all class...

fat as a class issue... bet i could find stuff relating the extremes of addiction to class too..
solve inequality, solve everything.

but perhaps the environment will equalise us soon enough.

been a month since the last entries...
run out of fight?

after my own heart

another article from the nytimes... (why can't i buy the hard copy of this newspaper in melbourne??) a balanced (in my opinion) discussion of the risks and benefits, and the data/information available about drinking during pregnancy.

conclusion - that the evidence compares excess with abstinence and finds for abstinence, BUT there's very little evidence for moderation (that word again). and there's a raft of historical evidence, anecdotal or otherwise, that probably implies relative safety in moderation.

i think EXTREMEs are dangerous... perhaps?

irrelevance

probably the point from the irrelevant 'ebm' was to cast aspersions on the manipulation of information by drug companies / MNC / NGOs for their own means.

and manipulation of information (against my views) just makes my life less pleasant, and my struggle for power less successful.


swim today?

back to the party

right-oh, point taken. working too hard. emotionally fragile (beware...)

story - horrible weekend. depressed monday (flat, lethargic, no pleasure), dentist tuesday, but the turning point was not the coffee/debrief conversation in the morning it was 'pleasure'

dinner with M & d on tuesday night. drink before hand at supper club, dinner at florentino's bistro with lovely aged red. such remarkable pleasure and relaxation from good food, good wine and good company. and there's something remarkable about that combination...

[note - no 'intoxication', imagine BAC never >0.05...]

i imagine my world would be a sadder, less 'pleasurable' place without those elements.

so to 'fight' - WHY vegetarian? why not alcohol in moderation? what pleasure???

Electro Booty Mudcake

Aj, this is not a dialogue anymore. Interesting posts, to be sure, but are we having a debate or simply waiting for the other to stop ranting so that we can start?

By the way, what does EBM stand for?


evidence based medicine

in moderation...

but to take myself back into our argument - how much do people who identify themselves as 'moderate drinkers' drink? you know that the basic rule of thumb is 'take the number given by the patient and double it, add one...'

so perhaps we just don't really know if drinking is bad for us? we know that not-drinking may not be as good for you as moderate drinking. or perhaps we could say that the statement is as true as its opposite?

i think its safe to say (plausible etc) that if alcohol affects your ability to function as a 'normal' member of society then there is a problem. if you are physically dependent, its unlikely to be healthy! and i'm happy to assume that 'binge drinking' is associated with increased risk of death by injury (again, it makes sense...).

but the glasses of wine with dinner? is that bad for you?
i doubt it. and i don't think there's overwhelming evidence to say i'm wrong.

ebm again...

after a difficult weekend at work... the 'light relief' i found was an article in critical care medicine about EBM, discussing the need to consider evidence through a window of 'biological plausibility', the ability to reproduce the setting in which the intervention took place, and the generalisability of any intervention...

they have a number of interesting articles mentioned in their discussion but this was my favourite ....

Remote, retroactive intercessory prayer said for a group is
associatedwith a shorter stay in hospital and shorter duration
of fever in patients witha bloodstream infection and should
be considered for use in clinical practice.

So in 2001 a group of Israeli's identified around 3000 pts who were sick with bloodstream infection between 1990 - 1996, randomised them into 2 groups, and allocated one group to have intercessory prayer said (retrospectively in 2001). The results were statistically significant (p<0.01).>

Little brown jugs

Aj, you'll love this nyt article about drinking mums. Let's slip out of these wet nappies and into a dry momtini

The entire tenor of the article is puritannical and wowserish. Clearly written by a childless postgrad.

Beardy Physicist

The 'Naughty Lola' of the title is a 'typical beardy physicist'. Is it only irony, or does he dress up?

Note that dressing up does not involve booze or food yet is heaps fun. Sometimes it is more fun shikkered, and usually more fun with an audience. Food and booze are amplifiers of good company and fun times. Still, maybe we should sell more pirate costumes and less booze. A latex nurses' uniform instead of the fifth pot. Let's get the TAC to fund it!

You accuse someone (me? Donald Rumsfeld?) of wanting to sterilize life so as to live longer. Naughty, naughty-play the ball, not the player. Accusing the other team of being killjoys is a broad swipe. Bit like the sassy daughter accusing the mum of being frigid by proxy only from lack of opportunity. Might be true, but the daughter should still at leastuse a condom...

