Risk, research, and red meat

Most people really don't understand the concept of risk.

Let me give you an example.  Let's say that there is a woman who has been identified as being at risk of having a stroke.  She goes to a doctor, who offers her one of three medications to reduce her risk of stroke over the next five years.

Medication A would increase her likelihood of remaining stroke-free from 91% to 94%.

Medication B reduces her risk of a stroke by 1/3.

Medication C reduces her risk of a stroke by 3%.

Which one should she take?

Most folks seeing this problem pick B, largely because it sounds better -- a reduction by 1/3 is a lot, right?  3% is a pretty paltry change, and 91% and 94% chances of remaining healthy are pretty close.

It comes as a big surprise to find out that all three of them are the same.

If she has a 91% chance of remaining healthy without the medication and 94% with it, her risk of stroke drops from 9% to 6%.  That's a drop of 3%.

It's also an overall 1/3 reduction in her risk.

Such mathematical monkey-business is why there's been such confusion over the WHO's recent declaration that red meat causes cancer (and processed meat, such as hot dogs and pepperoni, are even worse).   In fact, processed meat is now in "Group 1" -- "substances that cause cancer" -- along with tobacco, human papilloma virus, and asbestos.

[image courtesy of photographer Jon Sullivan and the Wikimedia Commons]

It's even accompanied by statistics that seem, frankly, pretty terrifying:

[M]eta analysis found that colorectal cancer risk jumps by 17 percent for every 100 grams (3.5 ounces) of red meat consumed each day.  Meanwhile with processed meat, colorectal cancer risk increases by 18 percent for every 50 grams (1.7 ounces) eaten each day.

Holy crap, right?  1.7 ounces a day (not much) translates to an 18% increase (a lot) in your chance of colorectal cancer (a disease that is high on most people's "Least Favorite Things to Think About" list).

Add that to another study that found that "2% of hot dogs contain human DNA," and it looks like we might see a lot of people finding other things for their summer barbecues.

The problem is that all of this stuff is misleading.  First, what does an 18% increase look like?  According to the National Cancer Institute's Surveillance, Epidemiology and End Results Fact Sheet on colorectal cancer, current rates of diagnosis estimate the number of new cases at 42.4 per 100,000 each year.  An 18% increase brings that number up to a little over 50.

In other words, if 100,000 people ate 1.7 ounces of salami a day for a year, you'd expect there to be eight more cases of colorectal cancer in that group as compared to a comparable non-salami group of 100,000.

Here's another problem with the WHO information.  "Group 1" substances are said to be "known to cause cancer."  But all that means is "known to increase your risk."  It doesn't say by how much, nor what the risk was to begin with.  For example, cycling to work and swimming naked in a crocodile-infested river are both outdoor activities that are "known to increase your risk of dying in an accident."  So on the "Outdoor Activities Risk" list, these would both be classified as "Group 1."

Which one would you prefer doing?

At the risk of beating the point unto death, Casey Dunlop of Cancer Research UK cited statistics illustrating how silly it is to put tobacco and bacon in the same category.  Tobacco is a product that is toxic in any amount, confers no benefits whatsoever upon the people consuming it, and is directly responsible for 86% of lung cancers and 19% of all cancers combined.  Even assuming the worst-case scenario, daily consumption of processed meat is responsible for 21% of colorectal cancers and 3% of all cancers combined.

Puts things in perspective, doesn't it?

Oh, and about the human DNA in hot dogs thing; this doesn't mean that the hot dog manufacturers are incorporating Soylent Green into their meat.  Given the sensitivity of DNA tests, this probably means the presence of a few cells from a bit of dry skin or something.  And if you think that it's only hot dogs that have this kind of contamination, I have news for you.  The amount of extraneous cellular material (to put it euphemistically) that we consume by accident on a daily basis has not been tested, but is undoubtedly high.  If you are a pet owner, and don't think you consume dog and/or cat DNA every single day, well... either you clean your house far more frequently and thoroughly than I do, or you're living in a fool's paradise.

