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I Never Meta Analysis I Really Like

David Gorski recently pointed out that Science Based Medicine is going on five years. Amazing. That there would be so much to write about day after day comes as a surprise to me. Somehow I vaguely thought that ‘controversies’ would be resolved. Pick a SCAM, contrast the SCAM with reality as best we understand it, and, once the SCAM was found wanting, it would be abandoned. Why would rational, thoughtful people persist in the pursuit of irrational behavior, contradicted by the universe?

Ha. More the fool me. I would never have guessed that these SCAMs are harder to kill than Dracula (at least one version of Dracula). Stake them and back they come*.

I have tried to avoid repeating repeating information found in prior posts by myself and others, in part because I am lazy and in part because, well, I have said it before. Just look it up. I have come to realize (all too slowly) that each blog entry should be  self contained and that much of the old material is lost in the corn maze (an punning homophone) that is WordPress. Reading my second favorite computer reinforces the realization that each post often needs to be an island universe, complete in itself.

Medicine is difficult. At least I find it difficult. You have to first come up with a cause of the symptoms, understand the underlying physiology and then try and determine the best course of therapy. I have it easy in Infectious Diseases, a much more binary specialty. Patients are either infected or not, I have a therapy or not and I either cure them or not. Not a lot of wiggle room in the treatment of, say endocarditis or pneumonia, and very little in the way of bias and placebo to obfuscate the therapy. Or so I would think.

Much of the rest of medicine is not as clear cut. As a physician there are multiple ways to assess the potential efficacy of a therapy. One is a definitive randomized placebo controlled trial. Those do not seem to occur as often this decade as in prior times when giants walked the earth. Or so my faulty memory suggests.

Another way is to try and master the literature, a futile endeavor. In two areas of medicine I have more than passing knowledge: Infectious Diseases and SCAM’s. The nice thing about having a breadth and depth of reading is you can understand where new articles fit into an overall picture. What was the patient population studied, what were the weaknesses of the study, how applicable is the information to other populations? The downside of such expertise is I have to rely on the kindness of strangers in other areas of medicine, since I know next to nothing.

The breadth of knowledge has also made sources of information that I once trusted much more suspect. Popular media? No way. Newspapers and magazines so often get it wrong in areas of my expertise that I no longer trust them in areas where I know nothing (just about everything else).

Meta-analysis? Nope. Talk about disillusion. I used to rely on meta-analysis, but they are worse than laws and sausages, ceasing to inspire respect in proportion as we know how they are made. I still like the meta-analysis and systemic reviews as a nice overview of a clinical topic, but, for reasons we will see, I am hesitant to draw any therapeutic conclusions from any meta-analysis.

And the worst source is an anecdote. If I have said it once, I have said it once, the three most dangerous words in medicine are “in my experience.” I had always though of it in the context of physicians deciding on a therapeutic intervention, not so much from the patients perspective. I realized that for patients that is often the primary way they deciding to try a therapy, especially a SCAM therapy.

What would you do if you were a highly intelligent intellectual at one of the top newspapers and were curious about acupuncture? With the research capacity of, say, the Chicago Sun Times, you could get the skinny on any topic, right? Or instead, you could ask you readers if you should get acupuncture. Sigh. A microcosm of why, compared to SBM bloggers, Sisyphus  had it easy.

That method of seeking medical advice has been around since 480 AC as mentioned by Herodotos:

‘They had a very practical habit: on the marketplace passer-by’s give
advice to the patient about their ailment, in which case they can sometimes rely on personal experience or take advantage of someone else who suffered from the same symptoms. Nobody can just pass by without saying anything. It is obligatory to ask the patient what ails him. They bury their corpses in honey and mourn in the same way as in Egypt.’ (Thanks to Cees Renckens for the quote).

The more things change, the more they stay the same. Except for the honey part.

Everything I distrust about medical reporting seems, of late, to have found a home in the Atlantic.  Check out the headline: Biological Implausibility Aside, Acupuncture Works by Lindsay Abrams.

Really? News to me. I tend towrds the opinion that if a process is biologically impossible, then it is more likely that a) any positive results are likely to be spurious and due to bias and b) if bias is removed,  the old double blind placebo controlled trial, then most effects will fade to zero.

It often appears that journals and magazines do not even bother to read their own reports. A scant two years ago the Atlantic reported on the work of John Ioannidis and why most of the medical literature is suspect

“Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice?”

and that in clinical trials

“the range of errors being committed was astonishing: from what questions researchers posed, to how they set up the studies, to which patients they recruited for the studies, to which measurements they took, to how they analyzed the data, to how they presented their results, to how particular studies came to be published in medical journals.

This array suggested a bigger, underlying dysfunction, and Ioannidis thought he knew what it was. “The studies were biased,” he says. “Sometimes they were overtly biased. Sometimes it was difficult to see the bias, but it was there.” “

One of the epiphanies of my understanding in how to approach the medical literature was when I discovered the works of Dr. Ioannidis. It would appear that Lindsay Abrams didn’t read the article about Dr. Ioannidis. More likely it was read and ignored. All the issues raised about the validity of the results of medical research never seem to translate into SCAM studies.

What was this earth shattering, high quality clinical paper that demonstrated after decades of lousy research that acupuncture works? Finally a large randomized placebo controlled clinical trial with good endpoints that demonstrates efficacy? Certainly all the prior trials that meet those criteria demonstrate acupuncture doesn’t work and that acupuncture is no better than placebo.

Readers of my entries know that my assessment of placebo: it does not alter  pathophysiology, just the perception of pain and disease, and then only a wee, clinically irrelevant, amount. I agree with the article that acupuncture is “nothing more than fancy ways of invoking the placebo.” And you know Crislip’s law: acupuncture effect = placebo and placebo effect = nothing, therefore the acupuncture effect = nothing.

I well know that interacting with a patient with a therapeutic intervention will alter the patients perception of what is occurring without altering the underlying pathophysiology. As the NEJM study revealed, if patients think they are receiving a therapy even when they are not, they will report their asthma is better even when the objective tests show no improvement. To my mind the placebo effect is no different than kissing a child’s boo-boo: it is subjectively beneficial although no objective changes occur to the boo-boo.  These human interactions are an important, if ineffective, part of the human relationships.

The Atlantic was referring to

“new, large study out of Memorial Sloan-Kettering Cancer Center, published in the Archives of Internal Medicine, cautiously suggests that there is indeed something more to acupuncture. A meta-analysis of 18,000 patients from 29 randomized controlled studies, it found that the treatment was more effective than controls in relieving back and neck pain, osteoarthritis, chronic headache, and shoulder pain. Significantly, it also found that real acupuncture was more effective than shams.”

Sigh. I see the word study, and I think oh good. Someone has done a clinical trial. Enrolled patients and compared, in a double blind manner, interventions against placebo. No. It is a meta-analysis. Calling a meta-analysis a study is not unlike a library declaring they acquired several dozen new books and magazines when their copy of Readers Digest arrives. Someone massaging preexisting data; hardly a study.  Nice for an overview of a topic, but worthless for drawing conclusions definitive conclusions.

When applied to real treatments, those based on reality and known physiology, the results of meta-analysis are often not predictive of well done clinical trials:

The outcomes of the 12 large randomized, controlled trials that we studied were not predicted accurately 35 percent of the time by the meta-analyses published previously on the same topics.

Of course, that presupposes that the topic is not tooth fairy science. If the interaction is based on nonsense, then the validity of an intervention is likely to be less. My bias, clearly stated here, is that one should be able to be able to reason up and down the pathophysiologic pathways of disease and treatment on basic biologic plausibility and basic principals.   It comes from being a truly holistic doctor, understanding infections at the level of amino acid substitution leading to drug resistance or disease susceptibility through to the interactions with the earths ecosystem.

That meta-analyses are unreliable should not be surprising. Most reality based clinical trials are flawed, and if you collect a series of flawed studies, you end up with one big flaw. The idea behind the meta-analysis, collecting all the cow pies into one big pile and making gold, is only as good as the quality of the initial pies. It is rare to collect Marie Callender’s.

I am not a true skeptic. I tend to avoid the words implausible and unlikely where I do not think they apply. As best can be determined, acupuncture, homeopathy, energy therapies, and a host of other SCAMs are, at the level of first principals, total bunk. And legitimate therapies cannot flow from pure bunk nor can a meta-analysis make pumpkin from cow.

Prior meta-analyses of acupuncture suggest they are substandard. The perhaps ironic and self referential Systematic Review of Systematic Reviews of Acupuncture published 1996-2005 suggests

“Systematic reviews of acupuncture have overstated effectiveness by including studies likely to be biased. They provide no robust evidence that acupuncture works for any indication.”

And as the Wikipedia points out

“The most severe weakness and abuse of meta-analysis often occurs when the person or persons doing the meta-analysis have an economic, social, or political agenda… If a meta-analysis is conducted by an individual or organization with a bias or predetermined desired outcome, it should be treated as highly suspect or having a high likelihood of being “junk science.” From an integrity perspective, researchers with a bias should avoid meta-analysis and use a less abuse-prone (or independent) form of research. “

This is no small issue if you happen to be a practicing clinician who takes the health and wealth of your patients seriously. Do I trust a meta-analysis that suggests linezolid is better than vancomycin for the treatment of pneumonia when the studies and the meta-analysis are sponsored by the company? It doesn’t completely abrogate the results of the trials, but it is well known that when the researcher has an axe to grind, the results will tend to sharpen the axe of the researcher.  All studies have bias, the question is how well they compensate.  I usually discount the results by about half when applied to the real world.

When approaching any study where the end points are subjective and at the limits of perception, two archetype need to be considered. The first is the endless ability of people to fool themselves.

At the turn of the last century a French Physicist, Blondlot, discovered N-rays. These rays were at the limit of detection and, like acupuncture, made no sense in the context of know reality. Multiple papers were published on N rays until a visiting professor, unknown to Blondlot, incapacitated the machine yet Blondlot still saw the N-rays.

N-rays were a purely subjective phenomenon, with the scientists involved having recorded data that matched their expectations.

Beware the N rays.

The other archetype is clever Hans, the counting horse, who actually was reading the nonverbal cues from his owner to know when to stop counting. Humans are probably more sensitive and skilled than horses at reading nonverbal cues, leading to

The observer-expectancy effect (also called the experimenter-expectancy effect,expectancy bias, observer effect, or experimenter effect) is a form of reactivity in which searcher’s cognitive bias causes them to unconsciously influence the participants of an experiment. It is a significant threat to a study’s internal validity, and is therefore typically controlled using a double-blind experimental design.

Both N-rays and clever Hans are examples of the importance of blinding the researcher and the patient and why if blinding is not adequate then any results are suspect, especially if the end points are subjective.

The studies of acupuncture that exclude N-ray and Clever Hans effects (i.e. really, really blinded) always show that acupuncture does nothing compared to fake acupuncture.