Risk management is a very personal issue. Health is a really important personal issue. I think we agree that we need to take risks in order to be happy. I thought we were arguing about data?

Lets delve into risk. Smokers usually claim happiness is more important than health, but there is a temporal factor. Happiness now versus sickness later. Guaranteed happiness now versus possible sickness later. _One_ won't give me a stroke. I have heard, as I am sure you have, similar arguments applied to comfort eating by really fat people. How sane are these arguments about risk? Crucially, how much happiness? Ecstacy is worth a fair bit of pain down the line.

Let's face it, many (what academics mean when they want to say 'most' but need to cover their ass from point-scoring seminar tools) heavy users are abusers, which means that they are probably addicts more scared of removal of their dependancy than excited by their habits. This is not happiness as I see it, it is the fading warmth of a wet nappy.

naughty lola...

the LRB is about to publish a book called They Call Me Naughty Lola - The London Review of Books Personal Ads: a Reader... (smh)

here are a few of the current edition's advertisements...

• My sexuality has never quite recovered from an early teenage exposure to President Servalan. Male from the unfashionable upper East side (of the British Library) seeks F to around 40 with a taste for fine wine, obscure dialogue, and interstellar conquest at .. email address
• Safety first. Dignity second. Trousers last. Rubbish wok-cooked foods enthusiast and flammable materials-wearing loon (M) WLTM F to 45 with fire-blanket and no small amount of knowledge regarding the correct batter-frying procedures of tempura. Bicester. Box no. 20/06
• Let’s wipe the slate clean. Lacklustre, melancholic and depressive rock-climbing PhD (M, 29) unable to get a foothold in anything seeks woman with those funny metal things that stab into crevices and stop you from plummeting to a certain death. Or something. Box no. 20/07
• ‘Du bist ein maultaschen’. Not, it transpires, the correct greeting when welcoming an ‘art’ publisher. Gullible publicity exec (F, 28) and the butt of all the jokes with the Frankfurt ‘in-crowd’ seeks avuncular M to 40 with penchant for hitting enemies with sticks. Box no. 20/08
• These adverts give birth to a thousand violent dreams. And when I awake I am no longer immune to the desperate cries of the damned. After-dinner speaker and corporate entertainer (M, 57) seeks lover/CV-writer/exorcist for nights of re-aligning my career path and silencing the voices. Box no. 20/09
• Consult the spirits to measure our compatibility:YES NO ABCDEFGHIJKLMNOPQRSTUVWXYZGoodbye Box no. 20/09
• Love? My eyes will tell you all. My forehead, however, is slightly more reticent. My knees won’t give you a damn word. Paranoid military nutcase and part-time undertaker seeks F to 50. Box no. 20/11

Needed something to make me at least smile amongst the lunacy... although remain profoundly relieved that milk has not yet proven itself to be very dangerous to one's health.

milk-ing it?

Someone actually researched this... more than once.
This is the abstract from a letter in Heart

Milk consumption, stroke, and heart attack risk:

evidence from the Caerphilly cohort of older men

Objective: To examine associations between milk consumption and incident heart disease and stroke.

Design: A representative population sample of men was asked to weigh and record their food intake for seven days. The total consumption of milk was obtained from these records. Details of all deaths and vascular events were collected during the following 20 years. Incident ischaemic strokes and heart disease events were diagnosed by standard criteria.

Setting: The Caerphilly cohort, a representative population sample of men in South Wales, aged 45–59 when first seen in 1979–83.

Participants: A representative 3:10 subsample of the men in the cohort.

Main results: 65 men (87% of those approached) returned satisfactory seven day diet diaries. After adjustment, the relative odds of an event in the men whose milk consumption was the median or higher, relative to those with lower intakes of milk, were 0.52 (0.27 to 0.99) for an ischaemic stroke and 0.88 (0.56 to 1.40) for an ischaemic heart disease event. Deaths from all causes were similar in the two milk consumption groups (relative odds 1.08; 0.74 to 1.58).

Conclusions: These results give no convincing evidence of an increased risk of vascular disease from milk drinking. Rather, the subjects who drank more than the median amount of milk had a reduced risk of an ischaemic stroke, and possibly a reduced risk of an ischaemic heart disease event. These conclusions are in agreement with the results of a previously reported overview of 10 large, long term cohort studies based on food frequency intake records.

