Omega-3s and Prostate Cancer: Murky research and an explosive media

You know you are getting respect as a medical source when your dad calls you and says:  "Brian, what do you think about fish oil and prostate cancer?"

In my now well practiced medical student voice, I replied "hmmm, I don't know, but I'll look into that."

For the past 10 days, the media has been screaming about the new finding of how fish oil causes prostate cancer.  Time, Huffington Post, NY Times, CNN and other outlets have all chimed in on a recent study that describes a reported increased risk of prostate cancer from the consumption of marine based Omega 3 fatty acids.  The data was significant and the publisher was the well renowned.  What happened? 

The study went like this.  Back in 2004, researchers wanted to know whether vitamin E or Selenium (NOT Omega-3's) had any link to prostate cancer.  So they took hundreds of aging men, did a baseline blood test for many different chemicals, proteins and vitamins, and told them to take either Vitamin E, Selenium, or neither.  Seven years later, the researchers followed up and determined that Selenium did nothing and Vitamin E caused a slightly higher incidence of prostate cancer.  They got a paper out of it, but decided to look back again at the baseline blood work to see if anything else seemed to be associated with the men getting prostate cancer.  Who knows how many statistical analysis were run on how many proteins, metal and other microscopic elements flowing through blood were examined, but one showed statistical significance:  Marine based Omega-3s.  

"I have a prostate, and in the context of my mostly-plant diet, will continue to eat fish and take a daily omega-3 supplement" - Dave Katz MD, Director of Yale Prevention Research Center

This isn't science.  This is statical wizardry.  Science is generating a hypothesis based on prior evidence and testing it.  This is fishing in a plethora of blood results to achieve statistical significance, knowing all along that a published finding will turn the eyes the media and every human with a prostate.   

If researchers thought that Omega-3s were associated with prostate cancer in the first place, they would have had participants take fish oil or eat fish.  But of course, they wouldn't because prior research has either found little to mixed evidence to say that omega-3 fish oils cause prostate cancer.  And there's some studies that says it prevents prostate and breast cancer.  However, they likely never got mentioned in mainstream media either because they agreed with our current notion that omega-3s are good for us, or because the finding that something doesn't cause cancer isn't alarming and therefore unworthy of major press.  

"This is an observational study, and these studies usually generate rather than confirm hypotheses...It is a little puzzling, interesting, and provocative. It raises questions but is a long way from being definitive." - Eliot Brinton, MD, director of atherometabolic research at the Utah Foundation for Biomedical Research 

This is why research is often a murky pond with a media that is quick to grow on it.   An observational study that does no more than create a hypothesis is proclaimed as drastic finding.  Researchers have no mechanism for omega 3s causing tumorigenesis and little context to say that it does.  Until a prospective study targeting omega-3s and prostate cancer arises, we shouldn't be convinced.  And hey, I hear salmon was just marked down at the supermarket.  

And the Battle Rode On

My armor fit tightly around chest restricting the fluidity of my movements.  The enemy, off in the distance, at times sliced through the air and created audible explosions off in the distance.  The potent smell around me was telling of where I was.

Previous attempts at victory had yielded success when I used the proper fighting technique.  Of course correct form is easy when the attacker isn’t beating down upon you.  I grabbed my weapon with both hands and tucked it closely under my arm.  One step into the battleground and instantly a shock of realism bolted up my spine.   I had recollections of fighting months ago and the memories were still vivid.  Nearing the enemies lines, I approached cautiously.  Calculated steps ensured that the moving mines wouldn’t pierce my legs; an incident that had placed my friends on crutches.  One wrong foot placement and my legs could be in dire peril.  Closer, Closer.

CRRASH, the sound of violent clatter was almost upon me, sharpening my perceptions of the situation.  I sensed another attack coming, and this time I jumped onto my stomach and forcefully punched through the first wave of enemies.  I knew I had time before the next group of attackers would emerge.  Straining everything inside of me, I lugged my weapon and armor forward. The blinding sun beamed luminously and heated my armor.

KA BOOM...An explosion ripped through the air mercilessly.  This charge was far more vicious and powerful than the last.  I attempted to avoid it, but there was little I could do.  It knocked me helplessly backward.  I cleared my vision with a newfound desire to conquer my competitor.

I slashed forward directly at my opponent in the distance, turned around and waited to pounce on him.  He came quickly, looking to disarm me.  But I pushed forward just ahead of him and began to stand over him. He started to cave in on himself, attempting to drag me with him. I remained firm with my feet solidly placed on top of my board coasting the wave all the way to shore.  

** This blog post was inspired by my time surfing over the weekend which felt like entering a battlefield. Wearing a wetsuit, avoiding stingrays, plowing through waves and finally standing several times were all parts of the experience.

Here's a poem I wrote for Valentine's Day (no particular person, sorry). Enjoy the clever nerdyness!

