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science

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Many Commonly Used Drugs Are Useless
Some medications are life saving. I am so thankful for the trusty med that tames my atrial fibrillation.

Many meds are helpful -- demonstrating superiority to placebo in ways that are clearly clinically significant and life enhancing.

But many (perhaps most) drugs are probably no more than very expensive placebos. Patients get prescriptions from doctors when their symptoms are most severe and improve with time and positive expectation, not because the med is really effective.

Doctors and patients need independent, objective information on drug efficacy and risks.

The multibillion dollar pharma marketing machine can turn even the most useless and harmful drugs into financial blockbusters. Doctors and patients need independent, objective information on drug efficacy and risks.

This is the first of a series of blogs aimed at setting the record straight. Dick Bijl is President of the International Society Of Drug Bulletins (ISDB), a wonderful organization representing 53 national drug bulletins, each charged with presenting the best available data on the pluses and minuses of different medications. Drug bulletins are a source of truth to help patients and doctors see through the fudged misinformation generated by ubiquitous Pharma propaganda.

Dick writes: "Let's use the treatment of lower urinary tract symptoms (LUTS) as a typical example of why and how medication use has become so excessive."

Elderly men often experience problems urinating -- weak or intermittent urinary stream, straining, hesitancy, terminal dribbling, incomplete emptying, urgency, frequency, incontinence, nocturia and/or post-micturition dribbling. These symptoms, so common in aging, provide a lucrative target market for pharma.

In the past, benign prostatic hyperplasia (BPH) was regarded as the most important cause of urinary symptoms. Nowadays, evidence confirming a link between LUTS and prostatic enlargement is regarded as weak. This hasn't prevented approval of many drugs for the treatment of BPH by the Food and Drugs Administration (FDA) and the European Medicines Agency (EMA).

The bar for approval is set very low. Drug companies have only to show that their medication has a statistically significant advantage when compared to placebo. The FDA and EMA don't require that the med achieve what is ever so much more important- clinically relevant improvement as evidenced by patients actually also feeling and doing better when taking the drug. Small statistical blips are all it takes to get a drug approved.

There is a huge difference between statistical significance and clinical relevance. For example, the International Prostatic Symptoms Score is often used to quantify the treatment effects of urinary drugs. The IPSS scale goes from 0-35 with higher scores indicating more severe symptoms. A difference of ≥3 points = some effect; ≥5 points = moderate effect; ≥8 pt. = clear effect). In practice, it turns out that patients can't detect improvements if they are less than three points.

The results of clinical trials have shown that most drugs used to treat BPH are statistically more efficacious than placebo, but have no real clinical relevance. Because their improvement was less than three points, patients will not detect any difference between these drugs and placebo.

The same lack of clinical relevance holds for drug combinations. A combination of an alpha blocker and a 5-alpha reductase inhibitor or an alpha blocker and an antimuscarinic drug often results in statistically significant decreases in symptoms compared to placebo or to the individual drugs given alone. But here also, the differences were of such small magnitude that patients will not detect them.

Only in a small minority of clinical trials was the decrease in symptom score more than 3 points.
The lack of efficacy of BPS meds supports a policy of watchful waiting instead of starting drug therapy. The natural course of LUTS is quite favorable and in the majority of patients the severity of the symptoms will not increase.

Most (or all) of the relief patients feel taking the med is probably due to natural improvement or placebo effect, not to the med itself -- but they don't know this and will often misattribute benefit to the drug.

And almost all the drug studies have been performed in secondary and tertiary care. The results of these studies can't simply be generalized to primary care because it is not plausible that these patients have the same characteristics and therefore the same prognosis.

It's not rational to prescribe drugs that do not improve functioning more than placebo. Use of medication for LUTS should be discouraged since it is no better than placebo, but adds the risk of side effects. Counseling and re-assurance should be considered first.

Informed patients will be much less willing to take a drug that carries the risk of side effects, while offering at best only a very slight improvement in symptoms.

Whenever it is decided to start drug therapy, the best choice are alpha blockers. Side effects should be taken into account: fatigue, decreased vision, severe postoperative ophthalmological side effects or complications, orthostatic hypotension leading to headache and dizziness.
5-alpha reductase inhibitors should not be regarded as an alternative because of their small efficacy and side effects like gynecomastia, erection and ejaculation disorders, decreased libido, impotence, and breast cancer.

The antimuscarinics do not have a positive balance of efficacy and they have anticholinergic side effects (e.g., dry mouth, abdominal pain and constipation). Phosphodiesterase inhibitors have been introduced in recent years but studied insufficiently in comparative studied to give them a place. Combination-therapy should not be given because it does not have an added value related to clinical relevance but does add side effects.

