statistical difficulties

[miriam_e]

In a couple of places recently I've read the uncritical statement that caffeine and nicotine have some apparent protective effect against alzheimers. I find this difficult to believe. I have seen spurious statistical effects before and have to wonder if this is another. Did study control for the number of people killed by cigarettes and coffee? If people die earlier from cigarettes then a younger, intrinsically more resilient group will remain, who may well be less likely to get alzheimers, but not because nicotine protects; it would be simply that the cigarettes had already killed the most susceptible.

I know people are fond of saying that caffeine is safe, but I frankly don't believe it (to my shame I do drink caffeine). When I was a kid I embarked on an experiment with a friend at school to mutate fruit flies by feeding caffeine to them. Doesn't sound like a safe substance to me. Doesn't it strike anybody else as odd that caffeine producing plants are rendered fairly safe from pests. Why would that be do you suppose? Perhaps the insects are, in a sense, smarter than we are. I am almost willing to bet that some day in the future we will find that caffeine has been afflicting society with massive health problems that we have been studiously ignoring, just as we did for so long with cigarettes, and still do to some degree with alcohol.

Comments

[dorjejaguar.livejournal.com]

I seem to remember hearing about some study that nicotine protects from parkinsons.
Also I've heard of numerous studies that show multiple benefits from moderate alcoholic beverage consumption.

Personally I can drink tea but if I drink coffee is fucks up my blood sugar. It's too much for me, however I know people that feel nothing but positive effect from coffee.
Also there's that nice constipation relieving effect it has.

Strait caffeine and strait nicotine, pure alcohol, I've no doubt can be harsh but I don't see why there can't be benefit from substances that contain these things.

Why do you feel so sure there isn't? Or is it just the protective effect against Alzheimers that you don't believe?

Personally I'm of the opinion that Alheimers is usually either poisoning or mad cow disease. Side effects or toxicity of numerous drugs could account for the dementia and aluminum in the brain could too.
I used to work with very old people and it never ceased to amaze me that the weren't prescribed vitamins or herbal remedies that have been shown to work but they were prescribed more and more drugs. Most of the time they just assume it's alzheimers if there is dementia. Which personally I think is cruel.

[miriam-e.livejournal.com]

I should emphasise that while I seriously doubt the reports of benefits from these drugs, that doesn't mean I think there could never be any benefit from them. Subtle, but important distinction.

My doubt comes from two main things.

Firstly, the only way to find out about the effect on alzheimers is through epidemiological studies. That is, statistics -- counting numbers of people with and without alzheimers, what drugs and foods they consume and in what quantities, how much exercise they indulge in, what kind of environments they are exposed to, how much they read or use their minds in hobbies, how happy they are, how many friends they have, what diseases they've been exposed to, and so on. Disentangling all these strands is a nightmare. But more treacherous is the way unexpected spurious results can pop up. If cigarettes tend to kill people in such a study then there may well appear to be fewer smokers with alzheimers at the end because the younger, more resilient ones will remain who could be less susceptible to alzheimers. If caffeine causes a similar culling of people with incipient heart problems then the same kind of effect may show. There are other possible complications. If we find that alheimers is connected somehow with diet (I'm not suggesting it is, I'm simply making a random argument to illustrate the complications) then anything which causes people to eat less might show a "protective" effect, and nicotine and caffeine both reduce appetite.

You would think that researchers would take account of all these effects, but you'd be wrong. Not only is it pretty-much impossible to guarantee that all bases are covered, but also some research is actually surprisingly sloppy. I've been reading scientific literature for most of my life and I've seen oodles of cases where researchers made quite superficial analyses of their data. Far too often the conclusions would be utterly misleading. There are many conscientious researchers out there who are very careful in there work, but there is also a lot of money to be made by pandering to lucrative drug markets... and cigarettes and caffeine are two of the most profitable.

