The Statin Wars: Lipitor Vs. Crestor

A tie. But I'd probably agonize over the decision to take either one of them.

I was reading Dr. Cinque's blog this morning. He gave it over to the comments of a Dr. Uffe Ravnskov on the results of the recent SATURN trial:

Effect of Two Intensive Statin Regimens On Progression Of Coronary Disease (SATURN), New England Journal of Medicine, November 15, 2011

This trial pitted Lipitor against Crestor, both statins, both very high doses. It had no placebo arm. It gauged the effectiveness of these drugs by measuring changes in the cross-sectional area of an artery wall (a surrogate measure of atherosclerosis).

In the end, there was no difference between the two. The doses of Lipitor (80 mg) and Crestor (40 mg) used were found to be equally effective at "regressing atherosclerosis."

Dr. Ravnskov (who I know only from reading his Amazon entry) had some criticisms. Take statins? Not if you value your kidneys and liver, and not if you're loathe to slap down $ on a drug that has "an uncertain effect on a surrogate end-point, which may or may not mean anything." He has a point, many points in fact.

Kidney Damage

"A more detailed review of adverse events reveals that “new proteinuria”, defined as an excretion of more than twice the amount of protein in the urine during the follow-up, in 1.7 [Lipitor] and 3.8% [Crestor], respectively in the two groups. An increase in proteinuria is a measure of progressive damage to the kidneys. This trial only lasted two years, so we don´t know what would have happened in the longer term."

Protein in the urine indicates kidney damage. What was happening to the kidneys of patients who were experiencing protein in urine twice that of normal? How many were? That wasn't even recorded! Healthy kidneys are adept at preventing protein from leaking into urine at all.

Liver Damage

"Equally it was stated that less than two per cent had laboratory signs of liver damage. However, liver damage was only recorded if the laboratory signs were at least three times higher than the upper limit of the normal range."

Table 4 shows the number of patients who experienced elevated liver enzymes at 3 times normal. Again you have to ask, what was happening to the livers of patients whose enzymes were up to 3 times normal? How many were there? No data.

Muscle Damage

"And whilst less than two per cent had muscular damage, this was only reported if the laboratory signs were at least five times higher than the upper limit of the normal value."

5 times! What was happening to the muscles of patients whose lab values were up to 5 times normal (and even 10 times! as Table 4 shows)? You could assume there were a significant number of patients with abnormal values. It's entirely possible that 100% of patients experienced muscle abnormalities; you don't know. Choosing this high cut-off precluded the authors from having to address statins' effect on muscles.

Imagine if you had a placebo group and could compare kidney, liver, and muscle function of those not on statins to those on Lipitor and Crestor.

Regression Of Coronary Atherosclerosis?

The goal of this study was to measure regression of atherosclerosis, via a marker: the change in PAV (Percent Atheroma Volume), which I understood as the change in cross-sectional area of an artery wall. One coronary artery in each patient was measured twice, once at the start of the study and once after 104 weeks of treatment. There was a statistically significant reduction in PAV of less than 1% for Lipitor and 1.2% for Crestor. They had a secondary endpoint, TAV, which also showed a statistically significant reduction from baseline. (I originally said that these reductions were statistically insignificant. But in the Results section it does say that "P<0.001 for the change from baseline in each group." I was incorrectly looking at the between group P values in Table 3.)

Not only were these changes tiny, but whether they indicate regression of coronary atherosclerosis is debatable. Dr. Ravnskov says they may well have been explained by non-drug effects, such as "mental stress, anxiety, exposure to cold, and even a sustained handgrip." Bear in mind there were only two measurements two years apart, making it difficult to account for these non-drug effects.

"In short, the degree of arterial dilation is a massive and uncontrolled variable in the SATURN study. This problem could have been solved if the investigators had included a placebo group."

The study also had a high drop-out rate (29%!), which Dr. Ravnskov attributed to patients' poor tolerance of the high-dose drugs. High drop-out rates reduce the internal validity of a study.

Can The Ability Of Statins To Stave Off Heart Attack Be Ascertained by Ultrasound?

The primary endpoint of the SATURN trial above, PAV (Percent Atheroma Volume) gained via ultrasound, has limited ability to determine plaque's risk. This editorial addresses that:

Seeking Alternatives to Hard End Points, Is Imaging the Best APPROACH?, Circulation, March 2010

Here's a slide from it, and the caption:

"Measures of total atheroma burden may not accurately estimate cardiovascular risk because they do not take into account coronary plaque morphology."

The percentage of plaque is about the same in Figures A and C. However, the plaque in Figure C has less dead tissue (necrotic core), a thicker cap, less evident inflammation, and is considered more stable that the plaque in figure A. PAV alone does not tell you this.

As Dave noted in Comments, the authors of SATURN say as much:

"Yet intravascular ultrasonography remains a surrogate end point, and a reduction in plaque volume should not be interpreted as equivalent to a clinical benefit in terms of preventing cardiovascular events."

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I try not to be too cynical but I was taken aback at the extent of these authors' conflicts of interest (AstraZeneca makes Crestor, Pfizer makes Lipitor). How in the world are we going to get at the heart of drug effectiveness when there's so much money to be made?

