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Nathan Goodyear

Reporting bias in medical research - a narrative review | Trials | Full Text - 0 views

  • bias is widespread in the medical literature
  • clinical decision making based on the "best evidence" will remain an illusion
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    bias is rampant in medical research.
Nathan Goodyear

BIA--part II - 0 views

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    good read on clinical application of BIA in the clinical setting.
Nathan Goodyear

PLoS ONE: Obesity, the Endocannabinoid System, and Bias Arising from Pharmaceutical Spo... - 0 views

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    good review of endocannabinoid system. More importantly, this article reveals the Bias present in the pharmaceutical arena, as it relates to their drug research.
Nathan Goodyear

Bioelectrical impedance analysis - 0 views

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    good review on the science behind BIA or bioelectrical impedance analysis.
Nathan Goodyear

Testosterone Supplementation and Sexual Function: ... [J Sex Med. 2014] - PubMed - NCBI - 0 views

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    Meta-analysis finds bias in industry studies versus independent studies.  No surprise there.   Testosterone in this meta-analysis was found to aid sexual dysfunction in men with hypogonadism.
Nathan Goodyear

Residual adverse changes in arterial endothelial fun... [Ann Med. 2007] - PubMed - NCBI - 0 views

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    could the flu vaccine cause a short-term increase in cardiovascular event risk?  According to this study yes.  So, with a recent study showing no benefit in children and adults, then with this finding of increased arterial dysfunction, increased CRP and fibrinogen, and increased LDL oxidation...why would an adult get the flu vaccine??? The focus should be on what the science shows, not an individuals bias!
Nathan Goodyear

Blood type diets lack supporting evidence: a systematic review - 0 views

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    This study, a review of 16 articles, found little scientific support for the "blood type" diet.  This is why I have not made this recommendation to our clients--no real data to support this diet.   One question, is what was the eligibility criteria for inclusion of the studies.  Only one out of the 16 was selected.  Inclusion/exclusion criteria in these studies can brian bias.
Nathan Goodyear

Comparative efficacy and tolerability of antidepressants for major depressive disorder ... - 0 views

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    could the anti-depressant industry in children and adolescents be a scam?  A review of the evidence finds very low quality of evidence with > 56% of the studies being funded by the industry itself; can you say conflict of interest or potential bias?  Review finds evidence only that fluoxetine is more effective than placebo in children and adolescents with depression.
Nathan Goodyear

A meta-analysis of the association bet... [Cancer Causes Control. 2013] - PubMed - NCBI - 0 views

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    Study was undertaken in China due to alarming increase in breast cancer in Chinese women. This meta-analysis of 36 articles found a 44% increase in breast cancer with one abortion.  This increased to 76% at 2 and 89% at 3 abortions respectively.   This study is very important and previous criticisms of prior studies linking abortion to breast cancer has been reporting bias.  In China, due to the one child policy, abortion is a way of life and there is no cultural shame involved.
Nathan Goodyear

http://www.2ndchance.info/onesize4all-Perricone2013.pdf - 0 views

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    Absolute must read!  Science. That is what physicians are.  Eliminate politics and bias.  Aluminum, common adjuvant in vaccines and well known neurotoxin, has been linked to post vaccine macrophagic myofascitis.  Now, world experts have placed it at the forefront of a new created syndrome "ASIA" which is autoimmune/inflammatory syndrome induced by adjuvants.  
Nathan Goodyear

Testosterone Dose-Response Relationships with Cardiovascular Risk Markers in Androgen-D... - 0 views

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    Study finds no worsening in cardiovascular biomarkers in women on Testosterone.  The women in this study were chose due to low Testosterone.  Testosterone was given IM at 4 different doses.  This is in contrast to other studies that have looked at endogenous Testosterone level.  Studies have shown increasing endogenous T levels in women is associated with increased CVD.  Studies on exogenous are lacking.  This points to limited risk associated with CVD and T therapy in women.   One caveat.  Two of the authors of this study have ties to the maker of the Testosterone enanthate used in this study.  Why is this important?  Prior studies have shown significant decrease in adverse event reporting in those funded by pharma--bias.
Nathan Goodyear

