: Am J Ther, 2004; 11: 507–16 Polar hysteria: an expression of hypervitaminosis A. O’Donnell J.

Reference 43a: J Tradit Chin Med, 1993; 13: 187–8 Treatment of 86 cases of local neurodermatitis by electro-acupuncture (with needles inserted around diseased areas). Liu JX.

Reference 43b: J Dermatol, 1994; 21: 729–31 Nodulocystic acne: oral gugulipid versus tetracycline. Thappa DM, Dogra J.

The first source says that “Isotretinoin use may be associated with short-term ocular events, especially conjunctivitis, underscoring the importance of educating patients and caregivers about these potentially important AEs of the therapy.” In other words: always read the label and be mindful of the balance of risks and benefits. To spin “may be associated with short-term ocular events” as “can cause permanent damage to the cornea” is typical of WDDTY.

The second source discusses accutane’s similarity to vitamin A, and thus the possibility that it may lead to hypervitaminosis A (but of course no actual vitamin is bad, as because natural). It’s an interesting paper that specifically note that accutane is indicated only for severe recalcitrant nodular acne but is being prescribed for less serious cases. However, this applies almost exclusively in the US, where drug manufacturers can advertise direct to consumers. In the UK, doctors are much closer to following the actual indications, because parents and patients are much less likely to pester the doctor for the drug they just saw advertised on TV. The increase in suicide with accutane should also be weighed against the fact that acne itself may induce suicidal thoughts. Bottom line: ask your doctor. This is the kind of thing GPs are trained for.

The third source is in a journal dedicated to promoting “traditional” Chinese medicine – in fact largely an invention of Mao. Such journals have serious issues with publication bias. The combined weight of evidence is pretty clear: needling results in only placebo effects. Electroacupuncture may have similar effects to TENS, but traditional it is not. Chinese acupuncture uses bamboo needles – bamboo is a notoriously poor conductor of electricity,

The fourth source, from 1994, promotes gugulipid (guggul). There’s decent evidence this works, but (as with every effective treatment) it has side-effects, which WDDTY either haven’t seen or don’t care about because natural.

It can cause side effects such as stomach upset, headaches, nausea, vomiting, loose stools, diarrhea, belching, and hiccups. Guggul can also cause allergic reactions such as rash and itching. Guggul can also cause skin rash and itching that is not related to allergy […].

Hormone-sensitive condition such as breast cancer, uterine cancer, ovarian cancer, endometriosis, or uterine fibroids: Guggul might act like estrogen in the body. If you have any condition that might be made worse by exposure to estrogen, don’t use guggul.

Underactive or overactive thyroid (hypothyroidism or hyperthyroidism): Guggul might interfere with treatment for these conditions. If you have a thyroid condition, don’t use guggul without your healthcare provider’s supervision.

So, quite a lot of problems there. And guess what? Thanks to assiduous lobbying by the supplement industry, you might well never find out about these.

Acne is a bugger. See your doctor for good evidence-based advice, and see a counsellor if you find the bullying of your peers to be distressing.

100 ways to live to 100: Think twice about these tests

Part of a series on WDDTY’s “free” advertorial report “100 ways to live to 100

Think twice about these tests

This is an area where WDDTY is more likely to be right, simply because there is a reasonable consensus that screening leads to overdiagnosis and false positives. However, WDDTY’s advice is based on prejudice and dogma. It is less complete and less well argued than the numerous evidence-based discussions of the pros and cons of various tests.

Our advice on avoiding unnecessary tests is this: read Dr. Margaret McCartney’s The Patient Paradox. This will help you to understand false positives and false negatives, and to ask intelligent and informed questions that will lead you to make a pragmatic choice over a particular test, rather than hysterical anti-medicine rejection of all tests however appropriate.

51 The PSA (prostatespecific antigen) blood test for prostate cancer

It produces false negatives a third of the time and has overdiagnosed more than one million men since its introduction in 1987.29 Unless you have an aggressive cancer, consider watchful waiting. Ditch statin drugs, which increase your risk of this cancer by one-and-a-half times, and reduce carbs, avoid red meat and eat a Mediterranean diet.

Reference 29: J Natl Cancer Inst, 2009; 101: 1325–9 Prostate cancer diagnosis and treatment after the introduction of prostate-specific antigen screening: 1986-2005. Welch HG, Albertsen PC.

PSA is a marker, it is useful in monitoring progression as part of “watchful waiting” (the standard of care for indolent prostate cancers) but its use as a screening test is controversial, not least because the “normal” level of PSA varies widely. From the Wall Street Journal:

Richard Ablin, a professor of pathology at University of Arizona College of Medicine, discovered the prostate-specific antigen in 1970, and for nearly as long, he has argued that it should not be used for routine screening.

