Sunday, May 17, 2009

Health and global warming: More dishonesty from Lancet

On anything with political implications, Lancet has been a Left-wing propaganda sheet for a long time -- and many of its purely medical articles draw unsustainable conclusions too -- as I often set out in FOOD & HEALTH SKEPTIC

Is a major new report about “the health effects of climate change” that describes “Climate” as the “biggest health threat” for the 21st century actually based upon a convenient forgetfulness of parts of the literature, and the scientific equivalent of chinese whispers? It may never be possible to answer that question in full and in full confidence. But there is one interesting, major detail that relates to something I just blogged about.
Today (May 14) the “Lancet and University College London Institute for Global Health Commission” launched a report titled “Managing the health effects of climate change” (Lancet 2009; 373: 1693–733).

I looked at the report in terms of cold- and warm-weather related deaths and this is what I have found: The Lancet/UCL 2009 report’s claim that warming is worse than cooling is based on a single book chapter from 2003 that forgets to mention two very relevant articles; and that disregards exactly the effect used in one of those two articles to demonstrate that cooling is worse than warming.

Here’s how I started: having had read that at least in Europe, cooling kills more than warming, I looked with interest for any mention of that aspect in the report. My search brought me to page 9:
From a conservative perspective, although a minority of populations might experience health benefits (mostly related to a reduction in disease related to cold weather), the global burden of disease and premature death is expected to increase progressively.(ref. 16)

That looked like a peculiar statement indeed: sporting a reference to “health benefits” for the few (all of them, in Europe?), but suddenly making warming a bigger killer than cooling on a global scale. When was all of that discovered, I wondered? Thankfully, I could find reference 16 on the web:

16. Campbell-Lendrum DH, Corvalán CF, Prüss Ustün A. How much disease could climate change cause? In: McMichael AJ, Campbell-Lendrum DH, Corvalan CF, et al, eds. Climate change and human health: risks and responses. Geneva: WHO, 2003.

Relevant quotes from Campbell-Lendrum DH et al. (curiously, again from page 9):
[...] Direct physiological effects of heat and cold on cardiovascular mortality – Strength of evidence

The association between daily variation in meteorological conditions and mortality has been described in numerous studies from a wide range of populations in temperate climates (16, 17). These studies show that exposure to temperatures at either side of a “comfort range” is associated with an increased risk of (mainly cardio-pulmonary) mortality.

Given the limited number of studies on which to base global predictions, quantitative estimates are presented only for the best supported of the direct physiological effects of climate change—changes in mortality attributable to extreme temperature for one or several days. For cold and temperate regions, a relationship from a published study was used (24) [...]

The mystery was just deepening, with people suddenly dying not because of warmth or cold, but due to daily meteorological changes, and in particular because of “exposure to temperatures” outside of a “comfort range”. It was time then to take a look at what those numerical references were about:

16. Alderson, M.R. Season and mortality. Health Trends 17: 87–96 (1985).

17. Green, M.S. et al. Excess winter-mortality from ischaemic heart disease and stroke during colder and warmer years in Israel. European Journal of Public Health 4: 3–11 (1994).

24. Kunst, A. et al. Outdoor air temperature and mortality in the Netherlands—a time series analysis. American Journal of Epidemiology 137(3): 331–341 (1993).

And what was even more notable were the “forgotten” references:

Keatinge, W.R. et al., Heat related mortality in warm and cold regions of Europe: observational study. BMJ 2000;321:670-673 ( 16 September )

Donaldson, G.C. and Keatinge, W.R. Excess winter mortality: influenza or cold stress? Observational study. BMJ 2002;324:89-90 ( 12 January )

In summary: the Lancet/UCL 2009 report claims warming is worse than cooling on the basis of a single book chapter from 2003 that mentions: a very old article from 1985; a 1993 research on Israel; a single 1994 article about the Netherlands to represent “cold and temperate regions“.

And that very same single book chapter avoids any reference to two much more recent works, from 2000 and 2002, covering the whole of Europe, and pointing in the direction of…cooling being worse than warming.