And that is the other thing that makes me doubt these reports. Money. I don't necessarily think the researchers are corrupt (though some certainly are). They could do good and honest work, but the news media is funded by advertising and more subtle forms of self-interested bias. A reporter who has a drinking problem will be delighted to make a big splash with a news item that might show some tenuous "protective" effect of alcohol, while disregarding all the population studies that show the longest lived segment of western society tends to be Seventh Day Adventists... who don't drink alcohol. Here's another example. Remember all those reports of the health benefits of vegetable oils back in the early 70s? That was just when margarine makers were boosting their products onto the market in a big way. Now we find vegetable oils are not the beneficial products they were made out to be. I'm pretty convinced money is the main reason they were promoted so heavily. We seem to be seeing the same kind of heavily marketed reports about the benefits of fish oils at the moment. I tended to think they were genuine until I noticed how heavily they are being pushed. Now I am extremely suspicious of them.

(I'm too long-winded and had to break this comment in two. Sorry.)

[dorjejaguar.livejournal.com]

I understand the culling effect that may not be accounted for.
I actually wouldn't think that researchers would take all these things into account because as you say, it's damn near impossible. I've seen sloppy research too, I've seen research slanted towards a desired end. And yes, whose funding it may make a difference.

Seventh Day Adventists are also vegetarians, right?

I've started to get real suspicious of things that are heavily pushed as well. Like soy for example or agave syrup. Or milk, that's another one. That used to be pushed real hard.

About aluminum, I read somewhere that fluoride helps it cross into the brain. They often put it in our water here and most toothpastes have fluoride in it along with a poison warning. "Hey brush your teeth with this but don't swallow it and if you do call the poison control center immediately!". Nice.

Hmm, cell suicide... could be.

Imagining the Romans... I can see it, how could they know, especially once they'd been drinking the water. But mostly they drank the wine, right?

While I worked taking care of older people I got a first hand look at how they're treated. Even with me giving the best care I could, there was so much more that could have been done better that I really couldn't affect (though I wanted to).

Personally I think smoking is a bad for health overall. Breathing smoke, generally not good (unless it's incense) and inhaling the chemicals they put in most cigs, really not good. That seems pretty obvious. But it may still be that nicotine could have a positive effect in some ways, in some situations.

As for alcohol, well that really depends. If the moment one quits drinking they need to sign up for an anti-anxiety med when previously a couple or few drinks put it right, well then alcohol is filling a need fairly safely. If one tends to get drunk and kick the dog or worse, that's different.
Hell if a couple or few drinks doesn't seem to be filling a need or harming anything but it's just a preference I can't see anything wrong with that either. I don't see why one should have to consult the research to make such a decision. It should be pretty obvious if harm is being done or not.
As you say research is very often very flawed. And even if it isn't personal freedom matters.

And caffeine, well I don't know. But I do know I have experienced evil evil withdrawals from coffee addiction so I know what you're talking about there.
I do have green tea every day but strangely no matter how long I wait to have it I never get a headache.
Maybe if you want to quit the coffee you can prepare yourself by substituting some green tea and having ibuprofen at the ready to take the edge off that headache.
If you wanta quit the tea too, that'll probably be easier than quitting coffee.
Keeping the tea ritual might help you wake up *because* it's a ritual.

I personally am wary of puritan ideals in general, especially when they masquerade as research conclusions. One shouldn't have to feel ashamed for liking coffee, tea, marijuana, alcohol, opium, or various hallucinogens (or cigarettes for that matter even if I think they're nasty). Shame has a way of making people want to get drunk. And that doesn't help.
Pleasure really is a good thing. Yes it has risks. Everything does.
I do think pleasure negative ideals are a factor that can mess with research, just like the desires and beliefs of the funders of the research or of the researchers themselves can.

I only bring it up because we're talking about substances that we generally tend to believe feel good to us.

Which reminds me, have you seen this?: http://www.ted.com/talks/view/id/252

By the way, I don't mind you being long winded. You're always thoughtful, and that's nice. :)

[miriam-e.livejournal.com]

A lot of great points here, as usual from you. :)
My apologies for taking so long to reply. Been busy, and then yesterday was taken down by a day of searing headache... I think I forgot to have my blasted caffeine. :(

Not sure if Seventh Day adventists are vegetarian or not. I don't know a lot about that loony branch of religion, though I had a friend who I greatly admired who was (probably still is) Seventh Day Adventist. If they are then that would tangle up the longevity studies still further. I don't think they drink coffee either.

Hmmm... I hadn't heard that about fluoride facilitating aluminium's access to the brain. That's a worry. Most of Australia's water has been forcibly fluoridated. Queensland, where I live is one of the few hold-out states, though it wouldn't affect me directly even if they adopted fluoridation (the damn politicians are pushing for it here as well). I am on rain-tank and well water. I've been meaning to scan and OCR a Scientific American article on flouride. I'll post here when I have.

