Friday, September 30, 2016

Seinfeld, Cheers, Scrubs, Please Watch and Learn!

Today's Funny Friday is Will and Grace back from the crypt for an all new election special.

So amazing. Please let all the aforementioned shows do this too!

Wednesday, September 28, 2016

Many Doctors, And Most Journalists, Don't See Past the Fat

In case you missed it, a few days ago the New York Times ran a great piece on weight bias in medicine. The headline asked, "Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past The Fat". The story detailed the fact that physicians and other health care professionals often fail to see past the weight and rather than treat the person and their concerns as they would any other, instead all of their ills are simply chalked up to being caused by obesity. As a consequence, not only does their treatment suffer, so too does their faith in medicine to the point where many people with obesity actively avoid going to the doctor.

There was a painful irony to the piece though. By calling people with obesity "obese patients", the New York Times was also not seeing past the fat.

People first language refers to the recognition that people cannot be their diseases. People can have diabetes, they're not diabetic. People can have arthritis, they're not arthritic. People can have cancer, they're not cancerous. And so too with obesity. People can have obesity, they cannot be obese.

The distinction matters. Not using people first language labels the individual by way of their medical condition, and when it comes to obesity, given the incredibly negative societal stereotypes associated with the word, labeling an individual as being obese carries with it real stigma.

At least part of the reason why many doctors don't see past the fat is that journalists, and society as a whole, don't see past the fat either and instead define and stereotype people by their obesity. While it's definitely a small step, if the New York Times (and other media outlets) actively adopted people first language for obesity in their style guides it would be a welcome and helpful change.

Monday, September 26, 2016

Why You Should Always Open Your Car Door With Your Right Hand

(Unless you live in England or any other left side of the road driving country - then you should always open your car door with your left hand)
Have you ever almost doored a cyclist (or almost been doored cycling)?

Dooring refers to when someone exiting a car opens their driver's door directly into the path of the oncoming cyclist that they didn't realize was there.

I saw this very short video this past weekend about a simple maneuver designed to easily reduce these sorts of at times even deadly accidents. It's called "The Dutch Reach", and despite the suggestive title, it's totally safe for work.

An incredibly simple behaviour that could save a person's life - it should be mandatory teaching in driver's ed.

Saturday, September 24, 2016

Saturday Stories: Humanity, Rats, and Fake Mayo

Andrew Sullivan in NYMag on how he used to be a human being.

Jordan Kisner in the Guardian on the war between man and rat.

Olivia Zaleski, Peter Waldman and Ellen Huet in Bloomberg on Hampton Creek, the Theranos of fake Mayo.

Friday, September 23, 2016

"Lots and Lots of Famous People" Want You to Vote on November 8th.

Today's Funny Friday is a great new get out and vote PSA from writer/director Joss Whedon.

Have a great weekend!

And yes, on November 8th, please vote.

Wednesday, September 21, 2016

Mouse Diet Studies Aren't Conclusive For Mice Let Alone People

Among the biggest frustrations in scientific knowledge translation is the extrapolation of outcomes from mouse studies to humans. It's frustrating because most people aren't just large rodents, and yet those mouse studies and their resulting press/publicity, are often used to push agendas. And it happens with diet studies too.

Simply put, we can't make conclusions of human diet outcomes based on studies conducted in mice.

But can we even do so in mice?

Maybe not.

It seems like there are 3 huge confounders for mouse diet (and other) studies.

The first is that a mouse's living arrangements (eg. noise, bedding, light, the pH of their water, and more) can markedly affect study outcomes.

The second is fecal-oral eating. Yes, mice eat each others' feces, and if we're talking the impact of diet on health, knowing which mouse ate how much of whose feces and what said feces contained might matter.

And lastly there's this tweet by Emily Deans who was recounting Ronald Kahn's experiences that noted that strains of genetically identical mice have different metabolic responses to identical diets (which may speak to the living arrangement issue, or to differing microbiomes, or both).

