The medical media yesterday were touting Dr. Nissen's report to the big cardiology conference about his latest study of Actos. Here's the headline that accompanied the report in Endocrinology Today:
Pioglitazone may slow progression of atherosclerosis in patients with type 2 diabetes.
But take a look at the actual JAMA journal article this presentation was based on. Its title is: Comparison of Pioglitazone vs Glimepiride on Progression of Coronary Atherosclerosis in Patients With Type 2 Diabetes: The PERISCOPE Randomized Controlled Trial.
What should immediately leap out to you is that in this study Actos' effect hardened arteries was being compared with Amaryl, a sulfonylurea drug which is part of a drug family that has long been suspected of worsening heart disease. Not a placebo.
This was a small study. Only 543 patients participated, split into two groups, but 90-some patients in each group dropped out. This left only about 180 subjects in each arm of the study. To their credit, the researches cite the small study size and the unusually high drop out rate as a possible problem.
The study only enrolled people who already had evidence of blocked arteries. It concludes that, compared to those taking Amaryl, patients taking Actos saw a tiny though statistically significant decrease in the thickness of problem arteries. They had improved CRP (a measure of inflammation) and HDL though there was no actual difference between the number who died in both groups during the study.
The group taking Actos had slightly better fasting blood sugars and fasting insulin levels than those taking Amaryl, though of course, as is the case in every drug study you will ever see, their actual fasting blood sugars were high enough to damage all their organs.
A cheery graph shows the average fasting blood glucose of each group. The group average of those taking Actos started at 147 mg/dl and dropped by 8.5 mg/dl by the end of the study.
But this graph ignores the standard deviation of the group. The standard deviation is a measurement of the range within which most of the values in the group cluster. In this study, the standard deviation for fasting glucose was 41. That means that most of the fasting glucose values clustered between 106 mg/dl and 188 mg/dl.
But here's another concern: though standard deviations are presented for the starting values and measurements in the middle of the study, no standard deviation is given for the amount of improvement experienced at the end of they study. That is presented as an average with a confidence interval--the latter being an estimate of how accurate that average might be. This is far less informative than information about the standard deviations of the individuals' improvements might have been. So it is possible that the inclusion in the group of several people who were very strong responders to the drug could have skewed the final result.
Averages presented without their standard deviations should always be treated with great caution. If you average my income, your income, and that of Bill Gates the amount you come up with could be $500,000,000. That's because you get an average by adding all your values and dividing by the number of values. But standard deviation would show you how misleading that average is, because it might be $499,950,000 telling you that values averaged fell in a range plus or minus $499,950,000. This example should show you why averages are meaningless without knowing the standard deviation.
A far better measurement of values in a group is the median, a measurement which lines up all your values in order of size and picks the middle value. The median of your income, my income, and Bill Gates' income is likely to be something like $50,000--a more informative statistic.
More importantly, by pooling group data and using averages to analyze the group, we miss the really important statistic: the actual change per individual. Though the authors present a dizzying description of highly confusing statistical techniques they used, ones I doubt anyone but they themselves could understand, one wonders why they did not simply look at the increase and decrease per individual of the parameters measured and present the median and standard deviations of these individual changes which would have been far more informative.
That said, Dr. Nissen has a very good reputation in the field, so lets give him the benefit of the doubt and conclude, as he did, that Actos did make a very small improvement in the thickness of arteries in the people who took Actos compared to those who took Amaryl.
It is time to ask your doctor for some Amaryl?
Probably not. There were two other statistics buried in this study that should give you pause. Both of them relate to the most troubling side effects of Actos.
We all know that one of the biggest problems with the sulfonylurea drugs is the weight gain they cause. Well, this study showed that people taking Actos gained more than twice as much weight as those taking the sulfonylurea drug, Amaryl. Not only that, the standard deviation of the weight gain in the middle of the study was much larger for those taking Actos, suggesting that some people on Actos gained a lot more weight than the average would suggest.
We know that Actos lowers the insulin resistance by growing baby fat cells and stuffing them full of new fat. These cells, once grown, will never go away, which is why people who gain weight on this drug report that even after they stop taking it, getting rid of the additional weight is extremely hard if not impossible.
The second side effect is worse: There were no bone fractures in the Amaryl group, but fully 3% of the Actos group experienced bone fractures.