The classic interpretation of clinical trials when an intervention, say mammary artery ligation is no better than a sham mammary artery ligation, then neither are effective. I have been in medicine a long time and that career is littered with interventions that were discovered to be no better than sham/placebo and (sometime slowly and reluctantly) abandoned by the medical profession. That, of course, has yet to happen with any of the SCAMs discussed on this blog. While no hospital still offers mammary artery ligation for angina, Centers of Integrative Medicine and their ilk become more common.

So that is the background I use in approaching a clinical trial, a meta-analysis, and a paper on SCAMs. I admit I  have to read meta-analysis with Mr Gumby like understanding of the manipulation of the data, since statistics and I have never got along, despite my affinity for other forms of mathematics.

So how does “Acupuncture for Chronic Pain Individual Patient Data Meta-analysis” stand up?

Color me unimpressed.

Done by Acupuncture Trialists’ Collaboration. So no different than a meta-analysis by big pharma; they have a dog in the fight. That’s ok, we all have a dog in the fight. But any result is likely inflated.

After a search 31 of 82 trials met their criteria for inclusion.  Or they left out 51 trials, the validity of which I cannot say.   Would any of that information changed the outcomes of the analysis?  I don’t know; I lack the time to look at all the primary data in preparation of this entry.

They found that sham and real (as if there is a difference) acupuncutre were more effective than doing nothing. I would expect that. The boo-boo is being tended too; there will be salubrious results.

Did they remove the N-ray and Clever Hans bias? Nope.

“health care providers obviously were aware of the treatment provided, and, as such, a certain degree of bias of our effect estimate for specific effects cannot be entirely ruled out.”

Right there you know that the results are mostly worthless:

“Putting their results into context, the authors of the study explain that for a pain rating of 60 on a 100-point scale, follow-up scores decreased to around 43 for those had received no treatment, 35 for those who had received fake treatment, and 30 for those who received acupuncture. This translates into a 50 percent reduction in pain for the acupuncture patients, and only 30 and 42.5 percent reductions for the control and placebo groups, respectively.

It is impossible to measure pain objectively (Radiolab did a great piece on this last week), and the difference in pain reduction between sham and true acupuncture, though statistically significant, was small. But the authors’ methodical elimination of biases, coupled with their massive sample size, give weight to their findings.

The biases are there probably more enough to account for the results of real being better than sham acupuncure, the effect inconsequential clinically, and a massive sample size of cow pies only leads to one big cow pie indeed.

Dr. Strawman then weighs in:

Should the lack of biological plausibility lead us to reject compassion and empathy as a means to help improve our patients’ health?

How about

Should the lack of biological plausibility lead us to reject a costly and worthless therapy with known complications and instead use our compassion and empathy in a manner that is not based on lies?

The Fail blog needs to link to the Atlantic. It is a perfect match.

That is not all that is new about acupuncture of late. The Cochrane reviews continues to prove they have no standards or they are really getting bored. They did a review of mumps treated with acupuncture. Really. They found one study. Honestly. They meta-analyzed away:

We could not reach any confident conclusions about the efficacy and safety of acupuncture based on one study. More high-quality research is needed.

They had the same conclusion with insomnia  and endometriosis.

Of course, pain, mumps, insomnia and endometriosis all have the same underlying pathophysiology, no wonder it ‘works’ for so many diseases. Somehow  I don’t think we need to do any research on using acupuncture to treat mumps, much less do a review.

Not unsurpizingly when there is double blinding, analgesic effects disappears. This was an interesting study since they treated acute pain rather than chronic pain patients who

gather a lot of information about different pain treatments and firmly believe in different therapies.

They tested the ability of acupuncture, sham or real, to effect acute pain (cold and capsaicin). It didn’t. While the real acupuncuture worked slightly better than sham for capsaisen-induced pain, the effect, like a Vickers results, “occurred mainly in a rating range that seemed irrelevant to clinical pain.”

In another study in the same issue of Pain there is no difference between sham (random punctures), ‘real’ or placebo (fake punctures) acupuncture for low back pain, but all three are better than conventional therapy. The big flaw in the study is that they used hardened acupuncturists with a mean of 8.5 years of practice who were not blinded. While not statically different, real performed better than sham better than placebo, suggesting a clever Hans effect.

Like the asthma study in the NEJM, the best one can conclude is that acupuncture is that it is another beer goggles of alternative medicine: it convinces the wearer the disease looks better than it actually is.

* I am avoiding a Whack-a-mole metaphor.

Posted in: Acupuncture, Science and Medicine, Traditional Chinese Medicine

Leave a Comment (148) ↓

148 thoughts on “I Never Meta Analysis I Really Like

  1. David Gorski says:

    I am avoiding a Whack-a-mole metaphor.

    Imagine my relief. It’s one of my favorite metaphors.

  2. BillyJoe says:

    “avoid repeating repeating”

    Isn’t it ironic that you cannot advise someone to avoid repeating repeating without repeating repeating.
    Sorry, carry on…

  3. DevoutCatalyst says:

    “It is impossible to measure pain objectively…”

    Could you look at the gait of people with painful conditions that affect their gait, and objectively measure that? What drove me out of the pentecostal church back in the 1970s was the fact that the people for who it was claimed to have been instantaneously healed before our very eyes and who also had had obvious symptoms — those people continued to have obvious symptoms. WTF. Whilst faith healers might be too stupid not to treat, say, arthritic joints, would the acupuncturist not tend to shy away from treating something that will transparently brand him or her a fraud? Unless a wobbling paying client reliant on a cane is the new measure of efficacy. Oh hallelujah.

  4. “Medicine is difficult”

    I know this may come off arrogant, ignorant, delusional : )…but, well..I find it easy… now. I used to believe it something beyond anything I could solve…that it was left to those very educated and trained. Now, without a question, to get/give proper diagnosis is something I am incapable of doing..absolutely, not having the education, equipment, staff, etc. That’s why I prefer someone to go to a conventional doctor first, to get proper diagnosis. But, from there… it’s kind of easy.

    Most all illness, whatever they are, however they happened, stem from two things. Toxins (from water, food, air, etc)…or lack of nutrients because of improper diet, or need of added vitamins/nutrients. I know I’m going to get blasted…or ignored..or laughed at..but, when it all settles…and you actually take the time think through or look into what I’m saying.. what I have been saying in other posts…hopefully, you will see for yourselves at some point, and utilize what I have said, and am saying…toxins and lack of nutrients are the cause of most all illness…and so when you get less (toxins), and more proper nutrients..you will be remedied..(as much as you possibly can at any rate). Yes, there are things from birth..unfortunately, which would/may be more difficult to turn around, but, I do believe even they can be alleviated as well, doing the same things for most other developed illnesses..get less toxins, add more natural organic food and nutrients.

    Now, I used to think, well, if I simply eliminate all toxins, then I will no longer get ill..however, no, I’ve changed on that. Unless you live in a nice weather condition year round tropical paradise, getting all the organic unchemicaled foods you can, you will need added nutrients..always.

    Regarding..”well, why did people get sick long before ‘toxins’ in food, water, air, medicines come along?”..the only answer to that is..they didn’t have available to them the natural foods always (depending on which climate they lived) (as in scurvy) and/or depending on how close they lived together it would be at the time for improper sanitary conditions. Other than that, it would have applied then too, too many toxins (improper sanitary conditions) or improper diet,not enough organic foods available to give them the nutrients they needed daily (added nutrients/vitamins).

    It is on my site Rustic Healthy, what I’ve been ‘alleviated’ from..asthma, arthritis, and a few other things..so I won’t go through that..I just wanted to say, it’s from my experience that I’ve found this out. It’s also actually helped my son as well, who is now an organic nutrient health nut too. :) having experienced it for himself. I’m not sure why conventional meds consider vitamins and nutrients and getting rid of toxins as an alternative actually, which is why I was amazed at the responses to it. I believe it’s very scientific..very factual. Your body is a self-healing ‘instrument’..when given the proper ‘ammunition’ to heal itself, and keep itself healthy, for many more years than what we’ve come to accept :)

    1. Harriet Hall says:

      Rustic believes most all illness stems from toxins and lack of nutrients.
      There is no evidence to support that belief. It is based only on wishful thinking and misunderstanding.
      The mnemonic VINDICATE covers the categories of disease causation that are supported by evidence:

      V = Vascular
      I = Infection (e.g. viruses, bacteria and fungal)
      N = Neoplasm
      D = Drugs (medications or illicit drugs)
      I – Inflammatory/Idiopathic
      C = Congenital
      A = Autoimmune
      T = Trauma
      E = Endocrine/metabolic

  5. qetzal says:

    I’m a bit shocked by the Cochrane Review on acupuncture for mumps. I know we’ve had previous discussions about various faulty Cochrane pieces, but (as a non-MD) I had the impression they were still mostly respectae and reliable. Now I’m starting to wonder.

    Perhaps SBM could do a post on Cochrane itself? Who are they? How are they funded? Are their failings mostly limited to insufficient consideration of scientific plausibility, especially regarding CAM, as has already been documented in previous SBM posts? Are they still generally reliable for more mainstream topics, or should we be discounting them more widely? (That is, even after discounting the value of meta-analyses, as today’s excellent post illustrates.)

  6. phayes says:

    “[...] since statistics and I have never got along, despite my affinity for other forms of mathematics.”

    You’ve smelled the rat. Now trust your mathematical nose a little more and follow that stench to its source. There you’ll discover that orthodox stats isn’t a form of mathematics at all (or at least not one fit for purpose). It’s the stinking pile of ill-founded garbage constructed by “a new group of workers, not [mathematical] physicists” who “rejected virtually everything done by Laplace” et al and “sought to develop statistics anew, based on entirely different principles”. It’s 20th century progress in applied mathematics in bizarre, scandalous reverse: as if at some point we’d gone from analysis back to calculus or from differential geometry back to Gibbsian vectors and tensors. Only worse. Much worse.

  7. windriven says:

    @qetzal

    Mission statements and their kin often tell a lot about organizations. The Cochrane Collaboration, according to their Policy Manual, bases their work on 10 key principles:

    Collaboration (they have 28,000 collaborators; too many cooks?)
    Enthusiasm (?!)
    Avoiding duplication
    Minimizing bias (to a fault; apparently calling quackery by its name is bias)
    Keeping up to date
    Relevance
    Promoting access
    Ensuring quality (By what measure?)
    Continuity
    Wide participation (See #1)

    Missing is any mention of scientific rigor. ‘Nough said.

  8. Scott says:

    @ Dr. Hall:

    But of course toxic reactions and nutrient deficiencies DO exist, albeit as much more limited things than rustichealthy claims. Where would (say) lead poisoning and scurvy fit under VINDICATE?