All this to say, in free-living humans, diet studies are anything but simple, and even in captive mice, the control of confounding variables is challenging.

Monday, September 19, 2016

Hey ParticipACTION, Kids Need Activity, Not Activity Trackers, Food, Not Candy Vitamins

Apparently ParticipACTION, Canada's Let's Move style campaign to promote physical activity, has some sort of partnership now with Flintstones vitamins. You know the ones, the candy ones.

According to Bayer (the manufacturer of Flinstones Active Kids Gummies, the Gummies are a, "Partner in Play".

Though I tried and failed to determine the exact amount of sugar in these Gummies, I think it's safe to say its comparable to the sugar in other Flinstones Kids Gummies which when I blogged about them last clocked in at roughly 3/4 of a teaspoon per daily dose (more than if you ate two actual Gummy Bears rather than two Gummy Bear vitamins).

Kids don't need vitamin fortified candy, they need varied healthy diets. They also don't need activity trackers, they just need to play. I realize money's tight for everyone, but these sorts of partnerships don't do our children any good.

Saturday, September 17, 2016

Saturday Stories: Illusions x 2 and BS Gatorade

Dr. Helena Matute et al. in Frontier in Psychology on "illusions of causality".

Dr. Vinay Prasad in Nature on the illusion of precision medicine in oncology.

Dr. James Hamblin in The Atlantic on the BS that is the new organic Gatorade.

[And just a quick note for those who might be interested - we selected the 5 beta testers for our upcoming distance program. Will let everyone know when the program is open to the public as a whole.]

Friday, September 16, 2016

A 25 Second Journey From Hangry to Happy

Who here hasn't felt like this Funny Friday video's featured hedgehog?

Have a great weekend!

Wednesday, September 14, 2016

I Hate That I Know How Good a Writer This Young Dad Is

This is Layton Reid and he's the husband of Candace, one of our office's former RDs. A number of years ago they moved to Halifax where they and their now 3 year old son Finn call home.

Certainly when they were living here in Ottawa I had no idea that Layton could write. Now I know that he can write circles around me. I also know that he's brave and vulnerable. That he's deep, thoughtful and funny. I know all of this in large part because I also know that he's dying. Just before their move Layton had a growth removed in walk in clinic. That growth, one he's now calling "Mel", was a melanoma. And it's spread.

Being friends with his wife on Facebook I regularly see his posts. His prose, venturing at times a bit towards poetry, captures his experiences with cancer, and does so with such poise and honesty that I wanted to use my platform here to share his words with others.

His latest post is a letter he wrote to Mel (copied below).

To follow Layton, you can find him on Facebook here.

Layton, you're an inspiration as a person, a husband and a father and I wish I didn't have to know that.
dear mel.

i hope you don't mind me calling you that. melanoma just sounds so formal, you know? i just thought i’d check in and catch up and let you know how things are going on my end. i feel like we never really get a chance to talk anymore, just the two of us.

finn turned three last month (total rapscallion) and candace is on this big minimalist kick lately. inexplicably, and due in large part to a handful of my cancer killing crew at the VG i am, as of today, still upright. what a trip. some days are better than others of course but i guess that goes with the territory, right?

as you’re well aware, three of my friends in the attic have bulked up a bit over the summer, so it looks like i’ll be in this week for a last ditch effort to see if we can at least keep them at bay before i start having panic attacks in public and pooping in my pants. again. i’m confident i can enjoy a diaper free existence until at least the end of the year, but what do i know?

all i know is until our paths cross again i just wanted to take a minute to say thank you. genuinely.

i know we’ve had our differences in the past and i know we've not always seen eye to eye, but i've learned so many lessons i never would have, had we not been introduced a handful of years ago in the back of a sketchy walk-in clinic in downtown ottawa. back where this whole silly adventure began. back when you taught me all the ultra important rules to remember about this unmistakably messy yet miraculous life of mine.