And amazingly enough, most of us are pretty healthy.  Funny thing, that.

Now, I'm not saying we should eat hot dogs and bacon and pepperoni with wild abandon.  Reducing your consumption of red and processed meat is definitely a good thing.  But everything has dangers; there are risks associated with every food out there.  The trick is to figure out which calculated risks are worth taking, and what the tradeoff is.

After all, as Chuck Palahniuk put it in Fight Club, "On a long enough timeline, the survival rate for everyone drops to zero."

Saunas, health, and half-truths

One of the difficulties in identifying woo-woo claims is that they are seldom pure, unadulterated pseudoscience.

The reason for this is that most people have at least a rudimentary background in science.  A purely woo-woo claim -- for example, that a mystic can look in her crystal ball and see the future -- inevitably generates the question, "how on earth can you do that?"  Falling back on the old answer of "because I am a psychic who is in touch with the unseen world" will only convince people who already think psychic claims are valid.  You will convince more people, and therefore sell more of what you're peddling, if you can mix in some science-y words and half-truths, leaving people to have to tease apart the claim and figure out what is real and what is bogus.

All too often, it takes more scientific training than the average person has in order to do that.  Which, of course, is what the purveyor of said woo-woo claim is hoping.

I ran into an especially good example of that just yesterday, with this website advertising the "Photon Genius Energy Infrared Sauna."  Here's the pitch:

The Photon-Genius is a dynamic energy sauna that provides more direct and targeted harmonic energy infrared (including full spectrum) than any infrared sauna in the world.

This combination importantly helps the body produce more nitric oxide (NO), the "miracle molecule" which helps preserve the elasticity of all the vessels in the body, because it is a "signaling molecule" that tells the blood vessels to increase in width or dilate. This has significant implications, because optimal blood circulation is a key factor in virtually all health issues, including Heart Disease, Alzheimers, Diabetes, Cancer, Obesity, Arthritis, Anti-Aging, ect. [sic]

For many, the biggest news about the Photon-Genius is its application in the evolving science of detoxification. At home and in clinics, the Photon-Genius infrared sauna is said to yield many benefits--including relief from different kinds of pain; stimulation of immune response; improvement in skin tone and conditions such as burns, eczema and acne; and the accelerated burning calories. But the detox application is health news that can benefit everyone. 

The Photon-Genius promotes energetic balance and coherence. Fully functional coherence of the biofield is the new and most comprehensive definition of anti-aging therapy, born out of quantum physics. When quantum coherence is restored to the biofield, the healing power of the body is now known to be literally limitless, dwarfing the benefits of any mere biochemical manipulation.

Which seems like a good place to start.

First of all, all saunas are "infrared saunas."  Infrared radiation is given off by any hot object, and when absorbed, is converted into heat.  So adding the word "infrared" is kind of like calling a light bulb an "electromagnetic-radiation-producing incandescent light bulb."  It's true, but redundant.

In the trade, though, there is a distinction.  What differs between an "infrared sauna" and an ordinary one is that infrared saunas use some sort of infrared emitter, and an ordinary one uses heated stones to warm the air -- but the result is the same.  You get hot, and sweat a lot.

So, what about the claims that saunas are beneficial to health?

According to an article by Dr. Brent Bauer of the Mayo Clinic, the answer is yes, maybe:

Several studies have looked at using infrared saunas in the treatment of chronic health problems, such as high blood pressure, congestive heart failure and rheumatoid arthritis, and found some evidence of benefit. However, larger and more-rigorous studies are needed to confirm these results.

On the other hand, no adverse effects have been reported with infrared saunas.

So that sounds good.