It is now well known to those of us who learn about drugs from sources other than manufacturer-funded studies that Actos builds those baby fat cells we mentioned above by hijacking the stem cells that should have turned into new bone. Over time this leads to osteoporosis, and there is no doubt that Actos causes osteoporosis in older women, a group whose thinner bones are more likely to fracture if weakened.
This study lasted only 18 months but there was still a very significant difference in the number of fractures between the two groups. So the high number of fractures--8 in this group of less than 200 people of mixed gender and ages taking Actos is extremely troubling.
Actos is a drug people will be put on not for months, but for years or even decades. Osteoporosis is one of the major killers of older women who break hips and then almost always die. So how Dr. Nissen can dismiss this drug as having a "reasonable safety profile" is beyond me.
And finally, whatever this drug did to artery thickness, there was no significant difference in actual mortality outcome in this study and, indeed, there were more fatal heart attacks in the group taking Actos. This study was short, but the other worrisome side effect of Actos in people who take it for longer time periods is that it produces congestive heart failure in people who did not have it when they started taking the drug. This is probably due to the edema (water swelling) it causes. It will be cold comfort indeed to know that your arteries are some tiny fraction thinner when you discover you have stretched your heart muscle to where it can barely function and that thanks to heart failure, your chances of surviving eight years is one in five--far worse than those for people with cancer.
April 1, 2008
March 31, 2008
More Insight into Who Should Take Statins
You will be seeing a lot of news coverage coming out of this week's cardiology conference about a large study of the statin drug, Crestor, which supposedly found it cut cardiovascular deaths in a group of people with normal LDL better than a placebo.
What most news coverage is leaving out is this: The group of people with "normal" cholesterol who took Crestor in this study weren't just any old group of people. They were people with elevated CRP.
This is an important distinction. CRP stands for C-reactive protein and it is a measure of inflammation. Earlier studies had shown that statins are only helpful in reducing cardiovascular events in people with pre-existing heart disease. Accumulating evidence suggests that they do this by reducing the artery inflammation that is characteristic of heart disease, not by reducing cholesterol. There has never been any truly solid proof that high cholesterol in and of itself causes heart attacks.
So this latest Crestor study may actually have done to finally narrow down who it is who should be taking statin drugs to the subgroup of people, whatever their cholesterol might be, whose CRP is elevated.
Given the way this new story is being reported, I'm not sure we can count on the drug company to give doctors thats message. Instead, the message might be that everyone, no matter what their cholesterol might be, should take this expensive drug.
This might be a mistake. Statins cause serious and sometimes irreversible side effects, some of them affecting mental function. They are particularly dangerous in older people.
If your doctor wants you to take a statin, demand that you first have a CRP test. If your CRP is normal and you have not been diagnosed with heart disease using a definitive diagnosis from something like an artery scan, rather than an inference from something like a high cholesterol test value, you may not need the statin.
I've done this myself, and my CRP was rock solid normal. That is one reason I have been very resistant to the idea of taking statins no matter how high my LDL might be. I saw a statin cause almost instant deterioration in my dad's hitherto stellar mental functioning, and no way am I gambling with mine!
Another piece of Crestor news is that a smaller study, which reanalyzed results of the Asteroid trial, found evidence of some regression in artery plaque in people taking Crestor. This particular trial did not investigate whether the changes observed actually mapped down to fewer heart attacks.
Also, keep in mind that these are reports at a convention, not peer reviewed research studies, and we won't really know how significant the findings were until we see the actual data in a publication. We also won't learn about the side effect profile of Crestor that was observed in these trials.
So, as is usually the case, the devil may well be in the details. For now, it's worth noting that most of the coverage of these reports is in the business press because the bottom line is that $tatin$ are all about profit$.
Here's one of the more informative reports about these studies:
Another Blow for Schering and Merck
What most news coverage is leaving out is this: The group of people with "normal" cholesterol who took Crestor in this study weren't just any old group of people. They were people with elevated CRP.
This is an important distinction. CRP stands for C-reactive protein and it is a measure of inflammation. Earlier studies had shown that statins are only helpful in reducing cardiovascular events in people with pre-existing heart disease. Accumulating evidence suggests that they do this by reducing the artery inflammation that is characteristic of heart disease, not by reducing cholesterol. There has never been any truly solid proof that high cholesterol in and of itself causes heart attacks.
So this latest Crestor study may actually have done to finally narrow down who it is who should be taking statin drugs to the subgroup of people, whatever their cholesterol might be, whose CRP is elevated.
Given the way this new story is being reported, I'm not sure we can count on the drug company to give doctors thats message. Instead, the message might be that everyone, no matter what their cholesterol might be, should take this expensive drug.