  9. Jan Willem Nienhuys says:

    In the period 1988-1990 the group of Paul Knipschild investigated several kinds of alternative medicine. The pubvliced a lot of short papers in Dutch on the subject of acupuncture. They had a rating system for ‘quality of paper’, somewhat in the same way as exams for freshmen are judged: so many points for this, so many points for that. Forgotten to randomize: 20 points less (rather than throw the whole thing out). They also published two articles in English:

    http://www.ncbi.nlm.nih.gov/pubmed/2147032

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1371348/

    The conclusions were that “The results from the better studies (greater than or equal to 50% of the maximum score) are highly contradictory. The efficacy of acupuncture in the treatment of chronic pain remains doubtful.”

    It was also clear from all their acupuncture studies together that the better the study, the worse the result. For a typical graph see page 381 in the second linked study. So ot much has changed since 1990.

    The same group studied homeopathy after that. Their surprise at the number of ‘high quality’ studies and the number of positive studies can be explained by their experience with acupuncture. Actually it didn’t amount to very much either, because scoring 60% of the maximum in a test is considered as ‘just passing’ (in Dutch culture). Getting a ‘just passing’ grade on a test for freshmen is not what I call a standard for decent science.

  10. I’ve always used vindicate to help think of causes when someone presents with a vague or strange complaint.

  11. Chris says:

    RH:

    I know this may come off arrogant, ignorant, delusional : )…but, well..I find it easy… now.

    Which is precisely why you fail. You think you are saying something profound, but it is almost always wrong.

  12. Jan Willem Nienhuys says:

    VINDICATE – 17 kinds of worms, and parasites (Plasmodium, amoebae, protozoa) also fall under infection. And scabies too. But where does poisoning (either by snake bite, arthropod bite or sting, or jellyfish sting, or eating the wrong kind of stuff) belong? And does radiation damage come under trauma?

  13. qetzal says:

    @Scott,

    At a guess, I’d say toxins could be included under Drugs, while nutrient deficiencies would fit under the metabolic accompanyment to Endocrine. But of course IANAMD.

  14. Harriet Hall says:

    @qetzal,

    Maybe you ANAMD, but you are correct. Toxins (and poisoning of all kinds, including jellyfish) are included under Drugs and nutrient deficiencies under Endocrine/Metabolic. And radiation could be considered a kind of trauma, since it damages DNA by physically disrupting chemical bonds.

  15. Janet says:

    I want to guess before Dr. Hall responds:

    It seems the second “I” includes Intoxication (substance), so that would take care of lead poisoning.

    Scurvy being a problem of collagen synthesis might come under “E”/metabolic?

    ——–

    Great post–a definite keeper to present to some people I know.

  16. Scott says:

    Thanks Dr. Hall! My curiosity is assuaged.

  17. The following is not science-based, but I feel it could help. Doctors, nurses, and pharmacists all have a code of deontology, for which they have received extensive training. This (and the aforementioned extensive training) is why we as societies tend to trust doctors when they start as strangers. Can the same be said of CAM practitioners? Is there for example a code of deontology for naturopathy or homeopathy? Something as stringent as what you see in the medical code of deontology?

  18. jt512 says:

    This acupuncture meta-analysis (Vickers et al 2012) strikes me as another spectacular failure of peer review (on the order of Bem [2011]). No journal editor should allow a meta-analysis to conclude that a treatment “is effective” when the meta-analysis comprises non-double-blind studies.

  19. Chris….in light of how illness and disease are treated almost categorically today I believe it is profound. I would challenge any doctor here to look at what someone comes in with..without the regular taught medical books. To think in terms of the environment and diet (I would say should be organic) of the person, then to look up the possible deficiency of the illness. Children have been treated with Vitamin C for pertussis successfully. What that told me was, before it gets to that, children lack vitamin C. So, in order to ‘immune’ their systems to pertussis..they should be getting a vitamin c supplement every day instead, along with other things..fish oil, perhaps..something to that effect is what I’m saying. It’s not a new way..entirely, but, it is different way of. And, since it’s been my experience, and some of those I know..I don’t see how it’s proven wrong yet.

  20. Harriet Hall says:

    Apparently there is more than one VINDICATE, and one includes intoxication under the I. The system is not perfect, and it really isn’t logical to include “idiopathic” since that means we don’t know the cause.

  21. Here’s another example of what I just posted in The Obesity Paradox..

    Fluoride causes Hypothyroidism..

    http://www.fluoridefree.net/fluoride-causes-hypothyroidism.php

    Fluoride causes Hashimoto’s Disease, one of the adverse health effects caused by fluoride added to our water. It took 35yrs before obvious symptoms of elevated cholesterol and TSH levels enabled diagnosis of thyroid dysfunction, ingesting unknown quantities of fluoride in water at levels considered to be “safe and effective”. The signs of low grade poisoning including fatigue, low energy, weight problems, urinary tract irritation and rashes were all there, for years prior to my diagnosis.

    FLUORIDE CONTRIBUTES TO OBESITY

    Obesity and related problems are rife in Australia – everyone points the finger at diet but nobody suspects fluoride in the water. Fluoride impairs thyroid function resulting in imbalances in metabolism that contribute to weight problems.

    Hypothyroidism is treated with iodine ..and, fluoride depletes your body of iodine…..so..it’s caused by ‘environment’ ..something not belonging in your body, not in the way it’s given, and so therefore ‘toxic’.

    Now it’s getting to the root of the problem..and how to treat it. That’s just another example. I have it myself actually, and I’ve been taking iodine in the form of Sea Kelp ..as natural a source as I can. I’ve lost some weight, and do not have the worsening condition of hypothyroidism..and hopefully, will not have it. But, that’s what I am talking about.

  22. Chris says:

    RH:

    Children have been treated with Vitamin C for pertussis successfully.

    Citation needed. And make sure you actually read it first, unlike the others you posted where you made claims that were not in the links.

  23. Harriet Hall says:

    @rustic,

    Just because someone says something on an activist website doesn’t mean it’s true. Your claims that fluoride causes Hashimoto’s and obesity are unsubstantiated and appear to come from statements on anti-fluoridation websites. Citation needed! I couldn’t find anything in PubMed, but maybe you can.

  24. Chris says:

    I would also suggest the RH actually read what Dr. Crislip wrote. Like:

    Another way is to try and master the literature, a futile endeavor. In two areas of medicine I have more than passing knowledge: Infectious Diseases and SCAM’s. The nice thing about having a breadth and depth of reading is you can understand where new articles fit into an overall picture. What was the patient population studied, what were the weaknesses of the study, how applicable is the information to other populations? The downside of such expertise is I have to rely on the kindness of strangers in other areas of medicine, since I know next to nothing.

    This means even if it is on the PubMed it cannot be taken at face value. There are several factors that need to be evaluated, and sometimes you need to rely on those with greater expertise. BUT! They actually need to know the relevant material, and not be some magazine columnist writing something on a study, when it was clear they only read the abstract.

    Dr. Crislip is criticizing an analysis of something where they grabbed a bunch of studies mushed them together. This is why he is so pained at noted it seems to assume that pain mechanism is similar for different ailments when he said:

    Of course, pain, mumps, insomnia and endometriosis all have the same underlying pathophysiology, no wonder it ‘works’ for so many diseases. Somehow I don’t think we need to do any research on using acupuncture to treat mumps, much less do a review.

    And this was indexed on PubMed: Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis.

    So, RH, if the folks here will tear apart a PubMed indexed paper, why would they care about unreferenced stuff from biased websites written by some random person with unknown qualifications? If you believe Lesley McMillan, then you should believe me when I tell you I can sell you a bridge. It is real, I can see out my front window (well one end of it). There are plans to remove the bridge and replace it with a new one. And here is the cool thing: it floats! All you have to do is bring your boat to the lake and tow it away.

  25. BillyJoe says:

    RH,

    “And, since it’s been my experience…I don’t see how it’s proven wrong yet.”

    Your experience should lead you to form an hypothesis which YOU need to try to prove wrong.
    Come up with tests that would prove your hypothesis is false. Only after repeatedly failing to prove the hypothesis is false will you have SOME confidence that your hypothesis MIGHT contain SOME truth.

    ….and then you might get some idea about what the author meant when he said medicine is hard.

  26. Zetetic says:

    rustichealthy……

    I’ve seen the old canard that Vitamin C can effectively treat pertussis too many times! The percieved effectiveness of Vitamin C as a treatment for Pertussis appears to be an erroneous cultural meme almost entirely rooted in urban legend. If vitamin C really worked, one would expect to see major current research reporting that vitamin C can effectively treat pertussis infections. After encounting this claim on an alt med forum a while back, I sought out scientific publications and there’s a paucity of supporting evidence, almost entirely from archaic, small and poorly designed studies. The most recent publications are the 1950s and the absence of any reference to it in over fifty years would strongly indicate that there is no substantiative evidence to support high-dose vitamin C as a treament for pertussis.

    The few scientific or medical studies done about the subject were done way back in the 1930s, before many standards of quality scientific research were in use. One often quoted early work, done by Dr. Otani in Japan, was published in a German medical journal in 1936. Undeserved credence is given to a number of “in vitro” tests (outside the body, usually in cultures or test tubes) that were done initially. In vitro studies rarely translate into successful “in vivo” (in the body) treatments. The patient related data collected was very “soft”, that is, highly subjective and mostly related to improved symptomology. Outcomes were referred to as “slight improvement” or “clear improvement” or just “improvement”, decidely non-quantitative. No assessment of the elimination of the actual Pertussis bacterium was attempted so the patients likely remained infective to others even though symptomology was reduced.

    This was followed by two additional studies, both done by the same researchers (Ormerod & Unkauf), in Canada in 1937. Both had extremely small samplings of 10 and 19 case studies, respectively. The use of only unblinded and uncontrolled positive case studies is the very weakest form of research and highly prone to selection and confirmation bias. Both studies appeared to show positive results. BUT – When a better designed independent replication that included negative controls (the gold standard for veracity in research) was attempted in 1938 by Gairdner in the UK, the researcher found when statistically comparing the two groups (Vitamin C treated & untreated):

    “…there was no striking difference in the course of the disease in the two sets of cases”

    And then concluded:

    “It is considered that the statement that the administration of vitman C in whooping-cough has an affect upon the course of the disease is at present unproven.”

  27. pharmavixen says:

    In my experience (as a pharmacist), when I’m advocating for an evidence-based modification to a patient’s medication regimen and the physician says, “In my experience…” I know I’ve lost the argument.