Dr. Nicholls reports receiving consulting fees from Roche, Esperion, Merck, Omthera, Sanofi-Aventis, and Boehringer Ingelheim, serving as an unpaid consultant for Abbott, Pfizer, LipoScience, Novo Nordisk, AtheroNova, and CSL Behring, receiving grant support from Eli Lilly, AstraZeneca, Novartis, Anthera, LipoScience, Roche, and Resverlogix and lecture fees from AstraZeneca and Roche;
Dr. Ballantyne, receiving grant support from Abbott, Astra-Zeneca, Bristol-Myers Squibb, Genentech, GlaxoSmithKline, Kowa, Merck, Novartis, Roche, Sanofi-Synthelabo, and Takeda, consulting fees and honoraria from Abbott, Adnexus, Amarin, Amylin, AstraZeneca, Bristol-Myers Squibb, Esperion, Genentech, GlaxoSmithKline, Idera, Kowa, Merck, Novartis, Omthera, Resverlogix, Roche, Sanofi-Synthelabo, and Takeda and lecture fees from Abbott, AstraZeneca, GlaxoSmithKline, and Merck;
Dr. Barter, holding an advisory board position for AstraZeneca, Merck, Roche, CSL Behring, and Pfizer, receiving grant support from Merck, consulting fees from CSL Behring, and lecture fees from AstraZeneca, Kowa, Merck, Pfizer, and Roche;
Dr. Chapman, receiving grant support from Merck and Kowa, consulting fees from Merck and Pfizer, and lectures fees from Merck and Kowa;
Dr. Erbel, receiving grant support from the Heinz Nixdorf Foundation and the German Research Foundation and support for travel, accommodations, or meeting expenses from Biotronik, Sanofi, and Novartis;
Dr. Libby, serving as an unpaid consultant for Novartis, Johnson & Johnson, Amgen, and Roche, serving in unpaid leadership roles for clinical trials sponsored by AstraZeneca, GlaxoSmithKline, Novartis, Pfizer, Pronova, and Sigma Tau, and having previously received royalties from Roche for the patent on CD40L in cardiovascular risk stratification;
Dr. Raichlen, being an employee of and owning stock in AstraZeneca;
Dr. Nissen, receiving consulting fees from Eli Lilly, grant funding from AstraZeneca, Pfizer, Novartis, Karo Bio, Novo Nordisk, Takeda, Resverlogix, and Omthera, and support for travel, accommodations, or meeting expenses from Novo Nordisk, Takeda, Karo Bio, Eli Lilly, Pfizer, Novartis, and Amgen.

If my physician wanted to put me on a statin to reduce the chance of a heart attack, I may agree (assuming diet, exercise, adequate sleep, stress management, smoking cessation, etc. all failed to reduce my risk, however that risk was measured), but I would request a copy of my lab values and compare them to my values prior to taking the drug. Not saying statins are solely responsible for lab changes, but at least I'd be informed. Damaged kidneys, liver, and muscles may very well be an acceptable cost for lessening heart attack risk, as these authors said, "Both agents had acceptable side-effect profiles."________

Just The Germ, Please

Here's some dried dent corn I put out to feed the birds, or the squirrels if the birds aren't fast enough.



When I looked closely I saw the fatty germ of the kernel was nibbled away and the starchy endosperm abandoned. I think the cardinals do this, and the squirrels. Not the blue jays; they'll stuff 5 or 6 whole kernels in their mouth and fly away with chipmunk cheeks! The smaller finches and wrens and black-capped chickadees and tufted titmice wait until the kernels are crushed and peck at the crumbs. I think.


Humans use diagrams; birds deduce on the fly.


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Thank You

To all the people who read and comment and email, it has been a pleasure. You give so much - your thoughts, your feelings, your time. I appreciate it all. Every speck. Thank you.
________Photo looking down the pipeline clearing one morning.

The Jungle, Part 3: Food Was Not As It Seemed

Another excerpt from Sinclair's 1906 exposé The Jungle.

"Their children were not as well as they had been at home; but how could they know that there was no sewer to their house, and that the drainage of fifteen years was in a cesspool under it? How could they know that the pale-blue milk that they bought around the corner was watered, and doctored with formaldehyde besides? When the children were not well at home, Teta Elzbieta would gather herbs and cure them; now she was obliged to go to the drugstore and buy extracts--and how was she to know that they were all adulterated? How could they find out that their tea and coffee, their sugar and flour, had been doctored; that their canned peas had been colored with copper salts, and their fruit jams with aniline dyes? And even if they had known it, what good would it have done them, since there was no place within miles of them where any other sort was to be had?"

The Food and Drug Administration (FDA) came into existance shortly after The Jungle was published. From the FDA's website:

"Although it was not known by its present name until 1930, FDA’s modern regulatory functions began with the passage of the 1906 Pure Food and Drugs Act, a law a quarter-century in the making that prohibited interstate commerce in adulterated and misbranded food and drugs. Harvey Washington Wiley, Chief Chemist of the Bureau of Chemistry in the Department of Agriculture, had been the driving force behind this law and headed its enforcement in the early years, providing basic elements of protection that consumers had never known before that time."

I see China experiencing the same problems with food adulteration and industrial pollution today as the US experienced at the beginning of the 20th century. I suppose expedited economic growth has its downside.

The Jungle, Part 1: Breakfast And Dinner
The Jungle, Part 2: Honeycombed With Rottenness
The Jungle, Part 3: Food Was Not As It Seemed
The Jungle, Part 4: Sausage And Lard
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The Jungle, Part 2: Honeycombed With Rottenness

Here's another excerpt from Upton Sinclair's The Jungle.

