Migraines could be a headache of the past

Is there hope for the many millions of migraine sufferers in the United Kingdom and around the world? Researchers at King’s College Hospital certainly believe that this is the case. While they are cautious about the findings of their latest research, the results certainly are one that point towards optimism for migraine sufferers.

It is estimated that the number of migraine attacks everyday in the UK number over 190,000. This figure was estimated by the Migraine Trust, and it was probably obtained by taking a sample size of the population, taking into account the number of migraine attacks experienced within that group and then multiplying it by the general population in the United Kingdom. This of course means two things: firstly, the figure was proposed by a group that has an interest in promoting awareness about migraines and is hence slightly biased, probably over-estimated. Secondly, bearing in mind that the UK population is over 66 million, and it is unlikely that the Trust surveyed 1 million people – or even anywhere near that – any differences could have been amplified by over 66 times.

What is the difference between a migraine and a normal headache? A migraine is a headache which happens frequently. Migraines themselves are classed as two types. Headaches which happen more than 15 days a month are known as chronic migraine, while episodic migraine is a term used to describe headaches which happen less than fifteen times a month.

The research uncovered that a chemical in the brain was involved both in the feeling of pain and sensitivity to sound and light. This chemical is known as calcitonin gene-related peptide, or CGRP. If CGRP is neutralised, or if part of a brain cell which it interacts with is blocked, then pain receptors are dulled and migraines are reduced.

There are currently four drug companies in the race to develop a CGRP neutraliser.

Race is an accurate term, for the company that develops and trials the drug successfully may win the patent for developing and marketing the drug over twenty years. Drug companies or pharmaceuticals are normally granted that period to reward them for the time and cost invested into research.

One such company, Novartis, trialled an antibody, erenumab on episodic migraine sufferers. Those who took part in the trial suffered migraines on an average of eight days a month.

955 patients took part in the trial and half of those who received injections of erenumab successfully halved their number of migraine days per month. 27% of patients also reduced their number of migraine days without treatment. The results suggest that the drug was successful, particularly as it worked for over 450 people, and that if it were used for those with chronic migraine it might be equally successful. Even if the same percentage were maintained (50% vs 27%), the number of working days saved by migraine prevention could have significant savings for the economy.
Another pharmaceuticals company, Teva, produced another antibody, fremanezumab, and trialed it on 1130 patients. Unlike Novartis’s trials, the participants in Teva’s were those with chronic migraine, with over 15 or more attacks each month. In the Teva trial, 41% of patients reportedly halved the number of days that they suffered migraine attacks. 18% reported the same effect, so the confidence interval in the trial is pretty high and suggests a high degree of positive use.

The study is very important and useful because of the understanding it offers in treating migraine, and the medical products can reduce the frequency and severity of headaches. It makes for fewer days lost to the disease and more positive, functioning people.

Besides CGRP antibodies, there are other current treatments for migraine such as epilepsy and heart disease pills. Even botox is sometimes used. However, all three come with side-effects and are not necessarily the best for everyone.

The hope is that CGRP antibodies, which are traditionally more expensive to manufacture, will in the long term be available at a more affordable cost, and would benefit those who currently get no benefit from existing therapies.

If the estimation that one in seven people live with regular migraine is accurate, migraine reduction could have significant life-improvement effects for humans. Chronic migraine is in the top seven disabling conditions and improvements in understanding it and how to manage it would not only improve the quality of life for those who suffer with it, but also in reducing the number of work days lost for the economy. But the benefits do not just remain with migraine sufferers. Having to live with chronic disabling conditions often leads to other symptoms such as depression. Who knows? Perhaps CGRP antibodies may even negate the effect of depression, resulting in a secondary effect. It may be possible that those who suffer from migraine alongside depression may even not require treatment for the latter if the CGRP antibodies prove to be effective.
Can you imagine a world without anti-depressants? At the moment millions live on some pain-relief medication of some sort. It would be great if they could be phased out. Although it might not be so great for the economy!