With All of my Cardiac Myocytes

You send me an SMS and my SNS starts to fly

When you are around me, you deflate my alveoli

Beauty is in your genes, constitutively expressed

Even in your scrubs and mask, I’m totally impressed

You give me tachyarrythmias when you try to call

It’s not safe to think of you without taking propranolol

As you are you don’t need botox, silicon or surgery

You are perfect to every integrin and cyclic A M P

Your smile is by far my favorite phenotypic trait

But also your ASIS and immaculate gait

If you were a cardiac interval, you would be a QT

You’re more valuable than a surgeon’s salary

When you feel depressed and want to sit and cry

I’ll lift you up inside like the levator ani

I’ll treat you out to dinner and treat you when you have the flu

I’m a practicing specialist and it’s in is pleasing you

I wish we were paired chromosomes, with ties no one could sever

Then we could be in metaphase, from now until forever.

I have a U-linked mutation and it’s in my DNA

Could we link like tight junctions just for Valentines Day?

Polluting the Pond

"There's always more fish in the sea."

Except if they're dead floating in a pond. Even Chuck Testa can't revitalize them then.

Of course I’m talking about that risky choice to reveal who you like which becomes known to an entire group of mutual friends. Much like buying a car or jumping off a ledge, the opportunity to step back and re-assess the alternative options once you have made the initial leap of showing your feelings is long gone. As soon as you have clearly expressed interest, you may as well bag your chances with any of that person’s friends too unless they’re apt to be a second option.

And who wants to be a second option? People want to be cherished, special, and selected above all others.

Picture this: You are a fisherman equip with poisonous harpoons. Your fishing territory is a collection of ponds separated by rocks much like a tide pool. Some of these ponds are colossal and swarming with fish while others contain just a few. Every time you feel like hunting you search for a desired fish within a specific pond, take aim and launch your harpoon downward. Whether you strike the fish or not, your weapon pierces the aquatic floor and exudes an insidious poison that soon makes all of fish in the pond croak and float to the top. Sometimes, you pull out your fish and other times you miss, but regardless, you pollute the pond. If you want to hunt again, you'll have to find a different pond because even if there were other fantastic fish in the polluted one, they're dead now.

This is what happens all of the time when people pursue other people.

Boy likes girl a and kinda likes another girl b who also likes the boy. Girl b knows girl a and knows that boy has first chosen girl a. Then things fall apart with girl a so boy then wants to be with girl b. Girl b hates being the second choice and floats away from boy. Girl c (if she exists) does the same and talks with girl b about how terrible boy is. Girl b and c bond and become best friends.

Ok, I made up the last part, but the point is that by selecting girl a, the boy just polluted the pond. In the pond was girl a, b, c and possibly more awesome fish too. Maybe he didn’t care that he forwent his chances with girl b and c by choosing girl a, but he should at least known he would kill the other fish.

So what can you do? Your best bet is to shoot for a smaller pond.  A pond where just a few other fish are swimming. If any hesitation of which fish to choose exists in a large body of water, you would be wise to wait to keep the water pure and the fish swimming. So next time when you go hunting, go small or you might go home disappointed. And also, aim away from bottom feeders.

*Disclaimer: This scenario has no relevance whatsoever within Jersey Shore much of the greek sorority and fraternity ponds.

How to Change People/(Social Norms), Part 2

About 3 months ago, I attended a global health conference at UCSD. I had seen a listing of the presentations before hand and this workshop was one of the main reasons I wanted to attend the conference was for a workshop called “Changing Social Norms. Ending Female Genital Cutting (FGC).” I didn't know much about it, but really, when else do you hear about these things?

It turns out that FGC is extremely common in Saharan Africa. The WHO even estimates that 100-140 million women are living with it’s consequences and over 92 million of them in Africa [1]. This was a far bigger number than I thought. Can you imagine being a part of a society with a disgusting ingrained practice in that causes unnecessary pain, infections, and permanently diminishes pleasure?

What’s the method to stop it? Most experts turn to the process by which foot-binding in China ended for a good example of how persisting social norms can change quickly [2]. Just over a hundred years ago, millions of female babies had their feet bound and broken for the sake of beauty. But this 10th century practice changed within a several decades and was eventually banned in 1912

So how did they do it? The successful method could hopefully be carried out to ending awful practices like female genital cutting. Oddly enough, after reading the blueprint for abolition, I was reminded of fundraising for a canned food drive or for magazine subscribers in Boy Scouts. According to Politial Theorist, Gerry Mackie PhD who has written several lengthy articles on social norms, it goes like this.

Step 1 “They [organizations] carried out a modern education campaign, which explained that the rest of the world did not bind women's feet.” (Canned Food Drive: There are starving people outside of your doorstep)

Step 2 “They explained the advantages of natural feet and the disadvantages of bound feet in Chinese cultural terms.” (Canned Food Drive: With each can, a child is fed for a day...you might not use the cans but others would.)

Step 3 "They formed natural-foot societies, whose members publicly pledged not to bind their daughters' feet nor to let their sons marry women with bound feet." (Canned Food Drive: Can you pledge to bring X number of cans on this day? There are many others who are doing it also.)

