Make mine espresso!

The apparent health benefits to drinking coffee are adding up, as a piece in The Atlantic notes.  One of the newly published benefits, though, seems to be another story in the you-choose-which-effect-you-prefer category: Caffeinated coffee protects against basal cell carcinoma!  Now this is about the easiest-to-swallow medicine one can imagine.  Just zip down to your local café for your meds (Rx: take several times daily, warm or iced; more than 2 is best, particularly for women; 1 a month doesn't help at all).  It is so convenient, and if you're an American you can also load it up with whipped cream, caramel swirl, cinnamon, and whatever else you crave.  And although it requires you to be on lifetime medication, rarely do doses and wants coincide so well.

The news is even better (except for Mormons): caffeinated tea, cola and chocolate are also protective boons to lifestyle--and, unlike Viagra, no prescription needed!

There is a problem, however, if you think about this even a little bit. As with so many other magical cures, there are side effects of the treatment and not all of them are good.  We've posted about this before.

Basal cell carcinoma is a slow growing skin cancer that can be the result of too much sun.  So, if you're in the Mediterranean, or Paris, or any Italian city, or any American city where foodies reign you have many outdoor places to take your daily doses.  They're the specialized pharmaceutical outlets known as "cafés."

Out there on the sidewalk, people are often exposed to the sun as they bask in caffeinated conversations about the troubles of the world.  Their sunlight exposure as they sip may cancel out or even overwhelm the caffeine's protective effect.  A clue to this possibility is that these results were based on the Nurses Health Study itself, and potential flaws the designers seem not to be aware of, but should be:  that was a Harvard study (which, surprisingly, doesn't in itself make it correct), and there's little sunshine where most of their subjects' live (even Boston didn't really start getting European-style outdoor sidewalk cafés until recently, and only for a part of the year at that).

Secondly, thanks to the stalwart policies of Starbucks, most coffee drunk today is so laced with sugary calories, as noted earlier, that its contribution to your waistline and hence your heart's ill health, is probably every bit as great as the effect of the tiny dose of caffeine.

Third, it is well known that because so many of us have gone off 'real' high-octane coffee, and because quality coffee tastes about the same whether high or low-octane, many restaurants are only making de-caf, no matter what is being ordered.  This means that in the future, if not in this retrospective study, reported coffee intake is not highly correlated with actual caffeine intake.  And this assumes the chemicals used in decaffeinating coffee is not harmful.  Likewise, the move from robusta to the more trendy arabica plants, may involve other components of the bean that aren't being measured.  Here we're not considering whether there are an GM issues, but one could ask whether arabica workers are being treated better or worse than their robusta counterparts, with any possible health outcomes for them.

Most epidemiological studies isolate one factor (which is how you get the NY Times to pick up your findings), rather than attempt to look at the net result in any sophisticated way.  Unfortunately, when you look for compensating factors you usually find them.  That's because evolution produces complex genetic factors with many different roles, and our traits are affected by many of them.  Stress an organism in one way, it responds in others.  Viewing each trait as being independent is often a mistake.

The world is dizzyingly complex!  So, perhaps the safest thing is to just take your coffee indoors, at night, save your skin -- and hope for the best.

Starry eyed at Starbucks! Bulletin from the Doublethink Department

Here is more of the java jazz we blogged about a while back. It's the ultimate sin in western life: something fun that may also be good for you. Tea and coffee are good for your heart! And we mean lots of tea and coffee. Of course, there have been countless studies of the caffeine hits that one can pick and choose from to find one's preferred results, and habits have changed a lot over that time, so confounding variables may also have changed but not have been measured. The rise of the coffee house culture, change in other components of diets (having berries with your tea, say), drop in smoking, all may be correlated.

Here comes the next ad jingle: "4+ cups of tea or 2-4 cups of coffee a day keep the cardiologist away."

Now let's take this nonsensical doublethink logic a step or two forward. First, If 4 cups reduces heart attack risk by 1/3, then the simple response is to drink 12 cups and be totally immune! That means you can hog up on Twinkies and BigMacs with double-sized fries, and if you eat all that along with a coupla cuppas, you can stride healthfully through life. Or sit at Starbucks and slug away, also eating hyper-fat, hyper-sugared muffins with abandon.

