Brain Cancer and Cell Phones (Or Not?)

Excuse me while I curse — “Oy vays mir!”

That is a pretty mild ethnic expletive in Jewish language as cursing goes and the translation is something like “oh, woe is me.”

I’m sure you’ve heard worse elsewhere.  However, this is engrained deeply in the limbic — deep, reflexive — areas of my brain, I suppose, since sometimes I forget that there is nobody around me who could possibly understand it.   It does not call upon any real or imagined universal powers.  Yet my grandmother of blessed memory spoke it often, when she thought someone around her was being really stupid, and could potentially be harmful — like a butcher who had slaughtered her chicken incorrectly  and we maybe could end up with some bile in the preparation. So by hearing this, you can be assured that I have surely been secreting bile.

I looked at the recent research about cell phones and brain cancer. I cannot begin to count the number of people, from “medical staffers” to alternative medicine professionals  — all of them loving and professional friends —  who have told me about things to put on my cell phone to keep me from getting brain cancer.  In their opinions, such devices are cheap and will save my brain, which they have generally decided will be of some use to society. I tend to agree with the latter part. I am not sure medical research can or will prove much of anything. Oh sure, we know that electromagnetic waves of many sorts are not terribly good for living things.  There are even some sources quoted in the above article, maybe even correctly. Let’s look at why and how most medical research known to me gets done. It usually gets done by university professor types who want to get it published so they can get “tenure.”  This is an amazing sort of job security which I have personally seen in multiple academic institutions.  Once you get this benefit, it seems to me that gainful employment is no longer required. And as long as the professor does not do anything that would — for example — actually kill humans, this person would remain employed with a pretty decent salary (although said salary would pale in comparison to working in the pharmaceutical industry — but people in that sector may actually have to do some work).

Of course,nobody in so enviable a position would actually consider advancing science.Why? They would – and do — choose topics for research that are sure to be funded, that will be certain to prove what they want to prove. Maybe such research will get them a little press coverage and make them look wildly clever.

Of course, there are foundations and multinational studies. They are usually somehow politically correct.  So my chief researcher (aka — beloved husband) turned up this delightful article for me.

Okay, so  I have never heard of the author, Dr. Ionnidis, and certainly never met him.  However, I think I love him.  Not in the same way I love my chief researcher — I think I love him the same way I love — for example — Daniel Ellsberg. I love people who dramatically expose things that have gone dead wrong.

Conventional scientific research has gone wrong as surely as the presidents and governments who consistently lie to their constituents. In both cases, there is a dramatic revelation of a process which we have trusted going terribly wrong.  And in both cases, exactly the same thing happens. Mainstreaming. After the startling revelations, the world continues with a process that is clearly flawed, endorsing and continuing that process.

As the current controversy of “WikiLeaks” shows that government procedures after publishing “The Pentagon Papers” continued as usual, so there are lots of people doing medical research with constantly contradictory findings.

Exposure creates momentary embarrassment – and possibly a few repercussions and reactions – but the status quo quickly settles back in.

Everybody maintains the same-old process.

Even though I’m not an expert in government, I know that in the scientific community, controversies and embarrassment recover quickly without anyone even looking closer at how research is done – much less making changes.

First, most research published in medical journals is done with an “accuracy” estimate of  “p over 0.05”.  That is some complicated mathematical statistical measurement that means that the probability of the findings being a result of what is studied and not just the luck of the draw is over 5% — or one out of twenty. If you think about that, one out of twenty of the articles published in a medical journal is sheer rubbish.  Of course, there is no way whatsoever to tell which one out of the twenty.

A lot of “big” studies, with “big” findings, like the ones about cell phones and brain cancer are “naturalistic” studies – meaning a lot of data is collected from a lot of people. Let us ignore for the moment that a lot of people lie a lot to medical researchers for nobody-knows-what reasons.

This is the “House, MD” axiom – formulated by the indefatigable Gregory House, MD  and repeated frequently on his popular TV series. But it also applies to research. That Dr. House is brilliant – even if he is fictional.

The ideal for research is based, still on a brilliant – and totally real — Persian named Avicenna who functioned in the second century AD.

The ideal research method today is called the “double blind placebo-controlled” study.

