JoNova

A science presenter, writer, speaker & former TV host; author of The Skeptic's Handbook (over 200,000 copies distributed & available in 15 languages).


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Shaking the foundation of medical research: Half of failed peer reviewed papers “spun” as success

Was that a half-truth or a lie by omission? Trick question…

Malcolm Kendrick reports on a new study that he says should “shake the foundations of medical research” but laments that it almost certainly won’t.

In the year 2000, the US National Heart Lung, and Blood Institute (NHLBI) insisted that all researchers register their “primary aim” and then later their “primary outcome” with clinicaltrials.gov. This one small change in the way medical studies were reported transformed the “success” rates in peer reviewed papers. Before 2000, fully 57% of studies found the success they said they were testing for, but after that, their success rate fell to to a dismal 8%.  When people didn’t have to declare what their aim was, they could fish through their results to find some positive, perhaps tangential association, and report that as if they had been investigating that effect all along. The negative results became invisible. If a diet, drug or treatment showed no benefit at all, or turned up bad results, nobody had to know.

The world of peer reviewed climate research: like a universe of dark matter

It’s not like climate science suffers from unpublished “negative results” — no, it’s more [...]

High risk for a heart attack? Might be better if your cardiologist is away at a conference

Researchers at Harvard wondered if high risk heart patients were more likely to die if they turned up at the hospital during national cardiology meetings when most of the experts are not around. Instead, it turns out that mortality rates during the conferences fell from 70% to 60%. Oops.

Who do you want to see if you’re sick? In this situation, possibly not your specialist.

High-risk patients with certain acute heart conditions are more likely to survive than other similar patients if they are admitted to the hospital during national cardiology meetings, when many cardiologists are away from their regular practices.

Sixty percent of patients with cardiac arrest who were admitted to a teaching hospital during the days when cardiologists were at scientific meetings died within 30 days, compared to 70 percent of patients who were admitted on non-meeting days.

“That’s a tremendous reduction in mortality, better than most of the medical interventions that exist to treat these conditions,” said study senior author Anupam Jena, assistant professor of health care policy at HMS, internist at Massachusetts General Hospital and faculty research fellow at the National Bureau of Economic Research. There is substantial ambiguity in how medical care [...]

The good news medical revolution — this week’s cancer breakthroughs

The word revolution is overused and done to death. But in the case of medicine, we are in the midst of one. Here are three stories just out this week. It’s possibly none of these will end up being useful clinically, but the sheer volume of results like these mean that sooner or later getting a diagnoses of cancer will mean something very different. It’s time for good news stories. Let’s redirect the gravy train of pointless climate and renewables research. (Sell the ABC and use the money to double our medical research budget. How many lives might we change?*)

These are not instant miracles, but potential ones. The bladder cancer drug ultimately helped about a quarter of all patients. It was a small trial. Two patients of 68 appeared to reach the holy grail: to be tested free of cancer (though it doesn’t mean they are).  The second news report talks about a small study targeting a similar mechanism to stop melanoma that only helps about 30% of patients — the study successfully predicted which ones. In both cases the idea is to stop the cancer from hiding from the immune system. Some cancer cells produce molecules called PD-1 [...]

Cutting calories can stop cancer cells from spreading

Something different to discuss – for the medical-revolution cynics among us. Cells from a human triple-negative breast cancer were implanted in mice under their mammary fat pads. Triple negative breast cancer is a nastier form of breast cancer which is harder to treat because these cells don’t respond to the usual anti-estrogenic drugs.

The mice were then allowed to eat only 70% as many calories as they would normally freely choose to eat.  This is a particularly interesting study because it shows that calorie restriction inhibited the expression of certain micro RNAs even from foreign (non mouse) implanted breast cancer cells, and this apparently kept the cancer from spreading. Notably fatalities from cancers don’t usually come from the initial solid tumor but from the metastasized version, so this is potentially very useful.

The mechanism involves strengthening the matrix around the cancer cells. When these cancer cells have metastasized they produce more of these particular micro RNA’s which in turn appear to stop production of proteins that strengthen the extracellular matrix. In other words, the cancer cells probably use the micro RNA’s to degrade the cellular matrix around them in order to spread. The implications of this are both that the [...]

A first: one patient’s widespread cancer treated with an engineered virus

Myeloma Cells | Wikimedia

This is another example of why I’m so passionate about getting research money out of dead-end efforts to change the weather and into medical research. The extraordinary news broke last week that the Mayo Clinic had used a genetically modified virus to cure treat one woman of metastasized and widely spread cancer – specifically myeloma. There are a lot of caveats, this research is quite risky, and it doesn’t apply to most people or most cancers, it is a proof of principle.