  28. kb says:

    Great article! The first paragraph brought to mind the adage of The Straight Dope: Fighting Ignorance Since 1973 (It’s taking longer than we thought).
    Sadly, I feel sometimes like despite all our efforts, ignorance is actually growing, and what’s more, it is developing a kind of new strain that is resistant to evidence, and is plaguing not only the masses (what’s new?), but also highly-educated people with whom, you would think, you could reason rationally. But to many people scepticism seems like a bitter way to live, and they prefer a make-belief world. Dr. Crislip’s warnings regarding the credibility of our sources of information is interpreted by many as “you can’t trust anyone”, leading the way to believing whatever one fancies, since there are no objective facts of the matter to be considered. And given the exponential rise in published research, this is certainly easier than actually looking through the deluge of studies, articles, reviews and meta analyses that are out there. Sometimes I think that even if I spent all day reading, there would still be more articles coming out everyday than I could read. I will never catch up on the literature (putting quality aside, of course).
    As a pain reaseacher I do, however, have a few remarks on what on Dr. Crislip wrote:

    “Readers of my entries know that my assessment of placebo: it does not alter pathophysiology, just the perception of pain and disease”

    But when it comes to pain, it is generally agreed that perception is an important factor in the condition, and many studies have shown that patients’ attitude towards their pain is predictive with regards to their recovery chances. Patients who are more anxious and feel more helpless about their pain recover more poorly. The whole rationale of cognitive behavioural therapy (most commonly used with the standard treatment for chronic pain) is to promote a change in the patient’s attitude to and perception of his or her pain. Therefore, in this case, it is not “just the perception of pain”. The perception can change the condition.

    On the issue of double blinding, Dr. Crislip write:
    Did they remove the N-ray and Clever Hans bias? Nope.

    “health care providers obviously were aware of the treatment provided, and, as such, a certain degree of bias of our effect estimate for specific effects cannot be entirely ruled out.”

    Right there you know that the results are mostly worthless:

    Unfortunately, non-pharmaceutical pain interventions do not lend themselves very easily to double blind studies. In my opinion, the best way to overcome this problem is to separate the treatment and testing, such that the testing (before the trial, after and at follow-up) is done by personnel unrelated to the carrying out of the treatments. Furthermore, it is crucial to consider what the control group gets. What are we comparing? CBT is generally accepted not because it has been proved superior in a double blind study (that kind of design would be impossible), but because it is more effective than other existing methods. Sadly, too many studies use a waiting-list/no treatment control group, which to me seems like no control at all. What does this say about the specific treatment that was tested? Nothing whatsoever.
    Recently I have been looking more closely into the data regarding mindfulness interventions. We all know, Mindfulness is all the rage nowadays. All the cool kids do it. Respectable universities have centres for it. It is applied to a vast range of conditions, from depression to chronic pain to cancer and AIDS patients and through to stress management and anxiety. It is often combined with brain imaging and immunological essays. But what is the placebo group getting? Often nothing, or very little. (if someone out there knows of some helpful review of this gargantuan body of literature, do make yourselves heard!).
    Here is a recent example from a study to be published in a top-notch journal (Brain, Behavior and Immunity), by some of the leading investigators in the field of psychoneuroimmunology, titled: Mindfulness-Based Stress Reduction training reduces loneliness and pro-inflammatory gene expression in older adults: A small randomized controlled trial
    So what have we got? The researchers conducted a randomized control trial with 40 healthy adults aged 55-85 years who indicated an interest in learning mindfulness meditation techniques. The study participants were assigned to participate in an 8 week program of Mindfulness Based Stress Reduction (MBSR) or no treatment.  The investigators found that the mindfulness meditation program decreased the level of loneliness and also decreased pro-inflammatory gene expression in immune cells and markers of inflammation, such as CRP.
    Gee-whiz! You take a bunch of elderly people who want to do X, and let them meet twice a week with people who also want to do X, and at the end of 8 weeks, they feel less lonely than a similar group who wanted to do X but didn’t get to. And their immune essays indicate that a change too! But does this show anything about the effects of Mindfulness training? If this is the kind of science we get at Carnegie Mellon and UCLA, I say we are in serious trouble.
    The main problem with mindfulness is that it is not science-based. Although attempts to describe and explain mindfulness and meditation in scientific terms are arguably less counter-science than, let’s say, the ideas of homeopathy or psychokinesis, they are still unsatisfactorily vague. A lot of people are fooled by colourful fMRI pictures, and fail to see that these can only establish a correlation, not a causality. The uncritical embrace of mindfulness interventions by many in the scientific field is a mystery to me.

    One point regarding acupuncture for pain: there is no solid evidence for it, and the method itself is incompatible with out scientific knowledge. I’d like to point out, however, that TENS (Transdermal or Transcutaneous electrical nerve stimulation) is a commonly prescribed treatment for pain, despite the fact that its efficiency is continuously debated (Steven Novella claims differently, here). But because TENS was constructed with a science-based theory in mind (gate-control theory of pain), it seems to require less evidence to be advocated. Nevertheless, the evidence supporting it is unreliable so it should be chucked into the the same bin as acupuncture, science-based or not (and while you are throwing out the trash could you dump that gate control theory as well?). The lesson here is that evidence-based should prevail over what is scientifically plausible.

    Finally, I get back to my first point: how should we fight this plague of ignorance? It seems to me that debunking myths and SCAMs is not enough, especially as the public is confronted with an overwhelming flood of contradicting information. The trouble with science is that it is too fragmentised, compartmentalised and specialised to be easily communicated in these “sound bite” time. What is required, IMHO, is a joint and conscious effort by the scientific community, to integrate the knowledge that has been acquired in separate but related research fields and to formulate a framework that links this knowledge to the realm of human health and presents this in plain language and at level of analysis that any person could relate to, thus promoting a better understanding of what constitutes “health” or “well being”. One reason that SCAMs are so popular is that they sell a beautiful and simple make-belief world. We should retort by pointing out that the world as revealed by science is magnificent in and of itself, no need to add any esoteric or mystical crap.

  29. Ztetic: I took Vit. C, when no one told me it couldn’t work for asthma. And, what I found out is..it worked..not once..twice..I would say atleast 100′s if not 1000′s of times over a period of 10 years. It wasn’t until I took them everyday, with other nutrients, and changed diet to organic, that I have rarely had a problem with asthma/colds/flu now for about 4 years. Yet, there are no clinical tests/trials I’ve found that are acceptable to conventional medicals regarding it. So, not finding one that regards it’s effectiveness for pertussis is not surprising to me now, but I will give some links for it anyway…which tell me they would work, because of what I know personally…

    http://www.whale.to/vaccines/whooping2.html
    Vitamin C and whooping cough

    Ninety children with whooping cough were given vitamin C orally or were injected with 5000 milligrams daily for 7 days, with the dosage being gradually reduced until a daily level of 100 milligrams was reached. A control group was given the whooping cough vaccine.

    Results:

    The duration of the disease in the children receiving vitamin C was 15 to 20 days, while the average duration for the children receiving the vaccine was 34 days. When vitamin C therapy was started during the catarrhal stage, the spasmodic stage was prevented in 75 percent of the cases.

    http://vaccinationcouncil.org/media/The-Vitamin-C-Treatment-of-Whooping-Cough.pdf

    This one is regarding Vit. D…

    http://healthyprotocols.com/pertussis.htm

  30. BillyJoe..prove myself wrong? The only way I could think of doing that is.. stop taking Vitamins for a length of time, 5 months? and if I get flu, cold, asthma attacks back, that will prove it to me..but, it still would not prove it to you or anyone else..and, you’d probably advise me to take asthma meds! Thanks ! :)

  31. It’s late, and I’m going to shut down now. I’d like to invite you all to visit my site..where some actual experiences of others I came across or spoken to me personally are..at the bottom of the home page. There’s other things also there that may be of interest..:)

    http://gethealthybehappy.yolasite.com/

  32. elburto says:

    RH – The vision of someone who believes it’s possible to eat a “chemical-free diet” claiming “Medicine is easy!”, is a perfect example of the Dunning-Kruger effect in action.

    You can’t just yell “Toxins!” and then declare yourself able to identify or eliminate disease.

  33. mousethatroared says:

    Here’s a link that may be relavant to the discussion of meta-analysis.

    http://www.fammed.wisc.edu/sites/default/files//webfm-uploads/documents/outreach/mindfulness/res-mindfulness-parachute.pdf

    Sorry if it’s been referenced before.

  34. @elburto..I’m saying toxins And vitamin deficiency. I believe the both, if looked studied and applied, will alleviate most common ailments prevalent today. As I said, no, not all, but more than we realize.

  35. Jan Willem Nienhuys says:

    believes it’s possible to eat a “chemical-free diet”

    Ha! That would be a diet without

    1. dihydromonoxide (see also http://www.dhmo.org/facts.html , how anyone dares touch the stuff is beyond me! )
    2. sodium chloride or NaCl
    3. pentahydroxyhexanal or C6H12O6
    4. 2-Amino-3-methylpentanoic acid or HO2CCH(NH2)CH(CH3)CH2CH3 and similar compounds
    5. cis-9-octadecenoic acid or CH3(CH2)7CH=CH(CH2)7COOH and similar compoumds

    and countless other chemicals. I suggest RH to try to use a diet without the above ingredients for a fortnight or so. Instructions how to do that by cheating can be obtained from Jasmuheen, foundress of breatharianism. How to do it without cheating, I have no idea.

  36. Harriet:

    Just because someone says something on an activist website doesn’t mean it’s true. Your claims that fluoride causes Hashimoto’s and obesity are unsubstantiated and appear to come from statements on anti-fluoridation websites. Citation needed! I couldn’t find anything in PubMed, but maybe you can.

    This is what’s on pubmed that I found..

    http://www.ncbi.nlm.nih.gov/pubmed?term=fluoride%20and%20hypothyroidism

    http://www.ncbi.nlm.nih.gov/pubmed/17725042

    Abstract

    The serum biochemical indexes (level of triiodthyronine, thyroxin, thyrothropic hormone of adenohypophysis, level of cholesterol, triglycerides) and the level of iodine excretion with urine in rats with hypothyrosis corrected by “Iodid-100″ and along with excessive intake of chlorine and fluorine ions into the organism had been studied. It has been revealed that hypothyrosis has negative influence on lipid metabolism indexes. “Iodid- 100″ usage stabilized hormonal and lipid status. Excessive intake of chlorine and fluorine ions by the organism decreased the effectiveness of iodine containing drugs.

    http://www.ncbi.nlm.nih.gov/pubmed/4088985

    Abstract

    Altogether 123 persons were examined: 47 healthy persons, 43 patients with thyroid hyperfunction and 33 with thyroid hypofunction. It was established that prolonged consumption of drinking water with a raised fluorine content (122 +/- 5 mumol/l with the normal value of 52 +/- 5 mumol/l) by healthy persons caused tension of function of the pituitary-thyroid system that was expressed in TSH elevated production, a decrease in the T3 concentration and more intense absorption of radioactive iodine by the thyroid as compared to healthy persons who consumed drinking water with the normal fluorine concentration. The results led to a conclusion that excess of fluorine in drinking water was a risk factor of more rapid development of thyroid pathology. Indicators of the fluorine content in daily urine provide most of the information on changes of the fluorine amount in the body.