Jurgis' new friend (Jurgis is the main character, a strong, earnest young man new to the US from Lithuania) describes the goings-on at Durham's, one of Chicago's main meatpacking plants. (To hear Sinclair describe these businesses, they are veritable countries-within-a-country):

"After Jurgis had been there awhile he would know that the plants were simply honeycombed with rottenness of that sort--the bosses grafted off the men, and they grafted off each other; and some day the superintendent would find out about the boss, and then he would graft off the boss.

Here was Durham's, for instance, owned by a man who was trying to make as much money out of it as he could, and did not care in the least how he did it; and underneath him, ranged in ranks and grades like an army, were managers and superintendents and foremen, each one driving the man next below him and trying to squeeze out of him as much work as possible. And all the men of the same rank were pitted against each other; the accounts of each were kept separately, and every man lived in terror of losing his job, if another made a better record than he.

So from top to bottom the place was simply a seething caldron of jealousies and hatreds; there was no loyalty or decency anywhere about it, there was no place in it where a man counted for anything against a dollar."

The Jungle, Part 1: Breakfast And Dinner
The Jungle, Part 2: Honeycombed With Rottenness
The Jungle, Part 3: Food Was Not As It Seemed
The Jungle, Part 4: Sausage And Lard

________Photo of Chicago's Union Stockyards in 1947, from Wikipedia. These stockyards operated until 1971. From the Civil War until the 1920s, more meat was processed here than in any other place in the world. I probably have remnants of meat from these packhouses in the cells of my body, from my mother's, bless her well-meaning heart, tanned pork chops.

The Jungle, Part 1: Breakfast And Dinner

Here's a passage from Upton Sinclair's The Jungle. The book was written in 1906 and was set in Chicago's meatpacking district. The characters are 12 newly-arrived Lithuanian immigrants.

"... at a quarter past five every morning. She would have ready a great pot full of steaming black coffee, and oatmeal and bread and smoked sausages; and then she would fix them their dinner pails with more thick slices of bread with lard between them--they could not afford butter--and some onions and a piece of cheese."

The dinner pails were packed for those in the group who worked in the stockyards during the day.



I'm only about a fifth of the way through. There's a lot here.

The Jungle, Part 1: Breakfast And Dinner
The Jungle, Part 2: Honeycombed With Rottenness
The Jungle, Part 3: Food Was Not As It Seemed
The Jungle, Part 4: Sausage And Lard
________Photo of the inside of one of Chicago's meatpacking plants from Wikipedia's entry on The Jungle.

Robin Gibb And Cachexia

Cachexia is a wasting condition. No matter how much you eat, you lose weight. It's often accompanied by loss of appetite, so you don't want to eat, which exacerbates the condition.

When I saw this photo of Robin Gibb a few months ago, I thought, uh-oh. Cachexia is often seen in late-stage cancer patients. At the time, I read that he had been treated for "stomach problems" and was on the mend. This morning I read that Robin Gibb was diagnosed with liver cancer. He's 61.

Robin Gibb is one of my favorite singers from my youth, one of the brothers who formed the hugely successful group The Bee Gees. I enjoyed their pre-disco, tightly-harmonized sound. Here are two songs by Robin that have been real earworms for me over the years:

I Started A Joke:



Massachusetts: (The song was written in 1967, at a time when "young people believed in having a political voice." Robin said of this song, "it is not literally talking about people going back to Massachusetts but represents all the people who want to go back to somewhere or something." )


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Can Cause Come After Effect?

It's looking like cause can come after effect. I can't even comprehend what that means.

Update, November 19, 2011: Remember this post below where a bunch of neutrinos were sent from Switzerland, through 454 miles of rock, to a lab in Italy? And it took them 0.0024 seconds, which was 60 billionths of a second faster than light would have taken (assuming light was traveling not through rock but through a vacuum)? Well, scientists conducted the experiment 20 more times and found the same thing:

Neutrino Experiment Repeat At Cern Finds Same Result, BBC



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Originally posted September 22, 2011:

(The photo to the right shows tracks of a subatomic particle called a neutrino, which have just been found to be traveling faster than the speed of light.)

I'm not going to pretend that I understand, or even know very much about, Einstein's theory of relativity. But I was exposed to E=mc² in University. In this equation, energy (E) is related to mass (m). That is, they are different forms of the same thing, and are related by c, the speed of light ... which is a constant. Or at least it was thought to be.

Faster Than Light Particles Found, Claim Scientists
Particle physicists detect neutrinos travelling faster than light, a feat forbidden by Einstein's theory of special relativity, The Guardian, September 22, 2011

Subir Sarkar, head of particle theory at Oxford University, said:

"If this is proved to be true it would be a massive, massive event. It is something nobody was expecting.

The constancy of the speed of light essentially underpins our understanding of space and time and causality, which is the fact that cause comes before effect.

Cause cannot come after effect and that is absolutely fundamental to our construction of the physical universe. If we do not have causality, we are buggered."

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Europe Bans X-Ray Scanners Used at US Airports

Interesting. ProPublica says that Europe just banned x-ray scanners used in airports because of health and safety concerns:

Europe Bans X-Ray Body Scanners Used At US Airports

But the US is continuing to use them "to detect dangerous or illegal items."

