Evidence-based medicine | Find Me A Cure

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A new test can predict the age at which menopause will occur, thus making it easier for couples to plan children.
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It goes against the grain of natural selection, yet in humans it is by and large fixed and universal. Around the age of 50, normal healthy women lose their ability to bear children. After a decade of gentle winding down, the reproductive system comes to a halt. Enhanced life expectancy — thanks to decades of development in healthcare — however, hasn’t been able to budge menopausal age even a wee bit. Today, a growing number of women spend almost half their life in the post-reproductive phase.

Scientists continue to be baffled by the phenomenon of menopause. While it hits all women, some unfortunate ones encounter it much early in life. A study by the Bangalore-based Institute for Social and Economic Change about four years ago showed that nearly 4 per cent of Indian women lose their ability to bear children before the age of 35, one of the lowest thresholds of menopause recorded anywhere in the world. The natural age for the onset of menopause is between 45 and 55.

In today’s world of career women and late marriages, getting to know the expected age of menopause would be a great support. It would help couples better plan their children.

A simple blood test may soon make this possible. A team of Iranian scientists — led by Fahimeh Ramezani Tehrani, who heads the Reproductive Endocrinology Department, Endocrine Research Centre, Tehran — say they have developed a test that can accurately predict the onset of menopause with an average error of four months. Ramezani Tehrani is scheduled to present the findings at the 26th annual meeting of the European Society of Human Reproduction and Embryology in Rome today. This is the first effort that can predict the age of menopause from a population-based study, say the scientists.

The researchers found that it is possible to calculate the onset of menopause by measuring the concentrations of a hormone called anti-Mullerian Hormone (AMH), which is produced by cells in women’s ovaries. AMH controls the development of follicles in the ovaries, which produces eggs (oocytes).

The researchers used blood samples from 266 women, aged between 20 and 49. The women were part of a study that has been going on in Tehran since 1988 to evaluate cardiovascular risk factors. The scientists took the samples at three-yearly intervals and also collected information on each volunteer’s socioeconomic background and reproductive history. The women also were subjected to physical examination every three years.

“We developed a statistical model for estimating the menopausal age from a single measurement of AMH concentration in serum from blood samples,” said Ramezani Tehrani, who is also an associate professor at the Shahid Beheshti University of Medical Sciences, Tehran.

AMH, along with the hormone Inhibin B, is secreted by ovaries and is hence a direct reflection of the quality and quantity of the oocytes, said Lakshmi Rao, a scientist at the Hyderabad-based Centre for Cellular and Molecular Biology. Rao, who studies the genetic causes of premature menopause, said this is an important observation for the prediction of menopause.

According to Ramezani Tehrani, there is a good level of agreement between the menopausal ages estimated by their model and the actual ages at which menopause occurred. As many as 63 volunteers reached menopause during the study, helping the scientists validate their model.

“The results from our study could enable us to make a more realistic assessment of women’s reproductive status many years before they reach menopause,” said Ramezani Tehrani.

As per their calculation, a 20-year-old woman who has 2.8 ng/ml (nanograms per millilitre) of AMH in her blood will reach menopause between 35 and 38 years. The scientists used this statistical model to identify AMH levels at different ages that would predict if a woman is likely to have an early menopause (that is, before the age of 45). They found, for instance, that an AMH level of 4.1 ng/ml or less in a 20-year-old woman, 3.3 ng/ml in a 25-year-old, and 2.4 ng/ml in a 30-year-old indicated an early menopause.

Similarly, an AMH level of at least 4.5 ng/ml at the age of 20, 3.8 ng/ml at 25, and 2.9 ng/ml at 30 predicted a menopausal age of over 50 years. The researchers found that the average age at menopause for the women in their study was approximately 52.

The Iranian scientists claimed that their estimates are sufficiently robust and can be used by medical practitioners in their day-to-day practice. They were confident that the findings would be further validated in larger studies.

The findings thus indicate that AMH is capable of specifying a woman’s reproductive status more accurately than chronological age per se. “But considering this is a small study that has looked at women over a period of time, larger studies starting with women in their twenties and following them for several years are needed to validate the accuracy of serum AMH concentration for the prediction of menopause in young women,” said Ramezani Tehrani.

The AMH test is already commercially available and clinicians advise it in case of assisted reproduction, said Rao. “It is not only inexpensive, but also throws useful data,” she added.

