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September 25, 2012

The drugs don't work: a modern medical scandal

Must read! The drugs don't work: a modern medical scandal | Ben Goldacre | Business | The Guardian
But we had both been misled. In October 2010, a group of researchers was finally able to bring together all the data that had ever been collected on reboxetine, both from trials that were published and from those that had never appeared in academic papers. When all this trial data was put together, it produced a shocking picture. Seven trials had been conducted comparing reboxetine against a placebo. Only one, conducted in 254 patients, had a neat, positive result, and that one was published in an academic journal, for doctors and researchers to read. But six more trials were conducted, in almost 10 times as many patients. All of them showed that reboxetine was no better than a dummy sugar pill. None of these trials was published. I had no idea they existed. . . . Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques that are flawed by design, in such a way that they exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce results that favour the manufacturer. When trials throw up results that companies don't like, they are perfectly entitled to hide them from doctors and patients, so we only ever see a distorted picture of any drug's true effects. Regulators see most of the trial data, but only from early on in a drug's life, and even then they don't give this data to doctors or patients, or even to other parts of government. This distorted evidence is then communicated and applied in a distorted fashion. In their 40 years of practice after leaving medical school, doctors hear about what works ad hoc, from sales reps, colleagues and journals. But those colleagues can be in the pay of drug companies – often undisclosed – and the journals are, too. And so are the patient groups. And finally, academic papers, which everyone thinks of as objective, are often covertly planned and written by people who work directly for the companies, without disclosure. Sometimes whole academic journals are owned outright by one drug company. Aside from all this, for several of the most important and enduring problems in medicine, we have no idea what the best treatment is, because it's not in anyone's financial interest to conduct any trials at all. . . .

September 19, 2012

For weight loss, too much exercise can be a bad thing

If your goal is weight loss, then half an hour day of moderately strenuous exercise is the optimal target. For Weight Loss, Less Exercise May Be More - NYTimes.com
The men were then randomly assigned to exercise or not. The non-exercisers, who served as controls, returned to their former routines, with no change to their diets or sedentary ways. A second group began 13 weeks of almost daily moderate workouts, consisting of jogging, cycling or otherwise sweating for about 30 minutes, or until each man had burned 300 calories (based on his individual metabolic rate). A third group tackled a more strenuous routine of almost hourlong workouts, during which each man burned 600 calories. The men were asked not to consciously change their diets, either by eating more or less, and to keep detailed daily food diaries throughout the 13 weeks. On certain designated days, they also were asked to don sophisticated motion sensors that would measure how active they were in the hours before and after exercise. At the end of the 13 weeks, the members of the control group weighed the same as they had at the start, and their body fat percentages were unchanged, which is hardly surprising. On the other hand, the men who had exercised the most, working out for 60 minutes a day, had managed to drop some flab, losing an average of five pounds each. The scientists calculated that that weight loss, while by no means negligible, was still about 20 percent less than would have been expected given the number of calories the men were expending each day during exercise, if food intake and other aspects of their life had held steady. Meanwhile, the volunteers who’d worked out for only 30 minutes a day did considerably better, shedding about seven pounds each, a total that, given the smaller number of calories that they were burning during exercise, represents a hefty 83 percent “bonus” beyond what would have been expected, says Mads Rosenkilde, a Ph.D. candidate at the University of Copenhagen who led the study. That impressive weight-loss windfall for the light-duty exercisers “was a bit of a shock,” he says.