lessons on perspective, patience, pain and above all, resilience.

i have loved and been loved more in the last few years than i have the first thirty five or so of my life and i appreciate things today that i most certainly would have taken for granted the day before we met. most importantly though i’ve accumulated a ton of cool scars to show finn before i have to eventually squeeze his clammy little hand into mine and remind him to be good to his mummy and hope he remembers just how much i loved him when he’s old enough to process this whole shitty nightmare of a situation i’ve inadvertently put my family through.

so, if we don’t get a chance to chat again before you decide enough is enough, just know that i’m grateful for everything you’ve done for me. i don’t know if that was your intention back when we originally met but at the moment that’s all i can think about. how you’ve changed my life, temporarily at least, for the better.

i’ll miss you mel, you old magnificent, malignant, murdering masterpiece. thank you once more for giving my family the strength to band together to fight for a cause much bigger than me, and thank you for the opportunity to safely gather my things and say my goodbyes one last time before i hobble proudly off into the sunset, camera in hand and a photo of candace and finn in my back pocket.

yours sincerely, and still alive.
layton reid.

Monday, September 12, 2016

If You Swap Sugar For Artificial Sweeteners, Will You Eat More?

Many people worry that consuming artificial sweeteners will lead to increased overall eating consequent to either the induction of hunger, or by way of simple "energy compensation".

A recent sugar industry funded study set out to explore that possibility.

The REFORM study looked at the impact of an 8 week crossover swap of ultra-processed sugary foods with ultra-processed artificially sweetened foods on 16 active young men and 34 active young women whose average BMI was 23.5 and whose average daily step count was 9,064. For 8 weeks they'd consume either sugary stuff or artificially sweetened stuff with a 4 week washout period in between and they were blinded to which treatment they were in.

The researchers were looking at a number of different variables including of course sugar consumption, but also body weight, energy intake, energy expenditure, blood pressure, arterial wall stiffness, fasting sugars and lipid levels.

At baseline the researchers report that the average daily energy intake of participants was a mere 1,900 or so calories, dramatically less than their reported predicted baseline energy intakes of 2,400 calories per day. They also reported that though blinded to whether the products they were consuming were sweetened with or without sugar, 83% of participants correctly identified which was which.

Though the researchers reported a decrease in the consumption of sugar consequent to the intervention, what they did not see was a change in body weight which in turn led the researchers to conclude that subjects compensated for the lesser calories found in artificially sweetened processed foods by eating more. They also didn't see any other changes in the other measured outcomes.

I'm neither excited nor disappointed by this study's findings as I just don't think any conclusions from it can be drawn. The small number of subjects in this very short study were young, active, and thin, their ability to accurately report their dietary intake was clearly inadequate, and the study, though blinded, wasn't well blinded given the vast majority of subjects were able to correctly identify which treatment arm was which.

I'm blogging about it today not so much because I think it's important as a study, but rather because I saw a bunch of folks I respect tweeting about it as if it provided new and valuable insights - an opinion I don't share.

Saturday, September 10, 2016

Saturday Stories: Death, Theranos, and Sexting

Heartbreaking piece by Naomi Rosenberg in The New York Times on how to tell a mother her child is dead.

Unbelievable piece by Nick Bilton in Vanity Fair on the house of cards that was (is?) Theranos.

Scary piece by Jessica Contrera in The Washington Post on the realities of young teens and sexting.

Friday, September 09, 2016

Trump Campaign Would Be Hilarious if it Wasn't so Damn Terrifying

Today's Funny Friday does a great job looking at what should be a prank, but horrifyingly isn't.

Have a great weekend!

Thursday, September 08, 2016

No Diet Works For Everyone and Every Diet Works For Someone.

Two weeks ago Kevin Hall and I had our diet commentary published in The Lancet. Not surprisingly, we upset some folks - primarily low-carbers. Some accused us of being low-fat cheerleaders. Others that we fostered an "animus" towards low-carb diets.