We conclude that the natural course of LUTS in men is generally favorable; the pathophysiology of LUTS is not clear; the relation between prostatic volume and urinary complaints is weak; the mechanisms of action of meds is uncertain; and positive effects are small in placebo-controlled studies.

Therefore, primarily counseling and non-drug treatment are indicated and drug-treatment should be discouraged. In case a drug is needed only an alpha blocker is indicated, but this often just a very expensive placebo-therapy."

Thanks Dick for this illuminating analysis. Before considering any med useful, we should subtract placebo effect from reported efficacy- and also consider the considerable risk of med side effects and Pharma's ridiculously high prices.

In a rational world, people would be taking many fewer drugs, for much clearer indications, with benefits always balanced by consideration of risks, and with prices reflecting real value.

Medication use is now much more governed by pharma's commercial interest than by what is best for the patient.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.

science

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robots

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r0B0t: Best Jobs at the Olympics: Guy with Red Flag at Trap-Shooting Competition

Nominee: Bearded, seated, red-flag-holding man.

Where to find him: Women's trap shooting final.

Job requirements: Wave a red flag whenever a trap shooter fails to hit the clay target. Sit without fidgeting for long periods of time. Look good in a hat.

Why this might be the best job at the Olympics: You have a very important role. You are the official arbiter of success or failure in trap shooting. There would be no trap-shooting events without you, the guy with the red flag. When a shooter misses the clay target, it's up to you to raise your red flag in a confident yet nonjudgmental manner. Your flag may not be bright red, but it's red enough.

As the guy with the red flag, you will get a lot of screen time. Your friends and family will have ample opportunity to see you on NBC's online trap-shooting livestream. “Look,” they will exclaim, “there he is, my good friend and/or relative, the guy with the red flag who's indicating that the woman with the gun just missed!”

Unlike other Olympic functionaries, the red flag guy is occasionally allowed to show some flair. Here, for example, he gives a slight nod of his head as he lowers his red flag. That's so red flag guy.

If you are lucky enough to be the red flag guy, you get to sit very close to the action, in your own chair, and don't have to worry about whether or not the person sitting next to you smells bad, because there is no one sitting next to you. Look at you, red flag guy, sitting there in the back-right of this clip, your red flag between your legs. You are the boss of trap shooting, in your own chill way.

Also, you get to wear a hat.

Why this might not be the best job at the Olympics: The job is sort of a downer, given that red flag guy springs into action to call out an athlete's failures. It's also fairly repetitive—flag up, flag down; flag up, flag down. Also, you have a lot of responsibility. You can't ever lose focus, or get up to get a Coke, lest you fail to raise your red flag at the appropriate moment. You also have to remember to bring the red flag every morning, and it seems like it would be easy to leave it at home if you are in a rush.

How this could be a better job at the Olympics: The red flag guy should have two flags: the standard red flag to indicate a missed shot, and one that says “good job” that he can wave to indicate a hit. Also, instead of a folding chair, the red flag guy should sit in a recliner.

Verdict: I'll give the job of “red flag guy” 3 out of 3 points for exposure, because it's hard to be more visible than the red flag guy at a trap-shooting competition. 2 out of 3 for enjoyment, because every day is a good day when your job entails sitting in a chair, wearing a cool hat, and waving a colorful flag. 1.5 out of 3 for enviability, because while he's cock of the walk today, at some point in the future the red flag guy will probably be replaced by a red flag robot. And 1 out of 1 in the category of “having a really good view.” 7.5 out of 10 for red flag guy. This is currently the best job at the Olympics.

robots

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robots

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r0B0t: Sunday's Best Deals: 4K TV With Roku, Produce Storage, Shark Steam Mop

Your new TV, produce you won't have to throw away, and the steam mop your arsenal is missing are just a few of today's best deals.

Bookmark Kinja Deals and follow us on Twitter to never miss a deal. Commerce Content is independent of Editorial and Advertising, and if you buy something through our posts, we may get a small share of the sale. Click here to learn more.

No need to worry about the quality of the built-in apps on your 4K TV when Roku is built right in. This 2016 model hit a new price low today by $40.

https://www.amazon.com/TCL-55UP130-55…

We're all probably a bit ashamed of the amount of produce we allow to spoil in the fridge, but these Rubbermaid FreshWorks containers use a few neat tricks to extend your food's lifespan, and avoid unnecessary waste.

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First, each FreshWorks product includes a “crisp tray” which elevates the food off the bottom of the container, giving moisture a place to drip, and air enough room to flow. Second and most importantly, the lids feature special filters that regulate the flow of oxygen and CO2 into and out of the containers. All told, Rubbermaid claims keeps food fresh up to 80% longer than store packaging.

