When Rudy Giuliani was running for president he cited data comparing healthcare in England and the United States. This is the essence of what he reported:

In Britain about 44% of men diagnosed with prostate cancer were alive 5 years later. On the other hand, in the US about 81% men diagnosed with prostate cancer were alive 5 years later. So Giuliani concluded that the 5-year survival rate for prostate cancer in the US is nearly double what it is in England (44% for England vs. 82% for the US). He was wrong. The risk of death from prostate cancer is virtually the same in both countries. 

In the US most prostate cancer screening involves looking for prostate-specific antigens (PSA). British doctors do not rely on PSA testing near as much as their American counterparts. In England most prostate cancer is identified through symptoms. These different approaches to diagnosing prostate cancer are key.

Here is how different screening practices lead to different survival rates.

The US has a higher proportion of prostate cancer diagnoses because US physicians rely on PSA screening. PSA testing often identifies small tumors that grow so slowly they do not harm a man before he dies from natural causes due to old age. These are sometimes called nonprogressive cancers. Nonprogressive cancers meet the pathological definition of cancer but never cause symptoms during a patient’s lifetime. On the other hand, because British physicians rely more on symptoms to diagnose prostate cancer, they usually do not diagnose men with nonprogressive cancers. 

So if PSA testing in the US identifies 3000 men with prostate cancer, 2000 of those may have nonprogressive cancer while 1000 may have progressive cancer. The 2000 nonprogressive cancer patients survive along with 440 of the 1000 progressive cancer patients. Thus the survival rate is 2440/3000 = 81%

If England relies on symptoms to identify prostate cancer, then it will miss the 2000 with nonprogressive cancer and just diagnose the 1000 with progressive cancer. Among the 1000 progressive cancer patients, 440 survive, just like in America. However, England’s survival rate is 440/1000 = 44%.

The upshot is that over diagnosing prostate cancers with PSA testing in the US is inflating survival rates. In reality, the risk of dying from prostate cancer is virtually the same in both countries. A 2001 report showed that there were 26 prostate cancer deaths per 100,000 men in the US and 27 cancer deaths per 100,000 men in England (Shibata & Whittemore).

The other dark secret of PSA testing is that it may be leading to unnecessary treatment. If PSA identifies a tumor then a man may choose surgery and/or radiation therapy. These treatments may be unnecessary if the tumor is nonprogressive, yet the man could be left with impotence and incontinence as a consequence of being treated.

If PSA testing identifies a cancer tumor, I think the next important question should be: "Is it progressive?" The answer(s) to this question and a thorough discussion between patient and doctor should inform one's decision to withhold or undergo treatment. (Source: Gigerenzer et al., 2008. Helping Doctors and Patients Make Sense of Health Statistics)
 
 
Recently there have been a number of advertisements claiming that drugs like Lipitor can cut your risk of stroke in half. Is this something to get excited about? It all depends on your risk of stroke.

If your risk of stroke is low, say 2%, then Lipitor will cut your risk of stroke to 1%. Is that reduction worth the extra expense and potential side effects associated with taking the medication? On the other hand, if your risk for stroke is 20%, then Lipitor may cut your risk down to 10%. That sort of reduction would convince many people at risk to take Lipitor. In both scenarios there is a 50% reduction in risk, but the need to take the drug is different. It all depends on level of original risk.

The same logic applies to screening and testing for health problems. With the recent death of Senator Ted Kennedy from a brain tumor, we may witness a phenomenon called the availability heuristic. Availability heuristic refers to people overestimate the future probability of an event occurring because of recent dramatic, publicized events. Thus some people may overestimate their chances of getting a lethal brain tumor because of Kennedy’s highly publicized death. If you are one of those people, there are plenty of places willing to give you a costly brain MRI even though you are currently asymptomatic (healthy) (www.brainscans.com is one such place).  

Well, if you are rich, then what is there to worry about? Why not get the screening done? The answer is that some tests can be harmful and others can lead to false positive results that may result in unnecessary additional testing and therapies.

Take, for example, those full body scanning centers that have recently popped up around the USA. Otherwise healthy people go to these centers to get scanned for diseases for which they are at low risk. Well, if they are rich enough to light their cigars with 100 dollars bills, then why worry, right? Wrong.