Should we be excited about the results? Well, yes. The combined large sample size of both studies, of over 2000 migraine sufferers showed that there was some weight behind the study compared to if – for example – it had been done only on one hundred participants. Secondly, while the research was undertaken by pharmaceutical companies, the outcome was actionable, meaning that it produced a result that was useful, rather than one that merely formed the prelude to a more extensive study. In previous posts I demonstrated how some – such as the coffee umbrella review – did not produce any significantly useful outcome. But we know from this particular research that it may work to neutralise either CGRP, or lessen its interaction with the particular brain cells in order to lower the effect of migraine.

Did the media have a field day with this? Unsurprisingly, no. You see, good research does not lend itself to sensationalist headlines.

Health umbrella reviews mask the real issues

You have to wonder why the breakfast tea doesn’t get the same level of attention. Or perhaps whether in France, the humble croissant is elevated to the same status. Or maybe the banana could soon be the star of another media show. But unfortunately it is coffee that headlines tomorrow’s fish and chips papers.

“Drinking three or four cups of coffee a day could have benefits for your health”. As we have seen previously, this kind of headline bears the hallmarks of a media health report:

1) repackaging of common information requiring little or no specialist examination;

2) use of a modal auxiliary verb (could) to conveniently justify or disclaim an

attention-grabbing headline – which, by the way, is point number three.

The health reports in the media also incorporate:

4) a statistically small group of trial participants, whose results are then blown up in proportion as if to be representative of the 7 billion people on the planet.

5) Assumptions. A media report about health could simply include assumptions.

Why dwell on coffee? For starters, it is a commonly consumed drink and so any meaningful research would potentially have bearings on millions of people. It is common media practice to focus on common food and activities because of the relevance to daily life.

But if you examine this carefully, why not tea? Why not write about tea? While conspiracy theories may be slightly far fetched, it is possible that – unless it is a speciality tea – coffees cost more, and any potential health benefits would lead people to spend more, hence generating more for the economy in the forms of tax. Perhaps this is why media writers don’t waste too much ink on researching the potential life-saving benefits of bananas, even though they are widely consumed. The research isn’t going to drive people to buy bananas in bulk, and even so, the extra revenue generated from a low priced item isn’t going to raise much extra tax.

Are there any notable similarities or differences in style across different countries? One wonders whether Parisian newspapers, on a regular basis, churn out headlines such as:

“Eating two or more croissants a day could reduce your chances of heart disease.”

“Pan aux raisins linked with dementia”.

The research done was an umbrella review to potentially examine whether further research should be undertaken into researching the effects of coffee and its role in preventing liver cancer. An umbrella review meant that no actual research was undertaken, but that existing research was examined and analysed to glean insights.

The problem with umbrella reviews is that they are very generalised, no actual research is done, and they are only brief analyses of existing research. This means that first of all, an umbrella review could arrive at a particular conclusion, but in no way should that be taken as the final conclusion.

In fact, the findings of an umbrella review are only the preliminary to more detailed investigation. If an umbrella review suggested that drinking coffee could prevent cancer, then what it is saying is more research needs to be undertaken, and the media needs to be ethically responsible by not reporting “Coffee prevents Cancer”, because there are people that look at newspapers and television as the source of their information and assume just because it has been released in the public domain, it is truth. Who could conceive that newspapers spend time and resources to publish trivial information and that television is pure rubbish?

The second problem with umbrella reviews is that the outcomes are only as good as the original sources. If someone gave you a set of grainy photos, then asked you to make a collage with them, then your collage is going to be as good as the grainy photos will allow. If the original sources were not thorough or exact in their investigation, are any subsequent findings based on these merely just a waste of time?

The third issue with umbrella reviews is that under closer scrutiny, the overall picture is distorted by over focussing on small statistical variances, or sometimes minute errors are magnified and lead one down the wrong path.

If you took a picture on your phone and then blew it up to the size of a mural covering the side of your house, the picture becomes very dotty. You might see big patchy squares. But if you started looking for that big patchy square from the image in your phone… one has to wonder what the purpose of that is.