It may sounds too good to be true, but customer reviews are fantastic, and Amazon's taking offering a 2-piece set for $17 today, matching an all-time low. If they save just a few batches of arugula or scoops of blueberries that you would have otherwise thrown out, they'll have already paid for themselves.

Even if you've integrated your robot vacuum and Dyson into your regular routine and take your shoes off at the front door, you still need to mop on occasion. This Shark Blast & Scrub Pocket Mop fires concentrated hot water at tough stains, so you'll need less elbow grease to get rid of them. It's also only $60 today.

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By now, you should know that Anker PowerLine Lightning cables are incredibly popular, but did you know there's another tier of cables above them? Anker's PowerLine+ line increases the bend lifespan from 5,000 to 6,000 and adds a nylon braided exterior. Want to see one for yourself? The 3' model is available in red for $13 today, or about two bucks less than usual.

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Hoover's Sweethome-recommended Air Cordless 2-in-1 vacuum acts as both an upright and a hand vacuum, all in a single, sleek, battery-powered package. $105 is within $5 of the best price Amazon's ever listed, so grab one before they're all vacuumed up.

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Just need a hand vacuum? This Bissell is also on sale today.

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If you've ever thought about pulling out your blender to make a smoothie, sauce, or dip, and then held off because you didn't want to clean 3,000 different parts, this deal is for you. The 4.3 star-rated Cuisinart Smart Stick Hand Blender is down to $27 today on Amazon.

The big advantage here is that unlike a traditional blender, you can dip the Smart Stick into whatever container you were already using to hold your ingredients; be it a single-serve cup or a huge mixing bowl. That saves you time, and means fewer dishes to clean up once you're done. Reviewers also say it chops through everything from fruit to ice cubes with no trouble, so it really can be a full blender replacement for most use cases.

http://www.amazon.com/dp/B00ARQVM5O/…

We've already started to see some bundle deals on the new and improved Xbox One S, but this is by far the best one yet.

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Whether you need a restock or want to try something new, you can save 15% on a ton of men's products today (with code LUXBEAUTY), including two of your favorite shaving creams.

Note: This only works on your first “luxe men's beauty purchase” on Amazon.

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If your phone supports Qi wireless charging, $8 is a great price for a charging pad. I recommend stocking up, and scattering these all around your home and office. Just use promo code FJ8ABTSW at checkout to get the discount.

https://www.amazon.com/Seneo-Wireless…

Amazon's free Prime Pantry shipping promotion seems to be a permanent fixture at this point, but each month brings a new slate of eligible items, and August's have just been revealed.

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As always, just add five of the items on this page to your Prime Pantry box, enter code PANTRYAUG at checkout, and the $6 shipping charge will be waived. Plus, if you happen to have a free Pantry shipping credit from accepting no rush shipping on a previous Amazon order, it should stack, granting you an additional $6 discount.

There are literally hundreds of products available for the promotion, so you should have no trouble finding five that you need. As for the rest of your box, check out this page for every Pantry item that includes an additional coupon.

Commerce Content is independent of Editorial and Advertising, and if you buy something through our posts, we may get a small share of the sale. Click here to learn more, and don't forget to sign up for our email newsletter. We want your feedback.

robots

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astronomy

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NASA 2016 --Identifies Eight Potentially Hazardous Near-Earth Objects: "Major Impact Could Cause Evolutionary Change"

NASA's asteroid-hunting spacecraft released a treasure trove of survey data, revealing hundreds of Near-Earth objects (NEOs) of which 72 are newly detected and eight of the 72 NEOs classified as potentially hazardous asteroids (PHA) in 2016 based on their size and how close their orbits approached our planet. Impact rates depend on how many comets and asteroids exist in a particular planetary system. In general there is one major impact every million years -a mere blink of the eye in geological time. It also depends on how often those objects are perturbed from safe orbits that parallel the Earth's orbit to new, Earth-crossing orbits that might, sooner or later, result in a catastrophic K/T or Permian-type mass extinction.

"The NEOWISE analysis shows us we've made a good start at finding those objects that truly represent an impact hazard to Earth," said Lindley Johnson, program executive for the Near-Earth Object Observation Program at NASA Headquarters in Washington. "But we've many more to find, and it will take a concerted effort during the next couple of decades to find all of them that could do serious damage or be a mission destination in the future."

The analysis also suggests that about twice as many PHAs as previously thought are likely to reside in "lower-inclination" orbits, which are more aligned with the plane of Earth's orbit. In addition, these lower-inclination objects appear to be somewhat brighter and smaller than theother near-Earth asteroids that spend more time far away from Earth. A possible explanation isthat many of the PHAs may have originated from a collision between two asteroids in the mainbelt lying between Mars and Jupiter. A larger body with a low-inclination orbit may have broken up in the main belt, causing some of the fragments to drift into orbits closer to Earth andeventually become PHAs.