This might be a mistake. Statins cause serious and sometimes irreversible side effects, some of them affecting mental function. They are particularly dangerous in older people.
If your doctor wants you to take a statin, demand that you first have a CRP test. If your CRP is normal and you have not been diagnosed with heart disease using a definitive diagnosis from something like an artery scan, rather than an inference from something like a high cholesterol test value, you may not need the statin.
I've done this myself, and my CRP was rock solid normal. That is one reason I have been very resistant to the idea of taking statins no matter how high my LDL might be. I saw a statin cause almost instant deterioration in my dad's hitherto stellar mental functioning, and no way am I gambling with mine!
Another piece of Crestor news is that a smaller study, which reanalyzed results of the Asteroid trial, found evidence of some regression in artery plaque in people taking Crestor. This particular trial did not investigate whether the changes observed actually mapped down to fewer heart attacks.
Also, keep in mind that these are reports at a convention, not peer reviewed research studies, and we won't really know how significant the findings were until we see the actual data in a publication. We also won't learn about the side effect profile of Crestor that was observed in these trials.
So, as is usually the case, the devil may well be in the details. For now, it's worth noting that most of the coverage of these reports is in the business press because the bottom line is that $tatin$ are all about profit$.
Here's one of the more informative reports about these studies:
Another Blow for Schering and Merck
March 28, 2008
It only took 50 years and many ruined lives for the truth to emerge
There was a story in the news today about a study to be published in the journal, Science which for the first time convincingly demonstrates that there are genetic factors associated with schizophrenia.
Schizophrenia Linked with Rare Often Unique Genetic Glitches
This story had particular resonance for me because my father was an influential Freudian psychologist whose career peaked in the 1950s. Many of his older psychiatrist friends had been students of Freud. So while I was growing up, I sat in on many a dinner table conversation between my father and his peers about schizophrenia and its causes.
My father's psychiatrist friends were powerful people in the psychiatric establishment in New York City. Often they'd brag about their celebrity clients. And they had no doubt at all about what caused schizophrenia: bad mothering.
The theories varied in details. Did a child become schizophrenic because they had what Bettelheim called a "refrigerator mother," or should the blame fall on the inconsistent mother who gave the child mixed messages? Others blamed the mother whose feminine sexual expression was too strong, but then, equal damage might have been done by the mother who confused her son about his gender identity by not being feminine enough.
All these theories had in common only this--that these influential doctors wrote and taught that the ultimate cause of schizophrenia was something the patient's mother had done wrong. And that these experts were utterly and irredeemably wrong.
But such was the power of these men within their profession that for decades they added an inconceivably cruel burden to the lives of the mothers whose lives were already hard enough, by telling them that their children's terrible untreatable mental condition was all their fault.
So you can imagine how I felt when I read that after years of futile searching for genetic causes of schizophrenia, scientists had been able to use new, sophisticated techniques of examining the genome to begin to identify some of the many different genetic flaws that interfere with the complex pathways involved in how the brain processes thought.
And that of course made me think of how another generation of powerful experts continue to increase the load of misery on another population whose condition is most certainly genetic in nature too: people with Type 2 diabetes.
Like schizophrenia, Type 2 diabetes is not one disorder, and it is not caused by one gene. Dozens of genes have been linked to the development of Type 2 diabetes--genes that affect insulin secretion, the function of mitochondria, and many other subtle factors. Only slowly is it starting to become clear that genetic flaws--inherited or induced by environmental toxins--disrupt glucose metabolism at any of a multitude of locations in the complex pathways involved and that without such a genetic flaw, no matter how fat or sedentary a person might be, they don't develop diabetes.
Don't expect the experts to change their tune on this, though. You'll still read diabetes "experts" pontificating that diabetes is "caused by obesity" and could be cured if people lost a couple pounds eating a low fat diet and got off their lazy butts and exercised.
In the case of psychiatry, my dad's friends never gave up their misguided theories. My dad died still convinced that Freud's toxic theories could explain anything that happened in the personality. But no one lives forever, and now he and his peers are all gone, replaced by a newer generation of psychiatrists who ditched Freud's toxic woman-hating theories in favor of drug treatments that, whatever their failings, could at least improve the lives of their patients.
We will probably have to wait for the current crop of experts to retire to see the same kind of change in public understanding of diabetes. One cannot help but hope that the diabetes experts continue to eat the low fat diets they are so enthusiastic about and maintain for themselves the A1cs they push on the public, to hasten the process.
