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And Now for Something Completely Different

This will be a departure from my usual posts. Several announcements in the news and medical journals have caught my attention recently, and as I delved into the details, I thought I would share them with our SBM readers. Topics include AIDS cures, the continuing danger of polio, eating nuts for longevity, racial differences in vitamin D, and the use of pharmacogenetic testing to guide the dosage of anticoagulant drugs. They are all examples of science-based medicine in action.

Have patients been cured of AIDS?

I read that the HIV virus had returned in patients thought to have been cured by bone marrow transplants, and I mistakenly thought they were referring to the original claim of cure I had read about. Nope, that one still stands.

The CCR5-Δ32 mutation encodes a cell-surface receptor that allows the HIV virus to attach and enter a host cell. People with two copies of that gene are resistant to HIV infection, even considered immune. An AIDS patient in Germany, Timothy Ray Brown, developed leukemia and was intentionally given a bone marrow transplant from a person who had that mutation, and the HIV virus became undetectable in his blood. He was considered to be the first person “cured” of AIDS. Bone marrow transplants are risky and are not an option for treating AIDS in the absence of a malignancy. Subsequently, two other men with AIDS and lymphoma were treated with bone marrow transplants from donors without the mutation; it was hoped that the “graft vs. host” battle would eliminate the HIV virus from their bodies, and indeed their HIV levels became undetectable. After several months, they stopped taking their antiretroviral drugs, and doctors hoped they had been cured. Unfortunately, detectable levels of the virus returned after 12 weeks and 32 weeks off medication, respectively.

The CCR5-Δ32 mutation remains an intriguing avenue for further research into mechanisms, vaccines, and the possibility of a treatment based on the mutation that doesn’t involve the risks of bone marrow transplantation.

AIDS is one of the great triumphs of science-based medicine. It took only 2 years to identify the responsible retrovirus after the first clinical cases were reported. Big Pharma was quick to prove the value of a drug that was already available (zidovudine) and to develop several classes of new, effective drugs known for highly active antiretroviral therapy (HAART). It took little more than a decade to turn a death sentence into a chronically-manageable disease with a nearly normal life expectancy. And at the same time, AIDS denialists and superstitious CAMsters were responsible for around 171,000 AIDS cases and 343,000 deaths between 1999 and 2007 alone. I can’t think of a better example of why science-based medicine is important and why we need efforts like this blog to combat nonscientific thinking.

Has a baby been cured of AIDS?

A child whose mother was HIV positive was empirically started on antiretroviral treatment 30 hours after birth, and treatment was continued after tests on the infant met the diagnostic criteria for infection. On treatment, the infant’s HIV-1 RNA levels progressively dropped until they were undetectable at 29 days of age. Compliance was suspected to be poor, and the mother admitted she had stopped giving the child medication at age 15 months. The child is now 30 months old and neither the virus nor viral antibodies are detectable. This is only one case report, and it’s too early to say whether the child is cured, but it suggests the possibility that early antiretroviral treatment in newborns may interfere with the development of persistent reservoirs of virus. These patients may not need a lifetime of therapy.

Will eating nuts prolong your life?

A study published in The New England Journal of Medicine showed an association between the reported frequency of nut consumption and mortality. Headlines trumpeted “Go Nuts!” Previous studies had suggested a beneficial effect, and a randomized primary prevention trial had shown a reduction in cardiovascular events on a Mediterranean diet supplemented with walnuts, hazelnuts, or almonds. The new study was a high-quality trial showing a dose-response relationship: the more nuts a person ate, the less likely he was to die of all causes and of specific causes (cancer, heart disease, and respiratory disease). Separate analyses for tree nuts and peanuts showed similar results. The authors stressed that they had found a correlation and were not claiming causation. Unidentified variables could have been a cause, and reverse causality is possible: maybe people in poor health are less likely to eat nuts.

The FDA allows advertisers to claim that “eating 1.5 ounces per day of walnuts, as part of a low saturated fat and low cholesterol diet and not resulting in increased caloric intake, may reduce the risk of coronary heart disease.” Besides the high calorie density of nuts, another caveat is the possible risk of salmonella from nuts.

Racial differences in vitamin D

A recent study measured vitamin D-binding protein levels in white and black Americans. The Institute of Medicine recommends a blood level of 25-hydroxyvitamin D greater than 20 ng per milliliter to maximize bone health, but blacks can have lower levels without any decrease in bone mineral density. Vitamin D levels are lower in blacks than in whites; but since levels of vitamin D-binding protein are also lower due to genetic variants, their bioavailable vitamin D is the same. Blacks have higher calcium levels, bone density, and slightly higher parathyroid hormone levels than whites. Evolutionary explanations have been suggested for racial differences that developed as people with dark skin moved to climates with less sun. Blacks are being over-diagnosed as vitamin D deficient based on blood tests that do not reflect a true vitamin D deficiency. We need a better test to measure bioavailable vitamin D.

No country is safe from polio

In 1988 polio was endemic in 125 countries, with 350,000 new cases of paralysis annually. Thanks to an aggressive vaccination campaign, the incidence has been reduced by 99% and polio is now endemic in just 3 countries (Afghanistan, Nigeria, and Pakistan). Wild-type poliovirus type 3 is close to eradication, and type 2 is probably already eradicated, but type 1 remains in circulation and is a threat to every country including those that are currently polio-free. China’s last case of indigenous wild-type poliovirus infection was in 1994. A few cases of wild-type virus infections have been imported from Myanmar and India since then. China experienced a polio outbreak in 2011 in the Xinjiang Uygur Autonomous Region. The index case was a 16-month-old girl with no history of travel, but nucleotide sequencing confirmed that it was a strain imported from Pakistan. 21 confirmed cases and 23 clinically-compatible cases were found. The population was already close to herd-immunity thresholds. Of the ten affected children, three had not received oral polio vaccine (OPV), two had received one or two doses, and five had received three or more doses, indicating primary vaccination failure.

The Chinese Ministry of Health declared an emergency and responded vigorously. They were able to stop the spread of the disease within a month and a half, but they continued vaccinating until 43.7 million doses of oral polio vaccine had been given at a cost of $26 million. Adults were included, and OPV was given regardless of vaccination history. The oral vaccine has several advantages: low cost, ease of administration, can passively immunize non-recipients, and produces better intestinal immunity to reduce spread. It has the disadvantage that it can cause paralysis on rare occasions and can regain some of the properties of wild strains. Adverse event reporting was required during the vaccination campaign, but I wasn’t able to find the resulting data; it would be interesting to know, so we could directly compare benefits to risks. Eliminating type 2 from the trivalent vaccine is expected to reduce the risks. One shot of inactivated poliovirus can be used to maintain the protection against a possible recurrence of type 2.

