Links for Monday, October 16, 2017: SNAP to keep seniors home, every-other-day iron, high school football's decline

SNAP is a good way to keep senior citizens out of the hospital. 

SNAP stands for Supplemental Nutrition Assistance Program. It is used by about half of the Medicaid beneficiaries who qualify for it. 

In certain iron-deficient women, it might be better to take iron every other day. 

Previous warnings about small trials apply here, but in a study in The Lancet, investigators assigned women with mild reductions in iron storage (serum ferritin levels of ~25 ug/L or less) but not moderate or severe anemia to receive 60 mg ferrous sulfate every day for two weeks or every other day for 4 weeks. Then the investigators checked their fractional iron absorption and total iron absorption. 

Two weeks following treatment, the alternate-day group had higher fractional iron absorption (22% vs. 16% ) AND total iron absorption (175 vs. 131 mg).

To make sure that this was an effect of timing and not just splitting the dose, a smaller group of women was then assigned randomly either 120 mg FeSO4 daily or 60 mg twice daily and the testing process was repeated. In this case, there was no difference between the two groups. 

So what's the take-home? First, there is no benefit (*ahem*, small study) in dividing iron doses into twice daily. Second, it might be beneficial, at least in this specific patient population, to give the iron less often, but for a greater length of time. Mechanism unknown, at least to me. I have some concerns about every-other-day dosing. It seems like a good way to drive down adherence to therapy. But the effect is promising. In an astonishingly British-sounding editorial (the authors are straight from Downton Abbey casting), one states that the results "are likely to lead to a more felicitous means of administering this widely used therapy." Felicitous, in case you were born west of eight degrees longitude, means "well chosen or suited to the circumstances." Or "pleasing and fortunate." But the latter definition will seem strange to anyone who's ever tried to pass a ferrous sulfate-laced stool.

Kansas is among states where high school football participation is down more than 10 percent. 

Speculation is that this is related to fear of traumatic encephalopathy and concussion. Speculation on my part is that this is the beginning of a slow decline in football in the non-deep-south.

Congrats to Allen County, Kansas on its 2017 RWJF Culture of Health Prize. 

Jony Ive, designer of the iPhone, says we use our iPhones too much.

Justin Moore, owner of an iPhone, agrees. Don't be a phoneworm. 

Links for September 1, 2017: building a better block, football broadcaster crisis of conscience, kibbutzing for happiness, meldonium, stem cell clinics, FSH, and whoppercoin

Ed Cunningham quit college football over concussion concerns.

That little click you just heard was another tiny domino falling in the decline of football. I've said before that the NFL was one thing, but it's such a small, relatively well-paid population that it doesn't mean much. Once concern starts spreading upstream into college, high school, and beyond, football is in trouble.

Can a Kibbutz make us happier?

In my neighborhood we've experimented with our version of Kibbutzing: we used to have a monthly (or so) breakfast where everyone in the neighborhood was invited to a single house for pancakes, breakfast burritos, etc. Like so much in life, though, it was overtaken by other Saturday morning chores. It's hard for even a breakfast burrito to compete with kids' soccer, the Home Depot, and volunteer duties. It's time to resurrect our Kibbutz. 

Caitlin Thompson doped like Maria Sharapova and liked it.

Caitlin brings up the possibility of this having been a placebo effect. I agree. It's hard to find clinical trial data on meldonium in English; almost all the trials are published in Russian:

And there are no systematic reviews. Wolfgang Schobersberger, Tobias Dünnwald, Günther Gmeiner, and Cornelia Blank wrote a nice narrative review (paywalled) on meldonium's transition to a performance-enhancing drug, though. The take-home from their article is right in the abstract:

The benefit of taking meldonium in view of performance enhancement in athletes is quite speculative, and is discussed without sound scientific evidence.

The FDA is (finally) taking on stem cell clinics.

A few years ago, a stem cell clinic opened here in Kansas, with surprising fanfare. IIRC, they convinced the Governor and even Kansas State Head Football Coach Bill Snyder to attend a grand opening. Coach Snyder is even in a video on their website. Not long after, I reached out to the docs in the clinic through their website to ask to talk about the evidence they were using to justify their treatment regimens. I never got a response. That clinic is not on the list, as far as I can see, of clinics that have been contacted by the FDA.

Is follicle stimulating hormone responsible for post-menopausal weight gain?

I'm skeptical. And I suspect the downstream effects of blocking FSH, which aren't completely known yet, might be worse than an extra 15 pounds.

