Take medical studies with a pinch of salt

Another article on medical issues in today's Globe is worth relaying. A study published recently in the journal Plos One suggests that psychotherapy (including cognitive behaviour therapy and interpersonal therapy) for the alleviation of depression is perhaps 25% less effective than previously thought.
This finding is the result of some medical detective sleuthing into publication bias in favour of encouraging findings. Published journal articles tend to exaggerate the benefits of psychiatric treatments, in much the same way as other studies have shown that they tend to exaggerate the benefits of antidepressant drugs, and for much the same reasons and to the same extent.
Many completed studies are never published, or even submitted for publication, mainly because the researchers think that a finding of no net benefit stands little chance of actually being published. Including such unpublished studies with negative or inconclusive outcomes in the overall results, as this review has tried to do, substantially reduces the observed effectiveness of the treatments, just as has been previously found in pharmacological trials. The study was not able to determine whether the authors of published papers have massaged data to make the treatment appear better than it really was  (as had happened in some of the drug trials), but that also seems distinctly possible. What's more, one assumes that a similar level of publication bias exists in other fields as well.
So, in conclusion, psychotherapy, and particularly cognitive behaviour therapy, is indeed modestly effective in treating depression, especially in combination with antidepressant drugs, but perhaps not to the extent previously thought. And peer-reviewed medical literature, although the best guide we have to the effectiveness of current practices and the promise of future developments, is good but not completely reliable.
The system is not broken, then, just slightly rickety. But maybe medical journal articles should come with a government health warning, and an added pinch of salt.

Why it is harder to lose weight today than it used to be

An interesting article in todays paper on weight control and obesity caught my eye. The article suggests that excess weight is not only about calorie intake and lack of exercise. Recent research at the universities of York and Alberta, but based on US source data, suggests that it really is harder to lose weight today than it was 30 years ago, and that a person in 2008 who consumed exactly same amount of calories as a person in 1971 would actually be about 10% heavier on average.
Now, this is not a huge discrepancy, and the study emphasizes that by far the most important factors in weight regulation remain calorific intake and exercise. But for the first time (at least to my knowledge) the extent of the influence of hidden, environmental factors has been quantified. Among these environmental factors are:

• Constant exposure to low-levels of environmental chemicals (such as pesticides, growth, hormones, plasticizers, flame retardants, heavy metals, etc) may interfere with hormone levels and lead to increased fat stores.
• Exposure to these kinds of chemicals in the womb may have the effect of pre-programming the body for weight gain later in life.
• There has been a large increase in the prescription of drugs (e.g. for mood disorders, migraines, hypertension, diabetes, etc) for which weight gain is a major side effect.
• Chronic stress and lack of sleep in our increasingly 24/7 lifestyle may cause higher levels of the stress hormone cortisol, which is associated with abdominal fat gain and impaired blood-sugar control.
• Many different studies have shown that our modern gut flora is inferior in numbers, quality and variety - largely due to highly-processed, low-fibre diets that are high in fats and refined carbohydrates - one consequence of which is the reduced ability to absorb calories efficiently.

So, overeating and inactivity are still the main culprits, but we should probably also be avoiding plastic containers, getting more sleep, and eating more unprocessed and organic foods, and particularly foods like whole-grains, fruit, vegetables and yoghurt that encourage the growth of healthy gut bacteria, and even looking more closely at our medications.
Nothing we didn't already know really, but studies of this kind have a way of concentrating the mind a little more.