But in fifty years the public will look with the same kind of horror on the doctors who blamed children and adults for causing their own Type 2 as they do on those toxic mother-hating theories.
I just hope I can hang on long enough to see it happen!
Schizophrenia Linked with Rare Often Unique Genetic Glitches
This story had particular resonance for me because my father was an influential Freudian psychologist whose career peaked in the 1950s. Many of his older psychiatrist friends had been students of Freud. So while I was growing up, I sat in on many a dinner table conversation between my father and his peers about schizophrenia and its causes.
My father's psychiatrist friends were powerful people in the psychiatric establishment in New York City. Often they'd brag about their celebrity clients. And they had no doubt at all about what caused schizophrenia: bad mothering.
The theories varied in details. Did a child become schizophrenic because they had what Bettelheim called a "refrigerator mother," or should the blame fall on the inconsistent mother who gave the child mixed messages? Others blamed the mother whose feminine sexual expression was too strong, but then, equal damage might have been done by the mother who confused her son about his gender identity by not being feminine enough.
All these theories had in common only this--that these influential doctors wrote and taught that the ultimate cause of schizophrenia was something the patient's mother had done wrong. And that these experts were utterly and irredeemably wrong.
But such was the power of these men within their profession that for decades they added an inconceivably cruel burden to the lives of the mothers whose lives were already hard enough, by telling them that their children's terrible untreatable mental condition was all their fault.
So you can imagine how I felt when I read that after years of futile searching for genetic causes of schizophrenia, scientists had been able to use new, sophisticated techniques of examining the genome to begin to identify some of the many different genetic flaws that interfere with the complex pathways involved in how the brain processes thought.
And that of course made me think of how another generation of powerful experts continue to increase the load of misery on another population whose condition is most certainly genetic in nature too: people with Type 2 diabetes.
Like schizophrenia, Type 2 diabetes is not one disorder, and it is not caused by one gene. Dozens of genes have been linked to the development of Type 2 diabetes--genes that affect insulin secretion, the function of mitochondria, and many other subtle factors. Only slowly is it starting to become clear that genetic flaws--inherited or induced by environmental toxins--disrupt glucose metabolism at any of a multitude of locations in the complex pathways involved and that without such a genetic flaw, no matter how fat or sedentary a person might be, they don't develop diabetes.
Don't expect the experts to change their tune on this, though. You'll still read diabetes "experts" pontificating that diabetes is "caused by obesity" and could be cured if people lost a couple pounds eating a low fat diet and got off their lazy butts and exercised.
In the case of psychiatry, my dad's friends never gave up their misguided theories. My dad died still convinced that Freud's toxic theories could explain anything that happened in the personality. But no one lives forever, and now he and his peers are all gone, replaced by a newer generation of psychiatrists who ditched Freud's toxic woman-hating theories in favor of drug treatments that, whatever their failings, could at least improve the lives of their patients.
We will probably have to wait for the current crop of experts to retire to see the same kind of change in public understanding of diabetes. One cannot help but hope that the diabetes experts continue to eat the low fat diets they are so enthusiastic about and maintain for themselves the A1cs they push on the public, to hasten the process.
But in fifty years the public will look with the same kind of horror on the doctors who blamed children and adults for causing their own Type 2 as they do on those toxic mother-hating theories.
I just hope I can hang on long enough to see it happen!
March 27, 2008
Medical Incompetence re Statistics
An article in today's Science Daily finally puts some numbers on a phenomenon that has been driving me batty since I started putting some serious time into reading medical studies 4 years ago. This study dealt with cancer trials, but as you will see if you read the article, the phenomenon discussed seems to be true of ALL medical research.
Science Daily: Some Cancer Trials May Have Incorrectly Reported Success
Here's what the researchers found after reviewing 75 articles published in 41 journals from 2002 to 2006. These were group-randomized trials related to cancer or cancer risk factors:
"... 88 percent of those studies reported statistically significant intervention effects that, because of analysis flaws, could be misleading to scientists and policymakers." This means that 9 out of 10 studies claimed success for drugs and treatments that were not supported by the data published with the study!
"Thirty-four of the articles, or 45 percent, reported the use of appropriate methods used to analyze the results." This means more than half of the studies did NOT use appropriate methods to analyze the results.
"Twenty-six articles, or 35 percent, reported only inappropriate methods were used in the statistical analysis." I.e. More than one out of three used statistics in a manner that was completely wrong.