Journal of Epidemiology and Community Health 2005;59:502–505.[Abstract/Free Full Text]


milk drinking...
is nothing sacred?

wrap me in cotton wool...

what gives you pleasure?
where is the 'happiness' in this equation?
what is the point of our existence... ??
is length of life the critical thing above all other factors?


found another recent article in The Lancet looking at BMI and cardiovascular disease and concluding that BMI is an unreliable predictor of survival... that people with a BMI less than 20 had a higher mortality than the other groups, and there appeared to be a survival advantage for those with a BMI >25... (its a meta-analysis of 40 studies with 250,152 patients...)

but don't take my word for it, here's the interpretation provided by the authors:

The better outcomes for cardiovascular and total mortality seen in the overweight and mildly obese groups could not be explained by adjustment for confounding factors. These findings could be explained by the lack of discriminatory power of BMI to differentiate between body fat and lean mass.
The Lancet 2006; 368:666-678


Does this confound our basic impression that obesity is the source of all evil?

Can we discuss what makes us HAPPY rather than the ways in which to make the world more boring and sterile?

Diet relativity

It's a reference frame issue: life just seems longer when you are eating less than you want. Joking aside, this makes perfect sense to me. So, Aj, are you going to implement it? I've started. Should have a BMI of 20 in about 2012. Consider the money I'm gonna save! Hard to eat less when one is drinking 20 g/day of alcohol, though.

Emergergency rooms will be filled with dickheads, true, and it is better for everyone to have injured drunks in casualty than somehere else. Prohibitiion is a bad idea, anyway. But what about responsible drinking? Should parents tell their children to drink sensibly? Yes, and lead by example. Ditto cannibis? Aj, what is the data on that?

Oh, nearly forgot drink driving. Is a person that puts a pedestrian in a wheelchair worse if they were drunk? No. Put everyone at fault in Jail for 20 years, and make licences hard to get and easy to lose. Not really a booze issue at all, given that speeding drivers (in both senses) are pretty dangerous, too.

Both monkeys look miserable. It's because they are locked up. Is this really the ethical animal experimentation that doctors are talking about, that saves lives and develops drugs?

the monkey plan

so the big pharma's are trying to find the 'key ingredient' in red wine that helps us live longer, and better! research on mice with a particular red wine extract recently mentioned in the NYtimes suggests that

Even more strikingly, the substance sharply extended the mice’s lifetimes. Those fed resveratrol along with the high-fat diet died many months later than the mice on high fat alone, and at the same rate as mice on a standard healthy diet.

They had all the pleasures of gluttony but paid none of the price.

I love that line 'all the pleasures of gluttony but paid none of the price' ...

we love the big pharmaceutic companies don't we?

what was i saying about data and its manipulation?

while on the topic of the NYTimes, its important to insert this reference while its still available...

there is animal evidence, originally with mice, now with monkey's, that seems to suggest that one can delay aging by living on 70% recommended daily calorific intake. (in fact that was a RACP written exam question in 2005]




which monkey looks happier?

data

and here's are failing, for all of us... the data.

is there independent information about any of this?
we're happy to definitely link lung cancer and smoking, but the links between alcohol & disease are more complex.

remember there are influences that would see us continue to drink, there are influences who would like to see alcohol removed from the world. all data must be considered... as we discussed perhaps much of this comes down to personality types? but where's 'the evidence'??

there are no RDBCT with alcohol, and there won't be... and i possibly wouldn't trust it anyway (sponsored by Southcorp, Lions, or a big Pharma with a new 'pill' to prevent alcohol use... perhaps)... Case control is as good as it gets, and how much do we trust the statistics?

this may come down to experiential arguement, which may depend on personality type...


as for the YOUNG MEN in ED argument - young men are often destructive, self-destructive, other-destructive. I don't think the drug is the issue, its part of being young and stupid, and it seems likely that those urges have been present for millenia. Does the presence of last amounts of Ecstacy in the party population reduce the violence in saturday night ED's? Maybe, but Ecstacy is also 'bad for you'... Is GBH a better option - unconscious rather than aggressive - you remember how much that drug annoys me in terms of ED resources, and that's completely leaving out the issues with the worst drug - ICE.

the answers are not straight forward. so people (yes, we were once) are going to be young and stupid - what's the safest way?