Lessons to be learned: polio vaccines are not 100% effective, and every country in the world remains at risk until worldwide eradication is achieved (hopefully by 2014). Vaccine rejecters are a danger to worldwide public health.

Genetic testing not useful to determine warfarin dosage

Pharmacogenetics holds great promise for predicting individual responses to drugs based on genetic variants, but so far there are not many practical applications. One of the first proposals was to guide warfarin (Coumadin) dosage by genome testing. When I first heard this, my initial reaction was “Why bother?” Warfarin is an anticoagulant used to reduce the risk of blood clots in patients with atrial fibrillation, artificial heart valves, deep vein thrombosis, pulmonary embolism, and other conditions. Dosage is adjusted to keep the international normalized ratio (INR) of clotting factors within a prescribed range, usually between 2.0 and 3.0. This requires frequent blood tests and dosage adjustments (up to three times a week at first, and eventually decreasing to monthly in fortunate patients whose INR is stable). All kinds of medications, foods, and other factors affect the INR, so fluctuations are common. Overdosage can lead to serious bleeding complications and can be counteracted by vitamin K. Some patients require much higher doses than others; but that’s not a problem, since you can simply start with a low dose and titrate upwards as needed. Genetic variants of cytochrome enzymes affect the metabolism, requiring either higher or lower doses than usual to maintain the desired INR.

Pharmacogenetic enthusiasts predicted that genomic testing would be a more precise way to control dosage and would reduce the risk of clotting or bleeding complications. Recently three studies were simultaneously published in The New England Journal of Medicine to determine whether usual care or genome-guided care provided better control. The first found no difference, the second found a small (7%) advantage to genomic guidance, and the third found no difference. An accompanying editorial points out that the studies only covered the initiation phase without long-term follow-up, and concludes that pharmacogenetic testing is of marginal usefulness at best and represents a large expense. It suggests we should concentrate on making the current practice safer with better management.

Posted in: Clinical Trials, Nutrition, Pharmaceuticals, Vaccines

Leave a Comment (84) ↓

84 thoughts on “And Now for Something Completely Different

  1. Keating Willcox says:

    Some of your work is excellent, but some leave me with a bad taste in my mouth. You never seem to get to the abuses of big pharma, and their intense personal attacks against any critics. Anyone aware of the over prescription of QADHD medications, schizophrenia medications, the hazards of acne treatments, and the vaccine for cervical cancer can see why we are so cynical about boosters of big pharma. There are frequent questions about the dangers presented by medical treatments and how reluctant big pharma and big medicine are to reduce their own profits. It’s not all black or white, but often that a medication which is helpful for a small population gets prescribed for an enormous population.

    Your analysis is so one sided in favor of any popular medication or treatment that you have little credibility. You never mention any evidence that exonerates any critics of big pharma or big medicine, so I just think you are a shill for these industries, wearing the hat of a neutral party.

    My suggestion is simple. report both sides of the story, and provide updates if new evidence changes what we think.

    1. baravelli says:

      @Keating Willcox
      Did you even read the piece, or did you just scan the text and not find the word “evil” in every sentence that also contained the words “big pharma”?

    2. Calli Arcale says:

      So your main criticism is that she hasn’t written on every topic that you’d like her to write on? Do bear in mind that she is only one person, and there is only so much time for her to write; obviously she will prefer topics that are of greater interest to her. That is why there are multiple writers here; with different writers, different areas of interest are covered, and there have been articles critical of drugs. Since we’re getting these articles for free, I think we need to be a little forgiving of how long it might take them to get around to our personal favorite topics. ;-)

      1. Sawyer says:

        Free? What about those massive $5 donation they bring in from the e-books? That generous funding clearly dictates that every single contributor devote 50 hours week to filling out FOIA requests, interviewing drug reps, and performing their own personal post-market drug trials. How hard can it be to fit this stuff into their schedule and still fight off the quacks and sCAMmers? This would clearly be an effective use of their time.

        I mean come on, it’s not like academia, industry, or the government would let alternative medicine in the door if we let up on the criticisms, would they?

    3. windriven says:

      Science, Willcox. Science. If you scroll up to the top you will note that this site is called Science Based Medicine. The authors here blog about scientific rigor in the practice of medicine. They do not blog favorably about asshat conspiracy theories, delusional speculations, or the vacuous ravings of pseudoscientific poseurs. Therefore, it is unlikely that you will find much here that is to your liking.

      1. Davdoodles says:

        I enjoyed reading that.

        When I come across quality, measured, snark, re-read it thrice, imagining it is being read aloud by one, then another, then another Christopher.

        Lloyd, Walken, Hitchens.

        In that order. As is my wont.
        .

    4. Chris says:

      “My suggestion is simple. report both sides of the story, and provide updates if new evidence changes what we think”

      Here is another suggestion: if you don’t like what they write on this blog, start your own blog.

      There nothing more pretentious than someone telling a blogger what to write about. Especially one that only shows up with just criticism just in the last couple of months.

    5. David Gorski says:

      You never seem to get to the abuses of big pharma, and their intense personal attacks against any critics.

      Would you like me to provide a list of posts by various SBM bloggers discussing the abuses of big pharma? :-)

      1. windriven says:

        However many you listed, Willcox would identify one that hasn’t been addressed and hold it out as incontrovertible proof that SBM is in the pocket of …what?… Big ACE Inhibitor or something. (You very well know that ACE inhibitors cause cancer of the toenail and have been covering it up all these years)

    6. Lytrigian says:

      You never mention any evidence that exonerates any critics of big pharma or big medicine

      You must not read this blog very often.

    7. WilliamLawrenceUtridge says:

      Keating, did you look in the search box? There are several posts discussing Big Pharma. If you use the search box, or delve into the archives, you might find posts like this one, or this review of Bad Pharma, or you could try this post by Dr. Gorski.

      But really what should be said is found in item # 36 here. If you want to write about topics that bother you, start your own blog – don’t complain about it here. Or, for that matter, feel free to submit a guest post.

  2. Sawyer says:

    and the vaccine for cervical cancer can see why we are so cynical about boosters of big pharma

    Nope, sorry. Covered numerous times on this blog and at pretty much every turn HPV vaccine is being used safely and in a manner that’s based on strong evidence. Are you suggesting that ScienceBasedMedicine should throw their weight behind the fear-mongers and conspiracy theorists that rail against Gardasil?

    I suspect Dr. Hall might occasionally want to write about questionable science coming from drug companies but, the endless stream of bad comments on the topic are an indication that it would not be a fruitful endeavor. I can’t blame her or any other SBM author for this sensible approach to what merits discussion.