That is, you divide all of your subjects into two groups, and they should all be as alike as possible.  For example, everybody chosen has a valid diagnosis of major depression but is not currently taking medications.

Then you give one of the groups a pill that actually does nothing – a placebo.  In common terms, a “sugar pill” – only nobody should use sugar because it causes chemical reactions in the body.  That term is just what commercials use for the masses to keep from confusing them.

Obviously, nothing should happen to the placebo group.

The other group gets whatever new stuff is being tried out.  It might be a pill, it might be a tin-foil helmet – whatever someone is interested in getting approved by the government (or at least marketing).

Then you can determine — or at least have a shot at determining  — if that one thing makes a difference. The “double blind” part of the test means that nobody in either group knows if they are getting placebo or the “good stuff.”  They are blind to that fact.  The thing that makes it double blind is that the researcher doesn’t know who is getting the placebo or who is getting the “good stuff.”  So both parties are blind.

The reason is that a researcher might unconsciously indicate to a subject if they are getting something that is expected to make a change or not.

The power of suggestion is very strong, and that is where we get the term “placebo effect.”  In every test, a certain percentage of people getting the placebo actually improve – sometimes as much or more than the people getting the good stuff.

It is counter-intuitive, I know, but well documented.  People get better because they believe the treatment will help them, or because they have bonded with the person who is treating them.

So, after the test is over and the researchers are told which people had placebo, they can tell if the “good stuff” did at least as much to help the subjects as the placebo.  In many cases, it doesn’t – so the new product isn’t approved by the government and is not (ethically ) marketed.

Obviously, the more people tested, the more reliable the results.  If you test two people, it’s pretty dicey.  A thousand would be better.  Also, the longer people are studied, the better.  You could tell more over the course of a year than you could over a weekend.

Going back to our brain cancer research, do you think they are gonna figure this one out in a naturalistic study of huge gobs of people reporting their usage on questionnaires? How could you standardize phone usage? Some people make or receive one call a week. Some people are plugged in to a Blue Tooth ear set 24/7.

Let’s reframe the test as using coffee instead of cell phones. When I lived in France a similar such study was done to see if drinking coffee protected someone from getting brain cancer — on thousands of people who lived all across Europe.  Some people drank coffee constantly all day and into the night — some others only drank coffee in a cafe (once weekly, perhaps) and never at home, or only at somebody else’s place.

Under these conditions, the coffee varied by brands with varying amounts of caffeine.  The coffee came from lots of different spots all over the world – Columbia, Arabia, America and who knows where else?  There are many strains of coffee, and all have different properties.  I remember reading about cardamom coffee so potent it could kill a cow (although I don’t think THAT was researched). I only have one stomach, and I was always curious about trying new things – but this was a little out of my comfort zone.

In one research paper about coffee, the conclusion was that coffee stops glioma (brain cancer) 34 % of the time.  That makes it better than a lot of drugs. But what if people who drank coffee were also more physically active (from all that caffeine), more social, or other things tougher to measure? What if those things, and not the coffee, were really doing the job?

No, I did not read the original paper, I admit.  I do understand that people are trying to increase the accuracy of research by using bigger numbers.  While this is laudatory, it is just not enough. All kinds of people in the computer field are developing methods to deal statistically with the incredibly large numbers of people you can access by internet. Yeah, what about “truth?”  Remember the “House, MD” axiom. By conducting research, we are supposed to be looking for the truth.

In the bible verse Proverbs 23:23 some translations quote, “Buy truth, and do not sell it.”

In my preferred translation, the quote is “seek truth.”  You can see why I favor this translation.  Such differences in translations have caused many questions and lots of problems in history – not just in the field of medicine.

An even more modern quote comes from actor Jack Nicholson in the popular film, “A Few Good Men” — .

“You can’t Handle the Truth…” Most people can’t handle the truth.  Denial leads to continuing in the previously existing path. I suggest (As does Dr. Ioannides) that the best bet if you are sick is not to have a doctor who mindlessly gobbles up the most recent research — which was likely provided by the pharmaceutical company sales rep who most recently visited.

You need a doctor who will actually spend time talking to you, about how you are unique among the world’s humans. I’m sorry that more doctors aren’t like that.  It usually leads to the question I fear most from my patients – “Why didn’t my other doctors ever tell me that?”