The “forgotten references” from 2002 may as well have been unknown to the authors of the 2003 book chapter. But that is no excuse for the authors of the 2009 report. Also, the fact that those articles were forgotten is obviously due to pure chance: because otherwise, it would be an unfortunate case of “foul play in citation“, a.k.a.“bibliographic negligence” or “citation amnesia“. [Omitting mention of "inconvenient" references is sadly all too common in every scientific literature I know -- JR]

But that was not all. Here a bit more from Campbell-Lendrum DH et al. (2003):
There also is evidence for a “harvesting effect”, i.e. a period of unusually lower mortality following an extreme temperature period. This indicates that in some cases extreme temperatures advance the deaths of vulnerable people by a relatively short period, rather than killing people who would otherwise have lived to average life expectancy. However, this effect has not been quantified for temperature exposures and is not included in the model. As there is large uncertainty about the number of years that the casualties would have lived (i.e. the attributable years which are lost by exposure to the risk factor) the relative risk estimates will be used to calculate only attributable deaths, not DALYs. [...]

That is not the way Keatinge WR et al (2000) presented their results three years before:
Some of those who died in the heat may not have lived long if a heat wave had not occurred. Mortality often falls below baseline for several days after the end of a heat wave, and this has been interpreted as indicating that some of the people dying during the heat wave were already close to death.

[...] Falls in temperature in winter are closely followed by increased mortality, with characteristic time courses for different causes of death. The increases are of sufficient size to account for the overall increase in mortality in winter, suggesting that most excess winter deaths are due to relatively direct effects of cold on the population.“

Campbell-Lendrum DH et al. (2003) may as well have had a disagreement with Keatinge WR et al (2000): but if that were the case, they should have referenced to it and discussed however briefly the reasons for their disagreement. And of course the authors of the 2009 report should have included some remarks on why they would care not a bit about the “harvesting effect”, since the…effect of that effect directly relates to people’s health (well, it kills them…)

In summary: the Lancet/UCL 2009 report claims warming is worse than cooling on the basis of a single book chapter from 2003 that disregards the “harvesting effect”, the very same effect used in a 2000 article to demonstrate that cooling is worse than warming.

It looks as if the information was available out there, but reached the authors of the 2009 report distorted by the opinion of the 2003 book chapter’s authors . One may be forgiven to equate that with a game of..Chinese whispers (a.k.a. Telephone)!

Obviously there are so many claims one can investigate. But the fact that I was able in a few minutes to identify what are potentially major flaws in the estimation of the net benefits of CO2, suggests that more problems may lurk somewhere else, in the Lancet/UCL report.


NHS GP told family of meningitis death mother to 'stop fussing' three days before she died

Rushed consultation means that obvious syndrome was missed. People are just cattle to government doctors

A mother-of-two died from meningitis three days after a GP told her worried family to 'stop fussing' and she would soon be 'right as rain.' Two doctors put Karen Finan's symptoms down to a nasty stomach bug when they were called out to see her on successive days. But she became so ill she was rushed to hospital by ambulance and admitted to intensive care. Despite carrying out tests and scans, hospital doctors also couldn't correctly diagnose the problem, said husband Darren Finan.

The 37-year-old mother's brain became swollen and her life support machine was switched off after doctors said nothing more could be done for her. A post mortem later revealed she died from meningitis of the brain and septicaemia.

Mechanic Mr Finan, 44, of Wakefield, West Yorkshire, said:'We feel angry at the doctors because they dismissed Karen's condition and didn't seem to have the time to examine her properly - she could have been saved. 'We were given a card for the Meningitis Trust that lists the symptoms. Every single one Karen had on that first visit from the doctor - fever, vomiting, drowsiness, confusion, and severe muscle pain. It was just a string of errors from start to finish. 'They say with meningitis that every hour is critical - the longer they misdiagnosed Karen the more she was slipping away from us. We have been robbed.'

Mrs Finan fell ill on April 14 suffering from sickness, diarrhoea and stomach cramps. Mr Finan said they weren't too concerned at first and his wife tried to 'carry on as normal.' But she began complaining of a painful headache and the next morning he called the doctor's surgery.

On April 15 a GP from their health centre in Stanley came to the house and diagnosed gastroenteritis. 'The doctor who came to see her didn't examine her at all, he took one look at her and said it was gastroenteritis. Not even Karen's temperature or blood pressure was taken,' he said. By the evening her condition had deteriorated further.