The fourth is that because umbrella reviews are a prelude to a more thorough investigation, their end results are slightly skewed from the outset. If an umbrella review is bound to provide a few avenues for later time-consuming research then it is fundamentally biased into having to provide one in the first place. Why, in that case, have such reviews in the first place? Some may point out that the flaw in the system is that umbrella reviews are relied on by those in academia and research to warrant the continued longevity of their positions. In other words, if researchers had nothing to research, they might be out of a job, so they best find something to stick their noses in.

Have you ever read the London newspaper Metro and come across some research news such as:

“Going to bed angry can wreck your sleep” (25 Sept 2017)

It is the sort of headline that makes you think “Why bother doing the research in the first place?”

It is likely that you have read a media report of an umbrella review.

What were the findings of the original coffee review?

Drinking coffee was consistently linked with a lower risk of death from all causes and from heart disease. The largest reduction in relative risk of premature death was seen in people consuming three cups a day, compared with non-coffee drinkers.

Now, when an umbrella review mentions drinking coffee is linked with a lower risk of death, it is important to be clear about what it specifically means. And what it is stating is that those who had a lower risk of death all happened to drink coffee. It might have nothing to do with the coffee itself. It might have been that they took a break to slow down a fast-paced lifestyle, and the taking of a break gave them a lower risk of death. By that logic of association, tea could also be linked with a lower risk of death.

Coffee was also associated with a lower risk of several cancers, including prostate, endometrial, skin and liver cancer, as well as type-2 diabetes, gallstones and gout, the researchers said. The greatest benefit was seen for liver conditions such as cirrhosis of the liver.

Again, to be clear, the above link means that those who were at lower risk of those cancers happened to drink coffee. But it is not necessarily stating the coffee had anything to do with it.

And coffee is such a commonly consumed drink, that it is easy to use it to draw links to anything.

If people who died from car accidents happened to drink coffee, an umbrella review might state that drinking coffee is linked with higher incidences of car accidents.

The findings can be summarised by a health analyst:

“Does coffee prevent chronic disease and reduce mortality? We simply do not know. Should doctors recommend drinking coffee to prevent disease? Should people start drinking coffee for health reasons? The answer to both questions is ‘no’.”

We should perhaps add a further third question: Did the umbrella review produce any actionable findings, and should it have been undertaken in the first place?

Probably not.

Is there any truth about the benefits of Classical music?

Is there any truth to the commonly accepted notion that listening to classical music improves mental capacity? Somehow it has been accepted in modern society that classical musicians have larger frontal cortices, better mental reasoning powers and perhaps intelligence quotients. Over the last two decades or so this idea has fuelled a rise in the number of pregnant mothers listening to classical music – whether or not they like it – and parents enrolling their children into music classes. The music of Mozart, in particular, has enjoyed a resurgence as its classical form is deemed to be more logical and organised, compared to music of other periods, assisting in triggering patterns of organisation in the brain amongst its listeners.

How did this idea about Classical music come about? In the 1990s scientists conducted a series of experiments where one group of students were played one of Mozart’s piano sonatas before a spatial reasoning test, while another group sat in silence. The group that was played the music beforehand performed better on that task than the control group. The effect on the control group was temporary and only lasted fifteen minutes, meaning that after the fifteen minute mark the disparities between the results were minimal and statistically the same. The results of the group found also that while music primed the individual particularly for mathematical tasks, after an hour of listening to Classical music, the effect on the brain was lost.

That piece of research was pounced on by the media and other individuals and seemingly perpetuated to promote the listening of Classical music. One governor of the state of Georgia even decreed that newborn babies be given a copy of a CD of Mozart’s works upon leaving the hospital. The Mozart Effect, to give it its common name, was written about in newspapers and magazines, and this began the spur of Mozart-related sales of music as well as the trend of mothers playing such music to their children in and out of the womb.

The most important question we need to ask is whether there is any truth in such research, and whether it can be corroborated.

We know that some forms of music has a soothing, calming effect on individuals. Playing the music to the students may have calmed that so they were not nervous, allowing them to perform better on the task. However, relaxation need not take them the form of Classical music. Any activity that promotes calm before a task – reading a light magazine, playing computer games, talking with a friend – can also hence be said to have the same effect as the classical music that was played.

What if the students in the group had read a joke book or comic beforehand, been less worried about the test and scored better? It might have prompted a deluge of articles claiming “Reading Archie (or The Beano – insert your own title here) improves your IQ”.