    And for the 100th time:
    http://www.sciencebasedmedicine.org/answering-our-critics-part-1-of-2/

    1. windriven says:

      @Sawyer

      I too was struck by his inclusion of HPV vaccine ADRs in his panoply of imagined horrors. I am hard pressed to think of a program emerging in the past decade that is likely to do so much good for so many people. Further, HPV vaccine ADRs are minimal and generally inconsequential.

      Imagine the consequences if public health was conducted as imagined by Willcox and his codelusionals.

  3. windriven says:

    This is tangential to today’s blog but there is an awe-inspiring quack-a-thon occurring right now on Fox News. This pits an MD, Susan Decotiis specializing in weight loss and hormone replacement therapy ‘against’ Brian Clement ND (Not Doctor) on the topic of the recent Annals of Internal Medicine editorial debunking the use of multivitamins. In a cognitive dissonance inducing twist the ND was arguing a slightly less batcrap crazy position than the MD! Both were dismissive of the Annals conclusion, Decotiis with an ‘in my experience’ argument and the ND who generally dislikes BigPharma multivitamins but seems to think that organic whole food extracts are the bees knees.

    Only Fox can pack that much unvarnished stupid in a 90 second segment. Needless to say there was no representative to support the Annals position.

    1. Kurt says:

      “Only Fox can pack that much unvarnished stupid in a 90 second segment.”

      If only it were so. Sadly, the world suffers from no shortage of people with that particular skill set.

      At a party recently, I met a woman who explained she kept her kids healthy by only feeding them food with ingredients she could pronounce. And yes, she did feel pronouncability was a signifier of healthiness. My son has a lisp, so he can’t eat any food with an ‘s’ in the name.

      She was quickly interrupted by another woman who insisted mothers had an innate ability to know exactly what made their children sick. I wonder why no mothers spoke up during the miasma/germ theory debates.

      I left the conversation because my back was getting sore from my wife’s constant poking as a reminder not to ruin the neighbor’s dinner party.

      So yes, you can find plenty of concentrated stupid depressingly all too often.

      1. windriven says:

        I’ve been to that party – at least parties very much like that. I’m not sure why but I don’t often get invites from that social set anymore. Was it something I said?

        I also have an in-law who is saving up for a trip to a Morgellon’s conference in Texas. Who knew? There are two MDs and one “MDes”, whatever that might be along with several PHDs. The MD psychiatrist is there to ‘dispel the myth that Morgellon’s is a delusional disorder.’ Oy vey. One of the MDs is also a Lyme ‘specialist’.

        It is one thing when Buffy and Jodi wax moronic about mothers’ innate abilities to know what caused their kids diseases, but what do you do when you have licensed physicians and highly educated professionals contributing to the delusions of a vulnerable population?

  4. Marilyn Mann says:

    The nuts study was an observational study. Unfortunately, I don’t find that kind of study very persuasive. However, as you point out, the PREDIMED trial had an arm that was Mediterranean diet supplemented with nuts (they actually gave the participants free nuts) and showed a reduction in cardiovascular events.

    John Ioannidis wrote a commentary on nutrition research recently that is worth reading (unfortunately behind a paywall).

    http://www.bmj.com/content/347/bmj.f6698

    Marilyn Mann

  5. irenegoodnight says:

    Thanks very much for this Dr. Hall. These examples will make handy references when I’m dealing with the altie crowd, especially the AIDS and polio topics.

    The sad thing is that you seem to have made no impression at all on commenter Wilcox, who is just the type we are trying to reach. Maybe the site could have very visible buttons with basic topics to attract the attention of new or intermittent visitors to encourage them to explore the archives a bit?

    Apparently it is not enough to tell people the truth–not when it totally upsets their already well-entrenched ideas–which Fox (thank you WD because I would never watch) and the Great Oz are so busy instilling in them.

    When will people understand that for all its failures and abuses, Big Pharma has done an awful lot of good?

  6. Harriet Hall says:

    @Keating,
    I have written about the abuses of Big Pharma, for instance at http://www.sciencebasedmedicine.org/osteoporosis-drugs-good-medicine-or-big-pharma-scam/ In fact, that article is a perfect example of “a medication which is helpful for a small population gets prescribed for an enormous population.” The reasons I don’t write more often about the abuses of Big Pharma is that plenty of other people are writing about it. “Bad Pharma” by Ben Goldacre, Marcia Angell’s books, etc.

    I try to write mainly about things that are not well covered elsewhere, and about things that interest me or that have particularly annoyed me. If they don’t interest you, you needn’t read. I try to use headings to make it easier to skip what you want to skip.

    The reason I usually support the mainstream opinion is that both the mainstream and I base our opinions on the available evidence.

  7. stanmrak says:

    Interesting that there is a link to “salmonella risk from nuts”, implying that nuts are more dangerous than hundreds of other foods when it comes to salmonella contamination.

    The truth behind the salmonella ‘scare’ with regards to nuts – specifically almonds – is that it’s a tactic big growers are trying in order to squeeze out the independent farmers by coercing the FDA to require pastuerization of raw nuts, an expensive process that small farms can’t afford. And something that is completely uneccessary. There has been no major outbreak of salmonella in raw almonds as there has been with lettuce, spinach, eggs, chicken, etc. — all foods that are still allowed to be sold raw. As a result, you cannot buy true raw almonds anymore; the ‘raw’ almonds you buy have been heat-pastuerized in most cases. Another example of how the FDA works for Big Agra, not the consumer.

    1. windriven says:

      I admire your legs, stan. You must have one heck of a workout regimen to be able to leap such incredible lengths.

      “implying that nuts are more dangerous than hundreds of other foods when it comes to salmonella contamination.”

      Um, no. Dr. Hall did not imply that nuts are more likely to have salmonella contamination than anything else. That is your inference and it is not supported by Hall’s text.

      “it’s a tactic big growers are trying in order to squeeze out the independent farmers by coercing the FDA to require pastuerization of raw nuts, an expensive process that small farms can’t afford.”

      On what basis do you make this claim? I understand that many small producers market through collectives such as Blue Diamond. The big danger for growers large and small is the dearth of honeybees for pollinization. You should work up a conspiracy theory about how Big Pharma is killing off honeybees to deprive the public of almonds thereby stimulating sales of drugs. Makes as much sense as anything else I’ve read from you.

    2. WilliamLawrenceUtridge says:

      Yes, and the sole reason raw milk is discouraged is to drive small farmers out of business. Nothing to do with consumer safety or the unanticipated risks of raw almonds.

  8. Rick L, RN says:

    Thank you. I enjoy reading yours and others takes on real issues in medicine instead of the usual topics on here which as someone who reads this site regularly, gets old. I would love to see a discussion on robotic surgery.