Mr Finan said:'She kept saying "I'm red hot" but when I touched her skin it was cold, I put a fan on full blast to try and cool her down, I touched her back and she was dripping wet.' Within 24 hours she could not speak and her eyes were rolling to the back of her head.

On the Thursday another GP came out and confirmed gastroenteritis. 'The doctor was saying Karen just needed to go to bed, we needed to stop fussing and she'd be right as rain by the weekend. It took me 35 minutes to get Karen up to bed, she couldn't walk or stand on her feet - she was like a dead weight.

'When the doctor left that day I told Karen I loved her. She looked at me and was able to mouth the words "I love you more" and went to sleep. That was it.' By the next morning Mrs Finan was so ill her family dialled 999 and she was taken to Pinderfield's Hospital in Wakfield.

Tests were inconclusive and doctors said she may have had a stroke, a blood clot or a bleed on the brain. Sadly her condition deteriorated and her brain became badly swollen and she died on April 19 with her family at her bedside. The couple have two children, Stacey, 18, and Fletcher, 12.

NHS Wakefield district medical director, Mark Napper, said:'We offer our sincere sympathies to Mrs Finan's family for their loss. 'We are very concerned to hear they are unhappy with Mrs Finan's care and, although the family have not contacted us with their concerns, we take this very seriously, which is why we are initiating an investigation.'


Human noses too cold for bird flu

Bird flu may not have become the threat to humans that some predicted because our noses are too cold for the virus to thrive, UK researchers say. An Imperial College London recreation of the nose's environment found that at 32 degrees Celsius, avian flu viruses lose function and cannot spread. It is likely that the viruses have adapted to suit the warmer 40 degree environments in the guts of birds. A mutation would be needed before bird flu became a human problem, they said.

Published in the journal PLoS Pathogens, the study also found that human viruses are affected by the colder temperatures found in the nose but to nowhere near the same extent. In effect, human viruses are still able to replicate and spread under those conditions, the researchers said. Both viruses were able to grow well at 37 degrees - human core body temperature and equivalent to the environment in the lungs.

They also created a mutated human flu virus by adding a protein from the surface of an avian influenza virus. This virus - an example of how a new strain could develop and start a pandemic - was also unsuccessful at 32 degrees.

Study leader Professor Wendy Barclay said it suggested that if a new human influenza strain evolved by mixing with an avian influenza virus, it would still need to undergo further mutations before it could be successful in infecting humans. "Our study gives vital clues about what kinds of changes would be needed in order for them to mutate and infect humans, potentially helping us to identify which viruses could lead to a pandemic."

She added further research could point to warning signs in viruses that are beginning to make the kinds of genetic changes for them to jump into humans. "Animal viruses that spread well at low temperatures in these cultures could be more likely to cause the next pandemic than those which are restricted."

She said swine flu - which was spreading from person to person, seemingly through upper respiratory tract infection - was probably an example of a virus which had adapted to cope with the cooler temperatures in the nose.

Professor Ian Jones, an expert in virology at the University of Reading, said: "This work confirms the fact that temperature differences in the avian and human sites of influenza infection are key to virus establishment. "It is certainly part of the explanation of why avian viruses, such as H5N1, fail to transmit readily to humans." He added that the research also showed that the proteins on the outside of the virus were key to its function at different temperatures. "This helps the monitoring of avian flu as it indicates which changes to look out for."


Amazing: British medicines regulator grants first ever licence to homeopathic remedy

At least it's safe, I suppose. There is nothing but water in homeopathic remedies

The UK medicines regulator has granted its first licence to a homeopathic remedy under controversial new rules allowing complementary therapies to make medicinal claims. The Medicines and Healthcare Products Regulatory Agency (MHRA) has granted an arnica homeopathic product a licence for the relief of sprains or bruising. Experts say that it contains zero active ingredients and condemned the decision as a “cynical mockery of evidence-based medicine”.

Nelsons Arnicare Arnica 30c pillules are the first product to be given a therapeutic indication via the Homeopathic National Rules Scheme, introduced in September 2006.

