Prevention vs Cure, quackery, bias and conflict of interest.

I believe in the maxim "Prevention is better than cure".

Image from www.nationalarchives.gov.uk

Some definitions:

Prevention. Cure. Quackery. Bias. Conflict of interest. Logical fallacies. In the case of the maxim, prevention means hindrance, as it's impossible to 100% stop illness from occurring. To someone who already has an illness, the maxim is obviously moot!

Quackery:

I have been accused of quackery. Despite having provided evidence to refute the claim, the person has refused to retract the accusation or provide proper evidence (other than Logical fallacies) to support it. EDIT: I blocked the person on Twitter. I am no longer on that person's quackery list.

Bias:

A long time ago, I mentioned a study Intensive lipid lowering with atorvastatin in patients with stable coronary disease.

"RESULTS: The mean LDL cholesterol levels were 77 mg per deciliter (2.0 mmol per liter) during treatment with 80 mg of atorvastatin and 101 mg per deciliter (2.6 mmol per liter) during treatment with 10 mg of atorvastatin. The incidence of persistent elevations in liver aminotransferase levels was 0.2 percent in the group given 10 mg of atorvastatin and 1.2 percent in the group given 80 mg of atorvastatin (P&lt:0.001). A primary event occurred in 434 patients (8.7 percent) receiving 80 mg of atorvastatin, as compared with 548 patients (10.9 percent) receiving 10 mg of atorvastatin, representing an absolute reduction in the rate of major cardiovascular events of 2.2 percent and a 22 percent relative reduction in risk (hazard ratio, 0.78; 95 percent confidence interval, 0.69 to 0.89; P&lt:0.001). There was no difference between the two treatment groups in overall mortality."

"CONCLUSIONS: Intensive lipid-lowering therapy with 80 mg of atorvastatin per day in patients with stable CHD provides significant clinical benefit beyond that afforded by treatment with 10 mg of atorvastatin per day. This occurred with a greater incidence of elevated aminotransferase levels."

Unfortunately, the statement "There was no difference between the two treatment groups in overall mortality." is incorrect. According to the full study (hidden behind a pay-wall) there were 26 more deaths in the 80mg/day group than in the 10mg/day group. That's not statistically significant, as the group sizes were ~5,000 each. However, the statement didn't mention statistical significance.

Therefore, the statement "Intensive lipid-lowering therapy with 80 mg of atorvastatin per day in patients with stable CHD provides significant clinical benefit beyond that afforded by treatment with 10 mg of atorvastatin per day." is also incorrect. Dying is worse than having major cardiovascular events (heart attacks & strokes), which are survivable.

Why is there a disparity between the publicly-viewable abstract, the full study and reality? From the full study:-

"Funding for the study was provided by Pfizer Inc., New York, New York. Dr. Shepherd has received consulting fees from AstraZeneca, GlaxoSmithKline, Merck, Oxford Biosensors, Pfizer Inc., and Schering-Plough, and lecture fees from AstraZeneca, Merck, and Schering-Plough. Dr. Kastelein has received consulting fees and lecture fees from Pfizer Inc., AstraZeneca, Merck, and Schering-Plough, and grant support from Pfizer Inc. and AstraZeneca. Dr. Bittner has received consulting fees from CV Therapeutics, Novartis, Pfizer Inc., Abbott, and Reliant, and grant support from Pfizer Inc., Atherogenics, Merck, Kos Pharmaceuticals, Abbott, CV Therapeutics, and the National Institutes of Health. Dr. Deedwania has received consulting fees and lecture fees from Pfizer Inc. and AstraZeneca. Dr. Breazna, Dr. Wilson, and Dr. Zuckerman are all employees of Pfizer Inc. Mr. Dobson is an employee of Envision Pharma Ltd., which was a paid consultant to Pfizer Inc. in connection with the development of the manuscript. Dr. Wenger has received consulting fees from CV Therapeutics, Sanofi-Aventis, Schering-Plough, AstraZeneca, Abbott, Merck, and Pfizer Inc., and grant support from Pfizer Inc., Merck, and the National Heart, Lung, and Blood Institute."

Atorvastatin is manufactured by Pfizer Inc.

Conflict of interest:

I like the article Is Vitamin D Shooting Me in the Foot?, because Dr. Ken D. Berry prescribes his patients an effective dose of Vitamin D3, even though it results in him losing money due to the drastic reduction in the number of benign skin cancers for him to freeze-off. Now, that's what I call integrity!

Can a breast cancer surgeon (who receives payment for curing breast cancer using surgery) give a truly impartial opinion on other cancer cures, or cancer prevention? Does he always clearly state his competing interest? I think not!

Sun exposure doesn't increase the risk of getting Malignant Melanoma. It probably reduces it.

Wait, WHAT?!?! I've done it again!

Here comes the sun, doo doo doo doo.

According to Does solar exposure, as indicated by the non-melanoma skin cancers, protect from solid cancers: vitamin D as a possible explanation,
"Vitamin D production in the skin seems to decrease the risk of several solid cancers (especially stomach, colorectal, liver and gallbladder, pancreas, lung, female breast, prostate, bladder and kidney cancers). The apparently protective effect of sun exposure against second primary cancer is more pronounced after non-melanoma skin cancers than melanoma, which is consistent with earlier reports that non-melanoma skin cancers reflect cumulative sun exposure, whereas melanoma is more related to sunburn."

See also Is Vitamin D Shooting Me in the Foot?

Insufficient sun exposure increases the risk of getting cancer. This isn't surprising, as cancer cells are constantly being created in our bodies due to defects occurring in DNA etc. Our immune system constantly destroys them. Only when cancer cells manage to evade the immune system (by pure chance) does cancer develop. Cells & an immune system weakened by Vitamin D insufficiency is asking for trouble. See Kelsey Nicole Olson.

Excessive sun exposure increases the risk of getting cancer.

Chronically-excessive sun exposure (outdoor workers) increases the risk of getting Basal Cell Carcinoma & Squamous Cell Carcinoma. These skin cancers are rarely malignant and rarely fatal.

Acutely-excessive sun and/or UVA exposure (holidaymakers & tanning booth users) increases the risk of getting Melanoma. This skin cancer is always malignant, and often fatal.

Combining insufficient sun exposure for 50 weeks of the year with acutely-excessive sun exposure for 2 weeks of the year is really asking for trouble. What makes the situation even worse is that Vitamin D insufficiency makes the skin burn more easily.

I take 5000iu/day of Vitamin D3 and my skin is far more resistant to burning than it used to be. I can go for long drives on a sunny day with the top down and not burn. My face goes pink, but that's all.

I've already read on Facebook about friends burning themselves to a crisp in the wishy-washy May English sun. It's not sun exposure that increases the risk of getting Malignant Melanoma. It's ignorance, apathy, stupidity and/or bad luck.

Be careful out there!

See also Vitamin D

Just say "NO". There's more to sunlight than Vitamin D3.

Just say NO?

Hat-tip to Richard Nikoley for posting the following video by Richard Weller, which I am posting as an embedded YouTube video rather than a Vimeo one, as YouTube gives me fewer problems.



Take-away message: Deaths from heart disease are 100 times higher than deaths from skin cancer (because the vast majority of skin cancers are benign).