Short-term testosterone therapy failed to increase CV risk in women | Endocrinology - 0 views

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    24 week study of 71 women post-hysterectomy finds no increase in cardiovascular biomarkers.  Several problems with this study.  First, there was a large drop out--24%.  Second and most important, the women were pretreated with estrogen prior to Testosterone therapies were initiated.  Other studies have proposed that this protects cardiovascular risk in women on Testosterone.  Previous studies show increasing endogenous Testosterone is associated with increasing cardiovascular disease in women.   This study would be much better if no estradiol was prescribed.  That would give an unbiased view of Testosterone in post-hysterectomy women.  Not much can be taken from this study. If you doctor doesn't know this, find another doctor.  Inherent bias in this study as ties to the manufacturer of the Testosterone was disclosed. This study point to the inherent flaws in so much of the medical literature today.  Most would read the headlines and read no further, but the "further" dispels the headline as flawed.
Nathan Goodyear

The Benefits and Harms of Systemic Testosterone Therapy in Postmenopausal Women With No... - 0 views

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    Only abstract available.  Meta-analysis of Testosterone therapy in post-menopausal women finds significant bias, some improvement in sexual function and cholesterol levels, yet safety and long-term data is significantly lacking.  Take this with studies on endogenous Testosterone in women, significant caution needs to be followed with Testosterone in women. Only abstract available here.
Nathan Goodyear

BMC Complementary and Alternative Medicine | Full text | An open label pilot study to e... - 0 views

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    Black Spanish radish found to up regulate phase I/II liver detoxification with tylenol exposure.  Now, this was sponsored by a maker of a herbal product so that would include some potential bias.
Nathan Goodyear

Testosterone levels improve in obese men following a common weight-loss operation: Slee... - 0 views

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    The ignorance of this authors statements is unmeasurable.  Numerous other studies have shown weight loss in men with obesity is associated with increased Testosterone production.  My book highlights the mechanism by which adipose tissue decreased Testosterone production.  The author was quoted as pointed to no Testosterone replacement (even if levels are low????) despite the evidence that Testosterone will improve glucose metabolism, build muscle (reverse sarcopenia obesity), improve cholesterol metabolism,  and significantly aid Diabetes control just to name a few; yet the author says, give surgery instead.  I am sure the author is a surgeon and thus bias might, just might, be present.
Nathan Goodyear

Testosterone and glucose metabolism in men: current concepts and controversies - 0 views

    • Nathan Goodyear
       
      80% of E2 production in men, that will cause low T in men, comes from SQ adiposity.  This leads to increase in visceral adiposity.
  • Only 5% of men with type 2 diabetes have elevated LH levels (Dhindsa et al. 2004, 2011). This is consistent with recent findings that the inhibition of the gonadal axis predominantly takes place in the hypothalamus, especially with more severe obesity
  • Metabolic factors, such as leptin, insulin (via deficiency or resistance) and ghrelin are believed to act at the ventromedial and arcuate nuclei of the hypothalamus to inhibit gonadotropin-releasing hormone (GNRH) secretion
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  • kisspeptin has emerged as one of the most potent secretagogues of GNRH release
  • Consistent with the hypothesis that obesity-mediated inhibition of kisspeptin signalling contributes to the suppression of the HPT axis, infusion of a bioactive kisspeptin fragment has been recently shown to robustly increase LH pulsatility, LH levels and circulating testosterone in hypotestosteronaemic men with type 2 diabetes
  • Figure 4
  • Interestingly, a recent 16-week study of experimentally induced hypogonadism in healthy men with graded testosterone add-back either with or without concomitant aromatase inhibitor treatment has in fact suggested that low oestradiol (but not low testosterone) may be responsible for the hypogonadism-associated increase in total body and intra-abdominal fat mass
    • Nathan Goodyear
       
