St. Swithin's- whoops- St. Patrick's Day.

I admit to little feeling at all for this holiday. It is probably a result of living in Boston for more than a decade, where with each every passing year I cringed a little more at the sheer idiocy that swarmed my otherwise marvelous Allston. My children are more Irish than I am, as their mother is nothing but, and I purely mutt, despite a moody garrulousness that points straight to Galway.

Waxing Irish is not my thing today, but rather, evidence! I find the "evidence-based" medicine and psychology and education "movements" to be rather funny. As I like to tell my teen-aged psychology students, "there really wasn't much empirically supported treatment at all before Dylan was born, that is, one human lifetime.." All the grand achievements of medicine are crammed into a very small time period.
Vaccines, check. Surgery, check. Databases, check. But perhaps the foundation for all of it is antibiotics. Modern medical life is unimaginable without antibiotics. Take them away, and surgical outcomes look pretty grim. They are the gold standard of effective, measurable treatment. And we over use them, and risk the whole enterprise.

Psychiatric medicine is my favorite hobby horse. It is so in the dark, so thoroughly infested with bad practices, so only occasionally effective that it boggles the mind. And yet, sometimes it is all we have. This era of massive over-medicating will seem as merely a groping extension of electro-convulsive therapy and lobotomies.

This site, Bandolier, is very interesting. A good layman's site for empirical research. Not the last word- there IS no last word in science- but a good place to start. For instance, health tips for the older young and younger old:

1. Eat whole grain foods (bread, or rice, or pasta) on four occasions a week. This will reduce the chance of having almost any cancer by 40%. Given that cancer gets about 1 in 3 of us in a lifetime, that's big advice.
2. Don't smoke. If you do smoke, stop. Nicotine patches, gum or inhaler won't help much, and acupuncture won't help at all. Try to reduce your smoking, as there is a profound dose-response (the more you smoke, the more likely you are to have cancer, or heart or respiratory disease). So cut down to below five cigarettes a day and leave long portions of the day without a cigarette.
3. Eat at least five portions of vegetables and fruit a day, and especially tomatoes (including ketchup), red grapes and the like, as well as salad all year. This protects against a whole variety of different nasty things:
   
   • It reduces the risk of stroke dramatically
   • It reduces the risk of diabetes considerably
   • It will reduce the risk of heart disease and cancer.
4. Use Benecol instead of butter or margarine. It really does reduce cholesterol, and reducing cholesterol will reduce the risk of heart attack and stroke even in those whose cholesterol is not particularly high.
5. Drink alcohol regularly. The type of alcohol probably doesn't matter too much, but the equivalent of a couple of glasses of wine a day or a couple of beers is a good thing. The odd day without alcohol won't hurt either. Think of it as medicine.
6. Eat fish. Eating fish once a week won't stop you having a heart attack in itself, but it reduces the likelihood of you dying from it by half.
7. Take a multivitamin tablet every day, but be sure that it is one with at least 200 micrograms of folate. The evidence is that this can substantially reduce chances of heart disease in some individuals, and it has been shown to reduce colon cancer by over 85%. It may also reduce the likelihood of developing dementia. Folate is essential in any woman contemplating pregnancy because it will reduce the chance of some birth defects.
8. If you are pregnant or have high blood pressure, coffee is best minimised. For the rest of us drinking four cups of coffee a day is likely to reduce our chances of getting colon cancer and Parkinson's disease.
9. Get breathless more often. You don't have to go to a gym or be an Olympic marathon runner. Simply walking a mile a day, or taking reasonable exercise three times a week (enough to make you sweat or glow) will substantially reduce the risk of heart disease. If you walk, don't dawdle. Make it a brisk pace. One of the benefits of regular exercise is that it strengthens bones and keeps them strong. Breaking a hip when elderly is a very serious thing.
10. Check your height and weight on a chart to see if you are overweight for your height. Your body mass index is the weight in kilograms divided by the height in metres squared: for preference it should be below 25. If you are overweight, lose it. This has many benefits. There is no good evidence on simple ways to lose weight that work. Crash diets don't work. Take it one step at a time, do the things that are possible now, and combine some calorie limitation with increased exercise. The good news is that in a few years time we may have some appetite suppressants to make it easier.

Or this analysis of older anti-depressants vs. inactive placebo in children (i.e. an inactive placebo may be more recognizable by the subject as a fake and thus make the anti-depressant seem more effective than it really is):

there is no evidence that tricyclics are more effective than placebo for depression in children and adolescents

any possible benefits are probably outweighed by the risks of toxicity

these patients may well respond to non-drug strategies


Pretty clear, don't you think? There are many studies that indicate that SSRI's (Prozac, etc) are not much better. The following is from a thorough, but short, analysis of the placebo debate and the role of the media:

...antidepressant research confirms an empirically demonstrated drug-placebo difference, although careful examination of this literature reveals that this difference is not nearly as large as most individuals believe, or as many of the pharmaceutical companies would have the public believe. Currently, the methodological problems with antidepressant trials preclude us from concluding definitively that the difference actually indicates specific biological effects of the drugs, as various nonspecific factors have not been adequately ruled out. Until these questions are answered, the media should understand that placebos can be double-edged swords, and that "expectancy" effects can result in harm as well as benefit.

There is more and more information and analysis becoming available. It requires some time and some scientific literacy. But it is worth it.