Or if the students had been offered a protein drink beforehand, it would not be inconceivable that someone would latch to that piece of research and declare that “Protein Drinks not just good for your body, but for your brain too”.

Mozart’s music has been said to embody the elements of classical music as we know it. Organised formal structures, chords and harmonies through related keys, use of contrasting tunes, contrasts in volume all feature in his music. But the music of other composers have such features too. Imagine if the composer Josef Haydn had been the lucky beneficiary of the experiment and his music had been played instead. The sales of his music catalogue would have hit the roof!

Subsequent scientists all found that listening to music of any form caused improvements, and the genre of music – whether rock or Classical – was irrelevant. But studies today still quote Mozart.

Is it ethical that the media promotes unsubstantiated research by reporting without closer scrutiny? As we have seen in previous blogs posts, the media reports on things without necessarily scrutinising the evidence, and entrusts so-called experts to corroborate the evidence, while it fills column inches and air time with modal auxiliary verbs? Huh? In simple terms, it means that if there is a sniff of a link between A and B, the media reports that “A could cause B”. Never mind whether it does or not, there is always the disclaimer of the word “could”.

In this instance, students performed better on a spatial reasoning task after listening to Mozart; hence the headline “Mozart could improve mental powers”. Diluted over several recounts, you could get “According to XXX newspaper, Mozart improves brain power” before arriving at “Mozart improves brain power”. Unfortunately, this is when the headline is then pounced on by anyone who would stand to profit from espousing this theme.

Who would profit from this? The Classical music world – performers, writers, musicians – can use this “research” to entice people into taking up lessons and buying CDs and magazines. If you read any music teacher’s website you may find them espousing the benefits of learning music; it is rare if you find one that advises it is a lot of effort.

The media will profit from such “research” because it means there is an untapped well of news to report and bleed dry in the quest for filling column inches and air time. News exclusives will be brought out, and so-called experts will also profit for appearing on the news and programmes, either monetarily or in the form of public exposure.

One must question the ethics of incorrect reporting. Unfortunately unsubstantiated research leads to more diluted misreporting, which can then form the basis of new research – research that uses these claims as the groundwork for investigation.

It is scary to think that all the medical research that has been done into effect of music and health could be biased because of the so-called effect of classical music. Could musical activities such as learning the piano help reduce Parkinson’s disease? Could listening to the music of Beethoven reduce the incidence of higher cases of Alzheimer’s disease? Could it all be wrong – have we all been sent down the wrong tunnel by an avalance of hype reporting?

It may be fair to say the human impulse is to buy first and consider later, because we are prone to regret. If we have missed an opportunity to improve the lives and abilities of our children, then we will be kicking ourselves silly forever with guilt.

So if you are still not convinced either way about whether classical music – either in the listening or the practice – really does have any effect, you could at least mitigate your guilt by exposing your child to piano music, for example that has predictable patterns in the left hand. Sometimes, listening to structurally-organised music such as from the Baroque may be useful, but it is also good to listen to Romantic music because the greater range of expression arguably develops a child that has more emotionally subtlety and intelligence.

You may find that ultimately, any truth in the research about Classical music and its mental benefits is not due to the blind passive listening, sitting there while the music goes on around your children. It is in the child’s inner drive to mentally organise the sounds that are heard, the trying and attempts to organise background sounds that really triggers the mental activity in the brain. It is more the practised ability in the inner mind to organise musical sounds that causes better performance in related mental tasks.

Physical and Mental Contamination

Is there a need to start worrying about your kitchen? I don’t mean in the home improvement context, never mind that the island unit is looking a bit worse for wear, and that your swanky appliances need upgrading so you can have two ovens to cook for your little army; or maybe you are thinking you could expand beyond the microwave and gas cooker. Or perhaps you are considering the option of creating an open plan kitchen. Whatever the physical changes you are considering, they are beyond the scope of discussion. Danger lurks in your kitchen.

It doesn’t come in the form of masked strangers brandishing kitchen implements. Or ruthless critics in the form of master chefs or children. No, the hidden danger in your kitchen is more subtle, more soft, yet potentially more lethal.