So the fact that PSA screening is problematic is not only not something “doctors don’t tell you”, it’s something that the inventor of the test itself has been saying for decades, and which medical journals are confirming.

PSA screening has been discouraged in the UK since the 1990s.

WDDTY can never resist a dig at statins (we’ll review that later), or an opportunity to plug the mediterranean diet (presumably in a modified version that does not include pasta, breads or tomatoes, since these are all fingered as causing problems within this article as well as elsewhere).

52 Routine mammograms (unless cancer is suspected)

This blunderbuss approach, which uses X-rays to detect breast cancer, doesn’t see cancer at its earliest stages and fails to pick up aggressive tumours. For every woman whose cancer is correctly detected, 10 healthy women will go through unnecessary worry, further testing and even treatment before doctors realize they’ve been misled by a false-positive. Consider thermography instead.

So close! This was almost a correct piece of advice, and then they went and ruined it by promoting a quack diagnostic technique instead.

Breast thermography is, to put it bluntly, useless as a diagnostic tool. It’s dissected here by David Gorski, a surgical oncologist specialising in breast cancer. To quote the American Cancer Society:

Thermography has been around for many years, but studies have shown that it’s not an effective screening tool for finding breast cancer early. Although it has been promoted as helping detect breast cancer early, a 2012 research review found that thermography detected only a quarter of the breast cancers found by mammography. Thermography should not be used as a substitute for mammograms.

Oh, and mammograms do detect cancer, just not perfectly. As with any area of medicine, breast cancer staging and screening is a work in progress. There is a debate about what to do with DCIS, for example. There is certainly a debate about routine mammography and the ages at which it should be considered. Above all, our understanding of the nature of indolent disease is developing rapidly. It seems likely that as the population ages many more people are likely to die with cancer than die of cancer.

53 Blood pressure readings

Many factors can distort a BP reading by as much as 5 mmHg: acute exposure to cold, recent alcohol intake, incorrect arm position, an incorrect cuff size—and even the presence of the doctor, now so common that it’s called ‘white-coat’ hypertension. Blood pressure falls at night, and night-time blood pressure is considered the most accurate predictor of heart attack.30 Consider 24-hour blood-pressure monitoring, not the old-fashioned cuff.

Reference 30: Lancet. 2007 Oct 6;370(9594):1219-29. Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study. Boggia J et. al.

Why don’t doctors tell you this? Oh, they do. A single high reading in the doctor’s surgery is never the trigger for intervention unless it’s very high. Normal range is 120/80 to 140/90, so the uncertainty of 5 mmHg is clinically insignificant – if your pressure is 200/100 this is not going to be down to the white coat effect.

Compare and contrast WDDTY’s advice with that from the National Institutes for Health.

54 Routine smear tests

Many doctors still offer women an annual smear test for cervical cancer—even though they’ve been told the test can do more harm than good. The test throws up many false positives—incorrectly ‘seeing’ abnormal tissue that triggers a series of further and more invasive tests, plus needless worry. Even the advises a smear test once every three for those aged over and once every five years for those between 30 and 65.31

Reference 31: Am J Prev Med, 2013; 45: 248–9 The times they (may) be a-changin’: too much screening is a health problem. Harris R, Sheridan S.

Routine smear tests are a curate’s egg. In women at high risk, they are likely to be warranted. In women at low risk, not so much. If your GP is not up on the current state of knowledge (and they should be), ask for a referral to a specialist gynaecological clinic.

The take-home message that must be reinforced here is not that screening is evil, but that a borderline positive smear is not a cause for worry, it is a prompt for further investigation only.

55 Routine dental X-rays

Your dentist keeps telling you it’s safer than an airplane flight, but dental X-rays could triple the risk of meningioma, a kind of brain tumour. Children who have a Panorex or full-mouth X-ray before the age of 10 run the greatest risk, and even bitewing X-rays increase risk. Regular exposure may also cause heart disease. Annual checkups should be urgently reconsidered, say Yale University researchers.32

Reference 32: Cancer, 2012; 118: 4530–7 Dental x-rays and risk of meningioma. Claus EB, Calvocoressi L, Bondy ML, Schildkraut JM, Wiemels JL, Wrensch M.

Actually we agree that you should avoid unnecessary X-rays, because unlike WDDTY we understand the difference between ionising and non-ionising radiation. X-rays are ionising radiation. 

But good dentists don’t do routine X-rays. They use them to diagnose and guide treatment. If your dentist recommends routine X-rays then consider changing your dentist.

If you want an example of gratuitous exposure to unnecessary X-rays, look to your local chiropractor.