  37. Here’s something, as in diabetes..everyone is looking at, blaming..sugar, fats, poor diet/exercise..etc. This shows the link of diabetes with toxins…

    http://chriskresser.com/how-toxins-are-making-us-fat-and-diabetic

    Each year the toxic burden in our air, food and water – and thus our bodies – grows higher than ever before. Companies manufacture 6.5 trillion pounds of 9,000 different chemicals each year. That’s about 3.25 billion tons – enough to fill an ocean supertanker. And the same companies release over 7 billion pounds of 650+ different pollutants into the atmosphere and water.

    A recent study by the Environmental Working Group (EWG) found the average person has over 91 toxic chemicals in their body. Some people had as many as 165, including 76 known to cause cancer, 94 known to be toxic to the brain and nervous system, and 79 known to cause birth defects and abnormal fetal development.

    Another EWG study found an average of 200 industrial compounds, pollutants, and other chemicals in the umbilical cord blood of 10 newborn babies. Chemicals found in the second study included the organochlorine pesticides DDT and dieldrin, perfluorochemicals, brominated fire retardants, PCBs, polyaromatic hydrocarbons, polychlorinated and polybrominated dioxins and furans, polychlorinated naphthalenes, and mercury.

    If that wasn’t enough, the Standard American Diet itself is highly toxic. Processed and refined foods, industrial seed oils, high fructose corn syrup, and even so-called healthy foods like whole grains and soy all have a toxic effect on the body.

    How environmental toxins cause diabesity

    An increasing amount of evidence has linked exposure to toxins with both obesity and diabetes. Toxins cause inflammation and immune dysregulation. And as you know from reading this series, obesity and diabetes are autoimmune, inflammatory diseases.

    This goes together with another …

    Persistent organic pollutants (POPs) that contaminate ground and water may accumulate in the tissues of animals and be passed up the food chain, leading to human exposure. Some POPs have recently been associated with the prevalence of diabetes in a serum concentration-dependent manner [6]. The triazine herbicide, atrazine (ATZ, 2-chloro-4-ethylamine-6-isopropylamino-S​-triazine),has been extensively used in the USA since the early 1960s, a time frame that corresponds to the beginning of a time frame that corresponds to the beginning of the present obesity epidemic.

    http://www.plosone.org/article/info:doi/10.1371/journal.pone.0005186

    and quite a few others I can give… toxins are the cause of two of the biggest health threats in modern time..diabetes and obesity imo.

  38. I’ve long protested any carbon-based diet.

  39. I’m looking forward to the next SBM posts:

    Homeopathy is not where the heart is
    It doesn’t work, chiropractic-ally speaking
    Location doesn’t matter: accupuncture-ing holes in the quackery

  40. johnekap says:

    I agree with this analysis and have recently expressed a similiar view:
    http://www.amc.edu/BioethicsBlog/post.cfm/the-mess-with-meta-analysis

  41. Harriet Hall says:

    @Skeptical Health,

    Glad you appreciate puns.
    You asked for “accupuncture-ing holes in the quackery”
    I already wrote about Puncturing the Acupuncture Myth

    I have tried to do my part to “Pun”ish our readers whenever possible:

    Thumbthing Worth Reading
    Chiropractic Strokes Again
    Weight Loss Customers are Being Hoodia-Winked
    Menstrual Synchrony:Do Girls Who Go Together Flow Together?
    One Hump or Two? Camel’s Milk
    Residents’ Working Hours: Should We Let Sleeping Docs Lie?

    It’s so much pun to play with the language!

  42. Quill says:

    Rustic Healthy seems to have a Whitman-Byronic sense of the world. So be it. :-)

    There is a pleasure in the endless anecdotes,
    There is a rapture on the opinionated lore,
    There is a society, where no science intrudes,
    By the deep chasm, and full of gentle murmurs o’ every bore.
    I love not rustic nature less, but Science more,
    From these our views, in which I weigh
    All I may see, or have seen before,
    To accord with the known universe, and know
    What I cannot plumb with sense, yet still can reveal.

  43. Quill..very poetic..yes, I do love nature. But I do appreciate science too, except, I believe there’s a difference between good science and bad science :) remember that guys? last time I was here..well anyway..yes, I do appreciate good science, it actually helps me appreciate nature even more, to know the bounty of good things in it that are here for us to use..except..in a Good way…to use, not abuse. What we have now is abuse. Whether it’s in the toxins in food, air, water, and yes medicines..or, now the upcoming battle of actually twisting nature, into gmos/ge’s, then force feeding millions of people without their awares (including babies and children). That’s bad science..no matter how you package it. If it weren’t, then, label it..be proud of what you’ve done..right?

  44. Chris says:

    RH has also invoked Scopie’s Law:

    In any discussion involving science or medicine, citing Whale.to as a credible source loses you the argument immediately …and gets you laughed out of the room.

    I am quite sure she will buy that bridge if offered. It is more real than any of her “facts.”

  45. BillyJoe says:

    RH,

    “BillyJoe..prove myself wrong? The only way I could think of doing that is.. stop taking Vitamins for a length of time, 5 months? and if I get flu, cold, asthma attacks back, that will prove it to me..but, it still would not prove it to you or anyone else..and, you’d probably advise me to take asthma meds! Thanks ! ”

    I said prove your hypothesis wrong by doing a CLINICAL TRIAL not through more useless PERSONAL EXPERIENCES.

  46. Chris says:

    BillyJoe:

    said prove your hypothesis wrong by doing a CLINICAL TRIAL not through more useless PERSONAL EXPERIENCES.

    The personal experience of some with Vitamin after eating liver was not so positive. Because vitamins are chemicals, and too much can be dangerous.

  47. BillyJoe..oh…yes well..there are clinical trials, but none of them conventional medicals accept, the ones I find and show anyway. I don’t get it..I do believe it’s a bias, conventionals simply refuse to accept them, and I’m still not certain why.

  48. jmb58 says:

    “toxins are the cause of two of the biggest health threats in modern time..diabetes and obesity imo.”

    Certainly environmently pollution exists. As a lowly undergrad I studied an industrial chemical called TCE. But the cause of diabetes and obesity? Like, the only cause? This is absurd in so many ways.

    Here is an antecdote, RH’s favorite type of evidence.

    Ethnic Navajo’s have one of the highest per capita rates of diabetes and obesity of any group. The vast majority live in one of the most sparsely populated areas of the continental US. We are talking about vast stretches of wilderness. Shouldn’t they be exposed to less toxins? Shouldn’t they have one of the lowest rates of diabetes and obesity? Maybe the Fry bread (a Navajo staple) isn’t organic. Or maybe its bread fried in lard.

  49. Chris says:

    RusticHealthy:

    I don’t get it..I do believe it’s a bias, conventionals simply refuse to accept them, and I’m still not certain why.

    It is because you have a closed mind and refuse to learn.

    You have not even read the above article, because it is not about vitamins. It is about a lousy form of paper review called a “meta-analysis”, which was about pain management and acupuncture. A paper that decided that the pain from mumps was caused the same way as the pain from insomnia and endometriosis. Which is very silly.

  50. Fair enough jmb…but according to this..they are just beginning to start organic ‘food forests’…to fix the problem of diabetes..

    There are almost no organic foods being sold on the reservation. People often have to drive two hours or 100 miles to get organic or fresh vegetables or fruits. Diabetes, heart disease and other diet-related diseases are at epidemic proportions on the rez….

    Food forests are a way of working with nature to create stable ecosystems that grow lots of food. We mimic how a natural ecosystem of trees would behave in this zone. Because this is open prairie land and the main trees are pine forests, we will be experimenting to some degree to create a good microclimate for fruit trees. There are a number of successful orchards around that we are learning from.

    http://www.permacultureguild.us/category/projects/pine-ridge-reflections/

    so it is organic diet also of fruits and vegetables! :) But, that still (to me anyway), doesn’t mean what we have in the regular food stores..non-organic, polluted water supply with more chems, are not affecting us. seriously? 100′s of chemicals? of course they’re affecting us..but, good point..you got me there :)

  51. @rustichealthy: Citation is needed regarding your mention of clinical trials. You do also know that clinical trials have to pass through an ethics board before they can get started, right? This is even before we are talking about peer review. Which is why I would, as non-medical person, rather trust “conventional” medicine, over the quackery you are offering.

  52. Francois..my ‘quackery’ is on pubmed..

    http://www.ncbi.nlm.nih.gov/pubmed?term=ascorbic%20acid%20and%20common%20cold

    I’m not sure why when I mention Vit. C and respiratory, why it’s considered ‘quackery’ among conventionals though.

  53. Harriet Hall says:

    @Rustic,

    “I don’t get it”

    No, you don’t. And you don’t seem receptive to efforts to help you get it.

  54. Harriet..when clinical trials don’t show what I’ve experienced for myself, then I question them..I’m sure as anyone would. And, when I find other studies that confirm the same as I’ve experienced, then it’s hard for me to understand why they’re not acceptable. It seems that’s the confusion and stand-off. It’s not that I’m being ‘obstinate’, and ‘refuse to learn’..it’s that it goes against everything I know and experienced for myself. I was just told that it was a ‘placebo’ that at 5 years old, a doctor used acupressure that cleared my throat..but me as a 5 year old ‘imagined it worked’ and so it did! ..that’s just amazing to me :)

  55. Chris says:

    RusticHealthy:

    Harriet..when clinical trials don’t show what I’ve experienced for myself, then I question them..I’m sure as anyone would.

    That is because there is a great deal of variability between individuals. The studies show what generally happens.

    And, when I find other studies that confirm the same as I’ve experienced, then it’s hard for me to understand why they’re not acceptable.

    Except you have not listed any real reliable studies. You have listed websites of persons who claim to have found something, but there is no proof. And that includes the abstracts from Russia and the Ukraine.

    You have been told several times that the plural of anecdote is not data. Your stories are not clinical studies, they are your stories. Especially when you are telling us something that happened when you were five years old. The reason you are being told you refuse to learn is because you still insist that your stories apply to everyone.

  56. @rustichealthy: Just because it is on PubMed doesn’t mean it’s credible. PubMed is just a journal database, like JSTOR for the humanities. Moreover, you never cited any of those papers in your previous posts. The research papers listed have nothing to do with the things you mentioned before. I also doubt that: 1. you have read the papers you are linking to, 2. you understand them.

    Secondly, your personal experiences have too many variables that can influence your perception of health or lack thereof. All of those variables do not negate the soundness of clinical trials.

    Quite frankly, I am wondering what you are trying to prove.

  57. Harriet Hall says:

    @Rustic

    “when clinical trials don’t show what I’ve experienced for myself, then I question them..I’m sure as anyone would”

    No. A critical thinker or a scientist wouldn’t. If clinical trials didn’t show what I had experienced I would question (1) my perceptions, (2) my memory of my perceptions, and (3) my interpretation of my perceptions.

    I’m sure I could almost always find a trial somewhere that seemed to corroborate my experience, but I know enough to weigh that trial in perspective with all the other trials that didn’t.

