Hits & Misses – 2009/2/26
Cancer patients who research treatment options are three times more likely to get the newest drugs than patients who don't spend extra time learning about their condition.
The doctor-patient relationship.
In an ideal world, people faced with medical decisions would discuss the pros and cons with their doctors. Doctors and patients would share opinions and information. And when doctors made recommendations, they would do so with patients' life circumstances and preferences firmly in mind… In the real world… too many people get care they don't want or need and miss out on options that make more sense for them.
Being fat is as bad as smoking.
Swedish researchers followed 46,000 men from the age of 18 for 38 years. Being obese or smoking more than 10 cigarettes a day doubled the premature death risk… Being overweight, seriously underweight or smoking 10 cigarettes or less raised it by 30%.
Does this mean if I lose weight I can resume smoking — for a zero increase in overall health risk?
Doctor behavior is easily explained. The patient is not the customer. The third party payer is the customer.
The obesity paper may be a classic case of piling on about overweight. In this case, the relative risk of mortality in men who were overweight was somewhere between 1.15 and 1.53. (No risk would be 1.0) The risk to obese men was 1.61 to 2.85. Compared to nonsmokers, heavy smoker risk was 1.92 to 2.31. Given the nature of statistical uncertainty, relative risk has to be at least 2.0 before some people will consider it serious.
In this study, after 38 years of follow-up in a sample of 45,884, 2897 men had died and 1806 had emigrated from Sweden, thus being lost to followup.
The paper doesn’t have any details on those who were lost.
Nor did it discuss types of deaths. For example, schizophrenics are both more likely to be obese and more likely to commit suicide. Few people would claim that obesity causes schizophrenia. Therefore, some of the excess deaths classified as being due to obesity might have actually been a result of psychiatric disorders correlated with obesity but not caused by it.
So Linda, what does all of that mean? Okay to be obese? It’s not as bad as we thought? Being slim is overrated?
Obesity is associated with a modestly increased relative risk of mortality. So is underweight. Whether it’s not as bad as we thought depends on how much of a risk you have been led to believe it poses. This study does not help clear any of this up despite the publicity afforded it.