Statistics, damned statistics and guns

Yet another mass school killing in the Land of the Free, this one in the small lumber town of Roseburg, Oregon. Nine dead, seven wounded, followed by a suicide, pretty standard fare. 26-year old gunman, a bit of a weirdo and a loner, and had attended a school for teenagers with behavioural problems, but still managed to buy his 13 guns legally, nothing new there. Barack Obama tries to make sensitive but meaningful noises after a mass shooting for the 15th time in his presidency, and vows to make gun control a political issue, but don't hold your breath.
But even these stark statistics, like the top of an iceberg, hide much worse below. And in the usual heart-searching and tub-thumping that accompanies these sad events, some truly shocking stats have surfaced.
Yes, Obama has made 15 public statements after mass gun violence events, but he has presided over no less than 994 mass shootings in the three years since his re-election in 2012 ("mass shooting" defined as an incident in which four or more people are killed or injured by firearms), with 294 just this year so far (more than one per day). More specifically, this is the 45th school shooting in the United States this year, which, if nothing else, serves to highlight the fact that President Obama did not make any public statement after the vast majority of them.
In total, 9,956 people have been killed by firearms so far this year in the USA, and more than 20,000 have been injured. The 11,385 people who have died on average annually in firearm incidents in the US between 2001 and 2011, compares to an average of 517 Americans killed annually in terrorism incidents during that period (INCLUDING the 2,996 killed on 9/11). In fact, between 1968 and 2011, about 1.4 million American deaths by firearms were recorded, well over the estimated 1.2 million US deaths in every armed conflict from the Revolutionary War to Iraq.
The USA has by far the highest per capita number of gun deaths in the developed world, according to the Human Development Index, over 4 times that of next-placed Switzerland, over 6 times that of Canada, and 20 times that of Australia and New Zealand. Also, a much larger proportion of America's homicides (around 60%) are gun-related than in other developed countries. In the undeveloped world, though, Honduras racks up over 20 times as many gun deaths as the USA per capita, Jamaica 12 times as many, and Brazil over 5 times as many. In absolute numbers, Brazil suffers over 4 times as many firearms-related deaths as America, and Colombia, Mexico and Venezuela all register more annual gun deaths.
There are thought to be around 310 million guns in the USA, almost one per person on average, although they are concentrated in the hands of about one-third of the population, particularly in the predominantly Republican and rural centre and south of country. But there is no gun registry in America, so these figures are ball-park estimates only.
Statistics? I'll give you statistics. You won't like them, though.

Indian man beaten to death for the principle of non-violence

Welcome to India in the 21st Century: a 50-year old man in the northern Indian state of Uttar Pradesh was beaten death with bricks and stones by a self-righteous Hindu lynch mob a couple of days ago, and his 22-year old son was left with serious brain damage. The man's sin? A rumour that he and his family had been storing and eating beef (yes, a rumour: the family maintains that the meat was mutton, and that the rumour was spread maliciously and unfoundedly by someone in the local Hindu temple).
Mohammad Akhlaq, as his name suggests, was a Muslim, living in the predominantly Hindu state of Uttar Pradesh, not far from the Indian capital of Delhi. But Uttar Pradesh, no doubt emboldened by pronouncements on the subject by the new Hindu Nationalist Indian Prime Minister Narendra Modi, is one of the 11 states in India that upholds a complete ban on the slaughter of all cows, calves, bulls and bullocks (although not actually on the eating of beef). In other states, the killing of cattle is allowed, and millions of Hindus do eat beef.
Many Hindus revere and all but worship the cow, which they see as symbolizing and exemplifying dignity, strength, endurance, maternity and selfless service, and the ancient Vedas exalt the cow as a prime example of the Hindu principle of ahimsa or non-injury. Fair enough, I suppose, random and absolutely nonsensical as it may appear to a non-Hindu. However, how that gives a state or a group of individuals the right to deny beef to a non-Hindu (or, for that matter, to a Hindu who happens to decide that that particular religious injunction is perhaps not so important) is quite beyond me. And how beating someone to death in order to uphold the principle of non-violence can make any sense to anyone is even more absurd.
I am a vegetarian, and have been for 35 years, although not for religious reasons. But I don't feel the need, or profess the right, to deny meat to other people. I am also an atheist, and have been for over 40 years, and I have just seen my decision to forego religion as a 14-year old absolutely vindicated. Again.

Blue Jays' playoff berth rejuvenates a city

I'm not the biggest baseball fan, but I do follow it some. So, let me chime in with kudos to the Toronto Blue Jays for getting to the playoffs for the first time in 22 years (I still wear a World Series Champs sweatshirt from 1993).
Four games ahead of the Yankees, with nine games to play, New York could still theoretically catch them (although on recent form that seems unlikely). But, after last night's win against Tampa, combined with a bit of luck as both Minnesota and Los Angeles also lost their own respective games, the Jays are now assured of at least a wildcard playoff berth. And what's more, they've done it with some style, with a league-leading offense (217 home runs so far), and a league-leading record since the All Star break (43-19).
But what's really interesting is what it's done to the city. With a bunch of major league sports franchises long used to losing and underachieving (in baseball, hockey, soccer, and to a lesser extent, at least just recently, basketball), the city has been starved of success for decades. The fans are remarkably forgiving, and still turn out in droves to home games, but until this baseball season they turned out with an air of resignation and doggedness rather than enthusiasm.
But with this sniff of a possible return to the good times, the excitement is palpable. The 50,000 seat baseball stadium sells out every home game, and playoff tickets sold out within two hours. People who haven't shown any interest in baseball for years are now professing to be die-hard fans (much to the chagrin of the "real" fans).
There is a kind of electricity in the air throughout the whole city, a discernable animation. Driving back through the city from the theatre last night, there were people everywhere and a kind of hum in the air. Conversations on the radio and in the street are peppered with references to the phenomenon: "How 'bout those Jays, eh?",  or the equivalent. The whole city - no, even the country - seems more upbeat than I have seen it for some years.
It's amazing what a few judicious baseball trades and the consistent sound of bat on ball can do for a city.