Here's the European Commission's Press Release from November 14:

Aviation Security: Commission Adopts New Rules On The Use Of Security Scanners At European Airports

"In order not to risk jeopardising citizens' health and safety, only security scanners which do not use X-ray technology are added to the list of authorised methods for passenger screening at EU airports."

Are Americans less vulnerable to ionizing radiation?
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Beer May Reduce Heart Disease Risk?

If I can get excited about a 20% reduction in risk of colon cancer (from eating fiber), it's only fair that I get excited about a 42% reduction in risk of heart disease (from drinking beer). Yes, Ronald, Happy Thanksgiving:

Wine, Beer Or Spirit Drinking In Relation To Fatal And Non-Fatal Cardiovascular Events: A Meta-Analysis, European Journal of Epidemiology, November 2011

Here's the abstract:

"In previous studies evaluating whether different alcoholic beverages would protect against cardiovascular disease, a J-shaped relationship for increasing wine consumption and vascular risk was found; however a similar association for beer or spirits could not be established. An updated meta-analysis on the relationship between wine, beer or spirit consumption and vascular events was performed. Articles were retrieved through March 2011 by PubMed and EMBASE search and a weighed least-squares regression analysis pooled data derived from studies that gave quantitative estimation of the vascular risk associated with the alcoholic beverages. From 16 studies, evidence confirms a J-shaped relationship between wine intake and vascular risk. A significant maximal protection—average 31% (95% confidence interval (CI): 19–42%) was observed at 21 g/day of alcohol. Similarly, from 13 studies a J-shaped relationship was apparent for beer (maximal protection: 42% (95% CI: 19–58%) at 43 g/day of alcohol). From 12 studies reporting separate data on wine or beer consumption, two closely overlapping dose–response curves were obtained (maximal protection of 33% at 25 g/day of alcohol). This meta-analysis confirms the J-shaped association between wine consumption and vascular risk and provides, for the first time, evidence for a similar relationship between beer and vascular risk. In the meta-analysis of 10 studies on spirit consumption and vascular risk, no J-shaped relationship could be found."

A J-shaped curve means there was benefit for a limited intake of beer (43 grams of pure alcohol, the amount in about 3, 12-ounce beers) or wine (21 grams alcohol, about 7.5 ounces of wine). Amounts above this led to increased risk, so more was not better. In fact it was worse than drinking no beer or wine at all.

The maximum protection for wine was 31%.
The maximum protection for beer was 42%.
No association was seen for spirits.
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Fiber From Whole Grains May Protect Against Colorectal Cancer

A new large analysis (~2 million people) investigating the link between dietary fiber and colon cancer:

Dietary Fibre, Whole Grains, And Risk Of Colorectal Cancer: Systematic Review And Dose-Response Meta-Analysis Of Prospective Studies, British Medical Journal, November 2011

Found that:

"A high intake of dietary fibre, in particular cereal fibre and whole grains, was associated with a reduced risk of colorectal cancer."

Interesting ... Fruits, vegetables, and beans were not as protective as whole grains:

"Our meta-analysis supports an inverse association between intake of dietary fibre, cereal fibre, and whole grains and risk of colorectal cancer, but we found no significant evidence for an association with intake of fibre from fruit, vegetables, or legumes."

How much:

"Our results indicate a 10% reduction in risk of colorectal cancer for each 10 g/day intake of total dietary fibre and cereal fibre and a about a 20% reduction for each three servings (90 g/day) of whole grain daily, and further reductions with higher intake."

What kind:

"Total whole grains included whole grain rye breads, whole grain breads, oatmeal, whole grain cereals, high fibre cereals, brown rice, and porridge."

Dagfinn Aune, lead study author:

"The more of this fibre you eat the better it is. Even moderate amounts have some effect."
- Fibre And Whole Grains 'Reduce Bowel Cancer Risk,' BBC, November 10, 2011

That same BBC article said:

"The lifetime risk of being diagnosed with colorectal cancer in the UK is estimated to be one in 14 (6.9%) for men, and one in 19 for women (5.4%)."

Wow, those are some risks.

Update, November 17:

I'm adding a graph from the study and an excerpt from their "Mechanisms" paragraph. The graph shows a statistically significant and linear inverse association ... as fiber intake went up, cancer risk went down.

Mechanism:

Dietary fiber:

"... may decrease the risk of colorectal cancer by increasing stool bulk, diluting faecal carcinogens, and decreasing transit time, thus reducing the contact between carcinogens and the lining of the colorectum. In addition, bacterial fermentation of fibre results in the production of short chain fatty acids, which may have protective effects against colorectal cancer."

These mechanisms aren't new to this blog, e.g. transit time and dilution. The interaction of fiber with colonic bacteria is notable. I saw this benefit with resistant starch too. (See Resistant Starch May Reduce Risk Of Colon Cancer.) Resistant starch isn't fiber per se; it's a vegetable starch that fails to get digested and ends up in the colon where bacteria feed upon it. I've written about it here.
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Americans Ate Less Meat, Less Fat, And More Grains 100 Years Ago

This is a repost from 2008:

The USDA Economic Research Service (ERS) recently updated their three data sets on food availability in the US:
Food Availability (Per Capita) Data System

Food availability doesn't equate directly to food consumption; spoilage and waste aren't accounted for. One of the data sets, Loss-Adjusted Food Availability, "adjusts aggregate food availability data for nonedible food parts and food lost through spoilage, plate waste, and other losses in the home and marketing system." It accounts for some loss but only goes back to 1970, that I can tell.