56 CT (computed tomography) scans

This whole-body, three dimensional imaging system is one of the most sensitive early-warning detectors of cancer, internal bleeding, heart problems, stroke and neurological disorders, but the standard course of two or three CT scans is equivalent to the radiation levels of Hiroshima or Nagasaki atomic bombs;33 just one scan is equivalent to around 500 standard chest X-rays, reckons the Royal College of Physicians of Edinburgh. Children who are scanned run a far higher risk of developing cancer.34 Ask for any other kind of imaging exam first.

Reference 33: N Engl J Med, 2007; 357: 2277–84 Computed Tomography — An Increasing  Source of Radiation Exposure David J. Brenner, Ph.D., D.Sc., and Eric J. Hall, D.Phil., D.Sc

Reference 34: Radiat Res, 2010; 174: 753–62 Thyroid cancer risk 40+ years after irradiation for an enlarged thymus: an update of the Hempelmann cohort. Adams MJ, et. al.

This is a rehash of a story in the December 2013 issue, “CT scans increase children’s cancer risk“. The second reference is puzzling as it refers to patients who had radiotherapy, not CT scans. The evidence for increased risk of cancers in children following CT scans is epidemiologically sound and does not rely on making inferences from unrelated research.

CT scans are used to rule out potentially life-threatening conditions, especially in children. Brain haemorrhage, for example. The sources are unanimous in supporting their diagnostic use and the fact that the benefits outweigh the risks, but equally unanimous in urging caution and ruling out other diagnostic tests first.

It should be pointed out that radiation increases risk, but does not inevitably produce cancer. Tsutomu YamaguchiW was exposed to radiation equivalent to the Hiroshima and Nagasaki bombs, having been caught in not one but both blasts. He died in 2010 aged 93. The Wikipedia article on hibakushaW (survivors of the atomic bombs) is interesting; the fact that the memorials are still being updated annually does indicate that being exposed to radiation is not a death sentence, however undesirable it might be.

The take-away message here is that it’s fine to challenge the diagnostic necessity of any test, but don’t rule out scans that reveal potentially fatal conditions just because of fear of some uncertain future consequence.

57 Routine prenatal ultrasound

The prenatal ‘miracle’, which uses high-frequency pulsed sound waves to image the fetus in the womb, gets it wrong so often that up to one in 23 women told by doctors they’ve miscarried may end up terminating a pregnancy. Scans see’ a miscarriage the pregnancy is viable, say researchers London and Belgium.35 Reserve this when something really wrong, and consider waiting before ‘completing’ termination if the test concludes you’ve miscarried.

Reference 35: Ultrasound Obstet Gynecol, 2011; 38: 503–9 Gestational sac and embryonic growth are not useful as criteria to define miscarriage: a multicenter observational study. Abdallah Y, et. al.

A second bite at the cherry for ultrasound (should we dock one from the tally of 100 things and make it 99 things?). Does the source support WDDTY’s conclusion? Only partly:

There is an overlap in MSD growth rates between viable and non-viable IPUV. No cut-off exists for MSD growth below which a viable pregnancy could be safely excluded. A cut-off value for CRL growth of 0.2 mm/day was always associated with miscarriage. These data suggest that criteria to diagnose miscarriage based on growth in MSD and CRL are potentially unsafe. However, finding an empty gestational sac on two scans more than 7 days apart is highly likely to indicate miscarriage, irrespective of growth.

In other words, there is a level at which ultrasound can detect a definitely non-viable pregnancy, but the margins are more blurred than was thought. This is in first trimester pregnancies, where only a few generations ago many women would not even know they were pregnant. Spontaneous abortionW is common in the early stages, often before the woman is even aware that she’s pregnant.

The source absolutely does not support a blanket rejection of obstetric ultrasonographyW, or even of early ultrasound where bleeding is present. However, the mandatory use of ultrasound introduced by anti-abortionists in some US states is unquestionably abusive and morally repugnant.

58 Peripheral bone densitometry

It’s the most commonly diagnostic tool for osteoporosis, and it measures usually the hip and spine, but bone mineral density (BMD) is not uniform throughout the skeleton. Although the WHO criteria for a healthy BMD apply only to the hip and spine, a wide range of ‘normal’ BMDs elsewhere in the body may be misdiagnosed as abnormal by these criteria. Diagnosing osteoporosis is still not an exact science, say researchers; you have a strong chance of being misclassified, especially when the test is done in those under 65.36

Reference 36: BMJ, 2000; 321: 396–8 The increasing use of peripheral bone densitometry (Editorial)

Differential diagnosis of osteoporosisW versus osteopeniaW is indeed a grey area, but it’s a distinction without a difference as both indicate a loss of bone density. DEXA scans can be perofrmed on central or peripheral bones, peripheral scans are easier and the machinery is smaller (and often portable).

