Saturday, April 21, 2007

HRT now linked to ovarian cancer!

The drumbeat of the anti-HRT war grows louder. Yesterday HRT was accused of causing breast cancer. Today it is accused of causing ovarian cancer -- on equally frivolous grounds. A PDF of the full journal article in "Lancet" is here. I reproduce a media report of it below. Rather than adding to my own comments of yesterday, I follow the media report with a reproduction of Prof. Brignell's comment on the nonsense. Prof. Brignell is a mathematician who campaigns against the ignorant and malicious misuse of statistics

HORMONE replacement therapy, a contested treatment for post-menopausal women that has already been linked to breast cancer, is also associated with ovarian cancer, a study in The Lancet said today.

Women who take HRT are on average 20 per cent likelier to develop and die from ovarian cancer compared to women who have never been on this treatment, according to the research. The evidence comes from a major British investigation into female health, the Million Women Study, covering 1.3 million British women from 1996-2001.

HRT entails taking substitutes for oestrogen or progesterone after natural levels of these key female hormones diminish after menopause. The idea behind it is to reduce symptoms such as hot flushes and vaginal dryness and boost protection against osteoporosis and heart disease.

The British researchers assessed data from 948,000 post-menopausal women, who had been questioned and later given a follow-up exam some three years later. Around 30 per cent were current HRT users; 20 per cent had previously received HRT; and the remaining 50 per cent had never taken it. Across all three groups, a total of 2273 women developed cancer, and 1591 died from it.

The increased risk of cancer, though, was shouldered by current HRT users, especially those who had been taking the hormones for at least five years. The risk was largely unchanged by such factors as a smoking habit or past use of oral contraceptives. Women who had stopped HRT had the same risk level as counterparts who had never taken the treatment.

In a commentary, Steven Narod of the Women's College Research Institute in Toronto, Canada, said the relative risk of 20 per cent might be thought of as small, "but enormous numbers of women have been exposed." In the Million Women Study alone, nearly 500,000 had taken HRT, he pointed out. Extrapolated across the British population, around 1000 extra women died from ovarian cancer between 1991 and 2005 because of HRT.

The HRT link with breast cancer surfaced in 2002 [See my post of 14th. for a comment on THAT crap study], prompting many women in the US to drop the treatment - a trend that notably coincided with a sharp fall in new breast cancer cases in the US. The authors of the new study are led by Valerie Beral of the Cancer Research UK Epidemiology Unit in Oxford, Britain. The paper appears in next Saturday's issue of The Lancet. Beral says HRT's effect should be seen in the context of breast and endometrial (uterine wall) cancer, as well as ovarian cancers. These three types of tumour account for 40 per cent of all cancers diagnosed in British women. "The total incidence of these three cancers in the (Million Women Study) population is 63 per cent higher in current users of HRT than never-users," the study notes.


The empire strikes back

By John Brignell

Like the environmentalists, the epidemiologists do not like to have their hegemony over their corner of the media to be challenged. No sooner has their dangerous and destructive nonsense over breast cancer been thwarted than they come out with even more dangerous and destructive nonsense about ovarian cancer. Valerie Beral, a women noted for the size of her Trojan Numbers, has come out with a relative risk of 1.2.

There are at least two well known confounding factors to which such an observational study such as this are prey:

* If the therapy is successful then the patient will have a marked change of life style.
* The reasons for which the therapy was prescribed in the first place might well pose a risk factor.

The second of these can be eliminated in a properly conducted double-blind randomised trial, but the first cannot.

A personal anecdote will illustrate how this factor works. Last year your bending author was reduced to life as a housebound cripple by a marked increase in arthritic inflammation. Eventually, therapy with Diclofenac and Co-Codomol restored an element of normal living and the patient celebrated by going out and digging over a large allotment. In retrospect this was rather foolish, a such violent activity after a period of forced idleness would have exacerbated any incipient heart disease. Fortunately, survival indicates that there was none.

It seems, however, more likely that the second of these confounding factors would be more important in this case, but more haunting is the possibility of confounding factors we have not thought of.

Which words in the truism "Correlation is not Causation" do the epidemiologists not understand? There is no reason to suppose from these tacky observations that any women at all have been killed by HRT.

Is there anything more despicable than pinning your claim to fame on scaring millions of women out of using a hugely liberating therapy? As for Cancer UK, which we all know from the constant begging letters, it could put the product of its suppliance to better use by supporting science rather than nonsense.


Prof. Brignell is too contemptuous of the study to comment at length on it above but he is making essentially the same point that I do: The very low percentage of women apparently affected makes it highly likely that the result is random noise. That some of the results are statistically significant rules out only one source of random fluctuation -- small sample size. A large enough sample will make ANY observed effect statistically significant. Statistical significance does not and cannot rule out other random (or non-random) events, effects and influences.