  9. Paul Spence says:

    “I read that the HIV virus had returned in patients thought to have been cured by bone marrow transplants”

    HIV stand for human immunodeficiency virus. Therefore “virus” after HIV is totally unnecessary.

    1. windriven says:

      True, but it remains common American English usage.

    2. Mark Crislip says:

      I know. I got money from my ATM machine to go to the SALT talks and ended up with a case of PJP pneumonia. So annoying.
      And is there a difference between unnecessary and totally unnecessary?

      1. windriven says:

        :-)

        “is there a difference between unnecessary and totally unnecessary?”

        Totally, dude. stanmrak is unnecessary. FBA is totally unnecessary.

  10. Science-based medicine cynic says:

    I’m tired of the triumphalism I see on this website. Look around at the epidemics of chronic degenerative diseases to see if science-based medicine has had much impact on them. And of course science-based medicine is the only way to solve biological problems, but we have so many problems which are not biologically based and can never hope to be approached with RCTs.

    It is a terrible injustice that the promoters of science-based medicine have become so triumphalist and extremist in their preaching. They should be humbled by the single obscure fact that mortality from breast cancer has not changed in the past 80 years. Where is the SBM in that?

    1. David Gorski says:

      Please name some of these medical problems “which are not biologically based and can never hope to be approached with RCTs” and explain.

      As for mortality from breast cancer, you are incorrect. Mortality from breast cancer has been steadily decreasing for the last 20-25 years, and it most definitely is lower than it was in 1933. In fact, it’s more than 25% lower. Age-adjusted mortality among women for breast cancer was around 30/100,000 females in 1930. In 2010 it was around 22/100,000 females.

      Source:

      http://www.ncbi.nlm.nih.gov/pubmed/23335087

      I expect that when the 2014 statistics are released next month breast cancer mortality will be lower still.

      It always amuses me when haters of science-based medicine cite statistics that they read on some alt-med site or other that aren’t even correct.

      1. Will Sagan says:

        I don’t hate science-based medicine or science-based anything. I hate being called an idiot. I hate fanaticism, cynicism, attacking, righteousness, exaggeration, and lying–whether it’s science or religion. Now in my 70s, I grew up absolutely loving science because I believed, perhaps wrongly, that it was the ONE field that considered EVERYTHING worth knowing about. You indeed have every right to sour my belief and have done so very thoroughly. I can see no difference between you and the religious right in your language, your hatred, or your sarcasm. I expect nothing more than that as a reply to me. Are there any scientists out there who have curiosity about the human experience, who do not think they already know everything, and who are not extremists but open to all possibility? I would like to be directed to their blogs for some hope and honest discussion about what’s new in science instead of what’s old and worn out and not science at all.

        1. WilliamLawrenceUtridge says:

          What fanaticism? Asking for evidence is “fanaticism”? Because that’s the basis of science-based medicine, evidence.

          There are scientists who are curious about the human experience. Anthropologists, for one. Within medicine, one could look into psychology (particularly positive psychology), psychiatry, or the massive amount of investigation into quality of life measures.

          Dismissing nonsense based on disproven, speculative or prescientific theories isn’t culling the human experience. It’s merely acknowledging that some ideas aren’t worth pursuing further.

          1. Will Sagan says:

            You will laugh and disrespect me for appreciating this, but it is true that many mainstream practitioners validate people’s positive results-based experience rather than negating them and lumping them into some black-and-white and exaggerated “every pseudo so-and-so is stupid” comment or “it was just your imagination” derogation. What works, works. Even my PCP has long-favored first trying something preventative or health promoting, with fewer possible dangerous effects (and asks me to check, out of his curiosity, with my naturopath) rather than rotely prescribing the cure-du-jour with its endless list of evidence-based life-threatening side effects. Granted, many other mainstream practitioners and their patients only want the quick fix.

            1. WilliamLawrenceUtridge says:

              Well that depends on your definition of “works”, doesn’t it? If you feel better after a treatment, did it “work”? Or did you see your doctor when your symptoms were at their worst, and thus they were merely regressing to the mean? When something “works” through placebo, like homeopathy or acupuncture, is it worth spending $20, $40 or $100 for the experience (particularly when you can get the same benefit from simply talking to your doctor)?

              If an approach has been validated by scientific tests and it just happens to be a naturopath who recommends it, they are being their usual parasitic profession upon real medicine. At best they are acting as a “personal medical shopper”, an activity you could undertake for the cost of a library card and some time.

              Doctors are bound into a relationship with patients, and have an obligation to be comforting and supportive of harmless delusions. I have no such obligation,and am quite happy to point out the illogic of your statements.

              Your PCP is not unique in first trying something preventive or health-promoting. This is a best practice, your caricature of pill-popping doctors aside. Keep in mind, anything that has an effect has side effects. The body is not built to neatly compartmentalize organs, which is why most of the serotonin in your body is found in your gut. If something “natural” or low-risk is provided by your doctor or naturopath, and it’s actually doing something you like – it’s also doing something you don’t want to another organ.

      2. Science-based medicine cynic says:

        Please name one major disease that SBM, working through a scientific inductive approach, has cured in the past 200 years. I thought so.

        It is not SBM that I object to (in fact, it is nice that there is such a thing as a human imagination for concocting mechanisms in order to account for, in post hoc fashion, the benefits of serendipitously discovered therapies, like statins). Rather, it is the overzealous, dogmatic, orthodox, extreme, and one-sided advocacy of SBM as the only possible approach that I object to.

        To think that science can come up with all the answers …. well, keep thinking that way. I’m sure you will. Let’s see what scientific reductionism will get you (other than big NIH grants from like-minded colleagues, but heh, that’s the game).

        And I was referring to case fatality rates for breast cancer, which have not budged one iota. You responded with population-based mortality rates, i.e. deaths per 100,000 in the general population. It is more instructive to take a sample of patients with breast cancer who are the same age and at the same stage in 1930 and 2010. In such a case, despite all the hoopla, there has been zero effect on mortality following the advent of surgical approaches developed much earlier on.

        1. Chris says:

          “Please name one major disease that SBM, working through a scientific inductive approach, has cured in the past 200 years. I thought so.”

          Um, most bacterial infections.

          Then there is the prevention of measles, mumps, rubella, smallpox, and a few others. Does it count if SBM prevents major diseases?

          Then there is making sure people with chronic diseases like type 1 diabetes, cystic fibrosis and HIV get to live lots longer than they used.

          “It is more instructive to take a sample of patients with breast cancer who are the same age and at the same stage in 1930 and 2010. In such a case, despite all the hoopla, there has been zero effect on mortality following the advent of surgical approaches developed much earlier on.”

          See http://www.sciencebasedmedicine.org/chemotherapy-doesnt-work-not-so-fast-a-lesson-from-history/

          I am also curious about the specifics of this statement: “Look around at the epidemics of chronic degenerative diseases to see if science-based medicine has had much impact on them.”