The Romans... their wine was in lead-lined containers too, and I think they lined their aqueducts with lead also, so it wasn't just the rich who got poisoned. The thought of this blunder is one of the things that scares so many people about fluoride now.

There is a possibility that nicotine could have positive effects, though I would be very surprised. If there was some, no matter how small I think the tobacco lobby would be singing about it very loudly. Anyway, it would need to be lavishly proven to me. As you say, the down-sides to smoking are too many to warrant its use, even if nicotine did show some benefit. I'm also wary of incense. The smoke is still mostly tiny soot particles that can damage lungs -- it is sweet-smelling danger. :)

The anti-tension qualities of alcohol... There are a couple of problems here. One is that any addictive drug, alcohol included, tends to cause the very problem that one takes to treat. In the short term alcohol may relax, but in the longer term causes more tension, which heightens the need to relax. Without it the person would likely not need the alcohol to relax anyway. The other problem is that humans have been drinking it since there were humans. It has become a part of who we are, and separating it out is not as simple as my statements might suggest. It is easy for me. I hate the stuff, but for one of my old girlfriends it was different. I don't know if she could manage without it. Perhaps it helped... I don't know. It eventually killed her, but her normal reaction to alcohol was utterly different to mine. I wouldn't be surprised if she had a physiological need for the stuff. In the middle ages alcoholic beverages were, I have read, linked to survival because contaminated water was so widespread. Brewed drinks guaranteed purity. I would not be surprised if some special ability to deal with alcohol grew out of that in some people... and perhaps even dependence. Who knows? I am just very wary of addictive substances.

I totally agree that shame is a terrible way to view drug use, and I think that's the main reason for the utter failure of the "war of drugs". I see it as a matter of practicality. If a drug can do something useful then okay, but the minute it stops being useful then it just makes good sense not to use it. It isn't a case of morality. I know someone who has had something of a battle with alcohol. I chat with her from time to time about it, but I stress to her that she shouldn't give up for moral reasons. She should stop because of the damage to her relationships, but only if she decides to. Other people can't really tell her what to do.

Puritanism is a really dangerous thing. It is worse because it can be so easily disguised as the sensible thing to do, but it makes for great intolerance.

Thanks for the pointer to the Dean Ornish talk... downloading now.

[dorjejaguar.livejournal.com]

Ugh, I'm sorry bout the withdrawal headache. Those suck.

Poor Romans with the lead in the wine. That's kinda sad.

I'm real glad you have a non fluoridated water source. That's awesome.
It's so weird that anyone would push fluoridation. What are the politicians getting out of that?
I seem to remember reading that it was outlawed in Europe though I could be wrong.
By far the biggest source has to be from toothpaste and people are shoving that right in their mouth.

The incense personally just gives me too much happy to not risk. I'm picky about the kind though I know it's all smoke. It just has a way of lifting my mood, kinda like the scent of flowers does. :)

All you say about alcohol, yah I've thought of, do think of. I wonder how much it's hardwired for some of us, I wonder how much we foster our own dependence. I hope humans can let go of the puritan shaming that often surrounds the subject. It only muddies the waters.
I've got a lot of questions about my own use and humans use of it in general.
In a lot of ways they are the same questions I have about meat. I've a lot of questions there too.

What were you referring to way back there when you mentioned the vegetable oils? I hadn't heard anything recent about them being not good. Just the normal trans fats and hydrogenated ones being bad thing.

I'd love to see that "war on drugs" disappear. The money could be used for such better purposes. Like education, health care, research, paying down the national dept, environmental protection, etc....

If we survive I wonder what the state of our knowledge will be in 500 years.
We're such babes in the woods still.

[miriam-e.livejournal.com]

I think the politicians feel they have to be seen to do stuff. It doesn't matter much whether it is truly good. I think it is the visibility that matters, like putting up statues to themselves. They keep wanting to bring daylight saving in to Queensland too, even though numerous surveys have shown most people don't want it, and scientific studies show that it wastes energy and doesn't get people more time. So it is with fluoridation, but perhaps with a subtle twist. It's my understanding that the soft drink and candy manufacturers and the aluminium industry want fluoridation. The sugar people, because it would remove one constraint on feeding their products to people because teeth would be more resistant. The aluminium industry wants it because they previously had to pay to get rid of the fluoride byproduct of aluminium refinery. Now they get paid by the government to dump it in our water. So I think the fluoride issue is not simply a matter of politicians wanting to be seen to do something; there is some corruption there too.