"Nine articles had insufficient information to even judge whether the analytic methods were appropriate or not." In short, one out of eight was so poorly written that it would never have been published in a peer reviewed journal had the reviewers understood statistics.
The people who conducted this damning review of cancer research--people whose careers depend on getting grants, often from drug companies--bent over background to avoid suggesting that the skewing of data was intentional.
But come on people. Drug trials are largely funded by drug companies who will earn a lot of money if the drug succeeds and lose a lot of money if it doesn't. Do you really want me to believe that it is an accident that their misuse of statistics results in 9 out of ten studies showing an intervention to be more effective than it really is?
I discussed this issue with one of my doctors recently. She laughed and said, "They only made me take one statistics course in medical school. The professor was terrible and I didn't learn a thing. I still find statistics baffling." What I found most troubling about this was that this doctor seemed to think this was somehow an endearing trait, like wearing striped shirts with polka dot pants.
It isn't. It is the reason that drug companies get away with publishing studies that anyone who did understand one college level course in statistics (self-included) can immediately see do not use statistical methods correctly--and universally misuse statistics to make ineffective drugs look effective.
Is it too much to demand that the people who publish medical studies--studies whose value is based entirely on the statistics they contain--send those studies for review to people who understand statistics before accepting them for publication? When people's lives--and wallets--are at stake, the answer should be, "Yes!"
But don't hold your breath. As long as scientists are rewarded mostly for publishing research, and as long as journals prefer to publish studies that report positive findings, and as long as most research is paid largely by people with a financial stake in the outcome, that is not going to happen.
Science Daily: Some Cancer Trials May Have Incorrectly Reported Success
Here's what the researchers found after reviewing 75 articles published in 41 journals from 2002 to 2006. These were group-randomized trials related to cancer or cancer risk factors:
"... 88 percent of those studies reported statistically significant intervention effects that, because of analysis flaws, could be misleading to scientists and policymakers." This means that 9 out of 10 studies claimed success for drugs and treatments that were not supported by the data published with the study!
"Thirty-four of the articles, or 45 percent, reported the use of appropriate methods used to analyze the results." This means more than half of the studies did NOT use appropriate methods to analyze the results.
"Twenty-six articles, or 35 percent, reported only inappropriate methods were used in the statistical analysis." I.e. More than one out of three used statistics in a manner that was completely wrong.
"Nine articles had insufficient information to even judge whether the analytic methods were appropriate or not." In short, one out of eight was so poorly written that it would never have been published in a peer reviewed journal had the reviewers understood statistics.
The people who conducted this damning review of cancer research--people whose careers depend on getting grants, often from drug companies--bent over background to avoid suggesting that the skewing of data was intentional.
But come on people. Drug trials are largely funded by drug companies who will earn a lot of money if the drug succeeds and lose a lot of money if it doesn't. Do you really want me to believe that it is an accident that their misuse of statistics results in 9 out of ten studies showing an intervention to be more effective than it really is?
I discussed this issue with one of my doctors recently. She laughed and said, "They only made me take one statistics course in medical school. The professor was terrible and I didn't learn a thing. I still find statistics baffling." What I found most troubling about this was that this doctor seemed to think this was somehow an endearing trait, like wearing striped shirts with polka dot pants.
It isn't. It is the reason that drug companies get away with publishing studies that anyone who did understand one college level course in statistics (self-included) can immediately see do not use statistical methods correctly--and universally misuse statistics to make ineffective drugs look effective.
Is it too much to demand that the people who publish medical studies--studies whose value is based entirely on the statistics they contain--send those studies for review to people who understand statistics before accepting them for publication? When people's lives--and wallets--are at stake, the answer should be, "Yes!"
But don't hold your breath. As long as scientists are rewarded mostly for publishing research, and as long as journals prefer to publish studies that report positive findings, and as long as most research is paid largely by people with a financial stake in the outcome, that is not going to happen.
March 26, 2008
Easy, Simple, and Wrong
It's already happening. My email box is starting to fill with letters that say things like this: "My [Mother, Brother, Friend--choose one] told me they heard on NPR that lowering blood sugar kills people."
The story they are referring to is the one that reported "excess mortality" in the ACCORD study. This was the study where they took a group of older people with Type 2 diabetes who had already had heart attacks and lowered their average A1c to 6.5% by pumping them full of every diabetes drug known to man. They hired dietitians to phone the study subjects on a regular schedule and nag them to eat a low fat/very high carbohydrate diet full of "healthy whole grains." To counteract the effects of all those "healthy" grains they added the high doses of insulin.
