How big is the bang from osteoporosis drugs?

From Susan Brown, PhD

Answering the question “how big is the bang from osteoporosis drugs?” can be quite challenging.
One reason is that the statistical calculations are complex and highly manipulated making them difficult to understand. Another is that the subjects included in the drug studies are generally highly-selected and may not represent “real-world” populations.
Recently scientists took an important step to help us separate hype from reality in regard to the benefits of bone drugs.
Researchers asked if “real-world” patients taking bone drugs received the same fracture-reduction benefits seen in the clinical trials. After analysis of hundreds of studies, they found that highly compliant, “real world” patients on osteoporosis drugs experienced a 21% reduction in all clinical fractures. This compares to the 24% overall clinical fracture reduction experienced by subjects in osteoporosis drug clinical trials.
What a different messages than we often hear — such as how bone drugs reduce your chance of fracture by 50%! Or have you ever been told that the fracture reduction on bone drugs is really more like 21-24%? That is — if you use the drug faithfully.
Now compare this 21-24% fracture-reduction benefit from bone drugs to the studies documenting that those taking vitamin D in any dose (much less a therapeutic dose) experience a 23-26% reduction in fractures. It seems to me that the bang from osteoporosis drugs isn’t quite as big as we’ve been led to believe.
As your bone health advocate, I congratulate these researchers on the enormous effort to analyze and synthesize data from hundreds of studies. I also congratulate the drug company which funded this study for clarifying the real fracture/reduction benefit of today’s bone drugs.

References:
Wilkes, et al. 2010. “Bisphosphonates and osteoporotic fractures: a cross-design synthesis of results among compliant/persistent postmenopausal women in clinical practice versus randomized controlled trials.” Osteoporosis International 21:679-688
Bischoff-Ferrari, HA et al. 2005. Fracture prevention with vitamin D supplementation: A meta-analysis of randomized controlled trials. JAMA, 293(18): 2257-2264

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Creeping Diseases

How we're fooled into using more medicine than we need.

This is a guest post from independent medical investigative journalist Jeanne Lenzer. She is a former Knight Science Journalism Fellow and a frequent contributor to BMJ, and has published works in  The Atlantic, The New York Times Magazine, Discover, The New Republic, and other outlets.

When doctors recommend tests, drugs or surgeries to prevent bad outcomes (think cholesterol-lowering agents to prevent strokes or cardiac stents to prevent heart attacks) they tap into our deepest sense of what constitutes commonsense: An ounce of prevention. Catch it early. A stitch in time.

It can’t be a bad thing to catch problems early, can it?

Unfortunately, one of the toughest things to explain is why detecting some illnesses at their earliest stages can cause more harm than good. Take this example: Since elevated cholesterol is associated with a higher risk of cardiovascular disease, doctors often prescribe drugs known as statins to people with elevated cholesterol levels in the hopes of reducing their risk of a heart attack or stroke.

Here comes the part that’s tough to explain – because it is so counterintuitive: Statins only help individuals who already have had a heart attack or stroke (with a few exceptions, and more on that later).

Of course, this makes no sense to most people. Isn’t the whole point of taking cholesterol-lowering agents to prevent a heart attack? Why should anyone wait until after a heart attack or stroke to begin taking a drug designed to prevent a heart attack or stroke?

The answer rests with disease creep and the simple statistical quirks that come with it. In the past, doctors treated diseases that caused symptoms. But now we have tests and imaging machines that can detect risk factors and illnesses in their earliest stages. Like cholesterol. Elevated cholesterol is not a disease. It doesn’t cause symptoms. It is a risk factor. People with high cholesterol levels are somewhat more likely to develop a heart attack or stroke, but they are at far less risk than individuals who already have cardiovascular disease. This is the definition of disease creep: when pre-conditions or risk factors are treated as if they are the same as the actual disease state.

Here’s a thought experiment (with purposefully exaggerated numbers) to help understand this puzzle: Imagine a group of people who have the rare but awful Disease A, which is so terrible that all of its victims will die. Now imagine the discovery of Wonder Drug X, which cures half of the patients with Disease A. Unfortunately, Wonder Drug X does have a pretty bad side effect profile – it’s a very powerful drug, after all – and 10 percent of people who take it will die from liver failure. Despite this worrisome side effect, Wonder Drug X is truly an advance for patients with Disease A: For every 200 patients with the disease who are treated, 100 will now survive and only 10 of the 100 survivors will die of the drug’s side effects. That means 90 more people out of 200 will survive thanks to Wonder Drug X.

But now imagine a different group of 200 people, who don’t actually have disease A, but instead have a genetic marker which “is associated with” Disease A. In this scenario only 1 in a million people in the general population will get disease A. If you have the genetic marker, the risk ismuch higher, such that 2 of these 200 people will develop the disease at some time in the future. The genetic test gets highly promoted – “find out your risk early, because we now have a treatment that works, and the sooner you’re treated, the better!” There is a tiny grain of truth to this – of the 2 people identified by the genetic test, 1 (50%) will now be saved by Wonder Drug A.   This might sound just as good as before; here’s a group of people with 10,000 times (!) the risk of the general population to develop a uniformly fatal disease. Surely it’s worth taking a drug that can cure that disease in half the cases, isn’t it?

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Support for Healthy Fats

For years I have been educating about the need for healthy fat in your diet, and for the sake of your health.

I haven't been alone in this effort as you may know if you follow Weston A. Price and others who know the real benefits of fat.  And yes, lard counts.