        2. WilliamLawrenceUtridge says:

          Please name one major disease that SBM, working through a scientific inductive approach, has cured in the past 200 years. I thought so.

          Um…how about all the vaccine-preventable diseases that have been driven to near-extinction? Polio, Hib-B, diphtheria, tetanus, and does smallpox count or do you have some sort of special argument there?

          I don’t think that anyone here thinks science already has all the answers, so that’s a straw man. If science knew everything, it’d stop.

          And as I said in a previous comment, what’s your alternative? If it’s so easy to come up with ideas a priori, step up – throw out an idea with your grasp of the fundamentals of human biology. Because it’s SOOOOO easy!

          1. Science-based medicine cynic says:

            I said cured, not prevented. I agree that vaccination has been a triumph. But based on the history of medicine, you must realize it was discovered completely by chance (Edward Jenner and the milkmaids and vaccinia). This is not SBM.

            None of the diseases you mentioned are even remotely curable once established. And from the inappropriate over-application of antibiotics to viral diseases and in the factory farm system, we are losing even this advance.

            1. Chris says:

              “I said cured, not prevented.”

              An ounce of prevention is worth a pound of cure.

              Why are you forgetting about Pasteur?

              So we are having an epidemic of “chronic degenerative diseases”, can you please give us the names of some of them? How about some specifics, and better yet, some actual data.

            2. Sawyer says:

              Now you’ve really stepped in it. Why don’t you point us to a single author on this website that promotes aggressive use of antibiotics? Off the top of my head I can recall Dr. Hall mentioning this in a discussion of Lyme disease, and I can’t remember what position she took. Hmmm….

              Please stop posting nonsense and spend some time reviewing other articles on this site. Not only are your complaints unscientific, but some of them appear to be mutually exclusive. No one owes you any discussion as long as this continues.

            3. WilliamLawrenceUtridge says:

              Why is “cure” better than “prevention”? In my book – rather than getting sick then getting better, not getting sick at all is a far better option. Why set your standard such that so many of the advances of medicine responsible for longer, healthier lives, are discounted?

              Oh, and antibiotics, surgery for solid tumors, heart transplants, chemotherapy for blood cancers. All curative. Now waiting to see where the goalposts move next. Yes, antibiotics are losing their effectiveness – but so what? Still curative. What do you want, a perfect solution to all human illness, with no side effects, at a low cost, that tastes like strawberries? Yeah, we all want that. Too bad biology is tough, counter-intuitive, specific, and self-regulating. But despite this, despite not understanding the genome until rather recently, medicine has still made great strides. You have our apologies for it not being perfect, but we’re working on it. Keep bringing up your great ideas though, they’re helpful. While you’re at it, could you come up with a solution for global warming? Maybe something like “they shouldn’t put so much carbon into the atmosphere!”

              Also, yes, vaccination for smallpox was serendipitous (though note that there is an enormously long history of smallpox vaccination preceding Jenner in Islamic countries, China and parts of Africa), the principle led to vaccinations for all sorts of other diseases. Like rabies. And why is an a priori discovery superior to a serendipitous one? In my book, the result is what matters. Longer, healthier lives.

            4. windriven says:

              You don’t get to pick and choose what constitutes medicine, asshat. I’ve listed plenty of cures along with plenty of preventions. Science based medicine is the whole smorgasbord, not just the pieces that you feel like recognizing.

              1. Chris says:

                So when will he come back to give us data on the epidemic of “chronic degenerative diseases”?

                I really want to know how we could have prevented obstructive hypertrophic cardiomyopathy. Which is what I also asked the insurance nurse after son’s surgery when she called to talk about “prevention.”

            5. Davdoodles says:

              Stomach ulcers.

              You’re welcome.
              .

        3. windriven says:

          Syphilis
          Pneumonia
          Kidney failure (renal transplant)
          Cellulitis
          Cholecystitis
          Atrial fibrillation
          Smallpox (eradicated from nature)
          Tuberculosis
          Cholera
          Pertussis

          Are 10 that leap to mind. Every frigging therapy and drug that grew out of the germ theory. Every surgical procedure. Most public health initiatives. AIDs was taken from death sentence to manageable disease in just a few years.But goodness, the list is nearly endless. What about chiropractic or naturopathy? Not just anecdotes, please. What has naturopathy accomplished on the par of eliminating smallpox? Which chiropractor pioneered AAA surgery? Which homeopath developed beta lactam antibiotics?

    2. Sawyer says:

      Maybe you should try talking with some doctors and researchers face to face. I have never encountered a practitioner of science based medicine that didn’t readily admit that nature has engineered some really nasty diseases that we won’t be able to solve for decades. It may look from a distance that doctors lack humility, but when you learn more about them you find that quite the opposite is true.

      This is the exact opposite experience we have with the quacks. They often pretend to be humble and open-minded at first, but upon further interaction it becomes clear how incredibly arrogant they are. Who are the people promising a cure for cancer, Alzheimer’s, and autism?

      1. Will Sagan says:

        I have a PCP, a neurologist, and a cardiologist who have all encouraged me to consult equally with my naturopath for help on things they can only shrug their shoulders about. They all say, and friends have had the same experience with their own practitioners so it seems like an evolving trend, that naturopaths do a lot more research and have some very valid solutions–basically that naturopaths are the experts in naturopathy. They’ve had equal or more medical training. Maybe your practitioners are in that defensive stronghold of doctors who don’t even like their patients to get a second opinion or to seek a less expensive place to get a recommended test. Practitioners who can’t or don’t work collaboratively with experts in all fields are falling by the wayside. And cancer IS being cured “under the radar” and without cancer-causing chemo. My older brother is a stage 4 survivor, and in the process, we saw many others. Someday your type of science will catch up.

        1. Science-based medicine cynic says:

          Naturopaths are quacks, but so are doctors. The only difference is that naturopaths realize this, doctors do not. Both over-promise and under-deliver. Most solutions to health problems do not lie in either the alternative medicine approach or the traditional medicine approach. Most solutions to health problems are based on preventing them in the first place. Most health problems are just too complex to treat effectively with our current reductionism-based tools once they have become established (“cut it out or nuke it or poison it to death”). Most malignancies, most neurodegenerative diseases, most metabolic conditions are not curable, not even adequately treatable with our band-aid solutions. The only solution is prevention.