Unfortunately, the people who report on medicine in the media rarely do more than repeat what they read in press releases. They don't ask the hard questions they should ask--like, in this case, "What exactly were the researchers doing to lower blood sugar?"
And because most of their audience is scientifically illiterate, reporters have to dumb down everything they say until someone who has no understanding of physiology or medicine can grasp it. Hence a complex story about a group of seriously ill people who were attempting to lower one of the more complicated measures of blood sugar function, who were given a toxic mixture of drugs whose interactions are not well understood, and who ended up experiencing very slightly more deaths per thousand than expected turns into this: lowering your blood sugar will kill you.
A second large study, ADVANCE, found no excess deaths associated with lowering average A1c to 6.5%. Sometime this summer when that study's results start to be published we will find out if their subjects' health actually improved. I've blogged about the differences in these two studies HERE.
But the media, having come up with the Man Bite's Dog story--lower blood sugars kill--did not spend much time on the ADVANCE story. Too Dog Bites Man.
But if my mail is anything to go by, it is likely that all over America people with diabetes have taken the dumbed down message they heard on the news and translated it into more carbs on the plate and less blood sugar testing. Mothers are calling their grown up kids and warning them not to keep their A1cs too low. And toes are dying, eyes are dimming and kidneys are clogging up. All because journalists translated a complex story into something the dumbest third grader could grasp.
I call it the "Brody Effect" in honor of The New York Times' Jane Brody, who built her career promoting another over-simplication that has had a toxic effect on people who get their health education from the media, the mantra: "Eating fat makes you fat."
Real science is complicated. Be very skeptical about any single sentence that purports to give you all you need to stay healthy. Be even more skeptical of health stories that get a lot of play in the media. The really interesting stuff rarely does. Especially if it takes more than thirty seconds to explain.
Thank goodness for the many folks online--most of them unpaid--who DO do the research, do report it accurately, and make it possible to find out the truth about what is really going on in the world of medical research!
The story they are referring to is the one that reported "excess mortality" in the ACCORD study. This was the study where they took a group of older people with Type 2 diabetes who had already had heart attacks and lowered their average A1c to 6.5% by pumping them full of every diabetes drug known to man. They hired dietitians to phone the study subjects on a regular schedule and nag them to eat a low fat/very high carbohydrate diet full of "healthy whole grains." To counteract the effects of all those "healthy" grains they added the high doses of insulin.
Unfortunately, the people who report on medicine in the media rarely do more than repeat what they read in press releases. They don't ask the hard questions they should ask--like, in this case, "What exactly were the researchers doing to lower blood sugar?"
And because most of their audience is scientifically illiterate, reporters have to dumb down everything they say until someone who has no understanding of physiology or medicine can grasp it. Hence a complex story about a group of seriously ill people who were attempting to lower one of the more complicated measures of blood sugar function, who were given a toxic mixture of drugs whose interactions are not well understood, and who ended up experiencing very slightly more deaths per thousand than expected turns into this: lowering your blood sugar will kill you.
A second large study, ADVANCE, found no excess deaths associated with lowering average A1c to 6.5%. Sometime this summer when that study's results start to be published we will find out if their subjects' health actually improved. I've blogged about the differences in these two studies HERE.
But the media, having come up with the Man Bite's Dog story--lower blood sugars kill--did not spend much time on the ADVANCE story. Too Dog Bites Man.
But if my mail is anything to go by, it is likely that all over America people with diabetes have taken the dumbed down message they heard on the news and translated it into more carbs on the plate and less blood sugar testing. Mothers are calling their grown up kids and warning them not to keep their A1cs too low. And toes are dying, eyes are dimming and kidneys are clogging up. All because journalists translated a complex story into something the dumbest third grader could grasp.
I call it the "Brody Effect" in honor of The New York Times' Jane Brody, who built her career promoting another over-simplication that has had a toxic effect on people who get their health education from the media, the mantra: "Eating fat makes you fat."
Real science is complicated. Be very skeptical about any single sentence that purports to give you all you need to stay healthy. Be even more skeptical of health stories that get a lot of play in the media. The really interesting stuff rarely does. Especially if it takes more than thirty seconds to explain.
Thank goodness for the many folks online--most of them unpaid--who DO do the research, do report it accurately, and make it possible to find out the truth about what is really going on in the world of medical research!
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