    Just for the record, there are no nerve connections between the sole of the foot and the throat. The nerves only come into close proximity if you put your foot in your mouth. :-)

    I question your ability to understand the literature. When asked to provide citations for your claim that fluoride causes Hashimoto’s, you offered a study showing that excess fluoride decreases the effectiveness of iodine containing
    drugs and another study showing that excess fluoride “caused tension of function of the pituitary-thyroid system that was expressed in TSH elevated production, a decrease in the T3 concentration and more intense absorption of radioactive iodine by the thyroid.” Neither study supports your claim.

  58. BillyJoe says:

    BTW, they way I pronounce “meta”, it should be “I never meta analysis I really liked”

  59. weing says:

    @rusti,

    Here are some definitions that may help you see what’s preventing you from learning. They are from the wikipedia page on cognitive biases.

    A cognitive bias describes a replicable pattern in perceptual distortion, inaccurate judgment, illogical interpretation, or what is broadly called irrationality.

    Experimenter’s or Expectation bias – the tendency for experimenters to believe, certify, and publish data that agree with their expectations for the outcome of an experiment, and to disbelieve, discard, or downgrade the corresponding weightings for data that appear to conflict with those expectations.

    Selective perception – the tendency for expectations to affect perception.

    Selection bias – the distortion of a statistical analysis, resulting from the method of collecting samples. If the selection bias is not taken into account then certain conclusions drawn may be wrong.

    Semmelweis reflex – the tendency to reject new evidence that contradicts a paradigm.

    Subjective validation – perception that something is true if a subject’s belief demands it to be true. Also assigns perceived connections between coincidences.

  60. Just the other day..because a few of us (not only me now) were talking about how Vit. C 1000 helped with one, my asthma, two, this other person’s friend’s respiratory problem…a third person (having read apparently what we had written) decided to try it for herself..came back to the forum, and actually told of her experience..and how Vit. C 1000 worked for her..and her asthma as well. It’s on my site with her permission, but I’ll take out the nic here…(this is on Craigs List Health & Healing Alternative)…

    Since I heard here about vitamin C for asthma 09/09 19:57:40

    and have been taking it I have had less asthma attacks. I was really in bad shape with asthma til I started the C. I now take about 2000 mg a day and doing much better.

    (My question: How long have you been taking it?)

    a few days, its really helping 09/09 20:57:45

    and we have allergies to our cat which it helps. I’m going to take around 5 grams a day and see how I feel. I’ve just been taking 1 a day.
    I am taking 2 grams a day, 1 gram in the morning and 1 gram in the evening, which is 1000 mg each.

    Now, this is it.. anyone who actually claims something like that…you would still say, since it’s not in clinical trial..that she has a misconception also as to what happened,…whatever it is happened, since it’s not showing in a clinical trial, (that’s available anyway), that there’s something wrong with that person. ..and not something missing in the clinical trials?

  61. I don’t purposely want to be ‘difficult’, honestly! :) it’s just that’s how strange it is to me. Just wondering, do any of you have asthma, or something respiratory…and if you did, because you didn’t find a clinical trial on Vit. C, you would not even try it for yourself? That would be hard for me to understand too. Or, if you had a patient, that’s having a difficult time, you would not even consider trying to give that person, or suggest that person take some Vit. C? …

    and Dr. Harriet. regarding foot/mouth :) ..but, ..how would a thought in your brain tell the nerve in your toe to move? perhaps there is something that is not found as yet. And, all nerves are connected to the spinal chord…so, wouldn’t that be the physical connection point perhaps?

  62. Francois, I’m trying to prove, there are natural, less toxic ways of healing and health..that I’ve found for myself, and like to tell them, in hopes, we can have a more body and environment friendly way..even in a (good) scientific way, so we’ll all live longer, healthier, and happier. :)

  63. I always appreciate how the people who know the least anatomy are the ones that hypothesize all of these non-existant pathways in the body. Here we have rustic healthy suggesting rubbing your foot can help “clear the throat.” I’ve previously told the story of a pair of ex-friends, who are massage therapists, that claimed they could cure mutliple problems with reflexology. He told the story of how he cured a cast of constipation by hitting the right point on the foot. I told him that no such pathways exist. I then asked him a high-school level biology question, “Where is the liver?” And he didn’t know. So here we have someone, just like rustic, who is hypothesizing about mythical pathways, but they don’t know the most basic anatomy of the body. (How sad is it that this guy learned fake pathways – reflexology – but did not learn any basic real anatomy? And this guy paid for this, with loans. Reminds me of another quack profession that involves back cracking.)

    It really is a child-like naivety. “Oh, all of these amazing pathways in the body could exist!” And it really is created purely out of ignorance.

  64. Harriet Hall says:

    @Rustic,

    Yes, nerves in the foot go to the brain, and nerves from the brain go to the foot.
    Also, nerves in the buttocks go to the brain, and nerves from the brain go to the buttocks.
    Also, nerves from the left hand go to the brain, and nerves from the brain go to the right hand.
    How do you think the reflexologists picked the foot? Do you think they did any kind of testing before they posited their imaginary connections? Do you think it’s possible they might have just made the whole thing up?

  65. Harriet Hall says:

    @Rustic,
    “anyone who actually claims something like that…you would still say, since it’s not in clinical trial..that she has a misconception also as to what happened,…whatever it is happened, since it’s not showing in a clinical trial, (that’s available anyway), that there’s something wrong with that person. ..and not something missing in the clinical trials?”

    When something like vitamin C has been tested (http://www.ncbi.nlm.nih.gov/pubmed/21185068, etc.) and someone reports an improvement that contradicts the studies, it is far more likely that the improvement was due to one of the factors Barry Beyerstein listed in his articles “Why Bogus Therapies Seem to Work.” http://www.csicop.org/si/show/why_bogus_therapies_seem_to_work/
    and http://www.quackwatch.com/01QuackeryRelatedTopics/altbelief.html

    It doesn’t mean there is something wrong with the person. As Richard Wiseman put it: “The ability to find patterns is so important to your survival that your brain would rather see a few imaginary patterns than miss genuine instances of cause and effect… [that is] the price you pay for being so amazing the rest of the time.”

  66. Jan Willem Nienhuys says:

    I then asked him a high-school level biology question, “Where is the liver?” And he didn’t know.

    This reminds me of the time that I had written to the newspaper concerning some kind of quack treatment. I was called by a lady who wanted to demonstrate her magnetic healing. I said, ok. So there a was on my office chair, correcting freshman calculus paper or whatever, when she knocked my door. I for got most of her demonstration. It consisted in part of passing her hands close to my body, skipping the middle part “that’s where we are not allowed”. Actually I am not quite used to strange women doing that even though she was not touching me, so I was sweating or blushing (or both) profusely. The most astonishing was that she brought a well worn cardboard cover of a box (about 40 cm in my memory) that must have contained a model human body.nIt looked like something from a toy store. On that cover was a picture of same with the organs visible in garish colors. This she used as a guide to determine what might be wrong with me. She had no idea what the names of the organs were. I pointed to the kidney or the liver or the gall bladder, but she apologized that the spirits just guided her but never told her the names of the organs.

  67. Oh, please rustichealthy, you have no idea what is natural and what is not. 19th-century “natural” home remedies included mixing castor oil and turpentine into milk. Other “natural” home remedies included the use of kerosene. Don’t tell me that turpentine and kerosene are not natural.

    Since you only listen to personal anecdotes, you people are not only dangerous, you kill people.

  68. No I wouldn’t use turpentine, or kerosene…but there are other things. Why do you, no, not only you, but others too..assume we’re non-thinking dolts? seriously? I look up natural remedies..if they sound doable and sane, I may try it..baking soda, applecider vinegar, coconut oil, just those three if you actually look them up for yourself..you will find a myriad of things they are and have been happily and successfully used for..if you were interested..or not. It’s ok..just don’t assume something doesn’t work until you’ve tried it! Isn’t that the scientific way of things? attempt/experiment/prove/disprove? or do you simply jump to conclusions over something because you’ve read/heard it? who’s scientific then? :)

  69. And .. FL…maybe you should look up what conventional meds have done..an average of 100,000 deaths a year, because of meds taken as prescribed, correctly..so, seriously..you need to expand your knowledge and thinking and information sources. http://www.bmj.com/content/344/bmj.e3989

  70. BillyJoe says:

    RH,

    “Just wondering, do any of you have asthma, or something respiratory…and if you did, because you didn’t find a clinical trial on Vit. C, you would not even try it for yourself? That would be hard for me to understand too.”

    I’ve never had asthma but, if I did, I would not “try” vitamin C. Why? Because it has not been shown to help asthma and there is no known mechanism by which it could help. If I tried it anyway I would be just like you – using personal experience to find out what works, and science has shown that personal experience is the most unreliable way to find out what works.

    If I look up cures for asthma, I would probably find a hundred different remedies based on personal experience. I cant “try” them all. Why would I pick one instead of another. Why would I pick vitamin C instead of Buteyko? The only way to decide is through a clinical trial. So I would look up clinical trials of treatments for asthma and see what has been proven to work and use that.

    I cannot understand why you would not do likewise.

  71. Harriet Hall says:

    @BillyJoe,

    “I cannot understand why you would not do likewise.”

    I can. Evolution shaped our brains to prefer stories to studies. It was a survival advantage in our ancestors’ environment, and it provided the only way to find out things before we had science. But now that we have science, that advantage has turned into a disadvantage. We can only learn to overcome our natural tendencies by discipline and education in critical thinking skills. It isn’t easy.

  72. @RH: I take your bullshit seriously. My friend died because she preferred to listen to quacks like you, until it was too late. So no, I don’t think of people like you as unthinking dolts, more like religious zealots. I’ll take my chances with conventional meds over snake oil if that ever becomes necessary.

  73. BillyJoe says:

    I suppose I was hoping that RH had moved beyond the tyranny of his genes after exposure to so much helpful advice on this forum.

  74. Sorry to hear regarding your friend..that’s fine, we all make choices regarding treatments we prefer.

  75. “that’s fine, we all make choices regarding treatments we prefer”? I’ve never seen such a callous statement.

  76. FL..sorry, I meant to your statement..

    “I’ll take my chances with conventional meds over snake oil if that ever becomes necessary.”..

    that you have a choice regarding treatment you prefer.

    Snake oil..I never had snake oil..nor would I and, I wouldn’t compare vitamins/nutrients/real food to ‘snake oil’. I might relate it to chemical meds though.

    1. Harriet Hall says:

      @Rustic,

      Snake oil is a general term used for any treatment promoted without evidence of efficacy. Many of the claims for vitamins and “real foods” qualify. It is not the vitamins themselves that constitute snake oil, but the way they are used.