The kitchen sponge.

Scientists estimate that the kitchen sponge contains the highest concentration of bacteria than anywhere in the house. On the face of things, this is not an unrealistic statement. The kitchen sponge is in contact with remnants of food as it passes over the crockery and cutlery, and while the latter are clean, microscopic elements of food have merely been transferred to the sponge. And even if you take the effort to rinse out the sponge, or go a step further by microwaving the sponge, trace elements of food bacteria will remain.

According to the Mail Online, one of the more sensationalist newspapers in the United Kingdom, there are 54 billion cells of bacteria residing on the humble sponge. But of course the Mail Online would say that – it is taking a simple fact and blowing it out of proportion in order to create a purchasing headline. (And what is a purchasing headline? It is one that intrigues you enough to make a financial physical purchase to discover more, or hook you in enough to commit your time to reading more, never mind that the headline was slightly manipulated in the first place.) The fact is, bacteria exist all around us. They are on the surfaces of things around us. But it is important to distinguish between good and bad bacteria. The majority of bacteria around us are harmless. The remaining bacteria can do us harm if they enter our bodies, which is why it is a good idea to wash hands before eating. This ensures the harmful bacteria on our hands, either from touching door knobs or taps or other contaminated surfaces, does not rest on food that we ingest. It is also a good idea to cover up exposed cuts so that bacteria does not enter the bloodstream.

Bacteria is all around us but we can’t live life in fear of it.

Can you imagine if the word bacteria was substituted with the word humans? It would give a better perspective.

The headline would read that something like “A higher concentration of criminals found in [name of city]”. But you can’t live like every human in that city will do you harm. You can only take necessary steps to avoid being negatively affected.

Just like bacteria.

The current guidelines around hand washing recommend that we  our hands with water and soap for at least 20 seconds, after instances such as using the toilet, handling raw food like meat and vegetables. It is advised that we wash our hands before eating or after contact with animals.

Does washing with specialist soaps make any difference? A study by Rutgers University and GOJO Industries in the US found that there was little difference, which suggests the science between Brand X and Brand Y is as manufactured as the products themselves.

The study involved twenty volunteers and examined variables of hand washing such as brand, volume and time elapsed. A non-harmful strain of the bacteria e-coli was placed on the hands of the volunteers and then examined after washing to see how much remained.

The study found that there was little to distinguish between normal soaps and anti-microbial formulations. In fact, as long as volunteers washed their hands with soap for thirty seconds, the difference in results after washing were negligible.

There were a couple of minor limitations to the study conducted by Rutgers and GOJO Industries.

Firstly, that sample size is too small. Secondly, volunteers could not ethically be asked to handle deadly bacteria so the results may have only be applicable to that particular strain of bacteria.

There was a major stumbling block to the research however. GOJO Industries manufactures hand soaps.

We have already examined in the past how it is not a good idea if pharmaceutical companies run their own tests because the authenticity cannot be guaranteed completely if there is a bias from the outset. If a pharmaceutical company or any other manufacturing company is going to invest time, money and effort into production, it is going to choose results which have a positive bias, rather than those with a negative one which either force further research, impacting on production time and costs, or one that cause the complete abandonment of results.

Is there anything we can trust anymore? The dilemmas we have are that the media distorts reporting, and research is funded with an agenda which produces an expected outcome. It is difficult to secure funding for research if there is no meaningful purpose behind it beyond sales.

Returning to the original issue of bacteria, as long as we take necessary precautions, that is the best we can do. These precautions include replacing the sponge regularly, and not leaving unwashed dishes in the kitchen, and washing our hands to avoid contamination.

And take in what you read and hear about health and news with a pinch of objectivity. Avoid contaminating your mind too!

A smart person thought up the mental improvement products

The trail of human evolution is littered with gadgetry that have outlived their usefulness. We can add devices such as the fax machine, walkman, mini-disc and tape recorder to the list of machines which seemed clever at the time but have now before obsolete. Those of us of a certain age will remember newer additions such as the PocketPC, a palm sized screen which was used with a stylus that tapped out letters on screen, and the HP Jornada, a slightly bigger tablet sized keyboard and phone. And who could forget the Nintendo Brain Training programmes for the DS and Fitness Programmes for the Wii?