Bigger text

Also, I can't read the reverse video- can we pick a fatter font?

Lushes don't nosh

"note - many of the serious adverse effects of alcohol are thought to relate to vitamin
deficiency - serious alcoholic = poor diet = thiamine deficiency =
sub-acute-degeneration-spinal cord (numb legs and funny walking)"

But, but, you cited a study that *proved* that moderate consumption improved health, and claimed to correct for diet, and still showed that more than 30 g/day wiped out the advantages. (What is a serious alcoholic, anyway?)


Not sure what a hazard ratio is, and a bit toey about the wide confidence limits, but the trend is unmistakable:

g/day Hazard ratio
-----------------
0-5 same
5-15 .6
15-30 .4
30+ .9

I gather 10 g is one standard drink.

My comment about emergency room traffic still stands, though. Any data on proportions of moderate use among drinkers, or systematic under-reporting of drinking levels? Effects on unhealthy people? Increased smoking amongst light drinkers? Still, these are minor quibbles that don't really justify criminalizing booze.

Flava Flav vs. Chuck D.

Lordy, numbered bullets! Very Hilary Clinton. I can see my posts getting more Flava Flav as yours get more Chuck D.

( BTW, one quick reason Hilary won't paint the red sates blue- she reminds everyone under 35 of Lisa Simpson.)

Some more background for all you good netizens: the 'puritanical abstinent one' (me) has two decades of hard drinking under his belt, which has kind of petered out after being diagnosed with (and treated for) Multiple Myeloma. Remormed addicts are the *worst* Dontcha think?

Aj, remember to make your oh-so-erudite references active links. Otherwise folk will spill their Shiraz as they are forced to type. :-)

Erudite Mayo link

this week's discussion

so last week, things were stressed over the cafe table as accusations were made about the evil of alcohol. drinking was lumped along side the well-recognised nasty tobacco (and yet i struggle...), and over-eating/obesity (mutually BMI sits >25). there was tension at the table... as the active drinker stared down the puritanical abstinent one. topic change, i believe, saved the day from ruination.

so subsequent discussion has seen some ground given in both directions. evidence has been sort from both sides, and concessions have been made, thus:

1. moderate alcohol consumption (1 std drink for women, 2 std for men) has health benefits in reduction of cardiovascular disease

problem - who drinks reasonably? its a challenge for us. and perhaps those who can achieve
moderate alcohol consuption have the personality type associated with reduced
cardiovascular death... (CONFOUNDING?)

2. excessive alcohol consuption has been linked to several significant evils including some cancers, liver disease, heart disease and neurological problems.

note - many of the serious adverse effects of alcohol are thought to relate to vitamin
deficiency - serious alcoholic = poor diet = thiamine deficiency =
sub-acute-degeneration-spinal cord (numb legs and funny walking)

this was the best reasoned summary i could find:

http://www.mayoclinic.com/health/alcohol/SC00024


so it seems to come down to questions of risk/benefit balance, and i can see an answer that involves happiness/pleasure/success with short-long term awareness...

this clearly, needs some work...

rationale, a beginning

we usually start with an explanation, although sometimes spontaneous topics of conversation do erupt...

we are old friends, who know each other too well. the stage was set for our friendship in the pubs and beer garden's of fitzroy & carlton in the early 90s. we are now older, and arguably wiser. and we continue to discuss/argue/fight about our favourite topics.

our backgrounds are 'post-graduate educated' - one with a 'medical bent', the other in the 'hard sciences', this only helps to foster difference and discussion!

current favourites issues are (in no particular order)
1. evil of alcohol,
2. evil of tobacco,
3. evil of 'obesity',
4. evil of multinational corporations
5. stupidity of GWB

climate change and the increasingly nasty way of the world also regularly sucks me in...

so we'll see if this forum works to perpetuate long, long standing debate.

Alcohol in moderation- in Australia? Forgeddaboudit. The sort of people who regularly drink two glasses of red and never binge are either the Dali Llama or fibbing.

Earnest botmaker: "How much do you weigh?"

Drag Queen: "How much do you drink?"

--"Kinky Boots"