  77. BillyJoe…I was on conventional ‘remedies’ for asthma..including 2 inhalers and steroids. I find vitamins and nutrients like Vitamin C, omegas, and organic foods, much better. There are studies regarding Vitamins and asthma, that actually concur with my own experience before my finding them..so that’s how I see them as more than likely correct..here are a few..

    http://www.doctoryourself.com/asthma.html

    http://sitemaker.umich.edu/fm_integrative-approach_asthma/vitamins_and_supplements

    http://www.seanet.com/~alexs/ascorbate/198x/smith-lh-clinical_guide_1988.htm

    http://www.sciencedaily.com/releases/2011/08/110830081532.htm

  78. David Weinberg says:

    Rustic Healthy, you said:

    “Harriet..when clinical trials don’t show what I’ve experienced for myself, then I question them..I’m sure as anyone would.”

    You should think carefully about this quote from Richard Feynman:

    “It doesn’t matter how beautiful your theory is, it doesn’t matter how smart you are. If it doesn’t agree with experiment, it’s wrong.”

    If you don’t know who Feynman is, do yourself a favor and read one of his many biographies. One of the coolest and most quotable scientists ever.

  79. David Weinberg..mine does agree with experiment, just not the ones conventionals accept. And, my theory is based on my own experience. What I still wonder at is, the clinical trials, and how they’re held and what exact substance is used. Perhaps they’re not adequate enough. I gave 4 studies above, that do concur with my experience…that’s all the more reason I’m convinced the clinical trials may not be adequate.

  80. @rustichealthy: It’s been obvious for a while now that you do not even understand the papers you are linking to. Your latest comment also shows you have no clue how a clinical trial works. Let me make it simple for you:
    1. A proposal of study, including hypothesis, is submitted.
    2. It is presented to an ethics board.
    3. It’s peer-reviewed. The peer review includes methodology review.
    3.1. It’s replicated by other scientists, to rule out any statistical variation and anomaly.
    4. Paper is published.
    5. The trial is replicated again and again and again.
    There are more, obviously, but none of the non-conventional “trials” you are referring to include any of the steps, most importantly the ethics board part. Why? Because there is no ethics board for quackery.

  81. Jan Willem Nienhuys says:

    Asthma is a complaint that has a ‘natural course’ that is not always predictable. In 1966 a retired homeopath, Fritz Donner, wrote to a colleague the following: (see also: http://www.kwakzalverij.nl/701/Donners_Brief_an_Schoeler )

    Früher behandelte ich Asthma nach der von Jousset angegebenen Thérapie du Fond, Eigentlich mit sehr guten Erfolgen, so dass mehr und mehr Asthmapatienten mir von Kollegen, die meine Vorlesungen besucht haben, zugewiesen wurden. Als ich eines Tages der Mutter einer jungen Asthmapatientin das Rezept überreichte, sagte sie: Dasselbe Mittel hat uns unsere Hausärztin auch verordnet, es hat gar nichts genützt. Da ich nicht wusste, was die Kollegin sonst schon gegeben hatte, wollte ich telephonisch näheres von ihr erfahren. Aber sie war verreist. Um die peinliche Situation zu überbrücken, gab ich ein Placebofläschchen ab mit dem Bemerken: Wenn sie auf das von mir verordnete Mittel schon nicht reagiert hat, dann muss man mal was Besonderes zu Anregung der Gesundheitsreaktion geben. Nach 3 Wochen kamen Mutter und Tochter überglücklich mit dem Bemerken, dass die seit Jahren bestehenden und fast täglich auftretenden Asthmaanfälle vollkommen aufgehört hätten (16 Jahre später erfuhr ich, dass der “Heilerfolg” seither angehalten hat). Die Mutter erwähnte, dass Frau Doktor doch recht gehabt hätte, die sie so dringend zu mir verwiesen habe, da ich “der einzige Arzt in Berlin, vielleicht sogar in Deutschland wäre, der Asthma heilen könne”!!!! Ich habe seither bis zu meiner Ausbombung den von jener Kollegin zu mir kommenden Patienten zuerst Placebo gegeben und – soweit mir bekannt geworden – auch “alle geheilt”. Also eine psychische Heilung, ausgelöst durch das dumme Geschwätz der psychisch nicht ganz vollwertigen Kollegin,…

    I’ll translate this for those that don’t know German (please excuse me for any errors in my English):

    I used to treat asthma with the Thérapie du Fond as indicated by Jousset [a Parisian homeopath, 1818-1910, JWN]. Actually I had quite good results, so that more and more colleagues that had attended my lectures referred their patients to me.

    One day I handed the mother of a young patient a prescription for her daughter. Then she said: “Our family physician also prescribed that, but it didn’t help at all.” I had no idea what else my colleague had been giving already, so I wanted to call her. But she had departed on a trip. To get out of this predicament, I gave her a placebo bottle with the remark: “When she didn’t react to what I just prescribed, then we must give something very special to stimulate the selfhealing reaction.”

    Three weeks later mother and daughter came back elatedly. They said that the daily asthma attacks that had plagued the daughter for years had stopped completely. (Sixteen years later I heard that this curative result was permanent.) The mother mentioned that the family physician had been correct in referring her to me with such urgency, because I supposedly “was the only doctor in Berlin, maybe even in the whole of Germany who could cure asthma”!!!! Until the time that we were bombed [the homeopathic department of the Rudolf-Virchow Hospital was bombed in 1943, WWII] I have given placebo for starters to all patients that came from that colleague, and as far as I know, I have “cured them all”. In other words, a psychological cure, triggered by the silly prattle of a colleague who herself wasn’t quite right in the head…

    —-

    Donner goes on to explain that after the war he was treating a different kind of patients, for whom he was not ‘the famous homeopath’ but just a doctor like many others, and then the placebo effect didn’t work at all. Of course Donner’s memory might have been colored a bit.

    Whenever I hear of a ‘wonder cure’ of asthma that had an effect on a credulous person, I think of this experience of Fritz Donner (he had more such stories). And when the ‘wonder cure’ has last been mentioned 30 years ago and no scientific research on it has been done since then, I think: some people will believe anything. I have no idea about the ‘natural course’ of asthma or any other disease, i.e. how often it goes away by itself, but I guess that people who only speak from their own experience don’t know either.

  82. Jan Willem…well..ok..I don’t know how to dispute that. I can see how some asthma can be controlled also with stress reduction. Mine comes on at all different times.. I felt my wheezing asthma come back last January with a fast coming on cold/flu ..taking Vit. C again with some other things, like apple cider vinegar, honey and cinnamon..the cold/flu went within an hour, and I still haven’t had a cold/flu in 4 years now..(not only asthma). I felt them coming on, but ‘chased them away’ with an extra dose of Vit. C (have been taking Vit C and other vitamins daily as well)..I think that’s kind of unusual, for myself certainly, but it seems for most people..getting a few colds each year is pretty much “normal” yet I haven’t had any. I can give you a few more incidences other people, that they worked on..when nothing else “placeboed” them then?…

    they’re on my site…with some others, but here they are on Craigs List..

    https://forums.craigslist.org/?ID=217205897 – man with allergies

    https://forums.craigslist.org/?ID=219419072 – woman with allergies and asthma

    This is one with eczema..and apple cider vinegar (not vit. C)… when nothing else worked…

    https://forums.craigslist.org/?ID=219230028

    My son, who had bad allergies for over 10 years, (to dust among other things) I’d mention once in a while how he needed perhaps vitamins..but, he turned it down. However, within a month or so of taking Vit. C, and a few other vitamins, going organic, and taking bee pollen granules, totally stopped all sneezing/congestion and hasn’t had it back since..over a year now. He’s now the new organic/vitamin health nut!

    Regarding arthritis, which I have also, in my lower back (x-rayed and diagnosed by my doctor)..since taking calcium with magnesium and Vit D, has not troubled me since (no pain meds)…

    A woman I know, had terrible pain from arthritis in her arms..the pain meds did not help (placebo her) either, however, after taking calcium supplements when I suggested it, took them and came back happily telling me how much better she was!

    Am I saying conventional medicine doesn’t work? No, they do!..most times..perhaps..but, they also bring with them other dangerous substances, that cause other problems..which I prefer looking for a more natural healthy way of going.

    My belief is, it’s not just one nutrient..I believe they all work together better..as they’re found in natural whole foods..anyway. Now, I know no one here will believe anything I say, unless you’re in the position of actually having/wanting to try it. I hope you all remember it then, to see for yourself is all. :)

  83. Chris says:

    Ignore RusticHealthy. She is as close minded as Thingy.

  84. trrll says:

    @rustichealthy

    Before you conclude that Vitamin C really helped your asthma, you might want to read this:
    http://www.nejm.org/doi/full/10.1056/NEJMoa1103319

    In this study, asthma patients were given either an active medication, a placebo, or nothing. Patients who received the placebo did indeed feel better than patients who received no intervention. But objective measures of lung function showed that they weren’t better.

    So the net effect of the placebo was to produce an illusion of improvement, by making patients less aware of their breathing problems.

    Considering that fatalities from asthma often arise because patients are not aware that they are suffering an attack, and delay seeking emergency treatment, can you see how this might not be beneficial, and why subjective impressions of improvement in asthma symptoms, not backed by careful objective measures of lung function, should be regarded with great suspicion?

  85. Zetetic says:

    @rustichealthy:

    Whaleto and Craigslist are NOT reputable references for anything! Try

  86. trrll..I appreciate the study. Actually, it seems to address Jan Willem’s post, of how placebos worked on some if not many given placebos as well. It does not mention Vitamin C as being used,

    Among the 39 patients who completed the study, albuterol resulted in a 20% increase in FEV1, as compared with approximately 7% with each of the other three interventions (P<0.001). However, patients' reports of improvement after the intervention did not differ significantly for the albuterol inhaler (50% improvement), placebo inhaler (45%), or sham acupuncture (46%), but the subjective improvement with all three of these interventions was significantly greater than that with the no-intervention control (21%) (P<0.001).

    nor does it mention omegas..which I found to be more effectively rounding out my treatment together. Vitamin C diminishing congestion (acting as a natural antihistamine) and omegas addressing inflammation..part of what effects or is part of asthma attacks as well. That was in my experience actually, before reading about them. I would very much like to see a clinical trial on it though. Just a note, the vitamin C clinical trials I've come across were ascorbic acid, and I found Vit C 1000 mg with bioflavanoids and rosehips (more closely to whole form) to be more effective ..so that would be another variable to consider.

  87. The Dave says:

    You mean I shouldn’t rely on classified ads and cetaceans for my medical/scientific knowledge? :)

  88. trrll says:

    @rustichealthy

    You’re missing the point rather dramatically. Your anecdotal evidence that vitamin C helped your asthma is based upon your subjective impression of benefit. But I just presented you with evidence that subjective impressions of benefit in asthma are not trustworthy–as evidenced by the finding that a placebo can produce a subjective impression of benefit without any objective benefit.

  89. trill..I would have considered it subjective before finding other studies that found Vit. C does help with asthma. That’s what makes me more sure of it.

