Donnerstag, 27. Juni 2013

A caustic reminder of the status quo: food and drink aimed for the kill

You all know the ultra-small bottles of alcohol as well as other miscellaneous items sold right next to the checkout counter. You do if you live in a country that allows such a display, for example Austria.
It is common knowledge that these items are aimed at people with low impulse control and children in particular. You do not need much knowledge of psychology to know this is true. And it works, that's why it's done.

Now, who buys that booze? Certainly not me. Nor have I ever heard or seen anyone of my friends buy these and we certainly know how to get drunk (from time to time). On the other hand, I have seen poor, ragged working class fellas' and "typical" alcoholics buy those**. So the whole scheme is most definitely aimed at alcoholics, those with the least control. Since the small bottles are always in sight and easy to hide and stash away, who else would succumb? (And to some extent it is aimed at teenagers, but I believe the laws have gotten strict enough to close this loophole)

These companies are prying on the weakest of the weak, the sick and the poor. Classy. No, really, people responsible for this, you are scum.

Literally, their bottom lines depend on killing people, because that is what alcohol does to alcoholics. It's the most pernicious kind of rent seeking (broadly, the extraction of profit at cost to others).

On a similar note
Obesity is a disease(-like) condition (1) that can be beyond a person's control. Many of those afflicted suffer from decreased impulse control or increased orexigenic drive (e.g. polymorphisms of hypothalamic effectors like NPY*) or reduced energy consumption via thermogenesis.

Companies abuse and exploit these sick people by providing ultra-easy, fast access to extremely calorie-dense and unhealthy foods (2). How could they not know that they are killing them?

Visibility and accessibility is a huge factor. I know that it is for me, and I normally do not have a problem to stay lean, but when I am unhappy or just see certain sweets/foods or both, sometimes an irresistible drive overwhelms my actual intentions of not buying them, or of buying something entirely different or a healthier alternative.
Anecdotally, this is true for most everyone else, at least to some extent. Unfortunately, right now I have no time to search the literature to confirm my suspicion.

I demand an end to this practice, as well as plain labeling, warning signs (for alcohol & probably other "ultra-processed foods"), a ban of alcohol for minors, etc.

(1) "Amid heated debate, AMA declares obesity a disease"

(2)  Lancet. 2013 Feb 11. pii: S0140-6736(12)62089-3. doi: 10.1016/S0140-6736(12)62089-3. [Epub ahead of print]
Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries.
Moodie R, Stuckler D, Monteiro C, Sheron N, Neal B, Thamarangsi T, Lincoln P, Casswell S; on behalf of The Lancet NCD Action Group.

*just giving a speculative example

**edit: I forgot to add, I concede that regular, "normal" people also buy these, but the above reasoning still applies

Freitag, 14. Juni 2013

The Alzheimer's pipeline: who fails next?

There are fields of study which require deep pockets, nerves of steel and a lot of serendipity. AD is one of them. As is HIV vaccination or the search for an HIV cure. As are several cancers e.g. pancreatic.
...between 1998 and 2011...drug developers have scrapped or halted development of 101 meds for the complex disorder and brought to market only three treatments for symptoms [!] of the disease...
Read more: Pharma counts just 3 Alzheimer's drug wins in 13 years (101 losses!) - FierceBiotech

The bad luck continues:
The brutal drumbeat of Alzheimer's clinical failure continues at Eli Lilly. After the Phase III failure of their gamma-secretase inhibitor semagacestat, and a delusional attempt to pretend that the anti-amyloid antibody solanezumab succeeded, now comes word that the company has halted studies of a beta-secretase inhibitor.
This one wasn't for efficacy, but for tox...

Several drugs are in the pipeline. This one's quite interesting:
In a Phase II clinical trial of 16 patients, Gammagard effectively shut down the progression of Alzheimer's with the optimal dosage. Patients who received a placebo or did not receive the optimal dosage continued to decline.
So far, this seems to be the most promising medication in the Alzheimer's pipeline, consistently stalling the progression of the disease for four years in a small clinical trial. Baxter's goal for the medication is to maintain high levels of functionality during the early stages of the disease. Though few patients are better than no patients, Phase III data are due in the first half next year and that, as tradition demonstrates, is where prospective Alzheimer's medications go to die.
Read more: The Alzheimer's pipeline: What's next? - FierceBiotech

Samstag, 8. Juni 2013

Understanding PREDIMED and the Mediterranean diet: heart-healthy or hype?

ResearchBlogging.orgI am going to discuss the failings of the PREDIMED study, real and imagined. I will do this in a Question & Answer style. Several questions are inspired by and NEJM comments and even statements by the low fat "gurus", Essselstyn, Ornish, McDougall or Pritikin. It is no surprise they are up in arms after the study has been published. It threatens their livelihood.

Finally, I get to talk about biogerontology, diet and health in one post. For once, I may be doing justice to the blog name. I will also talk about study ethics, particularly the balance of harms and benefits you may expose participants to. In jargon: clinical equipoise.

First, a summary of the study and its results:

N Engl J Med. 2013 Apr 4;368(14):1279-90. doi: 10.1056/NEJMoa1200303. Epub 2013 Feb 25.
Primary prevention of cardiovascular disease with a Mediterranean diet.
Estruch et al.

BACKGROUND: Observational cohort studies and a secondary prevention trial have shown an inverse association between adherence to the Mediterranean diet and cardiovascular risk. We conducted a randomized trial of this diet pattern for the primary prevention of cardiovascular events.
METHODS: In a multicenter trial in Spain, we randomly assigned participants who were at high cardiovascular risk, but with no cardiovascular disease at enrollment, to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil [MED/EVOO], a Mediterranean diet [MED/nuts] supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). Participants received quarterly individual and group educational sessions and, depending on group assignment, free provision of extra-virgin olive oil, mixed nuts, or small nonfood gifts. The primary end point was the rate of major cardiovascular events (myocardial infarction, stroke, or death from cardiovascular causes). On the basis of the results of an interim analysis, the trial was stopped after a median follow-up of 4.8 years.
RESULTS: A total of 7447 persons were enrolled (age range, 55 to 80 years); 57% were women. The two Mediterranean-diet groups had good adherence to the intervention, according to self-reported intake and biomarker analyses. A primary end-point event occurred in 288 participants. The multivariable-adjusted hazard ratios were 0.70 (95% confidence interval [CI], 0.54 to 0.92) and 0.72 (95% CI, 0.54 to 0.96) for the group assigned to a Mediterranean diet with extra-virgin olive oil (96 events) and the group assigned to a Mediterranean diet with nuts (83 events), respectively, versus the control group (109 events). No diet-related adverse effects were reported.
CONCLUSIONS: Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events. (Funded by the Spanish government's Instituto de Salud Carlos III and others; number, ISRCTN35739639.).

I believe the study to be well-designed - despite some short comings - and I do consider it pretty definitive results in favor of the Mediterranean diet and olive oil in primary prevention. Now it is time to act for governments!