Launched in 2005, Nintendo’s Brain Training programmes claimed to increase mental functioning. Nintendo’s premise was that the concentration required in solving a variety of puzzles, involving language, mathematical and reasoning, increased blood flow to the frontal cortex of the brain, which at least maintained brain functioning or helped improve it. After all, since the brain is a muscle, exercising it by bombarding it with mental exercises would keep it active and healthy, right?

It is the idea of keeping the brain active that leads many to attempt their daily crossword or Sudoku. The latter in particular has seen an surge in interest over the past decade and is now a feature in newspaper back pages and magazines. There are even publications exclusively filled with Sudoku puzzles, and even more complex versions where each traditional puzzle forms a square in a bigger and complex three by three grid. If you thought doing a Sudoku puzzle was hard, imagine having to work on it in relation to eight others. It would be absolutely mind-boggling!

Is there any truth about the positive enhancements to the human life that these objects or activities bring? Nintendo’s claims about the Brain Training programmes were doubted by leading neuroscientists, who doubted the tenuous links between the increased blood flow to the brain and the vaguely described positive effects to life. It is akin to making a blanket statement saying chess grand masters or academics are the happiest people around. Unfortunately it is yet another case of a company creating a product and then engineering the science around it.

Manufacturers of beauty products do it all the time. Whether it is skin care or facial products being flogged, you will find an aspirational theme within the first five seconds of the advertisement (“Look beautiful! Stay young!”) which is then followed by a pseudo-scientific claim, preferably involving percentages (sounds more authoritative) and a small sample size (easier to corroborate, or disclaim, depending on the need).

“Live young forever. XX skin lotion is carefully formulated to retain your natural moisture, so you look and feel twenty years younger. 86% of 173 women noticed a change in skin density after using it for three months.”

There you have it. The secret of beauty product advertising.

Unfortunately, if there was any display of mental acuity, it was by the marketing team of Nintendo. In pitching a product to adults, using the retention and improvement of mental agility as a plus point, they not only convinced adults to buy what was essentially a toy, but to buy one for their children as well. The DS alone has since sold over 90 million units worldwide, and when you take into account the cost of games and all that, you will have to concede that someone at Nintendo had the smarts to produce a tidy little earner.

(For those who were more concerned with retaining their physical functioning, the Nintendo Wii Fit programmes performed that function and filled in the gap in that market.)

The improvement of mental functioning is always a good basis for marketing any product. You can find a whole plethora of products huddling behind it. Multi vitamins, activity puzzles, recreational activities involving multi-tasking – all supposedly give the brain a workout, but more importantly, tap into the fears of missing out or the loss of mental function in the human psyche, that makes people buy not out of potential gain, but fear of lost opportunity and potential regret.

The loss of mental function can lead to Alzheimer’s disease, for which there is currently no cure. With 30 million people worldwide suffering from it, this presents an endless river of opportunity for people researching the disease, as well as people developing products to improve mental function in the hope that it can stave off the disease. Like the Nintendo Brain Training developers realised, it is not so much about whether these scientific products work that makes people buy them – the evidence that is produced is biased and not independent – but it is the fear of missing out and retrospective guilt that compels people to make the purchase. Buy first, examine the evidence later, is the apparent dogma.

Unfortunately we are at the stage of modern society where it is not just the product that needs scrutiny, but whether the scrutiny itself needs scrutiny for evidence of bias, either in the form of financial ties or expected research outcomes.

Mental improvement is an area that product developers – whether the products be vitamins, books or applications – will continually target because human beings will always seek to improve mental prowess, both in themselves and their children, in the hope that somewhere down the line it offers an advantage, or prevents the mental degeneration associated with the aging process. And the compelling reason to buy lies somewhere in the meeting points of being seduced by the aspirational ideals the product offers, the fear of missing out, and the assumption that the underlying evidence is empirical. The greatest mental sharpness has been displayed by the one who has understood the sales psychology of mental health improvement products and used it to his or her advantage.