  90. Harriet Hall says:

    @rustic,

    You have not yet learned that you can find studies to support practically anything, and that truth is approached by weighing ALL the evidence pro and con and paying attention to the quality of the different studies.

    This systematic review found WEAK evidence (no randomized studies) for the role of nutrition in asthma prevention, and it found NO evidence for a role for vitamin C. http://www.ncbi.nlm.nih.gov/pubmed/21185068

    This systematic review of randomized controlled trials http://www.ncbi.nlm.nih.gov/pubmed/19160185 found insufficient evidence to support using vitamin C for asthma.

    And here’s another negative review: http://www.ncbi.nlm.nih.gov/pubmed/18410255
    And there are more.

    And consider that these studies generally look at unreliable self-reports of dietary intake and that people who take vitamin C supplements or get more in their diet may be healthier in general, and the vitamin C may not be the causal factor. Maybe people who are healthy are more likely to eat a nutritious diet and to take extra vitamin C.

    What you did was to make up your mind based on your personal experience and then look for confirmation, rather than to wonder if you might be wrong and look for all the pertinent evidence pro and con.

  91. pmoran says:

    Rustic:trill..I would have considered it subjective before finding other studies that found Vit. C does help with asthma. That’s what makes me more sure of it.

    Reinforcing what Harriet has just said, the same can unfortunately be said about dozens of other dubious treatments. It is easier than we once thought to produce a few positive (usually preliminary) studies for inert treatments, only to find that the results cannot be replicated. Look at homeopathy, an extensively studied example. That looks great on paper if you select only positive studies.

    We should not say that you are definitely wrong in your suggestion that you have experienced a genuine therapeutic effect from Vitamin C (though some undoubtedly will say as much). That would require further large studies specific to your circumstances.

    Pharmacological doses of Vitamin C could have as yet unknown therapeutic benefits for asthma (as well as toxic potential when used long term), perhaps only in some subpopulations, and despite its extremely poor absorption in doses over about 1G daily, but present evidence remains not at all convincing for the reasons that others have outlined.. Is that “could have” strong enough to warrant the enormous expenditure that would be required to test it out in all possible ways and in sufficiently large, good quality studies? Probably not, in the present very competitive hustle for research funds..

    Is Vitamin C, despite the weak evidence, worth a try for those who find that conventional care is not adequately controlling their symptoms? There’s an interesting question.

    The answer will be “no” in these quarters, with some good reason, since poorly controlled asthma is a potentially deadly disease, and I seem to recall cases where self-experimentation has had fatal consequences. Any considering this should at least have an expert review of their whole situation first.

  92. Robb says:

    Rustic Healthy,
    For the love of god, please don’t use Craigslist anecdotes as some kind of proof or support for anything. They are the equivalent of:
    “So, the new Batman is going to win an Oscar for Best Picture.”
    “How do you know?”
    “Because my friend liked it.”
    I just learned the term “Strawman Sock Puppet” today actually. Many of your comments could go in the “How to” guide as textbook examples.
    Clinical trials are not without their flaws and limitations, but they still tell us more than some random internet cool story bro moment.
    As for vitamin C and asthma, the one study you linked (Science Daily website), it found some benefit for one age group only in asthma linked to mold and damp living conditions but overall concluded:
    “the effect of vitamin C on asthmatic children is heterogeneous.”
    Other studies have simply linked low levels of antioxidants like vitamin C with incidence of asthma. This doesn’t mean vitamin C will cure the asthma though.
    This meta-analysis of studies didn’t find much to write home about:
    http://www.ncbi.nlm.nih.gov/pubmed/19160185
    Vitamin C is a very important nutrient/antioxidant for maintaining health – so much so that I feel like we got short changed evolutionarily since many other mammals can make their own – but it isn’t a magic bullet by itself for diseases.

  93. Dr. Harriet, what I found in most ‘clinical trials’ was they used ascorbic acid, for one, and most used less than I would have, I took as much as I needed at the time..sometimes more than 2 or 3000 mgs..sometimes just 1000. Also, I did find one that said military and athletes did benefit from Vit. C, but not the general population type. You’re right, the military and athletes were likely in better shape, younger and better diet. But, that tells me, the general population either needed a better diet, or more of the right kind of Vit. C, or both, such as the one I found more effective in my experiment on myself. What I find in the studies that generally do concur with my experience is, they do use a little more Vit. C mgs. (though they usually used ascorbic acid). But, even they didn’t try Vit C and omegas together..except one that I actually found, and was kind of good news to me. It needs to be more looked into imo.

  94. jmb58 says:

    “Reinforcing what Harriet has just said, the same can unfortunately be said about dozens of other dubious treatments”

    That is why this blog is so great. I barely have time to keep up with the literature in my field, not to mention all of the topics covered here. Nice to have thoughtful, critical authors with a sophisticated understanding of how to analyse and interpret the medical literature.

    The comment sections often add interesting details and serve as a guide to CAM based points and counterpoints.

    Just wanted to give a shout out to all involved.

    Craigslist links were awesome. I needed a good laugh.

  95. pmoran…Harriet and Robb..I still have my inhaler..I never would go without it if I needed it..and still won’t! I simply haven’t had a reason to use it in 4 years now, and, interestingly, as I said, I haven’t even had a full out cold in this time either! Considering how prone I am to them especially in cold weather, or just sitting in front of a fan or a/c, I find that more than sufficient evidence (for myself) that Vitamin C and omegas, and probably my organic diet as well..all are working very well together. I try to tell others about all that I do, but, many times shut down trying to speak of them (both here and on CL :) that’s the purpose of my site..to stress it isn’t just about one magic pill. Robb I’ll try not to use CL testimonies here again perhaps :) I do appreciate all your concerns, as doctors, I am sure you can’t go only on my experience, and I understand that. I’m simply hoping to open up a better interest and stop the automatic conclusion that vitamins may be only placebos. That is my hope here anyway. :)

  96. Just to add..perhaps, what I’m actually hoping is, any one or all of you would actually try what I’m saying for yourself. Then you’ll be better able to see, or then find or make happen, a clinical trial that will hold more weight to it, so to speak, to show others. That’s what I’m hoping..understanding there is no reason to simply believe what I’m saying is true otherwise.

    1. Harriet Hall says:

      @rustichealthy,

      Trying something for oneself is not a way to determine the truth. Please read Beyerstein at http://www.quackwatch.com/01QuackeryRelatedTopics/altbelief.html and/or http://www.csicop.org/si/show/why_bogus_therapies_seem_to_work/ If you try something and feel better for whatever reasons, you will attribute your improvement to the treatment and your attribution may be wrong. That said, eating a healthy diet is always a good idea.

      Example: with the recent popularity of gluten free diets, lots of people tried putting themselves on a gluten free diet. Many of them felt better (maybe just because they were doing something to help themselves) and condemned themselves to a lifetime of diet restrictions when they were not really gluten sensitive.

      Another example: people think aspartame gives them headaches. They stop the aspartame and the headaches stop. In a double blind test, they get headaches when they are given a placebo and think they are getting aspartame, and when they are getting aspartame and don’t know it, they don’t get headaches.

      “Try it, you’ll like it” is OK for tasting new foods, but in medicine we have to TEST, not just try things for ourselves.

  97. Harriet, with respect..the first link http://www.ncbi.nlm.nih.gov/pubmed/21185068 Conclusion..weak but nonetheless supportive :

    The available epidemiologic evidence is weak but nonetheless supportive with respect to vitamins A, D, and E; zinc; fruits and vegetables; and a Mediterranean diet for the prevention of asthma. Experimental studies of these exposures are now warranted.

    the second “insufficient”… http://www.ncbi.nlm.nih.gov/pubmed/19160185:

    At present, evidence from randomised-controlled trials is insufficient to recommend a specific role for vitamin C in the treatment of asthma. Further methodologically strong and large-scale randomised controlled trials are needed in order to address the question of the effectiveness of vitamin C in children with asthma

    and with the third http://www.ncbi.nlm.nih.gov/pubmed/18410255

    A higher dietary intake of antioxidants was not associated with a lower risk of having asthma.

    So, in this one, it is indicated diet alone is not sufficient, but the others, added vitamins were supported and indicative of further study.

    I think that’s a little promising…imo.

    1. Harriet Hall says:

      @rustichealthy,

      “I think that’s a little promising…imo.”

      Yes, it’s a little promising, and suggests that vitamin deficiencies might contribute. BUT it doesn’t promise to support your argument for the role of vitamin C in asthma.

  98. trrll says:

    @rustichealth

    “trill..I would have considered it subjective before finding other studies that found Vit. C does help with asthma. That’s what makes me more sure of it.”

    This is a common cognitive error–one of those seductive bad habits that experience with actual scientific research and real statistics helps to break.

    I showed you that your subjective impression is not reliable evidence, but you rationalize that it is valid because you came across some weak studies that make similar claims. Your mistake is in imagining that a bunch of weak evidence adds up to strong evidence.

    This error in thought is the basis of the adage, “the plural of anecdote is not data.” What this summarizes is that a bunch of weak evidence does not “add up” to become strong evidence.

    Keep in mind that there are a lot of scientists (a major meetings in just my own field typically has attendance in the tens of thousands). Some results are going to be in error just by chance, just as you can occasionally get long runs of heads from flipping a fair coin. The risks are higher for studies that are not properly controlled–that are not double-blinded, or worse, do not even include placebos. Retrospective studies, which try to infer causality from correlation after the fact (e.g. studies that try to figure out what is a healthy diet by comparing what sick people and healthy people eat) are also particularly prone to error. And there is publication bias, so positive findings are more likely to be published than negative findings. So if you pore through PubMed just looking for abstracts that support whatever wishful thinking notion you might have in your head, you will almost certainly find it–particularly if you are willing to accept vague descriptions of research published in an obscure foreign language journal. Practicing scientists have learned this the hard way. They know that a PubMed search is just the starting point; to draw reliable conclusions, you have to read the actual studies–and have the statistical and scientific knowledge to read them critically–in order to separate the wheat from the chaff.

  99. The Dave says:

    RH:
    “I haven’t even had a full out cold in this time either! Considering how prone I am to them especially in cold weather, or just sitting in front of a fan or a/c,”

    Further evidence that you lack an understanding of epidemiology, paired with a healthy dose of confirmation bias, etc. Colds are not caused by getting cold (i.e going oiutside or “sitting in front of an ac”) but caused by an airborne, pathogenic virus. Perhaps you HAVE been getting colds, but they were nothing more than a minor sniffle, so therefore you forget about, thus confirming that”Vitamin C is keeping me healthy”

  100. Quill says:

    @ The Dave: well, wasn’t it Dr. Leechmore in the 17th century who said “Certain miasmas are prone to follow the cold currents of air, lodging in the humors and causing phlegm to form.”? I believe a descendant of his led the fight against air conditioning, warning the public that it would cause miasmatic colds, disorders of the water element and too much ease in the summer. ;-)

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