The potential for transformative medical breakthroughs is spectacular right now.  Medicine is, after all, just an information game. The information is expensive but the material resources are dirt cheap — all the answers to the holy grail of the fountain of health are found in rearrangements of common elements — like the kind found in the dirt of a pot-plant. For the first time humanity has the tools to hunt and hammer out the information. If people knew what glittering marvels were within reach, they surely would want to channel our best and brightest and all our spare resources.

The  main caveat here (a pretty big one) is that the trial had only [...]

Abbott takes Jo’s plan: dumps renewables, pumps medical research

Three years ago I made the case for dumping renewables, and doubling medical research — and both occurred in last night’s budget. (Yes, I hear the cry that this is just more big-government funded bad-science, bear with me, I’ll get to that). First let me bask in the glory (wink). 

I’m especially proud of the Op-Ed I wrote in The Weekend Australian in May 2011.  Indeed it’s very much my driving mission — to redirect corrupted and wasteful tax funds towards better uses, and to help four year olds with cancer, and all the other variants of human pain.

It’s big biccies… The Abbott Government is setting up a 20 billion dollar medical research future fund, which is expected to distribute $1 billion to research annually by 2022-23. It’s being claimed it is the largest in the world (I am not entirely convinced, but nonetheless, it’s radically big). We currently spend about $800m a year on medical research, so this would really double it. (Spooky).

But I can feel the barbs of skeptical libertarians already — saying the money should have been used to pay off the debt or returned to the people who earned it — and I’m sympathetic. [...]

There goes another consensus. Crash diets solve diabetes in 3 weeks

Sometimes the consensus deniers are right, which is exactly why the term is so pointless and so profoundly unscientific.

The medical associations were unequivocal. Crash diets were a fad, unhealthy, and only slow sensible weight loss could work. So millions of people were fed expensive drugs for decades, monitored, and some even given risky bariatric surgery. Patients with Type II diabetes were expected to be treated for years, or possibly the rest of their lives. Nearly a tenth of the national health budget of the UK was spent managing diabetes. Fully 8% of the population have the condition in the US.

Now a new (albeit very very small) study cured diabetes in some cases in as little as a week with a diet that was thought to be bad.

In the trial the very low calorie diet was done for 8 weeks. Sticking to 600 calories a day is not easy (some reports say it was 800 cals). It’s about a quarter of what a normal guy would eat. But it shrinks fat in the pancreas and liver, and that seemingly returns insulin levels to normal. The really amazing thing is that the benefits turn out to stay around far [...]

Consensus on human knee ligaments was wrong – new ligament found

How much don’t we know? This week doctors announce that yes, really, there is a whole ligament in the human knee that we didn’t know about, and it’s not a small one tucked away but a mid-size one and “hidden” on the outside of the knee. They’ve named it the anterolateral ligament (ALL), and it does matter if it fails, people’s knees collapse suddenly. “Only” 97% of people have one. But how is this, it was first postulated by a surgeon in 1879, and took 134 years to find. For much of that time you might have been told there was a consensus on knee anatomy, and because thousands of doctors have done knee surgery and knee replacements are now de rigeur, you might have thought the science was settled.

Sorry about the graphic photo, but when I saw that headline, I thought this would be a tiny artifact. You need to see it to appreciate just how remarkable it is that this has been missed for so long. UPDATE: It’s so remarkable, I find Chrism comments below are useful #5, #8, #12, and quite possibly the ligament was known by another name, or associated with a different malady. Is [...]

On climate change, the wrong choice kills people either way

Here’s a topic close to my heart. Before I became involved in climate change and currencies, my hot topic-of-choice for years was medical research and health. In my honours degree I worked to get a tiny step closer to treating Duchenne Muscular Dystrophy. When I saw that The Australian Government was threatening to cut medical research, I wanted to put a razor fine point on just what muddy thinking costs us. This article I wrote is published in The Weekend Australian today. We can’t afford to get the decision wrong on climate change. We must fight the battles that matter, not build fortresses against imaginary foes.

Wasting money on climate change betrays sick Joanne Nova From: The Australian May 07, 2011 12:00AM

LOST opportunities are invisible but deadly. On climate change, the call to buy insurance by pricing carbon is a cop-out. Where is the cost-benefit analysis? We’re thinking of axing Australian medical research yet we’re supporting solar panel manufacturers in China. It doesn’t have to be this way.

All the money spent employing green police, subsidizing solar or researching how to pump carbon dioxide underground is money not spent on medical research. Opportunity cost is a killer. [...]