I can't determine how or if they accounted for food produced by a consumer instead of by a marketing entity. That is, if you're eating eggs from your hens or carrots from your garden, are they accounted for in these data sets?

Still, as a proxy for consumption, they're revealing.

So, did we eat more meat 100 years ago than we do today? (Click graphs for larger.)


Grain:


Fats and oils:


This one shows just oat products. What's that blip between 1988 to about 1995?


A couple beverage graphs ... First, coffee/tea/cocoa. Imagine if Starbucks was around in the 40s? (When I was growing up, everyone drank hot coffee with breakfast. I see a lot more carbonated beverages these days.)


Is America more a wine- or beer-drinking country?


Using data in their Loss-Adjusted Food Availability Set, I generated this graph for calorie consumption. We're eating (or what is available for us to eat) 519 more calories a day (24% more) than we did in 1970.


You can easily generate these charts on their site. The raw data is accessible in Excel worksheets too. It's what I used for the calorie graph. I could play with this all day.
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Photo above is of a kitchen classroom in a housekeeping flat, New York, circa 1910, from Shorpy: The 100-Year-Old Photo Blog. Here's another: "December 1936. Farmer's wife churning butter. Emmet County, Iowa." (Click for larger.)

Light Therapy Edges Out Prozac In Head-To-Head Comparison

In a head-to-head comparison between the antidepressant Prozac (fluoxetine) and light therapy, the light therapy came out on top. Both therapies were equally effective at alleviating depression, but the light therapy kicked in sooner and had fewer side effects (agitation, sleep disturbance, palpitations):

The Can-Sad Study: A Randomized Controlled Trial Of The Effectiveness Of Light Therapy And Fluoxetine In Patients With Winter Seasonal Affective Disorder, The American Journal of Psychiatry, 2006




The light treatment group received 10,000-lux light and a placebo capsule. The drug group received 100-lux light (placebo light) and fluoxetine, 20 mg/day. Light treatment was applied for 30 minutes/day in the morning with a fluorescent white-light box.
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It's Genetic, There's Nothing I Can Do

I like this example Ramachandran gave about the nature-nurture question, from his book, The Tell-Tale Brain. I'm applying it to the occurrence of chronic diseases, however valid that may be. Are they determined mainly by one's genes (nature) or by one's environment (nurture)? Ramachandran says, "If the relationships are complex and non-linear, the question should be not, Which contributes more? but rather, How do they interact to create the final product?"

"The late biologist Peter Medawar provides a compelling analogy to illustrate the fallacy. An inherited disorder called phenylketonuria (PKU) is caused by a rarely occurring abnormal gene that results in a failure to metabolize the amino acid phenylalanine in the body. As the amino acid starts accumulating in the child's brain, he becomes profoundly retarded. The cure is simple. If you diagnose it early enough, all you do is withhold phenylalanine-containing foods from the diet and the child grows up with an entirely normal IQ.

Now imagine two boundary conditions.

Assume there is a planet where the gene is uncommon and phenylalanine is everywhere, like oxygen or water, and is indispensable for life. On this planet, retardation caused by PKU, and therefore variance in IQ in the population, would be entirely attributable to the PKU gene. Here you would be justified in saying that retardation was a genetic disorder or that IQ was inherited.

Now consider another planet in which the converse is true: Everyone has the PKU gene but phenylalanine is rare. On this planet you would say that PKU is an environmental disorder caused by a poison called phenylalanine, and most of the variance in IQ is caused by the environment.

This example shows that when the interaction between two variables is labyrinthine it is meaningless to ascribe percentage values to the contribution made by either. And if this is true for just one gene interacting with one environmental variable, the argument must hold with even greater force for something as complex and multifactorial as human intelligence [which was Ramachandran's topic when he summoned this example], since genes interact not only with the environment but with each other.

I understand this as ... A disorder may be rooted in genes, but whether or how it manifests depends upon the environment and on the presence and activity of other genes. If a man's father had heart disease and suffered a heart attack in his late 50s, is that necesssarily the son's fate? If a woman's mother was overweight, sedentary, and enjoyed the Standard Post-War American Diet, and was diagnosed with type 2 diabetes in her early 60s, is that necessarily the daughter's fate?

Related post: Genetic Nihilism
________Photo of identical twins who were raised apart from Boston University's Bostonia.

Hummingbirds Shake Their Heads To Deal With Rain

Hummingbirds Shake Their Heads To Deal With Rain, BBC, November 8, 2011

"Slow-motion footage has revealed how a hovering hummingbird is able to cope with wet weather.

The cameras show that the delicate bird shakes its head with such acceleration that it can reach a g-force of 34 (Formula 1 racing cars typically reach less than 6 g).

This mid-air manoeuvre takes just 0.1 seconds and removes almost all of the water droplets from its feathers."

Robert Dudley, one of the authors of the study, said:

"It is the extreme mobility - its head is going through 180 degrees in a 10th of a second or less - it is just extraordinary."

This Wired article explains that they are shaking their heads 132 times per second while they are flapping their wings 92 times per second. And they are doing this in mid-air "in precisely counterbalanced synchronization."