          Despite this, two thirds of public funding is wasted on basic science and mechanistic research (often called “Translational research”), which can never hope to come up with effective preventive therapies. Most animal and in vitro research is a total waste of money and time. Any effective treatments that we now have and use started with serendipity. Yet it also true that psychological approaches remain grossly underutilized. Spiritual approaches remain grossly underutilized. Nutritional approaches remain grossly underutilized (I am still waiting for the first ever trial comparing weight loss strategies with hard cardiovascular outcomes to be conducted). The reason is that these approaches are not sexy, cannot be patented, and cannot be studied with SBM. Therefore, they are written off.

          1. WilliamLawrenceUtridge says:

            Preventing disease, such as through vaccination? Through recommendations to adhere to a proper diet and exercise? Naturopaths basically recommend the same thing – but pretend they know about magic ingredients that will keep you young and healthy forever (without any evidence, except perhaps rats). I’m not sure what other preventive measures naturopaths bring to the table that aren’t totally speculative or already part of mainstream care.

            As far as test tube and rat studies being substantial wastes of time and money – that’s pretty true. But our alternatives are what? In some cases there are serendipitous discoveries – that must be tested for safety and efficacy in rats and test tubes, before graduating to higher mammals and eventually people. What’s your alternative?

            As for all discoveries being serendipitous, there’s a certain truth to that – someone notices a pattern, then tests it. The initial observation is often serendipitous, biology is too complex for us to be able to develop complete treatment modalities a priori, but the testing after the serendipitous is little but hard work and careful study (although I wonder if AZT for HIV might be such an a priori discovery). Of course, what you’re missing in your little narrative is the number of patterns that are noticed, but fail upon testing.

            And again, what’s your alternative? What have, for example, naturopaths developed that, upon testing, proved to be a valuable addition to medical treatments? And if you can come up with any examples, which of them haven’t become part of mainstream care once the appropriate trials have been conducted?

            There are an awful lot of extremely broad statements in your comment. How about something other than your own broad prejudice to back up your points?

            1. Science-based medicine cynic says:

              How about the study of naturopaths successfully reducing cardiovascular risk in a randomized trial in CMAJ published earlier this year? The lead author was an EBM type…

              1. WilliamLawrenceUtridge says:

                What study? You mean this study? The study that basically concluded “if you give people several extra hours of nutritional counseling, they do better”? The study that didn’t adequately control for the amount of time and attention patients received from naturopaths?

            2. Science-based medicine cynic says:

              Oh, and the TACT trial? I assume you have not heard of that study, one of Dr Gorski’s favorite targets?

              1. WilliamLawrenceUtridge says:

                We have indeed heard of that study, the one that had so much trouble with recruitment, that had so many ethical problems, that ended up being equivocal and basically showed it wasn’t worth undertaking hundreds of chelations and certainly wasn’t economical in the least? That TACT trial?

          2. Chris says:

            “Most solutions to health problems are based on preventing them in the first place.”

            So what is your recommendation in preventing obstructive hypertrophic cardiomyopathy?

            Last year my son had surgery to remove the extra heart muscle that was almost blocking his aortic valve, and was causing damage to his mitral valve. So he is much better and we are not calling 911 anymore.

            So how could we have prevented the abnormal growth of his heart muscle? There was a screen to see if he had one of the eighteen known genetic sequences that causes it, but it came up empty. So if your answer is that we should have done an extensive genetic screening when he was a fetus, it would not have picked up the specific sequence causing his abnormal heart anatomy.

            By the way, HCM occurs in about one in a thousand in the population, and is a major cause of sudden cardiac death among young people. So, obviously, since you know all the answers you should improve the world by telling us how to prevent it.

          3. Sawyer says:

            This is what most of us refer to as a “Gish Gallop”. You’ve posted so much misinformation and half-truths that no one here will have any hope of debunking all of it.

            I am curious where on earth you were told that mechanistic research was worthless. I’ve seen a lot of goofballs employ shoddy reasons for cutting back public funding of universities, but few have the gall to insist there’s no point in basic research whatsoever. You’re not hanging out with Birchers, are you?

            (preemptive apology for the genetic fallacy)

          4. Will Sagan says:

            I like what you say.

        2. WilliamLawrenceUtridge says:

          They’ve had equal or more medical training.

          AHAHAHAHAHAHAH AHAHAHAHAHHAHA!!!!!

          Training like what, homeopathy? Acupuncture? Ayurvedic medicine? The four humours? Any one of a dozen different mutually-contradictory systems? Your experience, at best, might indicate that naturopaths have a lot more time to spend researching the problems of individual patients than doctors do. That’s at worst a structural problem, at best an indication that for the premium you (or your insurance) is paying, you are getting someone willing to dig into pubmed or google scholar off-the-clock.

          And cancer IS being cured “under the radar” and without cancer-causing chemo. My older brother is a stage 4 survivor, and in the process, we saw many others. Someday your type of science will catch up.

          If this is true (and note that people do survive stage 4 cancers, it’s just rare, depending on the type), that just points to your naturopath being an asshole. If they have a cure for cancer, one that is invariably effective, for all patients, why isn’t that asshole publishing the fuck out of it? Why just save it for their patients? Greed? Are they just like Big Pharma, prepared to do anything to maintain their payroll, including keeping cancer cures to themselves?

          Or perhaps the people who died under a naturopath’s care aren’t around to give testimonials.

          Science doesn’t care where an effective intervention comes from, only that it is demonstrated to work under controlled conditions. If your naturopath is genuinely effective in treating late-stage cancers, more so than conventional care, you should nag them unto the ends of the earth to fucking publish so doctors can use these effective treatments as part of standard care.

          1. Will Sagan says:

            Thanks for the insults. It’s not my naturopath who cures cancer but who was smart enough to direct us to the man who does. The Mayo Clinic also directed us there. And he is published, just not where you would look. If you were serious about knowing rather than ridiculing, we could have an adult discussion. Curing cancer is a huge topic that deserves a place of honor, not jokes. It’s too personal to me. Finally, the naturopaths I know are M.D.s with various kinds of schooling and training beyond that degree.

            1. WilliamLawrenceUtridge says:

              Sounds like your naturopath was completely redundant to a real medical professional. As they all are, except when they’re giving actively harmful advice like avoiding vaccination.

              If your oncologist(?) is not published “where you would look” (that would be pubmed, or in the scholarly section of my local university library), I would seriously question what he is publishing about.

              Curing cancer is damned difficult. It shouldn’t be joked about, I agree. It also shouldn’t be treated as something easy to do, and untested (or outright ineffective) treatments should not be used by anyone. Exploitative assholes like Stanislaw Burzynski and Joe Mercola and Gary Null and basically anyone Suzanne Somers has a hardon for should be beaten with rubber hoses.

              If you want to have an adult discussion, don’t be coy. Say who your oncologist is, what approach s/he used to treat your cancer, and what the evidence base is.