Burger King is launching its own cryptocurrency that can only be used to buy whoppers. For real. 

I hope I'm not being burned by fake news here.

Links for July 27, 2017: lead levels and crime, CTE, happiness in bariatric surgery, and the Fda's cheese problem

Are high lead levels associated with high crime rates?

In a sample fraught with selection bias, 99.9% of autopsied NFL brains had chronic traumatic encephalopathy.

This bothers me less than I might have thought it would. NFL players are small in number, they have a job that they know is risky, and they're pretty well paid for the work. The fact that they have a now well-documented complication of their employment is only mildly interesting. Where this research needs to go now is into lower levels of play. If evidence begins to accumulate that college, high school, or younger players are at risk for CTE, then wholesale changes are going to be needed in football or the sport is in real danger. 

People with a BMI under 40 are happier and healthier after their surgeries.

I'm a big, big fan of bariatric surgery for people with morbid obesity. We simply have access to no other treatment that improves quality of life and prolongs life to the extent that surgery can. But now there's some evidence (albeit weak) that people should have surgery earlier, not later. In a study published in JAMA Surgery, investigators found that people who had surgery before their body mass index, or BMI, hit 40 were about 12 times as likely as people with higher BMIs to get to a non-obese BMI (that is, less than 30) after surgery. A couple things to consider here: first, surgeons want to operate, so we should acknowledge their bias in this study; of course they want people with lower BMIs to qualify for surgery. It opens up more patients for them and they get to operate on a less sick, less complicated population of patients. But second, weight isn't the only thing we worry about post-surgery, so why does this matter? Because people who got to a BMI of less than 30 were much more likely to be able to stop medications for cholesterol, diabetes (especially insulin), and blood pressure. They were also much more likely to see a remission in their sleep apnea. Finally, the people who got to a lower BMI were just happier, with a satisfaction rate of 92.8% vs 78.0% for folks who didn't get to a non-obese BMI. The study can be tossed into the growing pile of studies showing that gastric banding sucks. Patients who had any other surgery--sleeve gastrectomy, gastric bypass, or duodenal switch--were 8 times, 21 times, and 82 times more likely, respectively, to get to a BMI less than 30 compared with those who got gastric banding. And that doesn't even take into account the disturbingly high complication rate of gastric banding. Take-home points? If you're considering bariatric surgery, get it sooner rather than later, and don't get a gastric band. 

The USDA is all about cheese right now.

I have mixed feelings on this. On the one hand, it seems a little absurd that we so misallocate food subsidies that dairy farmers are literally pouring milk into holes in the ground:

Farmers poured out almost 50 million gallons of unsold milk last year—actually poured it out, into holes in the ground—according to U.S. Department of Agriculture data. In an August 2016 letter, the National Milk Producers Federation begged the USDA for a $150 million bailout.

On the other hand, given the growing evidence that excess meat intake is shortening American lives, diverting some of that desire for meat toward cheese, yogurt, and other dairy products isn't the worst thing in the world. 

Links for July 24, 2017: Athletes and their pee habits, mobile farmers' markets, and surgery as a placebo

Athletes are very resourceful at finding places to go when nature calls

Bill Walker at Kansas State (hail alma mater) was well-known for urinating into towels on the bench. He's not alone:

Mobile farmers' markets are hitting the road.

Food trucks are a surprisingly durable trend. So maybe it's no surprise. 

Surgery is one hell of a placebo.

You should still avoid it whenever possible. The average American has eight (8!) surgeries in his/her life. That's too many. 

This doesn't happen naturally.

Anabolic steroids are an integral part of the bodybuilding scene.

Why does this matter? Because they make people die young. An astonishing fraction of pro wrestlers, who also abuse performance-enhancing drugs in large numbers, die before age 60, and they die of things we associate with androgen abuse: liver cancer, suicide, risky behavior, and heart disease.

Michael Oher, subject of "The Blind Side," cannot pass a physical because of concussions.

I'm short on the long-term future of football in its current form.

Do Americans spend on health care just because we're a nation of consumers?

I'm skeptical. I hold out hope that Americans, if given the right version of price transparency, might spend less. But this series of graphs is pretty convincing to Tyler Cowen's argument:

ADDENDUM (7/24/17 11:28 AM): Is the President fit?

I suspect the headline is a double-entendre, but at least in terms of physical fitness, the answer is very clearly "no." But I'm not sure it matters that much, especially in the context of the swirl of controversy that surrounds the rest of the administration.