Prof. Brignell has some links in his article that I have not reproduced above. See the original for those links

This whole anti-HRT campaign is quite despicable. It aims to get women to take large risks (of osteoporosis etc.) in order to avoid tiny risks (of cancer)

Leftist politicians are making Britain's troops into wimps

During one of Britain's 19th century wars with China a British soldier in a force under Lord Elgin was captured by the Chinese and beheaded for refusing to Kow-Tow... The incident was in quite a contrast to the story of the British sailors and marines captured by Iran, admitting everything, and released flourishing gifts from Mr. Ahmadinejad. One of them told a press conference that he had cried himself to sleep after his captors cruelly called him "Mr. Bean" and took away the iPod which he had carried on a combat mission. The sailor said he also cried when he was reunited with the only female captive, Faye Turney. He further complained about the quality of the presents which the Iranians gave them when they were released.

I don't think that it's for me, who has never experienced such an ordeal, to blame him or any of them for being terrified. Possibly there were visions of years in an Iranian prison, lynching by fanatical mobs or videotaped beheadings in their minds. Further, we don't know what instructions they had been given on how to behave in such a situation -- possibly to co-operate with their captors and not provoke them or do anything to make the situation worse.

But to talk this way after release -- as well as two of them rushing to sell their stories to the media (the Ministry of Defense later changed its mind about permitting this, but that it was considered at all suggests the Government knows nothing about the ethos of the fighting services) -- seems a bit much to stomach. Surely even in a modern, politically correct Navy there is still dignity.

Anyway, one of Britain's most respected senior officers, General Sir Michael Rose, who led the UN force in Bosnia, is someone qualified by personal experience to comment. And he has claimed the incident has shown that the Royal Navy is no longer fit for modern warfare. The sailors failed to fight back, and behaved as though they were on a Mediterranean cruise, he said. The entire ethos of the military had been undermined:

"Nelson said that no captain could ever be criticized for laying his ship along the enemy and engaging him. We didn't quite get that here. There were junior soldiers in the Second World War who resisted heroically, in far worse circumstances, or in the Falkland Islands. What made young men in the Scots Guards or the Paras. charge with bayonets in the middle of the night when they had run out of ammunition, against enemy machine guns?"

General Rose appears to blame the Iraq war, and in this I disagree with him. Things started much earlier than that. Since before the Blair government took office -- and despite that government's willingness to commit the armed forces for war service -- there have been reports of a stream of initiatives forcing Political Correctness on the forces (combined with shortcomings in equipment, pay, housing and other support) that can only damage or destroy their traditions and morale. Here are a few examples: In 2004 it was reported that a Royal Navy ship, HMS Cumberland, in deference to the political correctness of Blair's Britain, had installed a Satanist chapel on board for the benefit of a Satanist crewman, a spokesman claiming: "The Royal Navy is an equal employer organization."

The Army set up a special school at Lichfield to teach drill-sergeants to be nicer to recruits. Shouting at recruits was banned, leading one 17-year-old to ask: "If Army recruits can't handle being shouted at by drill sergeants, how are they going to cope with the noise of gunfire or the screams of casualties?"

In 2001 women in the British armed forces were receiving breast implants at taxpayers' expense (costing about US $8,000 a pair) at make them "happier soldiers." If they were taken prisoner it might well make their captors happier soldiers too. Other service personnel had liposuction rather than route-marches to remove excess fat. Colonel Bob Stewart, DSO, former commander of the British forces in Bosnia, after pointing out that money needed to be spent on things like better guns and radios, said:

"Anyone who is so fixated about their breast size or so emotionally troubled about their gender has absolutely no place in a fighting army....The ideal soldier is physically tough and mentally balanced, so a serviceman who needs liposuction or a sex-change is in the wrong job. And, dare I ask, how a female soldier, who is so distressed by remarks about her appearance that she had to resort to implants, would cope under fire?"

At the Pirbright Depot, training-ground of the Guards Brigade and famous for producing some of the finest soldiers in the world, trainees were issued with red and yellow cards. Should they pull out a yellow card, it would show their drill sergeants they were upset and should be left alone for 15 minutes while their delicate nerves recovered from the shock of being shouted at. Should they be really upset and pull a red card, the drill sergeant would have to explain his behavior to a superior officer.

It was forecast that soldiers would be allowed to sue officers for giving the wrong orders, in accord with the European Convention on Human Rights. Eight other countries, from Russia to Liechtenstein, had asked for their armed forces to be exempt. General Sir Peter de la Billiere said that this was almost impossible to believe and that he could think of no decision that would do more to damage morale and discipline.