Source: The Telegraph (Kolkata)

4-year-old post on Arnold Zellner is oddly topical

You: Menopause test could close baby gap (guardian.co.uk)
Menopause ‘prediction’ test hope (news.bbc.co.uk)
Scientists say blood test will predict menopause (guardian.co.uk)
Scientists say test could predict menopause (ctv.ca)
Scientists say test could predict menopause (sfgate.com)
Scientists say test could predict menopause (msnbc.msn.com)
Later menopause for women with polycystic ovaries (newscientist.com)
Blood test may be able to predict menopause (cnn.com)
Researchers develop accurate way to predict the age when women will hit the menopause (physorg.com)

Are we being hoodwinked by alternative medicine? ……Two leading scientists examine the evidence. The first of a two-part extract from Trick or Treatment: Alternative Medicine on Trial by Simon Singh and Edzard Ernst:
MIRACLE CURE? Alexander Technique,……… aromatherapy and magnet therapy

Which therapies work and which ones are useless? Which therapies are safe and which ones are dangerous? These are questions that doctors have asked themselves for millennia in relation to all forms of medicine.

And yet it is only comparatively recently that they have developed an approach that allows them to separate the effective from the ineffective, and the safe from the dangerous.

This approach, known as evidence-based medicine, has revolutionised medical practice, transforming it from an industry of charlatans and incompetents into a system of healthcare that can deliver such miracles as transplanting kidneys, removing cataracts, combating childhood diseases, eradicating smallpox and saving millions of lives each year.

Evidence-based medicine is about using the current best evidence — gathered through clinical trials and other scientific investigations — to make medical decisions. Alternative medicine claims to be able to treat the same illnesses and diseases that conventional medicine tries to tackle.

We set out to establish the truth of these claims by using the principles of evidence-based medicine.

Some people will be suspicious of this, perceiving evidence-based medicine as a strategy for allowing the medical establishment to defend its own members and treatment, while excluding outsiders who offer alternative treatments.

In fact, the opposite is often true — evidence-based medicine actually allows outsiders to be heard; it endorses any treatment that turns out to be effective, however strange it may seem.

In the 18th century, for instance, lemon juice as a treatment for scurvy was regarded as implausible but the establishment had to accept it because it was backed up by evidence from trials.

We had no axe to grind — indeed Professor Ernst even practised as a homeopath for many years (as well as receiving treatment as a patient) — and we came to our conclusions based on a fair, thorough and scientific assessment of the evidence.

So what did we find? While some therapies do provide some health benefits (e.g. osteopathy), most have nothing to offer.

Many popular therapies are “effective” only because they are good at eliciting a placebo response; making the patient feel better simply because they believe the treatment will help.

You might feel that as placebos help patients, this alone justifies the use of the therapy. But any treatment that relies on the placebo effect is essentially a bogus treatment. And it’s far from cheap.

If alternative practitioners are making unproven, disproven or vastly exaggerated claims, and if their treatments carry risks, then we are being swindled at the expense of our own good health.

Too many alternative therapists remain uninterested in determining the safety and efficacy of their interventions. These practitioners also fail to see the importance of rigorous clinical trials in establishing proper evidence for or against their treatments — where evidence already exists that treatments are ineffective or unsafe, alternative therapists carry on regardless.

Despite this disturbing situation, the market for alternative treatments is booming, and the public is being misled over and over again, often by misguided therapists; sometimes by exploitative charlatans.

It is time for the tricks to stop, and for the real treatments to take priority. The same scientific standards, evaluation and regulation should be applied to all types of medicine.

If this doesn’t happen, then homeopaths, acupuncturists, chiropractors, herbalists and many other alternative therapists will continue to prey on the most vulnerable — raiding their wallets, offering false hope and even endangering their health.

ALEXANDER TECHNIQUE:-

WHAT IS IT?….. A technique for relearning correct posture and body movements. Alexander teachers guide their clients through exercise sessions using a gentle, hands-on approach. As plenty of repetition is needed, 30 to 100 such sessions are usually required to master the technique, demanding a considerable level of commitment from the client, in terms of both time and money.

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DOES IT WORK? ……Very little research so far has been conducted on the technique. Some promising findings have emerged in terms of improvement of respiratory function, reduction of anxiety, reduction of disability in Parkinson’s disease and improvement of chronic back pain.

However, for none of these conditions is the evidence sufficient to claim that the Alexander technique is effective.