      This does not fit with the research on receptors, specifically estrogen receptors.  These studies that the authors are referencing are looking at "circulating" levels, not tissue levels.
  • A smaller study with a similar experimental design found that acute testosterone withdrawal reduced insulin sensitivity independent of body weight, whereas oestradiol withdrawal had no effects
  • Obesity and dysglycaemia and associated comorbidities such as obstructive sleep apnoea (Hoyos et al. 2012b) are important contributors to the suppression of the HPT axis
  • This is supported by observational studies showing that weight gain and development of diabetes accelerate the age-related decline in testosterone
  • Weight loss can reactivate the hypothalamic–pituitary–testicular axis
  • The hypothalamic–pituitary–testicular axis remains responsive to treatment with aromatase inhibitors or selective oestrogen receptor modulators in obese men
  • Kisspeptin treatment increases LH secretion, pulse frequency and circulating testosterone levels in hypotestosteronaemic men with type 2 diabetes
  • Several observational and randomised studies reviewed in Grossmann (2011) have shown that weight loss, whether by diet or surgery, leads to substantial increases in testosterone, especially in morbidly obese men
  • This suggests that weight loss can lead to genuine reactivation of the gonadal axis by reversal of obesity-associated hypothalamic suppression
  • There is pre-clinical and observational evidence that chronic hyperglycaemia can inhibit the HPT axis
  • in those men in whom glycaemic control worsened, testosterone decreased
  • successful weight loss combined with optimisation of glycaemic control may be sufficient to normalise circulating testosterone levels in the majority of such men
  • weight loss, optimisation of diabetic control and assiduous care of comorbidities should remain the first-line approach.
    • Nathan Goodyear
       
      This obviously goes against marketing-based medicine
  • In part, the discrepant results may be due to the fact men in the Vigen cohort (Vigen et al. 2013) had a higher burden of comorbidities. Given that one (Basaria et al. 2010), but not all (Srinivas-Shankar et al. 2010), RCTs in men with a similarly high burden of comorbidities reported an increase in cardiovascular events in men randomised to testosterone treatment (see section on Testosterone therapy: potential risks below) (Basaria et al. 2010), testosterone should be used with caution in frail men with multiple comorbidities
  • The retrospective, non-randomised and non-blinded design of these studies (Shores et al. 2012, Muraleedharan et al. 2013, Vigen et al. 2013) leaves open the possibility for residual confounding and multiple other sources of bias. These have been elegantly summarised by Wu (2012).
  • Effects of testosterone therapy on body composition were metabolically favourable with modest decreases in fat mass and increases in lean body mass
  • This suggests that testosterone has limited effects on glucose metabolism in relatively healthy men with only mildly reduced testosterone.
  • it is conceivable that testosterone treatment may have more significant effects on glucose metabolism in uncontrolled diabetes, akin to what has generally been shown for conventional anti-diabetic medications.
  • the evidence from controlled studies show that testosterone therapy consistently reduces fat mass and increases lean body mass, but inconsistently decreases insulin resistance.
  • Interestingly, testosterone therapy does not consistently improve glucose metabolism despite a reduction in fat mass and an increase in lean mass
  • the majority of RCTs (recently reviewed in Ng Tang Fui et al. (2013a)) showed that testosterone therapy does not reduce visceral fat
    • Nathan Goodyear
       
      visceral and abdominal adiposity are biologically different and thus the risks associated with the two are different.
    • Nathan Goodyear
       
      yet low T is associated with an increase in visceral adiposity--confusing!
  • testosterone therapy decreases SHBG
  • testosterone is inversely associated with total cholesterol, LDL cholesterol and triglyceride (Tg) levels, but positively associated with HDL cholesterol levels, even if adjusted for confounders
  • Although observational studies show a consistent association of low testosterone with adverse lipid profiles, whether testosterone therapy exerts beneficial effects on lipid profiles is less clear
  • Whereas testosterone-induced decreases in total cholesterol, LDL cholesterol and Lpa are expected to reduce cardiovascular risk, testosterone also decreases the levels of the cardio-protective HDL cholesterol. Therefore, the net effect of testosterone therapy on cardiovascular risk remains uncertain.
  • data have not shown evidence that testosterone causes prostate cancer, or that it makes subclinical prostate cancer grow
  • compared with otherwise healthy young men with organic androgen deficiency, there may be increased risks in older, obese men because of comorbidities and of decreased testosterone clearance
  • recent evidence that fat accumulation may be oestradiol-, rather than testosterone-dependent
Nathan Goodyear