How about the whole nitric oxide thing?  The answer here appears to be that it's a half-truth:

In mammals including humans, NO is an important cellular signaling molecule involved in many physiological and pathological processes. It is a powerful vasodilator with a short half-life of a few seconds in the blood. Long-known pharmaceuticals such as nitroglycerine and amyl nitrite were discovered, more than a century after their first use in medicine, to be active through the mechanism of being precursors to nitric oxide.

Low levels of nitric oxide production are important in protecting organs such as the liver from ischemic damage.

So nitric oxide is a critical intercellular signal, and is an intermediary in a great many biological reaction mechanisms.  One interesting one is that being a vasodilator, if you get a boost of nitric oxide in the right place at the right time, it can trigger an erection -- this, in fact, is how Viagra works.

Whether that qualifies it as a "miracle molecule" is, I suppose, a matter of perspective.

As far as the connection between saunas, nitric oxide, and health, the answer (once again) is... maybe.  A study at Kagoshima University in Japan looked at the vasodilation effects of saunas in hamsters with cardiomyopathy, and found some positive effects.  Here's their conclusion:

Repeated sauna therapy increases eNOS [endothelial nitric oxide synthase] expression and NO production in cardiomyopathic hamsters with heart failure.

So if you have heart failure, a sauna might be helpful, especially if you're a hamster.  Virtually all of the other sources I found linking saunas, health, and nitric oxide were websites that were trying to sell saunas.

What about the claims that saunas aid in "detoxification?"  You hear that word a lot, especially on alt-med websites.  Particular herbs, foods, exercises, colon cleansing, or other practices help to "rid your body of toxins," as if your liver and kidneys aren't perfectly capable of dealing with whatever toxic metabolic byproducts your body creates.  Here's what the Skeptic's Dictionary has to say about detoxification:

Outside of being treated for poisoning or certain kinds of addiction, the word 'detox' has no meaning, according to a pamphlet published by a group of thirty-six people calling itself Sense About Science (SAS). (A summary of the group's findings may be found on their website.) There are thousands of products that use the claim of detoxification as their main selling point. SAS investigated 15 representative products and found that none of the products identified a single toxic substance as one their product removed, none of the manufacturers of the products could provide compelling scientific evidence that the product removes toxic substances, none of the sellers had a clue what the products actually do, and nobody involved in making or selling these detox products could provide a comprehensive definition of 'detox.'

So that one, predictably, is a bust.

Then, at the end, the claim rushes headlong into pure woo-woo nonsense.  "Restoring quantum coherence to the biofield," my ass.  I would like to sit down with whoever wrote this and ask if (s)he can define the term "quantum coherence" in a rigorous way, and to have him/her provide me with some evidence of the existence of a "biofield."

I'm guessing it would be a really short conversation.

Anyway, you get the idea.  In order to pull apart the strands of the sales pitch here would take hours of research -- it took me over an hour just to do the digging for the admittedly shallow analysis I've done here.   Some truth; some half-truth; some misleading facts; some complete, unadulterated bullshit.  Most people, frankly, don't have the time, energy, or training to evaluate critically a claim such as this one -- and when you couple that with a promise that the product is going to alleviate all manner of chronic health problems (this site claims that the "Photon Genius Energy Infrared Sauna" can help with everything from Alzheimer's to HIV), you have a recipe for people spending a lot of money for something with benefits that are, at best, unproven.

Now, don't get me wrong.  I like saunas, and find them relaxing.  A nice sit in a sauna after a hard workout is one of the most pleasant things I can think of, especially if it's the middle of winter.  And the positive health effects of relaxation are pretty clear.  (Although I draw the line at the behavior of a friend of mine, who likes to alternate baking in the sauna with rolling around naked in the snow.  "Let's make anatomically correct snow angels!", I remember him suggesting one time.  To which I responded: there are parts of my body I would rather not freeze off, thank you very much.)

But using bogus claims and half-truths to sell a product is unethical at best -- especially when it's framed in such a way as to make the layperson unable to tell if what they're reading is scientifically sound or not.