An all-too-fallible Pope

It is almost inconceivable to me that, in this day and age, the Catholic Church and the Papacy still indulge in the beatification and canonization of saints. There is just something so anachronistic, so positively medieval, about it that it is difficult to reconcile with modern 21st Century life.
It's also difficult to reconcile it with the apparently modern and thoughtful current Pope, Francis. However, while he criss-crosses the world doling out more-or-less sensible papal advice about global warming and the iniquities of capitalism, it must be remembered that Pope Francis is still mired in the benighted and fantastic dogma of the "One True Church", and he maintains the traditional repressive and antediluvian Catholic views on abortion, euthanasia, contraception, homosexuality, the ordination of women, priestly celibacy, etc.
The declaration of saints has become something of a cottage industry in the Catholic church in recent decades. Francis' ante-predecessor, John Paul II, in particular was a canonization junkie (and had the favour returned to him in 2013 by the last Pope, Benedict XVI, despite much criticism of John Paul's cover-ups of sexual abuse within the Church). The sainthood process requires one miracle for beatification, and a second for full canonization as a saint, although there do appear to be ways of "fast-tracking" sainthood and by-passing some of these rules. The miracles are typically in the form of healings from prayers to the candidate saint some years after their death, healings which the Vatican mandates must be "complete", "instantaneous", "durable", and medically and scientifically inexplicable.
It's all couched in such reasonable and quasi-legalistic terms that it almost seems to make sense until you stop and think about what it is that is actually being claimed. Pope John Paul's II's first miracle, for example, was supposed to be the healing of a French nun, Sister Marie Simon-Pierre, from a particularly aggressive form of Parkinson’s disease in 2005, although media reports in 2010 suggest that the sister has since fallen ill again, and at least one physician has questioned the initial diagnosis of Parkinson’s disease, suggesting that it may have been some other nervous disorder which is susceptible to spontaneous remission. But the Vatican approved it anyway, and Pope Francis performed the beatification ceremony, and he is, after all, infallible, isn't he?
However cynical you may be about the process, though, the current Pope's canonization of the 18th Century Spanish missionary, Father Junipero Serra, just the other day, is on very suspect ethical grounds. Serra is credited with introducing Catholicism among the Native American communities of California, although many commentators have objected to this on the basis that he actually imposed the religion in dictatorial fashion, including beatings and even claims of genocide, and in the process wreaked incalculable damage on the whole indigenous culture of the region. The Pope also chose to overlook the fact that Serra has only been credited with one miracle (the curing of a nun's mystery disease in 1960, after she apparently prayed to Serra on her deathbed).
To me, all this smacks of political expediency (i.e. the Church needed an American-based saint for the increasingly Latino population of America). Whatever your view, though, it is difficult to sanction this kind of celebration of cultural imperialism, and a modern, thoughtful Pope should be well aware of this.

Yogi Berra was no Yogi Bear

I know most of the Internet is probably doing the same thing, but I wanted to mark the death yesterday of Yogi Berra with a selection of my favourite Yogi-isms.
As well as being one of the best and most successful baseball catchers in history, Berra had a penchant for short snappy witticisms, at once nonsensical and somehow strangely wise, often following a similar format involving paradoxes or deliberate Spoonerisms. His epigrams appear to be designed to give an initial impression of stupidity or lack of education, while nevertheless containing a nugget of truth and a hidden subtlety. But Berra was far from stupid, and it is worth noting that he took great offence at Hanna-Barbera's naming of the genuinely stupid Yogi Bear cartoon character, and even took them to court over it.
Many of these bon mots are now so much a part of common parlance, and so identified with the man, that it is no longer even certain whether he said them first, whether he used those exact words, or even whether he said them at all. His 1998 book was called "The Yogi Book: I Really Didn't Say Everything I Said!" for good reason.
Anyway, for what it's worth, here are a few pearls he probably never said.