Several of the scans utilize CT technology. CT scans typically irradiate at higher levels than traditional x-rays. For instance, a chest x-ray delivers a dose of approximately 0.06 mSv, while a chest CT scan can deliver anywhere from 2.0 to 8.0 mSv, depending on the type of CT scan. That's a major increase in levels of irradiation for healthy individuals.
(Source: http://www.hps.org/publicinformation/ate/q2372.html).

Such tests are usually called for if a patient is symptomatic, has a history of disease, or has other risk factors. If none of these apply and a patient is in good health, the test may do more harm than good. Most physicians are aware of these issues, so check with your doc when considering screening tests.
 
 
How many times have you heard a claim like: Doing X increases your risk of getting disease A by 75%? Or how about a claim like: Taking supplement Y cuts your risk of getting a disease B in half? Such statements of relative risk can be very misleading. Here’s why.

In 1995, Britain’s National Committee on Safety of Medicines issued the following warning to women taking contraceptives: Rigorous studies have found that women taking 3rd generation contraceptives (contraceptives made after 1990) experienced a twofold (100%) increase in blood clots compared to a similar cohort of women who took 2nd generation (pre 1990s) contraceptives. In other words, newer contraceptives are doubling a woman’s risk of blood clots compared to older contraceptives.

It sounds like young women should avoid 3rd generation contraceptives because of the increased risk of blood clots, right?
Wrong.

Here are the hidden, yet important details on prevalence:

In reality, the contraceptive studies found that one out of every 7,000 women who took the 2nd generation pills had blood clots. This number doubled with 3rd generation pills where two out of every 7,000 women who took 3rd generation pills had blood clots. Hmm? So is a 100% increase from 1 to 2 blood clots in a sample of 7,000 women something to get deeply concerned about? Not likely.

If the prevalence rate of a disease is low, then a 2, 3, or 4 fold increase may not be important, unless you are among the few who get the disease. 

This fallacy also works its deceptive magic the other way – in preventing disease.

What if I told you that vaccine A cuts your child’s risk of getting disease X in half? Hmm? Sounds good, eh? Wait a minute. What is disease X’s prevalence rate? The prevalence rate/risk of getting disease X is 2 in 10 million, or 0.00002%. Now if your child is vaccinated, the risk of getting the disease is cut in half to 1 in 10 million, or 0.00001%. Does this sound reasonable? Probably not. Think about it this way: we would need to vaccinate 10,000,000 children in order to prevent one child from getting disease X.

Should we spend millions to vaccinate children against a disease most will never get? To do so might be a waste of healthcare resources and dollars that could be utilized elsewhere. 

So the next time you read or hear a result like “It increases the risk of disease X by 200%” or "It cuts the likelihood of developing disease X in half," look for the prevalence rate. As the prevalence in the population goes up, so does the significance of the risk. For instance, if the prevalence rate is 10% (10% of people are at risk for developing disease X), then a vaccination that cuts that risk in half to 5% is something to crow about.

(Source: Gigerenzer et al. (2008). Helping doctors and patients make sense of health statistics. Psychological Science in the Public Interest, 8(2), 53-96.)
 
 
Experienced bloggers know that when posts are read in haste, the chances of the main message being misunderstood increase. I am sure most of you skim read posts. I do it when time or interest are lacking. Of course there is nothing wrong with “skimming” through posts. The problem comes in, however, when skimmers post replies based on their limited understanding of posts. They are more likely than careful readers to assume that bloggers said something they did not say.

Recently I posted an article on carbon footprinting and having babies. I got a few replies, which I am grateful for. But I am disappointed with those who, for one reason or another, misread or incorrectly interpreted my main message. I was accused of calling people who are concerned for the environment and the earth’s resources “tools of the devil”. If this were the case then I would be a tool of the devil because I recycle and occasionally take mass transit out of concern for the environment.

What I said in the blog post (see below) was that people who are concerned about the environment and resources to the point of positing limited reproduction through education and government action are doing the devil’s bidding. They are putting their eco-fanaticism ahead of the God-given command for humans to reproduce.

There are a lot of reasons, many of them personal, for couples to have or not have children. Government mandated zero population policies in the name of environmental and resource management should not be one of them.