This is what a movement within UNICEF does called the Tostan Community Empowerment Program. And the results training women in villages within Senegal are astounding. “Immediately before the programme began, 7 out of 10 women stated that they wished to have their daughters cut. At the end of the programme, this proportion had fallen to approximately 1 in 10 among women who had participated in the programme, and 2 in 10 among women who had not participated directly, but lived in the same village.” [3]. The most surprising statistic to me is that 2 out of 10 women who didn’t even participate in the program changed their beliefs. Obviously, most members of the community were just practicing because everyone else was. Probably something similar to fashion trends US (without the same consequences).

“As of December of 2004, these meetings have led to public declarations by 1,527 communities, or approximately 30 per cent of the population estimated to practice FGM/C in Senegal in 1997.” FGC is still common in certain places in the globe, but at least we know we know eradication is possible and organizations are working to stop it.

Citations
1. WHO factsheet.
2. Footbinding in China.
3. UNICEF. Page 24.

How to Change People, Part 1

For some time, I’ve been thinking about how people change. How do people come to value new ideas ignite passionate for causes? I’ve always been fascinated by how people become themselves whether by their own ambition, family, friends or society. All play a role, but some influence people to greater degrees, especially whichever one a person spends more time with. Whoever you spend time with, you will become like without even knowing it sometimes. Studies have shown that “emotional contagiousness” exists and that your level of happiness is directly proportional to the happiness of your friends and their friends. [1] Whether you like it or not, you will pick up on some of the things people around you say and think as well as their attitudes and emotions. Sometimes, I even catch myself speaking with the same tone and jargon as friends I know or teachers I’ve been learning from recently. Even now as I write this, I’m writing under the influence of Atul Gawande, just because I’ve been reading one of his books today (I would definitely recommend Checklist Manifesto).

Now lets say you want someone to change. What if you want to make a person to lose weight or stop being so critical? One way would be to ensure that the people that surround them behave in a way that aligns with the change. Habits can change quickly around certain groups of people. I’ve seen, on multiple occasions, people who ordinarily cuss, but when they happen to be around people who don’t they follow suit. It would be too awkward otherwise. But you can’t always make someone go into a certain environment all of the time. There has to be other ways to make change intentional.

I’m sure psychologists have dozens of guidelines for how to change and motivate people, but here are two that I’m sold on.

1. If you want a person to change, never directly tell them that their beliefs are wrong. Also don’t tell someone that they NEED to change or else bla bla bla will happen. The “your wrong and this is how you should be” approach is tempting because it’s honest, logical and to the point. It might work with certain personality types, but in most cases, it’s bound to fail. You want to out argue the person, but most of the time, the person will become defensive or/and shut down. Then, future attempts will automatically be prone to further unwinable battles.

Instead, a person or group of people must (somewhat) independently realize that change is necessary and muster the motivation to do it. People feel most empowered to alter their beliefs or lifestyles when they have come up with the answer themselves. That way, they can take pride in their own intuition and ambition when positive change occurs. This route often involves a discussion of the topic. In this discussion, non-judgmental questions are crucial. At first, I was skeptical of this method since it feels childish to me, but any discussion can geared to the level of the individual. “What holds you back from losing weight?” “What’s fair in this situation?” “What do you think are reasonable goals for you?” These kinds of questions can help a person come to his own conclusions?

2. Accountability will help change and is sometimes necessary. For most, changing their ideology or lifestyle is extremely challenging. Something tantamount to waking up one day and swimming 10 miles or filing your nails on a chalkboard, at least at first. In rare cases, a person with incredible will power can stop an addiction, or habit just by wanting it away badly enough. But for most, it REQUIRES a SEISMIC environmental alteration or a PUBLIC declaration to do something differently. With accountability, you are constantly reminded that friends expect you to change. This makes failure a great embarrassment. And success stories from the flash diet show that peer pressure is one of the strongest factors in changing eating habits. [2].

Certainly, there are other big factors too. Cataclysmic events like a heart attack will often make a person serious about exercise and diet. Reward and punishments can work well too, but I believe only if a person establishes them independently.

How have you changed and why? What or who made you change? Did you know you changed when it happened?

1. Christakis, Nicholas and Fowler, James. SOCIAL NETWORKS AND HAPPINESS http://edge.org/3rd_culture/christakis_fowler08/christakis_fowler08_index.html

2. Flash diet. http://www.dailymail.co.uk/health/article-1052234/The-flash-diet-Taking-photos-meals-helps-slimmers-lose-weight.html

Tuesday Takeaway (Nov. 8th)

The gap between the rich and poor is partly due to the gap between the rich and young.

Three simple ways to gain energy without drinking coffee.

Like it or not, Facebook is becoming more and more about self-promotion.

NEW STUDY: Around 10% of college papers are plagiarized from wikipedia.

New clothing for establishing posture. Awesome, but hilarious.

"Suicide is not chosen; it happens when pain exceeds resources for coping with pain." A good article for anyone considering suicide.

Elections in Latin America:

Nicaragua's president Daniel Ortega is breaking rules to win again.

Bad news for Guatemala: Perez Molina, a high-ranked former military officer who was trained by the School of Americas will be presiding over Guatemala.