Dienstag, 22. Januar 2013

Embrace death... or not

The idea of death can reduce us humans to sputtering and mumbling. I know this from experience. Therefore the author of this article does not need to be embarrassed by being so horribly and totally wrong about almost everything he said.
At times death is so scary to people that they embrace it as something useful and desirable. Or they elevate quality of life on a golden pedestal as if quantity didn't matter at all. This form of cognitive dissonance is sometimes called "deathism".
I will take this opportunity to explain why living a very long and healthy life is worthwhile:

It starts with a reasonable objection: "...trying to link what is really a very small part of life to mortality. [is problematic or wrong]"
Yes, but that's a known issue in nutrition science. We use corroborative evidence and studies of dietary patterns to avoid bias.

All-cause mortality is the best (or at least it's exceptionally useful) and hardest endpoint in epidemiology, but the author does not like it, because it has something to do with dying:
You are going to die...
Everyone has their own motivations for pursuing a lifestyle that has more fitness and better nutrition in it. But one prevailing theme, not usually explicitly stated, is (and I'm going to make up a word here), "life maximization"...
Here's the thing: You don't know when you're going to die... 
Here's my main beef with long-term correlational mortality studies: The underlying assumption is that these events are not only bad, but preventable. I'm not talking about heart attack studies or stroke studies in which the subjects survive, but the ones where the subjects have heart attacks, or strokes and DIE. Or worse yet, the baffling, "All-cause mortality" variable. Somehow removing or adding a single food item or group increases or decreases ALL-CAUSE mortality (i.e. your chances of dying--from anything, including, but not limited to, being struck by a falling piece of space debris.)
So avoiding food that kills you is somehow supposed not to reduce your chance of dying during a given time-frame? How is that? (We can even show that food alters all-cause mortality during a given time-frame  in the lab!) Conceptually, this is similar to lifespan and we know for a fact that it can be increased. Since some 80% of people die due to CVD and cancer it is obvious why we can ignore meteorites and black holes as a first approximation.
All-cause mortality can tell us for instance if cancer risk offsets CVD benefits of a treatment/life-style choice, or in a real world example, perhaps, if death from bleeding offsets the cancer and heart benefits of aspirin.

Sonntag, 13. Januar 2013

HPV Vaccination: Just Do It!

Why am I writing on this topic and why now? Already in 2012, I have briefly reviewed the evidence on HPV to be able to make evidence-based recommendations. While at the same time our national insurance was cementing its anti-intellectual reputation by opting out of covering even a fraction of the vaccine cost - against international recommendations (*). Now that I am taking a class on DNA viruses I decided to take up the topic again.The following article is both a response to Medizin-Transparent (German, quoted in blue) and also a Question & Answer session on HPV. Although, I quoted them in German, everything of importance for the international reader is in English.

* alternatively the issue may be political, several of our parties despise things like Sex Ed

Why does Austrian insurance (incl. their "experts") ignore expert consensus and why do well meaning skeptics promote the status quo?
There is now consensus in favour of a very broad vaccination program. In 2012, both the "Advisory Committee on Immunization Practices of the Centers for Disease Control " and "The American Academy of Pediatrics" agreed on as much, the latter recommends (2):

"All girls and women 13 through 26 years of age who have not been immunized previously or have not completed the full vaccine series should complete the series." [all quotes emphasis mine]

"All boys and men 13 through 21 years of age who have not been immunized previously or have not completed the full vaccine series should receive HPV4 vaccine."

Vaccinating older males is also effective, but cost-effectiveness is unclear:
"Men 22 through 26 years of age who have not been immunized previously or have not completed the full vaccine series may receive HPV4 vaccine. Cost-efficacy models do not justify a stronger recommendation in this age group."