I burn incense occasionally too. It is nice. Even a tiny amount of it can alter moods without filling a room with a smoggy haze.

The vegetable oils... they were part of a very big campaign back in, I think it was the late 60s early 70s. I've always been very suspicious of that because nobody ever seemed to be able to point to actual facts, and it coincided too well with the explosion of margarine manufacturers and cooking oils. Now we are finding that they don't have the great advantages they were promoted for. I've often wondered if it was that decision-makers suddenly realised how much DDT was in animal fat and what a danger it posed to the entire population, but to scare people away from DDT would have hurt the chemical industries. Much better to sell them something new. I may be wrong in this, and expect I'll never know... but I shall always wonder.

We truly are still in our infancy. I'd love to be able to see where we will be in 500 years... if we survive the next few decades, that is.

I've been following some of Sam Harris' interest in trying to get a science of morality established. It seems to me that if he gets his way we may vastly accelerate our ability to do good. That would be soooo wonderful to see.

[dorjejaguar.livejournal.com]

Hmm, yah, you're probably right about the politicians motivations. I find it difficult to fathom some of their actions.
Well goodness, now I'm questioning the vegetable oil thing. Although it hardly matters, I gotta put something in the pan when I'm cooking and I favor at least a bit of fat for the taste.

I don't know about this Sam Harris person. Who is he?

[miriam-e.livejournal.com]

Sam Harris? :)
I'd been wondering whether to write more about his latest exploits here. I think you've just decided me. :)

[dorjejaguar.livejournal.com]

Yay! I am looking forward to it. :)

[miriam-e.livejournal.com]

Gosh. I just watched another Dean Ornish talk on TED. I kept thinking of you while watching it. It is a brilliant talk and I'll be showing it to a number of my friends.
http://www.ted.com/talks/lang/eng/dean_ornish_on_healing.html
or to download it:
http://www.ted.com/talks/download/video/3247/talk/377

[dorjejaguar.livejournal.com]

:) Thank you. Yup, his stuff is lovely.

[miriam-e.livejournal.com]

Ummm... you may be right. I may be getting a little mixed up and the report on nicotine may have concerned parkinsons. My points would still hold though. I'd have to see really carefully prepared figures to believe they'd disentangled all the complicating factors properly... and I actually don't think any analysis is really capable of doing that yet.

As to what alzheimers really is... that seems less and less sure. I used to favor the idea that aluminium toxicity was involved. It still bothers me to the extent that I don't use any aluminium cookware. And prion infection (mad cow) is almost certain to cause some of the cases. But for the bulk of cases, nowadays I tend to lean towards the idea of some kind of infection causing the body to attack itself, similar to how some autoimmune diseases may work. I don't think the immune system is allowed in the brain, but there are still protective methods the brain uses against infection, not least of which is apoptosis -- cell suicide.

However, in the end I really have to admit that I just don't know. I'm not really attached to this or any other explanation, and will be delighted when the puzzle is finally solved. I bet it ends up being something nobody was expecting, but really obvious when all the clues are laid bare. We'll all look at it and say, "How did nobody see this?" (Imagine the Romans and their lead-lined water storage.)

How we treat people with alzheimers and other long-term problems can be terrible. Our over-reliance on drug quick-fixes is awful. My own feeling is that it won't improve a lot till we have personal robots to help us. It is coming, but is still a little way off. Damn.

Decades ago I heard a talk by a guy who was a doctor at a nursing home who insisted that many cases of "dementia" were actually confusion resulting from low fluid intake. As we get older our regulatory mechanisms (temperature control, appetite, thirst) fade. He said that giving people water instead of diuretic drinks like tea and coffee at this home made a major improvement to their lives. (Knowing how addicted to their tea and coffee some people are I bet they were not happy about it.) I don't know how correct he was, but I have noticed my Dad tends not to drink much water unless Mum pushes him to. And dehydration does lead to confusion.