PLOS ONE: Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Ther... - 0 views

  • For all TT prescription subjects combined, the post/pre prescription rate ratio for MI (RR)was 1.36
  • In men aged 65 years and older the RR was 2.19 (1.27, 3.77), while in men under age 65 years the RR was 1.17
  • increasing RR with increasing age.
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  • The RRs were 0.95 (0.54, 1.67) under 55 years
  • 1.35 (0.77, 2.38) at 55–59
  • 1.29 (0.71, 2.35) at 60–64,
  • 1.35 (0.44, 4.18) at 65–69, 1.62
  • 3.43 (1.54, 7.66) at 75 years and older
  • The adjusted post/pre RR for PDE5I across all ages was 1.08
  • For TT prescription, in men under age 65 years, the RR was 2.90 (1.49, 5.62) for those with a history of heart disease and 0.90 (0.61, 1.34) for those without
  • In men aged 65 year and older, the RR was 2.16 (0.92, 5.10) for those with a history of heart disease and 2.21 (1.09, 4.45) for those without.
  • Among men aged 65 years and older, we observed a two-fold increase in the risk of MI in the 90 days after filling an initial TT prescription
  • Among younger men with a history of heart disease, we observed a two to three-fold increased risk of MI in the 90 days following an initial TT prescription and no excess risk in younger men without such a history
  • Among older men, the two-fold increased risk was associated with TT prescription regardless of cardiovascular disease history
  • our own findings appear consistent with a higher frequency of thrombotic events following TT prescription among men with more extensive coronary vascular disease.
  • Our findings are consistent with a recent meta-analysis of placebo-controlled randomized trials of testosterone therapy lasting 12 or more weeks among mainly older men, which reported that testosterone therapy increased the risk of adverse cardiovascular-related events (OR = 1.54, 95%CI:1.09, 2.18), as well as serious adverse cardiovascular-related events (OR = 1.61, 95%CI:1.01, 2.56) which included myocardial infarction along with other conditions
  • This association appeared unrelated to average baseline testosterone level (p = 0.70) but varied by source of funding (p = 0.03), with a stronger summary effect in a meta-analysis of studies not funded by the pharmaceutical industry (OR = 2.06, 95%CI:1.34, 3.17) compared with studies funded by the pharmaceutical industry
    • Nathan Goodyear
       
      This supports prior analysis that studies done by pharmaceutical corps will be more favorable to their product(s) than those independently funded.  This is called bias.
  • the evidence supports an association between testosterone therapy and risk of serious, adverse cardiovascular-related events–including non-fatal myocardial infarction–in men
  • there is some evidence that low endogenous testosterone levels may also be positively associated with cardiovascular events
  • effects of endogenous and exogenous testosterone may differ. Exogenous testosterone (TT) is associated with physiologic changes that predispose to clotting and thrombotic disorders including increased blood pressure [18], polycythemia [19], reductions in HDL cholesterol [18], [20], and hyperviscosity of the blood and platelet aggregation. [20]–[23]; TT also increases circulating estrogens [24], [25] which may play a role in the observed excess of adverse cardiovascular-related events, given that estrogen therapy has been associated with this excess in both men and women
  • did not include information on the serologic or diagnostic indications for treatment.
  • no association between PDE5I prescriptions and the risk of MI
  • Recently TT has been increasing extraordinarily rapidly, including among younger men and among those without hormone measurement
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    New cohort study finds increased risk of Testosterone in men > 65 and those : these are based in marketing-based medicine not evidence based medicine.
Nathan Goodyear

Bioelectrical impedance analysis: population reference values for phase angle by age an... - 0 views

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    Phase angle is a useful tool in assessing cell death/health balance, as well as cell membrane.
Nathan Goodyear

Gender Bias in Autoimmunity Is Influenced by Microbiota - 0 views

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    autoimmune disease sexual preference appears to have Gut origins.
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