High-Speed Video Shows How Hummingbirds Stay Dry, Wired, November 9, 2011

All this flapping and shaking requires calories. This particular hummingbird eats about five calories a day, "which translates, from the dietary perspective of a 160-pound human, to more than 18,000 calories."

Birds are something else.
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Boy With Flute

Photo by Vladimir Zotov:


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Test Children's Cholesterol?

Experts Urge Cholesterol Tests For 9- To 11-Year-Olds, Boston Globe, November 12, 2011

No benefit studies exist? Then why would we test?

"The guidelines aren’t well thought out and represent an irrational exuberance for testing," said Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic. He pointed out that no studies have been performed to show that universal cholesterol screening improves health outcomes in children."

Statins aren't innocuous. They are potent drugs with side effects:

"But some doctors say they worry that a greater number of children will be put on cholesterol-lowering statins at younger ages - and possibly kept on them for years or decades without knowing what benefits or long-term risks they would incur from the drugs. Some people experience muscle pain and liver problems from taking statins. In rare cases, life-threatening muscle damage can occur."

Why not skip the test and encourage lifestyle changes anyway?
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A Lot Of Deer This Year

A herd trotting past the deck a few days ago. I was standing at the door. One stopped when she heard the camera.





They come close to the deck. I'm fortunate they haven't availed themselves of my in-a-pot garden. Not too much:



A few does decimating a bush:





Here they are leaving; the matriarch giving me a dirty look. This herd was 8-deer strong. They pass several times a day.



This is why I can't have a garden. The only thing they won't eat is a ground cover called pachysandra. Everything else is on the plate. Trees, bushes, even chicks as I now know. They have an affinity for poison ivy. I watch them pick it out between the lillies. Then they eat the lillies.

We don't live in the woods. The neighbor's house is 30 feet away. But we live on a clearing for a gas pipeline and the deer use it as a trail. I once counted 17 deer in the side yard. You couldn't see the grass for all the brown fur. Mowing is an exercise in aerosolizing deer poop.

The deer around here aren't cute, they're scary. This video is a good example of what happens if you get too close, which I did a few times:




Beware The Rut

A couple days ago, before the sun came up, I heard weird gruffy-howls outside the bedroom window. Our motion-detector lights flicked on and I saw 5 large horned males stalking each other, charging each other, wailing, snorting, steaming. One buck's rack was so heavy I didn't know how he held it up. He stood in the center, slowly swinging his horny head from side to side. No way was I going to take the trash out that day!
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100 Centenarians Surveyed

For the past 6 years, UnitedHealthcare has conducted a survey of 100 centenarians. Here are the results of this year's survey:
100@100 Survey

It's just anecdotal. And since the survey was conducted over the phone, only "healthy and articulate Americans in this age range" could participate. About half had a high school degree or less and 88% were white.

Here are a few responses. There are more on the link.

I'd love to know what they thought a healthy diet was:



Immortality occurs in one's 20s:



I wonder if this was an open-ended question or if they named names. That 0% answer leads me to think they named names:



What is the one innovation you will you tell UnitedHealthcare when you reach 100 and they interview you? (I have to say the internet.)


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1895 Eighth-Grade Final Exam From Salina, Kansas

Examination Graduation Questions of Saline County, Kansas. April 13, 1895

GRAMMAR (Time, one hour)
1. Give nine rules for the use of Capital Letters.
2. Name the parts of speech and define those that have no modifications.
3. Define Verse, Stanza, and Paragraph.
4. What are the principal parts of a verb? Give principal parts of do, lie, lay, and run.
5. Define Case. Illustrate each Case.
6. What is Punctuation? Give rules for principal marks of punctuation.
7 - 10. Write a composition of about 150 words and show therein that you understand the practical use of the rules of grammar.

ARITHMETIC (Time, one hour)
1. Name and define the Fundamental Rules of Arithmetic.
2. A wagon box is 2 feet deep, 10 feet long, and 3 feet wide. How many bushels of wheat will it hold?
3. If a load of wheat weighs 3942 pounds, what is it worth at 50 cts. per bu., deducting 1050 lbs. for tare?
4. District No. 33 has a valuation of $35,000. What is the necessary levy to carry on a school seven months at $50 per month, and have $104 for incidentals?
5. Find cost of 6720 lbs. coal at $6.00 per ton.
6. Find the interest of $512.60 for 8 months and 18 days at 7 percent.
7. What is the cost of 40 boards 12 inches wide and 16 ft. long at 20 cents per sq. foot?
8. Find bank discount on $300 for 90 days (no grace) at 10 percent.
9. What is the cost of a square farm at $15 per acre, the distance around which is 640 rods?
10. Write a Bank Check, a Promissory Note, and a Receipt.

U.S. HISTORY (Time, 45 minutes)
1. Give the epochs into which U.S. History is divided.
2. Give an account of the discovery of America by Columbus.
3. Relate the causes and results of the Revolutionary War.
4. Show the territorial growth of the United States.
5. Tell what you can of the history of Kansas.
6. Describe three of the most prominent battles of the Rebellion.
7. Who were the following: Morse, Whitney, Fulton, Bell, Lincoln, Penn, and Howe?
8. Name events connected with the following dates: 1607, 1620, 1800, 1849, 1865.