General Sir Charles Guthrie said the "creeping advance" of health and safety legislation in the armed forces might be creating a climate of "risk aversion" and future soldiers might be able to sue the army for putting them in risky situations.

A "task force" was reported to be investigating whether anti-discrimination legislation would mean disabled people would be taken into the forces -- leading to one cynical observation that blind paratroops would know to pull the ripcord when their guide dogs' leads went slack. One serviceman who quit the Royal Marines in disgust wrote:

"The government's obsession with political correctness has been applied to the military with such relish that at times it seems almost insane. I have lost count of the number of forms I have had to fill in giving details of my ethnic origin. These forms used to be anonymous, but the last one I had to complete carried my name, rank and service number. Perhaps this was a reaction to an earlier (anonymous) form, which had revealed that in our all-male unit there was a huge number of Bangladeshi single mothers. There was always a great reluctance to fill in these forms, the fear being that anonymity had been removed so that the government could check how many members of ethnic minorities were being promoted. In response, the military chain of command offered soldiers an inducement: if they did not complete the forms correctly, without jokes, on a Friday afternoon, they would remain in barracks for the weekend and fill them in at their leisure. No doubt that's what New Labour means when it talks about being 'investors in people'.... I would have felt a lot more 'invested in' had I been sent on operations with a gun that worked properly."

He continued, regarding the application of health-and-safety standards to training:

"The steep ravines worn into the slopes that recruits had to run up and down at various points on the seven-mile course were also contrary to all sorts of well-meaning legislation. The recommendation was for proper steps and handrails to be installed -- just like the ones you find in the mountains of Afghanistan or the wadis of Iraq."

Possibly the British sailors taken prisoner by Iran were simply following orders. It may have been just one of those things, and will be soon forgotten: all wars are full of SNAFUs and aberrant incidents. During World War II a British Admiral and former head of Naval Intelligence, Sir Barry Domville, was imprisoned as a security risk, but that did not mean the Royal Navy's traditions were crumbling. But the whole thing at present looks like political correctness coming home to roost. I doubt the sailors can be blamed: the fault is at a much higher level.


British jailbirds treated better than retirees

Michael Sams, who murdered the teenage prostitute Julie Dart and kidnapped the estate agent Stephanie Slater before imprisoning her in a coffin, has boasted that he is better off in jail than living as a pensioner on the outside. Sams, 65, who is serving four life sentences at Whitemoor prison, Cambridgeshire, wrote to Inside Time, a newspaper for prisoners, in response to a campaign for inmates to be allowed their state pensions.

"How many pensioners in the community, who are totally dependent on the basic state pension and live in rented accommodation, are able to spend around œ20 per week on luxuries?" the former tool repairer asked. "Most struggle to keep warm in winter, afraid to put the heating on, barely eating, let alone getting three square (ready-made) meals per day. And three or four choices per course at that! "Free access to the gym each day to keep those joints supple and no bills except for 1 pound per week TV rental. "Have you ever seen an OAP inmate in tatty clothes or scruffy trainers? Not a hope! Materially, we OAPs in prison are far better off than those in the community."

He opposed the campaign to give inmates a pension, but was in favour of allowing retirement-age prisoners who are unable to work the same weekly amount as those who can. He also advised younger criminals to invest their "gains" in a private pension so that when they "retired" in prison they would have a steady income.

Sams was jailed for life after his wife recognised a recording of his voice played on the BBC Crimewatch programme. The killer, from Sutton on Trent, Nottinghamshire, pleaded guilty in 1993 at Nottingham Crown Court to kidnapping Miss Slater, 25, in January 1992, to false imprisonment and to demanding a 175,000 ransom for her. He denied kidnapping Miss Dart, 18, from Leeds, in July 1991. He also denied murdering her, making two demands for a 140,000 ransom and blackmailing British Rail for 200,000 by threatening to derail a train, but was convicted.

Mervyn Kohler, spokesman for Help the Aged, said yesterday: "In material terms, Mr Sams is probably absolutely right. But there's one small shortfall here. Given the choice, I'd much rather be outside than inside." Norman Brennan, founder of the Victims of Crime Trust, said that he was appalled by Sams's claims. "I think the whole country is sick to death of listening to the bleeding hearts and hearing about the human rights and civil liberties of those who have committed the most appalling crimes," he said. A spokesman for Inside Time said: "Michael Sams is of course fully entitled to his opinion but I have to tell him that . . . he is very much in a minority of one. "We remain firmly of the opinion that it is morally wrong to deny state pension benefits to serving prisoners."