Needless to say the BMJ article does not undermine the use of bone densitometry, but does question the use of a pragmatic epidemiological definition of osteoporosis, as the threshold for intervention. In other words, it may be valid to treat low-end osteoporosis as osteopenia – essentially using calcium and vitamin D as a first line of treatment before launching right in with bisphosphonatesW. This is what any good doctor would do anyway. But how will the doctor make the diagnostic call without a DEXA scan? Would you prefer a core DEXA, involving a trip to the radiology department of your nearest big hospital and a longer procedure with greater X-ray exposure, or a possibly clinic-based scan that will give a less accurate but probably still clinically useful answer?

As usual, WDDTY takes an absolutist stance that doesn’t help.

59 Biopsy

In a biopsy, a small bit of tissue is removed under local anaesthetic to diagnose a serious illness like cancer. Besides infection, puncturing nearby organs, and causing tears and bleeding, the greatest danger is that biopsies can inadvertently ‘seed’ or spread cancer. With breast biopsies, the risk of recurrent cancer from a ‘needle metastasis’ is about one in 15.37 Request PET (positron emission tomography) or MRI (magnetic resonance imaging) instead.

Reference 37: Acta Radiol Suppl. 2001 Dec;42(424):1-22. Aspects in mammographic screening. Detection, prediction, recurrence and prognosis. Thurfjell MG.

The relevant section of the abstract is:

Local recurrences in 303 nonpalpable breast cancers with preoperative localizations and breast conservation therapy were evaluated for needle-caused implant metastasis. A total of 214 percutaneous biopsies were performed. There were 33 local recurrences. Needle-caused seeding or implantation as based on the location of the recurrence in comparison to the needle path in the mammograms was suspected in 3/44 (7%) invasive cancers without radiotherapy.

This absolutely does not support the idea of rejecting biopsy. These instances of needle-caused seeding are primarily in women who had breast-conserving surgery (“lumpectomy”) for active cancers, and note that it’s more likely to happen when women opt not to have radiotherapy. In the absence of cancer, there are no seed cells.

The overall thrust of the article is actually a vindication of diagnostic mammography:

Screening mammograms comprising of 32 first round, 10 interval and 32 second round detected cancers and 46 normal were examined by an expert screener, a screening radiologist, a clinical radiologist and a computer-assisted diagnosis (CAD) system. The expert screener, screening radiologist, clinical radiologist and the CAD detected 44, 41, 34 and 37 cancers, respectively, while their respective specificities were 80%, 83%, 100% and 22%. Later, with CAD prompting, the screening and the clinical radiologist detected 1 and 3 additional cancers each with unchanged specificities. Screening mammograms comprising 35 first round, 12 interval and 14 second round detected cancers and 89 normal findings were examined without and with previous mammograms by experienced screeners. Without previous mammograms, the screeners detected 40.3 cancers with a specificity of 87%. With previous mammograms, 37.7 cancers were detected with a 96% specificity.

Neither PET nor MRI can accurately diagnose whether a tumour is malignant or not. If your doctors recommend a biopsy, it’s because they think you are likely to have cancer. The utility of baseline mammograms is demonstrated, as is the importance of having a properly trained clinical radiologist review the films.

As to the issue of seeding, Prof. Bill Heald CBE, pioneer of the total mesorectal excisionW procedure for colorectal cancer, is a firm advocate of lavage to minimise seeding – he routinely flushed the abdominal cavity and port sites with copious amounts of dilute antiseptic.

Discouraging people from having a truly accurate differential diagnostic pathological test to differentiate the presence, type and possibly aggression of a cancer? I’d question the medical credentials of anyone giving such advice. If indeed they had any.

60 Computed tomography (CT) angiography

The use of intravenous dye and CT technology to provide an ‘inside view’ of the coronary arteries is fast replacing the exercise stress test done in doctors’ surgeries. It’s also doubling the rate of invasive cardiac procedures, including surgery, say Stanford University School of Medicine researchers.38 Ask to have the standard gym bike or treadmill stress test instead.

Reference 38: JAMA. 2011 Nov 16;306(19):2128-36. Association of coronary CT angiography or stress testing with subsequent utilization and spending among Medicare beneficiaries. Shreibati JB, Baker LC, Hlatky MA.

WDDTY advocate an older test because it finds fewer cases. Remind me again why that would be a valid criticism? Computed tomography angiographyW is a relatively new technique. As with any CT scan, there is exposure to ionising radiation. As with any CT scan, it will only be appropriate when the risks are outweighed by benefits. Rejecting a test on ideological grounds, as WDDTY do, is foolish.