ORTHOGRAPHY (Time, one hour)
1. What is meant by the following: Alphabet, phonetic, orthography, etymology, syllabication?
2. What are elementary sounds? How classified?
3. What are the following, and give examples of each: Trigraph, subvocals, diphthong, cognate letters, linguals?
4. Give four substitutes for caret 'u'.
5. Give two rules for spelling words with final 'e'. Name two exceptions under each rule.
6. Give two uses of silent letters in spelling. Illustrate each.
7. Define the following prefixes and use in connection with a word: Bi, dis, mis, pre, semi, post, non, inter, mono, super.
8. Mark diacritically and divide into syllables the following, and name the sign that indicates the sound: Ball, mercy, sir, cell, rise, blood, fare, last.
9. Use the following correctly in sentences:
cite, site, sight
fane, fain, feign
vane, vain, vein
raze, raise, rays
10. Write 10 words frequently mispronounced and indicate pronunciation by use of diacritical marks and by syllabication.

GEOGRAPHY (Time, one hour)
1. What is climate? Upon what does climate depend?
2. How do you account for the extremes of climate in Kansas?
3. Of what use are rivers? Of what use is the ocean?
4. Describe the mountains of North America.
5. Name and describe the following: Monrovia, Odessa, Denver, Manitoba, Hecla, Yukon, St. Helena, Juan Fermandez, Aspinwall, and Orinoco.
6. Name and locate the principal trade centers of the U.S.
7. Name all the republics of Europe and give capital of each.
8. Why is the Atlantic Coast colder than the Pacific in the same latitude?
9. Describe the process by which the water of the ocean returns to the sources of rivers.
10. Describe the movements of the earth. Give inclination of the earth.

PHYSIOLOGY (Time, 45 minutes)
1. Where are the saliva, gastric juice, and bile secreted? What is the use of each in digestion?
2. How does nutrition reach the circulation?
3. What is the function of the liver? Of the kidneys?
4. How would you stop the flow of blood from an artery in the case of laceration?
5. Give some general directions that you think would be beneficial to preserve the human body in a state of health.

Here are some answers. I don't see the Physiology section listed. Just as well. Besides "eat," number 5 is still being debated, diet-wise.
________
An aside ... This site lists "Rules For Teachers" in 1872:

1. Teachers each day will fill lamps, clean chimneys.
2. Each teacher will bring a bucket of water and a scuttle of coal for the day's session.
3. Make your pens carefully. You may whittle nibs to the individual taste of the pupils.
4. Men teachers may take one evening each week for courting purposes, or two evenings a week if they go to church regularly.
5. After ten hours in school, the teachers may spend the remaining time reading the Bible or other good books.
6. Women teachers who marry or engage in unseemly conduct will be dismissed.
7. Every teacher should lay aside from each pay a goodly sum of his earnings for his benefit during his declining years so that he will not become a burden on society.
8. Any teacher who smokes, uses liquor in any form, frequents pool or public halls, or gets shaved in a barber shop will give good reason to suspect his worth, intention, integrity and honesty.
9. The teacher who performs his labor faithfully and without fault for five years will be given an increase of twenty-five cents per week in his pay, providing the Board of Education approves.

Wow.
________

Paleofantasies

A few interesting posts about the Paleo Diet from Elizabeth Nolan Brown:

Why Would Anyone Follow The ‘Paleo Diet’?

Yes, There’s Lots of Good In the Paleo Diet; I Still Think It’s Bunk

I don't know this author, but she makes a lot of sense.

I liked this bit from an author she referenced:

"We have what the anthropologist Leslie Aiello called “paleofantasies.” She was referring to stories about human evolution based on limited fossil evidence, but the term applies just as well to nostalgia for the very old days as a touchstone for the way life is supposed to be and why it sometimes feels so out of balance.

The notion that there was a time of perfect adaptation, from which we’ve now deviated, is a caricature of the way evolution works.

How much of the diet during our idyllic hunter-gatherer past was meat, and what kind of plants and animals were used, varied widely in time and space. Inuits had different diets from Australian aboriginals or Neotropical forest dwellers. ... The argument that we are “meant” to eat a certain proportion of meat, say, is highly questionable. Which of our human ancestors are we using as models?

Evolution lurches along. ... There is no one point when one can say, “Voilà! Finished."

- Marlene Zuk, Evolutionary Biologist, University of California, in The Evolutionary Search For Our Perfect Past, New York Times, 2009

Update, November 7: Yet another scientist, Barbara King, a biological anthropologist at the College of William and Mary, citing the concept of paleo-fantasy:

The Paleo-Diet: Not The Way To A Healthy Future, NPR, October 27, 2011

"In short, there was no single hunter-gatherer foraging strategy, and genes no more "designed" our eating behavior than they designed our language or our ways of relating between the genders."

________

2009 Swine Flu Responsible For Over 10,000 American Deaths

I was reading Dr. Greger's latest post about the meat industry suing the state of California because California passed a law "meant to keep “downed” animals — those too sick and disabled to walk to slaughter — out of the American food supply."

Anyway, this item stood out:

"Even if one doesn’t eat meat, more than half of downer pigs tested in the Midwest were found to be actively infected with swine flu, both the classic swine flu virus and the triple hybrid mutant that led to the 2009 human pandemic that killed more than ten thousand Americans."

Where have I been? The 2009 swine flu killed 10,000 Americans?

Recalling the 2009 swine flu:

• April, 2009 - An outbreak of influenza occurred in Mexico and the US.
  
• June 11, 2009 - WHO declared an H1N1 pandemic.
  