NHS care 'left to student nurses'

Lives are being put at risk because student nurses are being left on their own with patients, a study has claimed. A poll by the Royal College of Nursing of 1,500 student nurses found nearly half had been left unattended with patients without warning. Guidelines say student nurses should always be monitored except those in their final year and even that has to be prearranged. The government said patient safety was of "paramount importance".

The survey showed 44% of student nurses had been left unattended without warning and without a doctor or qualified nurse present. Eight in 10 of those said it had happened on at least three occasions. Of the 553 first-year students questioned, 42% said they had been left on their own. And 15% said they had witnessed adverse events while left unattended. But 84% said they did not report that they were left unsupervised.

Gill Robertson, the RCN's student nurses adviser, said there were reports of students just eight weeks into their training being left alone. She said this could happen on surgical wards and other areas of a hospital where patients were extremely ill. "That is like the average person being left with a patient. It should not be happening and is a risk to patient care."

She added nurses were being stretched because of the cuts being made - the RCN estimates over 22,000 health staff posts have been lost in the last 18 months. And another survey of nurses working in 173 hospital wards revealed a third of nurses thought patient care was being compromised on each shift because of reduced staffing.

RCN general secretary Peter Carter agreed the financial problems in the NHS were to blame for the problem. "Those registered nurses left have to do ever more with even fewer resources." Mr Carter also said he was concerned by the reports of student nurses not being able to get jobs once they had qualified. "I am hearing worrying stories from nurses who qualified last September who are still unable to get jobs because trusts are freezing entry levels posts to save money."

Health Minister Lord Hunt said: "Patient safety is of paramount importance to the government and NHS staff alike. "We would expect any nurse, whether in training or in practice, to report any incident they feel has an adverse effect on patient safety." Liberal Democrat health spokesman Norman Lamb said: "This is extremely worrying - patients' lives could be at risk. "The damaging deficits in the health service not only result in job losses but have a serious impact on the remaining workforce."


NHS bungles pay deal -- more pay for less work

A pay deal that gave hospital consultants [senior doctors] a salary increase of 25 per cent left them working shorter hours and treating fewer patients, the National Audit Office has found. It says that the consultants deserved more money, but it was regrettable that the public and the NHS had not seen benefits in greater productivity and better services.

The contract, agreed in 2003, cost œ715 million in the first three years - œ150 million more than the Department of Health estimated. In that time the average consultant's pay rose to œ110,000 a year while the average number of hours worked fell from 51.6 a week to 50.2. Although there was an 11.3 per cent increase in the number of consultants working in the NHS in the two years after the agreement, the amount of consultant-led activity increased by only 4 per cent. "The bottom line is that the Department of Health has increased consultants' salaries without demonstrating any extra productivity in return," said Edward Leigh, MP, chairman of the Commons Public Accounts Committee, to which the audit office reports. "This is one more example of weak financial management by the Department of Health. It drove through the new pay deal with scant regard for proper evidence and solid financial forecasting."

Sir John Bourn, the Comptroller and Auditor-General and head of the National Audit Office, said: "Consultants deserve to be paid properly for the work that they do. However, the new contract was introduced to benefit not only consultants but patients and the health service in general. "Although a new contract was needed, it is regrettable that the costs are higher than expected and that we are not yet seeing any clear evidence of improvements in productivity or services for patients."

In negotiating the contract, the department used out-of-date information on the hours that consultants actually worked. In spite of evidence that the average was between 50 and 52 hours a week, the department worked on the assumption that it was 47 hours. It then agreed a contract with the British Medical Association that was based on an average of 43 hours a week. In fact, consultants continued to work much longer hours than these, and under the new contract were paid for them. As a result, the contract cost œ150 million more than the department expected.

Lord Hunt, the Health Minister, said: "The new arrangements reward and incentivise consultants who make the biggest contribution to service delivery and improving health services. This has helped us to recruit and retain highly skilled consultants, historically a challenge for the NHS. We now have low vacancy rates - fewer than 2 per cent - and more than 10,000 more consultants working in the NHS than when the Government came to power."

Andrew Lansley, the Shadow Health Secretary, said: "This confirms that the Government simply didn't understand what consultants were doing before they made assumptions about the new contract."


Polygamous husbands settling in Britain with multiple wives can claim extra benefits: "Polygamous husbands settling in Britain with multiple wives can claim extra benefits for their "harems" even though bigamy is a crime in the UK, it has emerged. Opposition MPs are demanding an urgent change in the law, claiming that the Government is recognising and rewarding a custom which has no legal status and which is "alien" to this country's cultural traditions.... Officials said yesterday a review was now under way into whether the state should continue to pay out income support, jobseeker's allowance and housing and council tax benefits to 'extra' spouses."

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