Cellphones and Cancer again?

There's a book out there by the name of "Disconnect" by Dr. Devra Davis, of U. Pittsburgh, that has been making rounds in the lay print due to the sensationalist claims it makes about cellphones and cancer. You've all probably heard about the alleged link between cellphones and cancer where people claim, on the thinnest of mechanistic argument, that cell phones can cause brain tumours. Various research groups have then been looking at whether or not there's a cancer risk primarily through observational studies, since it's very difficult to tell someone how much they should talk on their cellphone for the next x years, and the results have been the messy mix of results that you typically find if either there is no real effect, or if the effect is so subtle as to be nearly negligible.

Personally, I'm inclined to the "No Effect" camp a little more. Here's why: It's all about mechanism. It sounds dangerous when you hear about EM radiation and all that, but realize your toaster gives off EM radiation. So does the sun. And light bulbs. And... well, about everything in the office, these days. You, right now, are giving off radiation! But it really, really doesn't matter. The wavelength of the EM radiation needs to be the right length to excite chemical bonds and cause them to break, form, etc. We'd call such wavelengths "ionizing radiation," and cellphones do not give off ionizing radiation. The best they could do is make your head slightly warmer. This is in contrast with something we know gives off ionizing radiation - the Sun.

The Dr. Davis harps on how "Industry Knows," like there's some massive cover-up of the topic, and points to disclaimers in the fine print of cell phone manuals warning not to keep the phones too close. Ever heard of a CYA? The legal evidence of effect in a law suit is a far lower bar than the rigour demanded by scientist. Companies can be, and have been, sued for things that were later shown to be totally harmless upon actual study. All Nokia needs is to be sued for an ungodly amount by someone who has a brain tumour from another source to really ruin their day, and the fine print lets them say, "Well you didn't use the phone as we instructed."

One other thing I would like to note - the news stories are coming off making Dr. Davis look like some sort of cancer expert. This is interesting, because to the best of my google scholar abilities, as well as looking at her public CV, I can one peer reviewed paper on cell phones and cancer. It looks like she's spent most of her time recently tilting at aspartame (which to be honest, sends up a whole lot of red flags in my mind). Now, I won't begrudge her the right to write a book - I have zero publications on cell phones and cancer - but the Times and other journalists should know that one study does not an expert make.

Photo credit.

Does your doctor have a conflict of interest?

This morning, I was listening to KUAC when I heard a story about Doctors who had been disciplined in the past, but were now receiving money from pharmaceutical companies. You can read the original ProPublica story here. I think most people are vaguely familiar with this happening - or at least I hope most people are - but along with that story came a wonderful utility to find out if your doctor had reported income from the drug companies. Immediately, I checked for a doctor that had behaved very strange and found that their strange behaviour was all their own (or is hiding their pharmaceutical income). But perhaps you'd like to check your own too; I've gone ahead and linked the entry on Alaskan doctors here.


I should hasten to add that I'm not against pharmaceutical companies per se, as I'm a huge fan of new and modern drugs. I'll take a refined and purified analgesic over some willow bark and mashed up porcupine quills any day of the week (or at least those days where I need an analgesic). I am slightly leery of their marketing arms though, which can get up to some... morally dubious things. What really surprises me is that the amount that Doctors have received is so small; 257 million since 2009 seems like chump change. We're talking about 7 massive companies what have far more than that to throw around...

Does caffeine help you drink?

It was my brother who told me that drinking coffee while drinking alcohol was a good idea - it would lessen the effects of intoxication. I launched into an ethanol fuelled discussion of how physiologically implausible that sounded to me, but we were celebrating a great occasion, and so I don't think I got much beyond slurring something about cyclic AMP before we instead had some of Arizona's finest porter. But I recall that exchange fairly well, a few years later.

It's with the fact that I'm taking on my brother that I write this - here's a man who can, and has when I was younger, beat me up, so I'll be diplomatic about it. Energy Drink-Cocktails have been in vogue for the last little bit, so Ferreira and colleagues decided to perform a small experiment of the effects of Redbull® and vodka. They took 26 subjects, all Brazilian males, and were put on treatment of one of two doses of vodka (a lesser and greater amount), modulated with and without Red Bull. There were a total of 3 treatments at least 7 days apart, and the whole thing was double blinded throughout - meaning neither researchers nor subjects knew whether they were getting alcohol, or the alcohol mixed with the energy drink. They also standardized the subjects on calories in a novel way - they used a big mac as a pre-drinking caloric unit. Who knew McDonalds was a research tool?

The graph most worth reproducing is the one that shows absolutely no effect on breath alcohol concentrations. I've included it to the right. I'm not fond of breath measurements (blood is better), but that aside, the effect is pretty clear: there is none. Co-drinking caffeine does not appear to modulate your BAC. Already, one urban myth dead.

But even if it doesn't effect your BAC, perhaps it effects how intoxicated you are, or your performance while intoxication. They tested this, by examining motor co-ordination and visual reaction time. In both cases, there was no effect of energy-drink on performance. Having a Red Bull® does not improve your ability to function while intoxicated. The popular myth of co-administered caffeine appears well and truly dead. But this raises the question, why did such a persistent myth get started?