China’s harsh and ungodly One Child policy is a classic example. As BYU political science professor Valerie Hudson pointed out, the decision among many Chinese families to have a boy through selective reproduction practices (typically through abortion of female fetuses) is creating a huge problem. She warned that by the year 2020, China will have 30 million surplus uneducated, unskilled, unemployed, and unmarried young males. Historically when such surpluses existed in China, totalitarian regimes have used the boys as soldiers in war. (Source: http://www.washingtonpost.com/wp-dyn/articles/A24761-2004Jul2.html?referrer=emailarticlepg)

It is interesting that supposedly enlightened academics, writers, and government bureaucrats in the US are making similar arguments. Here is an example. An environmental writer for the SF Chronicle recently wrote the following about scientific research which implicates babies in carbon footprinting.

Thinking about zero population growth as something that can be obtained by empowering people, rather than forcibly sterilizing them, makes the issue more approachable. I'm glad the [carbon footprint] study reveals childbearing as an important environmental decision, but science will have to learn how to stop considering women and fertility to be interchangeable if we are to make any progress on the population issue. (Source: http://www.sfgate.com/cgi-bin/blogs/green/detail?entry_id=45122)

Another example of eco-fascism at its worse.
 
 
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Over the last decade there has been a massive influx of health care information into the public domain through the internet. Physicians have responded to the increase in public information by entering into a collaborative relationship with well-informed patients. Gone are the days where “The doctor knows best.” Today many clinicians prefer working with well-informed patients to come up with best treatment options. In health care it is sometimes called “empowering the patient.”

A few years ago my baby daughter underwent surgery to fix a displaced hip. The surgery was successful, but my daughter still needed regular x-rays to check the position of her hip. On one visit the orthopedic surgeon wanted to do a 360 degree CAT scan to check the placement of the hip. Now she is a very competent surgeon, and equally important, she is a good communicator. I felt comfortable expressing my concern with subjecting the hip to high levels of radiation from the CAT scan. There had already been plenty of x-rays, and I wanted to minimize irradiating the hip. The surgeon respected my opinion and, after some discussion, presented an alternative that everyone was happy with.

Unfortunately, there is a sinister side to our health care information age. It has perpetuated health care conspiracies. You probably know someone who is very skeptical about the health care profession. You’ve probably heard someone say that health care wants to keep people sick because revenue comes from sick people. These attitudes are not only misleading, they are damaging.

Last week I talked with one of my brothers who is a physician. He said that occasionally he encounters people who do not want to take medication because they think it is not God’s will, or they are “suspicious” toward the medical profession because of something they read on the web. I also talked with my sister who is a labor and delivery nurse. She said that occasionally she encounters couples who reject medical advice for the same reasons. In my sister’s case, extreme skepticism has led to infant deaths and injuries.

As I explain in my book Truth and Science, modern science is a gift from God. Notwithstanding the pitfalls of modern health care, God has given us medical and pharmaceutical discoveries to prolong people’s lives in the latter days. Skeptics and conspiracy theorists may fail to realize that the medicine or technology that can improve their quality of life may be a gift from God or an answer to their prayers.

When interacting with the medical profession, I say get informed, get involved, and recognize God's blessings.

 
 

The Word of Wisdom (WofW) is a unique revelation in the sense that we are able to confirm it’s legitimacy with science.  I dare say that 176 years ago when the WofW was given, people had a difficult time seeing the wisdom in it.  To some pioneers living back then, the WofW must have seemed like a rule from heaven without justification (kind of like polygamy).  I imagine some early Latter-day Saints said things like: “Why can’t we smoke?” or “What could possibly be wrong with drinking hot drinks like coffee and tea?” 

But as the faithful know, when God commands, we should not ask “why”; we should go and do.  Today no one is asking “why” questions about the Word of Wisdom.  The answers have been provided in abundance by science.  

The WofW says that drinking wine and strong drink is not good.  Nothing drives this point home more than the fact that alcohol consumption causes about 24,000 deaths per year from alcohol-related car crashes in the US alone, and leaves another 500,000 seriously injured.  Some people get all upset about 4000 US soldiers killed in Iraq – where is the outrage over the approximately 24,000 alcohol-related car crash deaths last year!?  Alcohol consumption also costs about $90 billion in lost production and health care costs in the US.  In short, alcohol consumption has had devastating effects on our modern society.  It has affected us in ways that could not have been predicted 176 years ago.

The WofW says that tobacco is not for the body and is not good for man.  The nicotine in tobacco is very addictive, so many people get hooked on smoking and are unable (or unwilling) to quit.  The CDC’s national center for chronic disease reports that in the 1990s, smoking killed an average of 440,000 people per year in the US.  More-freakin-over, smoking cost the nation about $92,000,000,000 in lost productivity between 1997 and 2001!  Back in the day when the WofW was given, smokers who died of lung cancer just died - nobody knew why (there are few if any references to lung cancer in 19th century medical texts).  However, today we fully understand the devastating cost of tobacco.