But wait! What if you drink 16 or more cups a day?? That means you'll have less than one heart attack. It's not the same as being immortal, but it may mean you'll grow a second heart so that if you stop honoring TeaTime you could have a heart attack in one of those hearts but live on your spare. How about that! Isn't epidemiology great?

But, but.....here comes the party-spoiler. The same Big Study found that if you take any milk with your coffee and tea, this negates the entire protective effect. Now all this titration makes a chem lab seem like amateur city, and how it works only a chemist would know. Of course, another response is to ask how such nonsense can make it into the journals, much less the news. Well, it's easy to see how science reporters might pick this stuff up, given the nature of their profession. But epidemiologists should know better.

Anyway, all such musings aside, this little celebratory note about something you enjoy being good for you--a rare enough finding--is to point this out, to reassure you, and who knows, maybe it'll lead on to bigger and better things? If caffeine hits the spot, maybe nicotine is next? Or a few stiff drinks a day to keep the doctor away?  Remember when eggs were poison?  Too full of cholesterol to be part of any thinking person's diet?  What happened to that?

OK, there's a serious message here. 30 years ago the Big Story was that coffee, even a small amount, caused pancreatic cancer.  So how do we know when we should believe a study that comes along and is reported as the Big Story? Is there any reason whatever to believe this one, or should we wait until tomorrow's contradiction?

This is a very serious issue of widespread import for science and the society that supports it and depends on its results. There is no easy answer, and accountability is difficult to impose for many reasons. But the problem is real, especially in our era in which science is not just what a few idle rich do, but is an institutionalized part of our national 'system.'

The nature of the science involved makes these results problematic. Why don't we tell epidemiologists that if they want funds to do something, that it should actually answer a question definitively. If they protest that this is hard to do, then let's say that if they want funds they have to suggest a better way? Otherwise, the same money could pay for exercise centers (with coffee bars) to reduce disease much more effectively than the results of these studies generally do.

Finally, why not ignore most of these Big Stories, and just go go and eat what you want--just do it in moderation. You'll do better by far than you can by attempting to follow every bit of New Advice that comes along.

Health story of the day -- Java jolt cures Alzheimer's!

Here's a particularly cruel health result of the day, it seems to us. The BBC reports that coffee may reverse the symptoms of Alzheimer's, at least in mice force-fed the equivalent of 5 cups a day (or 2 lattes, 14 cups of tea, or 20 soft drinks -- wait, didn't we recently learn from the BBC that people who drink that much cola are susceptible to hypokalemic periodic paralysis?).

The new story says that caffeine seems to prevent plaques from forming in the brain, the 'hallmark' of the disease, or reduce those already there. Oddly, other researchers have found that these plaques are neither always found in people who had been given a diagnosis of Alzheimer's, nor are they always associated with dementia when they are found. So reporters aren't doing their job and/or researchers enjoying the limelight aren't coming clean (assuming they at least know their job).

This is a perfect example of a story prematurely reported about a scary disease, and thus that will sell. Because it will sell. Everyone fears losing their memory as they age, and quick and easy cures are surely eagerly sought by caretakers and the affected alike. Many have seen the awfulness of close and loved relatives with this disorder.

But mice are not people, and the dementia bred into an inbred strain of mice cannot be assumed to be the dementia any of our grandparents suffer or suffered from. As with all 'simple' diseases, the more researchers learn about dementias in people, the more questions they have--indeed, 'Alzheimer's' has always been a diagnosis of exclusion (that is, impossible to confirm until after death), and the signature amyloid plaques in the brain that were assumed to confirm the diagnosis on autopsy have been shown to be non-confirmatory after all. The idea of Alzheimer's itself as a single definable disease is fading within the research community as more is learned about dementias (unless perhaps your lab is committed to the line of inbred Alzheimeric mice it took you years to breed).

So, once again, scientists prematurely rush to the press with a story that may well cause caretakers to force-feed elderly patients with caffeine at best, and at worse cruelly encourage hope of a cure where in fact there is none. We write often about oversimplifying genetic determinism, but this is a case about oversimplifying environmental determinism--a problem that actually predated genetic determinism in the history of 20th century epidemiology. Surely by now both researcher and media should know better than to hype such claims.

There are many ways to get dementia. There are also many ways to get your morning energy boost even if tea, say, won't help your state of mind without drowining you or making you park all day in the bathroom. And there are many ways to spin a story to the news media.

But don't forget to have your coffee....or you'll forget to have your coffee!

Right.