There's no good figure for this (basically a page of tables), but at the same time they asked their subjects a variety of questions about wellbeing, and how they felt at the time. It covered the field from tiredness, tremor, to speech impairment and so on. Now, right now, these menus are basically a laundry list, and some of the results can easily show up as positivity spuriously. With that in mind, they found that individuals felt they had significantly better motor co-ordination than they in-fact had. Remember, they were double blinded, so they didn't know what they had just drank. The expectation bias should be weak in this instance - something about the energy drink makes us /feel/ illusory confidence in our motor skills. Perhaps it prevents us from feeling how poor our skills have become, or perhaps it bolsters confidence in the skills. It's hard to divine which, from the data.

Aside from the problem of multiple tests on that, I've got one other criticism of the study, and that's how they standardized their subjects. I've long suspected that self-reported alcohol consumption is not a reliable indicator of true alcohol (or other drugs) consumption. There's a stigma attached to excessive drug consumption, and so people are likely to under-report their use. There needs to be a better way to gauge participant alcohol consumption.

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Ferreira, S., de Mello, M., Pompeia, S., & de Souza-Formigoni, M. (2006). Effects of Energy Drink Ingestion on Alcohol Intoxication Alcoholism: Clinical and Experimental Research, 30 (4), 598-605 DOI: 10.1111/j.1530-0277.2006.00070.x

Everything you wanted to know about Hangovers (but were too afraid to ask)

Recently, I read a statement by the American Heart Association about Alcohol, saying that although moderate alcohol reduces your risk of stroke, if you don't already drink you should not begin drinking because drinking raises your risk of cancer. This is an interesting statement, because I think it is incorrect. Cancer is rare, Stroke is common. Even though alcohol increases the probability of those cancers by quite a large amount, many times a small value is still a very very small value. Where as a minor reduction on the probability of stroke results in major gains in life expectancy.

However, while I was challenging myself to back up this mathematical statement with numbers (maybe I'll make a second post about it with the math!) I took a diversion off into hangover land. I rarely get hangovers - I suppose I'm lucky in that respect - but I was curious what promotes hangovers. So I read "The Alcohol Hangover" by Wiese et al. 2000. It's a review paper of the state of Hangover Science, in 2000. If anyone has a newer paper, I'd be curious to read it.

First, I was shocked to find out how much hangovers cost the economy - 148 Billion Dollars a year in decreased productivity and absenteeism. That's staggeringly huge, and so it seems to suggest whatever we can do to treat hangovers is well advised, to reduce this economic burden.

Second,  there isn't a very good definition of what a Hangover is. Some symptoms include Headache, Poor sense of being, Diarrhoea, Loss of Apatite, Fatigue and Nausea, but even the most common feature, headache, is only reported in 66% of hangovers. I wonder if people who suffer, say, Diarrhoea when they are hungover one one instance are more likely to have it in other hangovers. Does it vary person to person, or episode to episode? Sadly, anecdote fails me here; I think a full study would be needed.

A study referenced in Wiese's paper suggests that far from reduce alcohol intake, not only is there no evidence that hangover incidence decreases rates of alcohol intake, but there are indications that it may prompt further alcohol intake! Think of "The Hair of the Dog" type of treatment. Obviously, if we consider this early morning drinking a societal ill, we should work on reducing the overall incidences of hangovers.

Here's something else counter-intuitive: According to a variety of sources cited in the paper, light to moderate drinkers (those of 0 to 3 drinks/day for men, and 0 to 1 for women) are 70% more likely to experience hangover symptoms than heavier drinkers.

Very little is known about about hangover causes, since it's not strictly dose-dependant with respect to the Ethanol (alcohol) content of a drink. Those sayings about never mixing beer with wine are all total garbage, more or less. There are some factors, among which are Acetaldehyde, a metabolite of ethanol, and congeners, which are impurities from ethanol production that include tannins, acetone, phenolics, etc. But it seems clear from this paper (and another that I read) that it's all a bit of a black box, still. What does and doesn't cause it is terribly mysterious. And Wiese et al. is very clear that the research into hangover alleviation is suggestive, but muddy still.

But if you do want to prevent hangovers, there's one other thing you can do; I'd offer you this quote, then:

Clear liquors, such as rum, vodka, and gin, tend to cause hangover less frequently, which may explain why patients with chronic alcoholism use these liquors disproportionately. In an experimental setting, 33%% of patients who consumed 1.5 g/kg of body weight of bourbon (which has high congeners) but only 3%% of those who consumed the same dose of vodka (which has low congeners) experienced severe hangover (41).

Maybe all those vodka snobs are onto something. But I would caution you, before you throw out all your bourbon, that a 2010 paper didn't replicate those results.

Wiese JG, Shlipak MG, & Browner WS (2000). The alcohol hangover. Annals of internal medicine, 132 (11), 897-902 PMID: 10836917

On fMRI

So, supposedly a study using brain scans found that 4 of 27  patients in a vegetative state could actually answer questions. We're invited to feel horror at the thought of being locked in. Indeed, that seems horrible.

But, on the other hand, they found that a dead salmon did a lot of thinking in an fMRI, too.

These people, in the fMRI world, have what we like to call "Problems" with their statistical methods.

Expectations in medicine

A neat little 6 minute video I stumbled across where a researcher discusses expectation biases in both pain control and beer.



His story about vinegar in beer reminded me about the study where they took expensive wines and sold them for cheap, and cheap wines and sold them as expensive, and both at their real prices. What mattered more than the sort of wine was the price tag. The higher the price, the more people reported enjoying it, it's quality, etc. We expect a 100 dollar bottle to be great, and a 2 dollar bottle to be questionable so much that it takes amazing push to get over that hump.