And remember that canola is not considered a healthy fat and it is a trans fat, even if the following article suggests it is not.  Canola is also toxic to your liver and too monounsaturated for health as well as being for the most part a GMO substance. Please read our articles about canola or request the mot recent issue of our newsletter fmi.

  

submitted by Emily Main   -    Olive oil is sooooo five minutes ago. People who are into healthy cooking oils and fats have moved on to duck fat, real lard, goose renderings, and coconut oil, according to a new report published by the market research firm Packaged Facts and the food trend spotters at the Center for Culinary Development.
Interest in these long-forgotten, more traditional fats is all part of the back-to-the-land movement that has triggered the growth of farmer's markets and reconnected people to whole fruits and vegetables, grass-fed dairy products, and pasture-raised meats, the report's authors note. It's no longer enough for top-line chefs and adventurous home cooks to eat grass-fed steaks; those steaks need to be finished with duck fat or real butter.
And it's not just the fact that these fats are traditional or come with a sense of nostalgia. Nutrition science is beginning to turn the idea that all fat is bad for you on its head, with high-profile nutritionists like Walter Willett, professor of epidemiology and nutrition at Harvard School of Public Health and a professor of medicine at the Harvard Medical School, working to debunk the idea that low-fat diets are healthier. Many of the recommendations that we all follow regarding fat, he's found, are based on rather weak science that has been repeatedly questioned over the decades. That type of diet is also depriving people of a variety of nutrients found only in the animal fats and other cooking oils that have been demonized under the assumption that saturated fat is bad for you.
As a general rule, whatever kinds of fat you buy, keep your chemical exposures to a minimum by buying certified-organic plant oils and pastured or grass-fed animal fats.
Olive oil remains one of the healthiest oils you can drizzle over a plate of veggies, but if you're interested in branching out, here are 6 other healthy varieties of cooking oil now gaining traction in the culinary world:• Ghee. Also known as "Indian clarified butter" or "drawn butter," ghee is butter that has been melted over a low temperature so that all the water content has boiled away and the milk fats have been skimmed off (check out our instructions on how to make your own ghee). What remains is a nutty, intensely flavored fat that withstands higher cooking temperatures than butter and can even be stored in your cabinets, rather than in the fridge (it won't go rancid). Indians believe it has healing qualities. And it's even more nutritious than butter: The process of creating ghee concentrates the conjugated linoleic acid—a healthy cancer-fighter that also prevents atherosclerosis (hardening of the heart's arteries)—found in the butter.
• Rice bran oil. Rice bran oil is quickly becoming the "go-to oil for fried food," the report found, particularly in high-end, independent, and ethnic restaurants. It tolerates a much higher cooking heat than canola or peanut oil, and like both of those, it's trans fat free. Health-wise, animal studies have shown that rice bran oil (which is made from the inner husks and germ of rice) can lower LDL ("bad") cholesterol levels, but it contains high levels of polyunsaturated fat, which go rancid quickly and need to be refrigerated to maintain shelf life.
• Lard & schmaltz. The prime example of fats we all thought were bad for us, lard and schmaltz (rendered chicken, pork, or goose fat) may have been wrongly demonized for years. The main fat in lard—oleic acid—is a monounsaturated fat linked to decreased risk of depression, says Drew Ramsey, MD, coauthor of The Happiness Diet (Rodale, 2010). Those same monounsaturated fats, which make up 45 percent of the fat in lard, are responsible for lowering LDL levels while leaving HDL ("good") cholesterol levels alone. Lard and schmaltz also tolerate high cooking temperatures—they're often recommended for frying—and have long shelf lives.
• Duck fat. Like lard, duck fat is high in monounsaturated fats, which make up 50 percent of its total fat content, with saturated fat making up just 14 percent (less than butter). Most of that fat is healthy linoleic acid, an essential fatty acid that keeps cells healthy, boosts calcium absorption, and aids in kidney function. Though it's still used mostly in high-end restaurants, it's showing up on specialty food store shelves and even some bigger retailers, such as Williams Sonoma. It can tolerate high cooking temperatures and has a long shelf life, but, like ghee, it has an intense flavor, so it's not a great all-purpose fat (and, considering the prices it goes for, you wouldn't want to use it every day, anyway!).
• Coconut oil. As with the other fats here, coconut oil's high saturated fat content (92 percent) has earned it an—undeserved—bad reputation over the years. "But there are a lot of health benefits that go beyond just what kind of fat it is," says Trevor Holly Cates, ND, a naturopathic physician with a practice in the Golden Door Spa at the Waldorf Astoria in Park City, Utah, and a board member of the American Association of Naturopathic Physicians. For instance, coconut oil is high in lauric acid, a nutrient our bodies need to help our immune systems. One of the only other major dietary sources for lauric acid is breast milk. Coconut oils are very common now in regular and specialty grocery stores, so keep an eye out for them.
• Nut & seed oils. Rounding out the report's trendy fats are nut and seed oils, such as walnut, avocado, pecan, and pumpkin seed oils, which are showing up not just in regular grocery stores, but in chain and fast-food restaurants, as well. Each different nut or seed oil has its own unique chemical makeup, but most of them, with the exception of avocado oil, have high levels of polyunsaturated fats compared to the healthier monounsaturated fats. They're good for salad dressings, but they do go rancid quickly and shouldn't be used for cooking.
Source: Sustainable Food News (16 Dec. 2011).

from Rodale News

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