    3. Composer 99 says:

      There is nothing wrong with honestly characterizing stunning advances in quality of life from the eradication or near-eradication of some deadly diseases and/or the massive reduction of mortality from others as stunning advances in quality of life.

      I should hope you also have cites for “Look around at the epidemics of chronic degenerative diseases to see if science-based medicine has had much impact on them.”

      1. WilliamLawrenceUtridge says:

        I’m really enjoying the whole “if you take away all the interventions that improve quality and quantity of life, what has medicine done for us” angle that is being presented. It’s tops.

    4. Skeptical_Canadian says:

      @Science-based medicine cynic

      You hoist the words “triumphalist” and “extremist” upon us science-based folks. Au contraire, perhaps you should have a close look at the CAM space – it’s not hard. Just have a look at any messaging from Adams, Mercola, Oz et al. Their simplistic promulgations of their anti-science commandments do society a great disservice. They triumphantly claim all things they know are truth, that they know their remedies cure pretty much everything. Equally, they’re extremists existing at the fringe elements of society claiming knowledge and experience when they have none. They thrive by fooling the unwary and unwise. Science deals with the physical (materialistic) domain. There is no second branch of science, there is but one.

      1. Science-based medicine cynic says:

        And what has SBM done for you and your family lately? Is Edward Jenner’s serendipitous discovery of vaccination considered “Scientific-Based Medicine”? Do you and your family get vaccinated (you should)? Other than, is anything in the annual screening physical from your GP or internist considered evidence-based? I’ve noticed that none of the modalities used actually reduce all cause mortality (ie save lives).

        Would you consider the serendipitous discovery of penicillin in the penicillium mold to be “science-based medicine” or “accidental discovery-based medicine”? And all of the knock-off drugs that have followed….

        How many drugs do we have to treat cholesterol? Beyond statins, is there any evidence for any of them? (nope). And how were statins discovered? Serendipitously…..

        1. Dave says:

          How about rituximab/CHOP for diffuse large B cell lymphoma (>90% cure rate for limited stage , > 50% cure rate for advanced disease – what’s the cure rate for herbs?), imatinib for CLL, HAART for HIV infection, DMARDS for rheumatoid arthritis, Tysabri for multiple sclerosis, cladribine for hairy cell leukemia, ace inhibitors for congestive heart failure, thrombolytic agents for stroke? Just to name a few.

          Add to this the things we don’t do now because SBM has proven they’re not effective – as you point out, we don’t generally use atromid, probucol, niacin etc for cardiac protection though they lower cholesterol, because studies have not shown they prolong life. What the heck is wrong with trying to make sure what works and what doesn’t in a controlled, reproduceable way? You have a better idea?

          As far as annual screening, read the current guidelines. Recommendations for this are constantly being revised.

        2. Chris says:

          Um, stopping stronger and increasing seizures in an infant.

          Then there was the surgery for obstructive hypertrophic cardiomyopathy.

          Oh, and then there was repeating strep infections, which were stopped when it turned out one kid had it without symptoms, so all three kids got antibiotics.

          Then there was respirator support when one kid was literally suffocating from not being able to breath during a nasty coughing disease (like croup). His oxygen level when he entered the emergency department was less than 60%.

          Also, their grandmother is no longer in pain and bent over after back surgery.

          Also, my stepmother’s family all used to die an early painful death from a genetic form of hypertension. Just after her brother died in his late thirties, the first diuretic blood pressure medication were introduced in the 1950s. She and her siblings then lived well into their 80s, and even 90s.

          Really, do you have a point that is accompanied by actual data?

        3. Sawyer says:

          Your other posts annoyed me, but this one is flirting with a legitimate point.

          Let’s assume for a moment that the rigorous, materialist, well-defined system of science based medicine is not directly responsible for world changing discoveries. Okay, maybe. But why are you listing Jenner and Fleming instead of Mesmer and Hahnemann? Do you think it’s dumb luck or some sort of cosmic fate that has allowed us to distinguish these treatments as real?

          I don’t know what the best discovery process is, but I sure as hell know what the best filter is to affirm those discoveries.

        4. WilliamLawrenceUtridge says:

          SBM has meant neither I, nor my wife, have a smallpox vaccination scar, unlike our parents. Huzzah! I do get vaccinated, every year for influenza, and I’m happy to do so.

          As for the annual physical, thus. It’s funny, for every talking point you throw up, there seems to have been a SBM post. Are you trying to Poe us?

          Why is “serendipity” your standard? Why is that meaningful? Why are you pretending “science” is what it’s not? Science is a method of testing. You seem to think it is some sort of perfect prediction tool, designed to produce models that exactly emulate, in a mechanistic way, the way the body (universe?) works. The facts that science test and demonstrates to be reliable certainly help build models that make predictions that can be tested to establish further facts. But science is a method, not a fact.

          Science is not the same thing as precognition. The fact that science tests and discards hypotheses that fail testing is a feature, not a bug. It’s SCAMs and the like, that never test, and above all, never discard, a hypothesis. For Dog’s sake, homeopathy, the four humours, vital energy, they’re all still part of SCAMs, crucial to them, despite the chemical synthesis of urea several centuries ago!

        5. Young CC Prof says:

          So, let’s say I discover a new medicine serendipitously. My uncle’s cancer goes away after he eats a weird plant from the yard.

          Now, I want to save lives and incidentally make money for myself! So, I call up a chemist to analyze exactly what’s in that herb, and whether any of the substances might have anti-cancer properties. We isolate the active ingredient, so it can be dosed precisely. I test it on animals and then humans under carefully controlled conditions.

          I find out exactly what types of cancer it works on, and what the best and safest dose is, and how many times it has to be administered. I learn that the drug can be toxic to the liver, but careful dosing and monitoring can treat the cancer without destroying the liver. Eventually, I’ve got an FDA approved anti-cancer drug.

          But nope, I didn’t use science, because it was based on a serendipitous discovery.

        6. nancy brownlee says:

          “And what has SBM done for you and your family lately?”

          It’s keeping me alive. I have Carcinoid disease, very, very well controlled, thank you- thanks to SBM, and to the synthesis of artificial somatostatin : octreotide, trade name Sandostatin. And every time I see the Novartis corporate logo, I could kiss it. Roll on, Big Pharma. Roll on, SBM.

        7. Denise says:

          Why do you imply that serendipitous and scientific are mutually exclusive?

          The history of scientific advancement is full of things found by accident. Nobel Prizes have been given for some. Observations may be fortuitous, but discerning the implications of what you have observed, and the development and rigorous testing of hypotheses that follow from the observations are something else entirely.

          Would you dismiss our knowledge of atomic subparticles as nothing but serendipity because Rutherford discovered the proton by accident?

        8. mousethatroared says:

          “And what has SBM done for you and your family lately?”

