Occassional Dimes

David Rieff: Susan Sontag's son discusses her last days with Teri Gross.

Designs for the Real World: Dot Earth comes to MIT.

The Most Energy-Efficient Airline: One big catch, the plane never actually takes off!

World Equity Markets: The Wall Street Journal has a nice graphic that captures recent turmoil in stock markets across the world.

fMRI and Wine Tasting: "If a person is told they are tasting two different wines and that one costs $5 and the other $45 when they actually are the same wine, the part of the brain that experiences pleasure will become more active when the drinker thinks they are enjoying the more expensive vintage."

Are Cholesterol Drugs Any Good?: According to recent research, probably not.

Now do some simple math. The numbers in that sentence mean that for every 100 people in the trial, which lasted 3 1/3 years, three people on placebos and two people on Lipitor had heart attacks. The difference credited to the drug? One fewer heart attack per 100 people. So to spare one person a heart attack, 100 people had to take Lipitor for more than three years. The other 99 got no measurable benefit. Or to put it in terms of a little-known but useful statistic, the number needed to treat (or NNT) for one person to benefit is 100.

Compare that with, say, today's standard antibiotic therapy to eradicate ulcer-causing H. pylori stomach bacteria. The NNT is 1.1. Give the drugs to 11 people, and 10 will be cured.

A low NNT is the sort of effective response many patients expect from the drugs they take. When Wright and others explain to patients without prior heart disease that only 1 in 100 is likely to benefit from taking statins for years, most are astonished. Many, like Winn, choose to opt out.

Plus, there are reasons to believe the overall benefit for many patients is even less than what the NNT score of 100 suggests. That NNT was determined in an industry-sponsored trial using carefully selected patients with multiple risk factors, which include high blood pressure or smoking. In contrast, the only large clinical trial funded by the government, rather than companies, found no statistically significant benefit at all. And because clinical trials themselves suffer from potential biases, results claiming small benefits are always uncertain, says Dr. Nortin M. Hadler, professor of medicine at the University of North Carolina at Chapel Hill and a longtime drug industry critic. "Anything over an NNT of 50 is worse than a lottery ticket; there may be no winners," he argues. Several recent scientific papers peg the NNT for statins at 250 and up for lower-risk patients, even if they take it for five years or more. "What if you put 250 people in a room and told them they would each pay $1,000 a year for a drug they would have to take every day, that many would get diarrhea and muscle pain, and that 249 would have no benefit? And that they could do just as well by exercising? How many would take that?" asks drug industry critic Dr. Jerome R. Hoffman, professor of clinical medicine at the University of California at Los Angeles.

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Occassional Dimes

In Defense of Food: Michael Pollan talks about his new book on Science Friday.

Monsanto and the Future Seed: Very quietly GMO seeds are being adopted across the world. From the U.S., where they originated, through Asia, Africa, and even Western Europe. Monsanto and other agriculture conglomerates are targeting the large food producers rather than consumers. So while your chips and snacks probably contains GMO's, you may not find GMO's in the produce section of your grocery. I have yet to come across any large-scale study showing that GMO's pose health risks to humans. My objection to GMO's is that they make farmers even more dependent on the large agricultural conglomerates. Even farmers who refuse to use GMO seeds could be sued, if their own seeds and fields inadvertently start getting invaded by the GMO seeds.

Sick (The Untold Story of America's Health Care Crisis): Anyone interested in the U.S, Health Care system needs to read this book. Each chapter covers an aspect of the health care system through the story of an individual family, with families spanning several states across the country. The author also does a great job of providing the history of health care in the U.S. Exceptionally well-written book on an ever important subject. I recommend it highly!

The Auto Loans Crisis: While the crisis in housing loans has been covered extensively in the media, there is a serious disaster looming in the car loans industry.

Researching Charities: GiveWell provides research on charities similar to what equity analysts do for stocks. If you are trying to decide which charities to support, check out their useful site.

Malaysia and the Philippines: Interesting article on the prospects of these Southeast Asian neighbors in the battle to capture market share in the Business Process Outsourcing (BPO) market. According to this ZDNet article the top four markets in 2007 (with their market share) were: India (11.5%), China (4.4%), the Philippines (1.4%), and Malaysia (1.2%).

Previous Dimes can be found here.

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