As opposed to conventional or herbal medicine, homeopathy is based on the principle that a substance that can make people ill can be diluted thousands of times to treat the symptoms it would otherwise create. Manufacturers of homeopathic remedies were previously banned from listing the clinical conditions or “indications” that products might be used to treat, due to a lack of evidence that they work. But under the new license granted by the MHRA, the label on a £5.30 packet of 84 pillules will now read: “A homeopathic medicinal product used within the homeopathic tradition for symptomatic relief of sprains, muscular aches and bruising or swelling after contusions.” The homeopathic pillules are designed to be sucked or chewed and to be taken between meals.

Robert Wilson, chairman of Nelsons, said that the fact that therapeutic indications could be included on the packaging “not only opens the practice of homeopathy up to new users but also gives it added credibility as a safe and natural complement to conventional medicine”.

But Edzard Ernst, professor of complementary medicine at the Peninsula Medical School in Exeter, said there is no evidence that the product has any benefit over a placebo treatment. “This is a huge rip-off and the label now makes false and misleading claims,” he said. “There is no biological plausibility for this to work — it makes a cynical mockery of evidence-based medicine.”

Nelsons, the largest manufacturer of natural healthcare products in Britain, also produces herbal tinctures for the Prince of Wales’s Duchy Originals brand, which Professor Ernst has also criticised as “outright quackery”. Last week, the Advertising Standards Authority reprimanded the Duchy brand over its promotional materials, ruling that claims made about the effectiveness of the tinctures were misleading.

Professor Ernst said that arnica-based homeopathic remedies were the most studied of all homeopathic products, but added: “Arnica is actually poisonous if you swallow it, so these pills contain essentially zero active ingredient.” A randomised trial published by Professor Ernst and colleagues in 2003 showed no benefit from arnica in prevention of pain and bruising after surgery for carpal tunnel syndrome, with more adverse events in the arnica group than with placebo. He added that systematic reviews of all studies, including those from advocates of homeopathy, came to the same conclusion.

Bruises and sprains would heal in time, so people would not be doing themselves harm if they took the pills, he said, “but you might as well be swallowing water”.

The MHRA said that the National Rules scheme was introduced to resolve an inconsistency in European legislation that meant that homeopathic products introduced before 1992 could state indications for their use, whereas remedies approved after that date could not make such claims. A spokeswoman for the Agency said that the National Rules Scheme “involves the assessment of quality, safety and consumer information”. “This means that if an applicant can demonstrate that their product has been used in the UK homeopathic tradition for the relief or treatment of specific minor conditions or symptoms then the applicant may be granted a homeopathic marketing authorisation.”

But, she added: “Indications are limited to the relief or treatment of minor symptoms or minor conditions, ie, symptoms or conditions which can ordinarily and with reasonable safety be relieved or treated without the supervision or intervention of a doctor. “Indications for serious conditions are prohibited.”


Must not call probable homosexuals "gay"???

Batty Britain again. Isn't homosexuality supposed to be wonderful there?
"A man and a 14-year-old boy have been banned from attending football matches for three years for shouting homophobic chants at Portsmouth and former England defender Sol Campbell [pic above]. Ian Trow, 42, from Milton Keynes in southern England, and the boy – who cannot be named for legal reasons – pleaded not guilty to indecent chanting but were convicted by magistrates in Portsmouth overnight.

The chants were aimed at Campbell during a match against his former club Tottenham at Portsmouth's Fratton Park stadium in September last year.

After a three-hour trial, Georgette Holbrook, chairwoman of the magistrates' panel, found the two defendants had chanted: “Come on gay boy, that's my gay boy.” She said: “We find that the words used were in extremely bad taste, they were inappropriate, shocking and disgusting, and as such they were indecent.”

In a statement read to the court, Campbell said he had felt “totally victimised and helpless by the abuse I received.

Both Trow and the boy were banned from watching football matches for three years, while Trow was also fined STG500 ($1000) and ordered to pay STG400 ($800) costs.

The prosecuting authorities in England said that while cases of racist chanting have been prosecuted before, this was the first case of indecent chanting to be brought to the courts.


"gay" is "indecent"? Whatever happened to "gay pride"? Some very confused thinking there.

Note that Campbell does not deny being homosexual above but that he has never "come out". The fact that he is black may account for that. The view that he is homosexual is widespread because of a number of unusual things about him -- such as an interest in fashion, an inability to bond with fellow footballers and a high level of emotionality.

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