• October 25, 2009 - President Obama officially declared H1N1 a national emergency.

This CDC graph seems to confirm it:



Maybe it would be a good idea to minimize flu outbreaks in factory-farmed livestock herds, since factory farming isn't going away anytime soon.
________

Chuck

Speaking of pets, this is Chuck, the cardinal:


Let me blow up the important part:


I feel a little bad showing Chuck without his crest. He's bald in this photo, molting I suppose. He was much less demonstative without his head feathers but no less endearing to me.

I starting feeding him last Spring. We went through two litters together. His mate nestled their eggs while he searched for food. (She built her first nest in a white azalea bush right outside our window, weaving big white azalea blooms throughout. What a sight!) I called him Charlie. When he twerped, my husband would say, "Chuck's here." I was at Chuck's beck and call.

A hurricane passed through in August. The day after there wasn't a twerp or peep to be had. Where do birds go during storms? I feared for Chuck. Then in the windy, rainy birdless silence ... "twerp! twerp!" Chuck made it through the storm! I was deep-down joyful. I gave Chuck some organic walnuts (I usually gave him really old millet). I bet he thought he died and went to heaven.

Sticker Shock At The Vet

It looks like the cost for keeping a pet is following the same trend as the cost for keeping a person. This article:

The Dog Maxed Out My Credit Card, Wall Street Journal, November 2, 2011

Says spending on routine doctor visits has ballooned in the last decade:

• Dogs: Up 47%
  
• Cats: Up 73%
  
• People: Up 76.7%

"The average household in the U.S. spent $655 on routine doctor and surgical visits for dogs last year."

That doesn't include costs for grooming, food, drugs, insurance, and other items like training, beds, houses, clothing, toys, and exercise equipment.

"When asked how much they'd spend to save their pet's life, 70% of owners said "any amount," according to a 2006 survey of 5,200 [Veterinary Pet Insurance Co.] policyholders."

"Any amount." That brings me to the question of pet diet. If we discover that, say, there's a lot of arsenic in chicken, should we be rationing the amount of chicken we feed to pets? Maybe opt for the lower-arsenic organic bird?

From what I've seen, pet food in this country is of such poor quality and questionable safety, the garbage restaurants throw out at the end of the day probably has more nutrition, if not better taste. Although I can't speak for pets.

It's an extremely profitable business, pet food. Can you imagine paying pennies for the floor sweepings of factory-farmed poultry houses, mixing it with a few vitamins, sashaying through regulation loopholes, and charging premium prices? Perhaps we should Occupy pet food manufacturers.
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Maple Syrup: Grade B Becomes Grade A

Today, "Grade A" maple syrup is light in color and slight of flavor; "Grade B" is darker and more robust. That will change officially by 2013 when all pure maple syrup sold in stores will be labeled "Grade A" and come in 4 color classes: Golden, Amber, Dark, and Very Dark.

Some history of maple syrup, From:
Making the Grade: Why the Cheapest Maple Syrup Tastes Best, The Atlantic, November 1, 2011

Colonial America was hooked on white granulated sugar, and wanted its maple trees to produce it:

"They took the concentrated maple sap and poured it into conical molds, refining it into white sugar-loaves like those produced in Britain from cane syrup.

Maple sugar, a distinctively American product, was touted as the equal of the sugar served in the most elegant Old World salons. The clearest syrups and whitest sugars, which betrayed the least hint of their rustic origins, commanded premium prices."

Post Revolution, Benjamin Rush envisioned an "ignoble purpose" for the sap, but it never took off:

"It affords a most agreeable molasses," he wrote, suggesting that it "might compose the basis of a pleasant summer beer." It was at least as well suited for rum, but Rush piously expressed his hope that "this precious juice will never be prostituted by our citizens to this ignoble purpose."

By the end of the nineteenth century, some were glimpsing the value of the real, raw deal:

The USDA "scorned the idea of refining maple sap into white sugar, noting that maple sugar and syrup were "prized for their peculiar flavor, and are luxuries rather than staple articles of the daily diet."

But Americans still preferred lighter varieties, opening the door to adulteration with corn and glucose syrups. By the early 1900s, one scientist estimated:

"The amount of Vermont Maple Syrup sold every year [was] ten times the actual production."

No matter, by the end of WWII, "pancake syrup" was entrenched:

"Brands backed with corporate heft, like Quaker Oats' Aunt Jemima and Unilever's Mrs. Butterworth, and which included only trace amounts of actual maple syrup [were introduced]."

The turnaround came in the 1980s, when technology and romance married, spawning a lucrative market for the most maple-y of maple syrups. But they were suffering under the weight of a "Grade B" label. The answer? Call them all Grade A:


________Photo of maple syrup taps from Schmidling Productions:

"The sap starts to run as soon as above freezing days occur and stops if it stays above freezing for more than a day. It also stops at night when it freezes but then resumes in the morning if it warms up again.

The sap is simply water containing about 3% sugar that was produced by the leaves in Fall and stored in the roots. In Spring this sugar is required by the new buds for development. When the new leaves start photosynthesizing and producing sugar, the flow stops completely."

There are a lot of gems in this Atlantic article, such as the ethical promotion of a product: "Best of all, it would destroy the market for Caribbean sugar cane, produced by slaves laboring in horrifying conditions," and tie-in to the 1906 birth of the FDA. Thanks, shaun!