The WofW highly recommends herbs (vegetables), fruits, and grains.  It should come as no surprise that vegetables, fruits and grains make up the bottom portions of our food pyramid.  They are at the bottom of the pyramid because science has shown that they are the foods that we should consume the most to ensure good health.  I am certain that early 1800’s science did not have extensive information on healthy eating habits.  I don’t think that people living back then would have claimed that an apple was healthier than salted pork.  In fact, the salted pork would have been more appealing to them because of its greater potential to satisfy hunger.  However, nowadays we understand the importance of healthy eating.

And finally, the WofW counsels us to eat meat sparingly.  The results of a recent research project funded by the National Institutes of Health (NIH) found that “Americans who ate the most red meat boosted their overall risk of death by 30% during a 10-year period compared to those who ate the least.”  The researchers claimed that “if the heaviest red meat eaters ate as little as the people who consumed the least, they could prevent 11% of deaths among men and 16% of deaths among women.”  Now more than ever before we see the wisdom in the divine counsel to eat meat sparingly.  (Note, neither this study nor the WofW tells us that we should become vegetarians.  Red meat is a good source of iron and fat-soluble vitamins such as A, D, E and K, and antioxidants such as glutathione or carnosine.)

Indeed, as science progresses we are more fully realizing the wisdom in the WofW.  God said that he was warning and forewarning us by giving the WofW – Now we know some of the reasons why.

 
 

My employer is a leader in healthcare delivery and outcomes.  Because of its reputation as a leader, medical professionals from around the country come to its semi-annual conference on quality improvement.  I recently attended this four week conference. I heard from at least 20 professionals who talked about a wide variety of challenges facing health care.  The last presentation impacted me the most; it got under my skin, so to speak, and for a good reason.  

The final presenter’s goal was to show how transparency in healthcare organizations improves outcomes.  She showed a video of parents with children who are suffering from cystic fibrosis.  The parents in the video were concerned that their children were not receiving the best possible care for their cystic fibrosis at Cincinnati Children’s Hospital. 

The organization with data on which hospitals are delivering the best outcomes is the national Cystic Fibrosis Foundation (CFF), but the CFF was not talking.  The foundation did not want to release data on which hospitals were producing the best outcomes and which were producing the worst.  This secrecy is a major concern given that the difference in survival years between the best and the worst cystic fibrosis treatment centers was 17 years!  That means that children from the best treatment centers were, on average, living 17 years longer than children from the worst treatment centers. 

The parents fought with the foundation until it gave them what they wanted – the name of the hospital with the best outcomes in cystic fibrosis care.  After discovering which hospital offered the best care, the parents and medical staff from Cincinnati visited the best care facility to learn what they were doing and what worked well.  This information was then incorporated into care programs at Cincinnati’s children’s hospital to improve the outcomes and prolong the lives of children suffering from cystic fibrosis in Cincinnati, Ohio.  

Watching the video and seeing young kids who were suffering from cystic fibrosis was heartbreaking enough; what made it even more heartbreaking was seeing their parents struggling to get the CFF to reveal the hospital offering the best care.  The thought that a lack of transparency in healthcare outcomes is reducing the lifespan of children suffering from cystic fibrosis is distressing.  You would think that we should be “pulling out all the stops” when it comes to helping these children.

In my opinion, what is equally distressing is our increasingly lack of transparency with the Light of Christ.  Every step that science (and society in general) takes toward godless secularism is a step away from the enlightening power of the Light of the Lord.  That same Light that inspired great discoveries in scholars like Newton, Boyle, Faraday, Einstein, and Salk has the potential to reveal promising treatments and cures for devastating diseases like cystic fibrosis.  The more we humble ourselves before the Lord and seek His guidance through prayer, the more secular knowledge we will receive through the enlightening power of the Spirit of the Lord.  On the other hand, the more we move towards secularism, the less we benefit from this enlightening power.

By increasing transparency in healthcare and improving our transparency with the Light of Christ we will advance our understanding of diseases and ultimately enhance the quality of people’s lives.  We will also, as Orson Pratt stated, help science move “higher and higher until [it is] crowned with the glory and presence of Him who is eternal.”  A wonderful goal, indeed.

 
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