• “It’s déjà vu all over again.”
• “If the people don’t want to come out to the ballpark, nobody’s going to stop them.”
• “Baseball is 90 per cent mental. The other half is physical.”
• “Pair up in threes.”
• “He hits from both sides of the plate. He’s amphibious.”
• “Nobody goes there anymore. It’s too crowded.”
• “We were overwhelming underdogs.”
• “It’s tough to make predictions, especially about the future.”
• “It gets late early out here.”
• “You can observe a lot by watching.”
• “The future ain’t what it used to be.”
• “You should always go to other people’s funerals, otherwise, they won’t come to yours.”
• “When you come to a fork in the road, take it.”
• “We made too many wrong mistakes.”
• “A nickel ain’t worth a dime anymore.”
• “Why buy good luggage, you only use it when you travel.”
• “I usually take a two-hour nap from one to four.”
• “Never answer an anonymous letter.”

Diesel cars are not just a problem in the USA

In a huge wake-up call for the automobile industry, German auto giant Volkswagen has been caught out deliberately falsifying the emissions from their popular diesel cars.
Jettas, Beetles, Golfs, Passats and Audi A3s sold in the US market - still a tiny market compared to Europe - have been found to be fitted with sophisticated computerized "defeat devices" that can sense when the car is being tested, rather than being drive on the open road, and switch to a kind of safety mode in which emissions are much lower than usual. Once out on the road again, the devices switch back to full power (and emissions), resulting in cars in daily use that spew out as much as 40 times the nitrogen oxide pollutants (collectively known as NO_X) allowed by US Environmental Protection Agency rules. The problem was initially spotted by an NGO called the International Council on Clean Transportation (ICCT), which was carrying out independent emissions testing, including on-road testing, in association with the Center for Alternative Fuels, Engines and Emissions at the University of West Virginia.
Volkswagen AG has admitted to the fraud, and says that up to 11 million Volkswagen cars worldwide are fitted with the device. The company may face up to $18 billion in fines in the USA alone, to say nothing of possible legal action from consumers and shareholders, and CEO Martin Winterkorn has already announced his resignation. Environment Canada has since announced its own investigation into Volkswagens in Canada, as has Italy, France and South Korea, and a Europe-wide probe is likely.
About half of Volkswagen's sales are diesel cars, and in Europe as a whole diesel cars make up about 50% of all cars (closer to 70% in France and Spain), as compared to a measly 3% in the USA. Proponents point out that diesel fuel is more powerful than standard gasoline and 20-40% more efficient, and as a result diesel cars emit less carbon dioxide that gasoline cars (although not as much less as was once thought, and even this is now being questioned). On the other hand, they tend to produce substantially more nitrogen oxides and particulate pollution.
The BBC has produced a good primer on what you should know about diesel fuel, but suffice it to say that, in addition to pumping out almost as much carbon dioxide as gasoline, the other pollutants that diesel produces are perhaps even more worrying. Nitrogen dioxide (NO₂) is particularly nasty, and can cause or exacerbate a number of health conditions, including inflammation of the lungs, asthma and bronchitis, as well as an increased risk of heart attacks and strokes. The particulate matter from diesel exhausts has been shown to cause cancer and, although diesel cars are fitted with extremely effective filters, many people remove these filters to improve fuel economy and performance and, in addition, NO₂ forms something called secondary particulate matter when it enters the atmosphere, the effects of which are not yet fully understood.
Since the 1990s, many European nations have actively subsidized diesel (and heavily taxed gasoline) in the honest belief that diesel is better for the environment and can help cut greenhouse gas emissions. More recent scientific evidence suggests that this may not in fact be the case, and there are even moves now to limit diesel cars in some cities. NO₂ levels are well above European Union legal limits in many cities, including parts of London, Paris and Munich, and tests by the ICCT have shown that modern diesel cars in normal use emit on average seven times the prescribed European limit for NO_X (US limits are even more stringent). Indeed, some sources estimate that hundreds of thousands of premature deaths in Europe may be laid at the door of the recent popularity of diesel cars.
After these revelations, big changes may be afoot in the European car market. Volkswagen, however, may or may not be around to see it.