          My son was born with a cleft lip and palate. Because of science based medicine, his cleft has been repaired and he can eat, speak and live a normal life.

          Because science based medicine has been researching the long term consequences of the surgeries typically used with CLCP, our surgeon knew that a procedure commonly used 20 years ago to allow normal speech production, often causes sleep apnea. He delayed this surgery in preference of using specific speech therapy methods (that have been developed through testing and research) to strengthen velopharyngeal muscles. Because of this, the surgeon was able to use a different procedure with lower risks of sleep apnea. The surgery and speech therapy dramatically improved my son’s intelligibility and he has no signs of sleep apnea.

          So, in short, because of science based medicine my son can speak.

    5. WilliamLawrenceUtridge says:

      Look around at the epidemics of chronic degenerative diseases to see if science-based medicine has had much impact on them.

      Yeah, it’s a real shame that people now live long enough to develop wear-and-tear on their bodies. Life sure was better when people died of infectious diseases and trauma in their 30s, or you had to have ten kids just to have two survive.

      I’m not sure why you think a single example of a debatable and complex issue regarding a single type of cancer (incidentally, what type of breast cancer? ‘Cause there’s not just one) disproves the entire science-based medicine approach.

  11. Thor says:

    Thanks for another good post, Harriet. I was pleasantly surprised to read about the nut study a few weeks ago. Finally, science had ‘proved’ the health benefit of a certain food. Then I read the following article analyzing the statistics of the study, which puts the results in perspective, reducing the conclusions of benefit. Sadly, I’m with Crislip when it comes to statistics—they’re usually Greek to me. What say thee about this piece?

    http://skepchick.org/2013/11/bad-science-journalism-eat-nuts-live-longer/.

  12. Skeptical_Canadian says:

    @Science-based medicine cynic

    You hoist the words “triumphalist” and “extremist” upon us science-based folks. Au contraire, perhaps you should have a close look at the CAM space – it’s not hard. Just have a look at any messaging from Adams, Mercola, Oz et al. Their simplistic promulgations of their anti-science commandments do society a great disservice. They triumphantly claim all things they know are truth, that they know their remedies cure pretty much everything. Equally, they’re extremists existing at the fringe elements of society claiming knowledge and experience when they have none. They thrive by fooling the unwary and unwise. Science deals with the physical (materialistic) domain. There is no second branch of science, there is but one.

  13. Skeptical_Canadian says:

    Apologies for the double post.

  14. Dave says:

    Sorry, gllevec is for CML, not cll.

  15. Adam Morrison says:

    Wow, the tin-foil is strong in some of these comments.

    Great article Harriet, I had heard of the patient cured of HIV following the bone marrow transplant, but the news articles never mentioned the donor had the CCR5-Δ32 mutations. Now the whole process makes more sense to me and how the recipient was ‘cured’. Thanks!

  16. SNFinVA says:

    I guess that someone hasn’t noticed the progress being made by SBM with Hepatitis C treatments, either. Here’s an example for you:
    My husband underwent an experimental drug therapy to treat his HepC over a decade ago and is still virus-free. He is considered cured. The drug combo he took (for a year) had something like a 45-50% success rate.
    Since then, more advances have been made, and better drug therapies are being developed that are better at treating the more difficult cases.

  17. PMoran says:

    “They should be humbled by the single obscure fact that mortality from breast cancer has not changed in the past 80 years”

    It is weird that you should pick one of the cancers for which this is definitely not true when there are a few where there has been little or no improvement in cure rates. Even in the data I looked at ten years ago absolute mortality rates from breast cancer were declining in the US, England and Australia, despite substantial increases in incidence of the disease.

    Look at the breast cancer graph for the UK here.
    http://www.users.on.net/~pmoran/cancer/cancercure.htm

  18. Palatine Uvula says:

    Throughout elementary school I suffered from asthma attacks ranging from severe to life threatening, so when people like Science-based medicine cynic ask what science has done for us I get a little annoyed. I don’t know what we did before the advent of salbutamol but I’m pretty sure dying was one of them. People like sbm cynic have been lucky enough to avoid being so grateful for a drug’s discovery, and I think that’s why they don’t respect the normality modern day medicine has provided for some of us. I’ve grown out of the worst of my asthma but I can assure you when they do happen I’m not reaching into my pocket to call up a naturopath.

    1. TBruce says:

      I don’t know what we did before the advent of salbutamol but I’m pretty sure dying was one of them.

      It was. I had twin uncles who both died in childhood from asthma.
      Sometimes I wish we could send the likes of cynic back in time and see how he would like experiencing severe illness in the Good Old Days.

    2. Calli Arcale says:

      I thank the rescue inhaler in my coat pocket often. Not that I use it often, but when I need it, the relief is instant. And I thank the advances in inhaled steroids; my grandmother took Prednisone many times for her asthma, and has all the classic problems that result from that, most notably the unbelievably fragile skin. I won’t need to fear that, because I can use inhaled steroids that limit the dose my whole body has to endure in order to stop the bronchospasm.

      BTW, Palatine Uvula, you have a truly awesome screen name. ;-)

  19. Andrés says:

    Dr. Hall said (my bolds):

    The Institute of Medicine recommends a blood level of 25-hydroxyvitamin D greater than 20 ng per milliliter to maximize bone health

    Not at all, actually they said (again, my bolds):

    For vitamin D, the 2011 DRIs are based primarily on the integration of bone health outcomes with evidence concerning 25OHD levels, which suggest that levels of 16 ng/ml (40 nmol/liter) meet the needs of approximately half the population (median population requirement, or EAR), and levels of at least 20 ng/ml (50 nmol/liter) meet the needs of at least 97.5% of the population (akin to the RDA).

    If you want to try to get good bone health for all of your population without excluding something like 1 out of 40 you have to go higher than 20ng/ml. If you want to maximize bone health it seems that you will have to go to the 36-40ng/ml range as Bischoff-Ferrari et alter state (take a look at Figure 1 suggesting something like a level 10ng/ml lower for black people):

    Thus, the data for bone health, based on BMD in younger and older adults and on the prevention of hip and any nonvertebral fractures in older adults, suggest that serum 25(OH)D concentrations between 90 and 100 nmol/L are desirable.

    Is the evidence clearcut enough to experiment with higher levels than 20ng/ml at the population level? Well, I am certain that a big portion of the vitamin D deficiency has been iatrogenic caused by dermatologists, so we should first come back to square one with no more evidence needed. Black people living far away from the equator should begin supplementing right away (not dermatologists’ fault).

    Moreover, I trust the Vitamin D Council on this matters and supplement 5000IU/day the days I don’t sunbath without protection in order to get to the 50-60ng/ml level (I try to ensure a good supply of vitamin K2 and magnesium too).

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