Since December 2013, the Near-Earth Object Wide-field Survey Explorer (Neowise) mission has identified 439 NEOs — asteroids or comets that at some point orbited the Sun and became close to the Earth. With the release of this fresh batch of data, Neowise has completed another milestone in its mission to detect, track and classify the comets and asteroids that approach the planet.

An asteroid is considered an NEO when its distance from the Sun during its closest approach is less than 1.3 times the average Sun-Earth distance, experts said.

In September 2013, WISE was reactivated as Neowise to distinguish populations of potentially-dangerous NEOs.
Neowise principal investigator Amy Mainzer said the spacecraft discovers large and dark NEOs, helping scientists by complementing the network of ground-based telescopes that operate at visible-light wavelengths. "On average, these objects are many hundreds of meters across," said Mainzer.

NASA scientists said no NEOs are likely to hit the planet anytime soon. Still, space rocks can remain undetected, such as the Chelyabinsk meteor that streaked across Russian skies on Feb. 15, 2013. The meteor exploded, shattering glass windows and injuring more than 1,100 residents. Experts say this meteor was the result of a collision between two astronomical bodies.Fragments of the meteor revealed that the collision did not happen days or months before it hit Earth, but about 290 million years ago.

Meanwhile, NASA unveiled an asteroid detection program in early January 2016 which would help defend the planet in case any dangerous hidden asteroids are near Earth.

Because the telescope detected the infrared light, or heat, of asteroids, it was able to pick up both light and dark objects, resulting in a more representative look at the entire population. The infrared data allowed astronomers to make good measurements of the asteroids' diameters and, when combined with visible light observations, how much sunlight they reflect.

“The threat of the Earth being hit by an asteroid is increasingly being accepted as the single greatest natural disaster hazard faced by humanity,” according to Nick Bailey of the University of Southampton's School of Engineering Sciences team.

In 2009, Bailey and his colleagues used raw data from multiple impact simulations to rank each country based on the number of times and how severely they would be affected by each impact. The software, called NEOimpactor(from NASA's "NEO" or Near Earth Object program), was developed for measuring the impact of 'small' asteroids under one kilometer in diameter.

Results indicated that in terms of population lost, China, Indonesia, India, Japan and the United States face the greatest overall threat; while the United States, China, Sweden, Canada and Japan face the most severe economic effects due to the infrastructure destroyed.

The top ten countries most at risk are China, Indonesia, India, Japan, the United States, the Philippines, Italy, the United Kingdom, Brazil and Nigeria.

“The consequences for human populations and infrastructure as a result of an impact are enormous,” says Bailey. “Nearly one hundred years ago a remote region near the Tunguska River witnessed the largest asteroid impact event in living memory when a relatively small object (approximately 50 metres in diameter) exploded in mid-air. While it only flattened unpopulated forest, had it exploded over London it could have devastated everything within the M25. Our results highlight those countries that face the greatest risk from this most global of natural hazards and thus indicate which nations need to be involved in mitigating the threat.”

The team also examined how the consequences of an impact change with increasing impact energy. Initial results indicate that a 100 meter diameter asteroid will predominantly cause localized casualties and damage across a few countries when impacting on either land or ocean. However, the consequences of a 200 meter diameter asteroid hitting the ocean increase significantly, with the generated tsunamis reaching a global scale. At 500 meters in diameter, almost any ocean impact will generate significant casualties and economic cost across the world.

As Stephen Hawking says, the general consensus is that any comet or asteroid greater than 20 kilometers in diameter that strikes the Earth will result in the complete annihilation of complex life - animals and higher plants. (The asteroid Vesta, for example, one of the destinations of the Dawn Mission, is the size of Arizona).

The asteroid that hit Vredefort located in the Free State Province of South Africa is one of the largest to ever impact Earth, estimated at over 10 km (6 miles) wide, although it is believed by many that the original size of the impact structure could have been 250 km in diameter, or possibly larger(though the Wilkes Land crater in Antarctica, if confirmed to have been the result of an impact event, is even larger at 500 kilometers across). The town of Vredefort is situated in the crater (image).

Dating back 2,023 million years, it is the oldest astrobleme found on earth so far, with a radius of 190km, it is also the most deeply eroded. Vredefort bears witness to the world's greatest known single energy release event, which caused devastating global change, including, according to many scientists, major evolutionary changes.

The Daily Galaxy via NASA: nasa.gov/wise, wise.astro.ucla.edu and jpl.nasa.gov/wise