While I can't speak for Kevin, I can honestly state that I'm totally fine with low-carb diets. For some people they're a life changer and our office is happy to work with patients on them. I've also got nothing against low fat, Paleo, intermittent fasting, vegan, gluten-free, or any other diet that has a name.

What matters most to me, and what was also the crux of our commentary, is whether or not a person likes their chosen diet enough to sustain it. Food is not simply fuel. Food is comfort, food is celebration, and food serves as the foundation of a huge part of our social lives. Regardless of whether or not one diet vs. another diet affords a person an additional few pounds of loss (or even whether or not it confers specific health benefits) pales in importance to whether or not a person likes that diet's style of eating enough to live with it for good

As noted in our piece, every diet out there has its long term success stories, and so moving forward, if you see anyone out there suggesting their diet is the best (or that your diet is the worst) rest assured they have an agenda. Their agenda might simply reflect an n=1 mentality of, "it worked for me therefore it's what you should do", it might reflect basic post-purchase rationalization, or it might reflect genuine science and studies that infer greater short term losses or potential health benefits. But if they can't wrap their heads around adherence (which on an individual basis is an expression of whether or not you like what you're eating and don't miss what you're not) as any diet's long term's most critical component, their ideology is showing.

Temporary efforts will only yield temporary outcomes no matter how exciting the outcomes might be in the short run.

Tuesday, September 06, 2016

UK's @ValeofYorkCCG Launches World's Worst Obesity Policy

The UK's Vale of York NHS Commissioning Group has been reported to be planning to deny people with obesity elective surgeries for an additional year in a bid presumably to inspire encourage help whip and prod people into losing weight.

The policy's two primary presumptions are ignorant and misguided.

The first has to do with the value of BMI as a clinical tool. While it's true that the risks of medical complications and morbidities rise with weight, BMI is a measure of bigness, not health. Half of the NFL have been reported to have BMIs greater than 30, as did my friend and colleague Dr. Spencer Nadolsky pictured below in his wrestling days when he sported a BMI of 32.

The second presumption is that obesity is a disease of personal responsibility and choice. While no doubt weight can be dumbed down to eat less, move more, I still find it shocking that public health professionals and policy makers exist who believe that somehow people with obesity simply haven't absorbed enough societal guilt, shame, and discrimination to finally lose weight.

But putting those two erroneous presumptions aside, the notion that blame based medicine is something that the UK wants to adopt is plainly repugnant. Medicine's not about blaming and shaming. Life is complicated. Clinically useless truisms aside, obesity is complicated, and moreover we have yet to discover a non-surgical, reproducible, and uniformly effective plan for the management of obesity. And while there's no argument about the fact that in a ideal world everyone would take it upon themselves to live the healthiest lives possible, there's two problems with that argument. Firstly, not everyone is interested in changing their lifestyle, and secondly, statistically speaking, the majority of even those who are interested and successful with lifestyle change will ultimately regress. Meanwhile the burden of suffering that the elective surgery those with obesity are being denied may add to absenteeism, presenteeism, pain, depression, and more.

If someone from the NHS's Vale of York is reading this, I want to remind you of one of your stated values as it would appear as if it's been forgotten,

We believe that health outcomes should be the same for everyone. We will reduce unnecessary inequality."
For shame.

Saturday, September 03, 2016

Saturday Stories: Muscle Confusion, Palliative Care, and Retirement

Brad Stulberg in The Science of Us on how muscle confusion is confused.

Priya Sayal in the Toronto Star with a call to rename palliative care.

Eric Moskowitz in The Boston Globe with a sweet story about retiring from McDonald's.

Friday, September 02, 2016

Do You Remember Learning to Drive?

I don't remember it so well, but after watching today's Funny Friday video, I can't help but hope that driverless cars will be a viable alternative to teaching them how to drive.

Have a great weekend!