AROMATHERAPY:-

WHAT IS IT? Plant essences (known as “essential oils”) are used to treat or prevent illnesses or enhance wellbeing. Most commonly, the diluted oil is applied to the skin via a gentle massage, but it can also be added to a bath or diffused in the air.

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Aromatherapists believe that different essential oils have different specific effects. Aromatherapy is advocated for chronic conditions such as anxiety, tension headache and musculoskeletal pain.

DOES IT WORK? Some clinical trials confirm the relaxing effects of aromatherapy massage. However, this is usually short-lived and therefore of debatable therapeutic value. Some essential oils do seem to have specific effects. For instance, tea tree has anti-microbial properties. However, these effects are far less reliable than those of conventional antibiotics. There is no evidence that aromatherapy can treat specific diseases.

CHIROPRACTIC THERAPY:-

WHAT IS IT? Chiropractors use spinal manipulation to realign the spine to restore mobility. Spinal manipulation can be a fairly aggressive technique, which pushes the spinal joint slightly beyond what it is ordinarily capable of achieving, using a technique called high-velocity, low-amplitude thrust — exerting a relatively strong force in order to move the joint at speed, but the extent of the motion needs to be limited to prevent damage to the joint and its surrounding structures.

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Some chiropractors claim to treat everything from digestive disorders to ear infections, others will treat only back problems.

DOES IT WORK? There is no evidence to suggest that spinal manipulation is effective for anything but back pain and even then conventional approaches (such as regular exercise and ibuprofen) are just as likely to be effective and are cheaper. Neck manipulation has been linked to neurological complications such as strokes — in 1998, a 20-year-old Canadian woman died after neck manipulation caused a blood clot which led to stroke. We would strongly recommend physiotherapy exercises and osteopathy ahead of chiropractic therapy because they are at least effective and much safer. The dangers of chiropractic therapy to children are particularly worrying because a chiropractor would be manipulating an immature spine.

HYPNOTHERAPY:-

WHAT IS IT? The use of hypnosis, a trance-like state, for therapeutic purposes. Hypnotherapists treat a range of chronic conditions, including pain, anxiety, addictions and phobias.

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DOES IT WORK? Dozens of clinical trials show that hypnotherapy is effective in reducing pain, anxiety and the symptoms of irritable bowel syndrome. However, the evidence is that it’s not effective to help you stop smoking, even though it is frequently promoted in this context.

MAGNET THERAPY:-

WHAT IS IT? The use of magnetic fields from static magnets, which are usually worn on the body, to treat various conditions, most frequently pain. These days rapidly fluctuating magnetic fields are used in conventional medicine in high-tech imaging machines (such as MRI scanners) and for promoting the healing of bone fractures. However, alternative medicine tends to use static magnets, which create a permanent magnetic field, to treat many conditions, mostly to alleviate chronic pain.

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DOES IT WORK? There is no evidence that static magnets offer any medical benefit for pain relief. As they are usually self-administered, there is a danger of missing serious diagnoses and losing valuable time for early treatment of serious diseases.

OSTEOPATHY:-

WHAT IS IT? A manual therapy which focuses on the musculoskeletal system to treat disease. Osteopaths use a range of techniques to mobilise soft tissues, bones and joints. Osteopathy and chiropractic therapy have much in common, but there are also important differences.

Osteopaths tend to use gentler techniques and often employ massage-like treatments. They also place less emphasis on the spine than chiropractors, and they rarely move the vertebral joints beyond their physical range of motion, unlike chiropractors. Therefore osteopathic interventions are less likely to injure.

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In general they treat mainly musculoskeletal problems, but many also claim to treat other conditions such as asthma, ear infection and colic.

DOES IT WORK? There is reasonably good evidence that the osteopathic approach is as effective as conventional treatments for back pain, but there is no good evidence to support the use of osteopathy in nonmusculoskeletal conditions.

People with severe osteoporosis, bone cancer, infections of the bone or bleeding problems should confirm with the osteopath that they will not receive forceful manual treatments.

LOOK BEFORE YOU LEAP:-

*Advice for anyone considering alternative medicine:

*Consult and inform your GP — the treatment might interfere with any ongoing conventional therapies.

*Do not stop your conventional treatment unless your doctor advises that this is sensible.

*Alternative therapies can be expensive, so make sure there is evidence to support the efficacy of a therapy before spending huge sums of money.

*Every treatment carries risks, so make sure the risks are outweighed by the benefits.

Sources: THe Telegraph (Kolkata, India)

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