Jul 15 2008
Should I Take a Multivitamin?
I’ll start with a confession. I used to do something irrational. I used to take a daily multivitamin, not because I thought there was good scientific evidence to support the practice, but for psychotherapy. I tried to eat a healthy diet and worried about it. By taking a pill, I could stop worrying.
Then I found out that higher intake of vitamin A was associated with an increased risk of hip fractures in postmenopausal women like me, and I stopped. (High doses of vitamin A also cause births defects and are contraindicated in pregnancy.) Now I only take supplemental calcium and vitamin D, not on general principles but because of personal risk factors.
We’re being bombarded by advice to take vitamins and various other supplements. Health gurus like Andrew Weil recommend that everyone take vitamins (which they just happen to sell). The orthomolecular followers of Linus Pauling want us to take megadoses of vitamins. Ray Kurzweil tells us we should take vitamins to make us live longer; he takes 250 vitamin and supplement pills a day and thinks he will live forever. (You can read about his ideas in his book Fantastic Voyage: Live Long Enough to Live Forever.) Who should we believe?
I don’t get my medical information from popular sources. I rely on primary sources and on secondary sources that I have come to trust to accurately represent the current state of the peer-reviewed medical literature, for instance, the American Academy of Family Physicians and The Medical Letter.
The official position of the American Academy of Family Physicians is not to recommend vitamins or other supplements for the general population. They say
The decision to provide special dietary intervention or nutrient supplementation must be on an individual basis using the family physician’s best judgment based on evidence of benefit as well as lack of harmful effects. Megadoses of certain vitamins and minerals have been proven to be harmful.
The Medical Letter is an independent unbiased source written by a group of experts who review all the literature and provide periodic updates. Their most recent review of vitamin supplements (Vol 47 No 1213, p.57-8, July 18, 2005) concluded,
Supplements are necessary to assure adequate intake of folic acid in young women and possibly of vitamins D and B12 in the elderly. There is no convincing evidence that taking supplements of vitamin C prevents any disease except scurvy. Women should not take vitamin A supplements during pregnancy or after menopause. No one should take high dose beta carotene supplements. A balanced diet rich in fruits and vegetables may be safer than taking vitamin supplements. No biologically active substance taken for a long term can be assumed to be free of risk.
That’s it. That’s all science has to say about vitamins for the general population. Of course there are specific indications for individual patients with various health conditions. Patients who have had gastric bypass need large doses of vitamins. Niacin can be used therapeutically for patients with hyperlipidemia. There are lots of specific indications that your doctor knows about and can prescribe for. And if you have one of those indications, you may need a higher dose than you would get from a multivitamin.
Enthusiasts misrepresent the science. For instance, they are selling products to “prevent” age-related macular degeneration. A combination of high-dose beta-carotene, vitamin C, vitamin E, and zinc delays progression in patients who already have the disease, but there’s no evidence that it can prevent it from developing in the first place.
Beta-carotene is touted as an antioxidant, but it also has pro-oxidant effects in the body. There is good evidence that high-dose beta-carotene supplements can be harmful.
Supplemental beta-carotene may increase the risk of lung cancer, prostate cancer, intracerebral hemorrhage, and cardiovascular and total mortality in people who smoke cigarettes or have a history of high-level exposure to asbestos. Beta-carotene from foods does not seem to have this effect. In people who smoke, beta-carotene may increase cardiovascular mortality. In men who smoke and have had a prior myocardial infarction (MI or heart attack), the risk of fatal coronary heart disease increases by as much as 43% with low doses of beta-carotene. There is some evidence that beta-carotene in combination with selenium, vitamin C, and vitamin E might lower high-density lipoprotein 2 (HDL2) cholesterol levels. HDL levels are protective so this is considered to be a negative effect. Dizziness, reversible yellowing of palms, hands, or soles of feet and to a lesser extent the face (called carotenoderma) can occur with high doses of beta-carotene. Loose stools, diarrhea, unusual bleeding or bruising, and joint pain have been reported.
In addition to vitamins, we hear recommendations for all kinds of other diet supplements. There’s no good evidence for most of them. For fish oil, one of the most popular supplements, the evidence boils down to this:
(1) In patients who have had a heart attack, fish oil improves survival.
(2) It reduces triglycerides.
(3) In patients with high cholesterol levels it reduces the risk of coronary events but does not decrease mortality.
(4) It reduces blood pressure slightly.
Studies show fish oil may increase the risk of death and arrhythmias in patients with certain heart conditions, and high doses can worsen control of diabetes and can increase bleeding tendency.
The Medical Letter says,
Eating fatty fish may be beneficial for healthy people, but there is no evidence from prospective trials that fish oil supplements prevent cardiovascular disease in the general population.
I vote for leaving the fish oil in the fish.
Lots of people believe that vitamin supplements make a difference in our health and give us energy. Lots of people think taking vitamins will make you live longer. Different people believe many things; the real question is whether there is any evidence to support their beliefs.
You can find all sorts of studies and speculations suggesting that various supplements are good for you, but when you stick to rigorous science, the evidence just isn’t there. There are two philosophies: to take everything that is suggested just in case, or to wait for scientific validation before taking anything. Based on long experience, I consider the latter course more reasonable. I can’t begin to tell you how many times I’ve heard strong recommendations for something that was later shown to be useless or harmful.
One example: Vitamin E was strongly recommended to prevent heart disease and for other indications. Then they discovered that the high doses they were recommending were toxic. They lowered the dose. Then better studies showed that supplementation with vitamin E either did no good or made things worse.
More and more studies are showing that while vitamins in food are good for you, extra vitamins in pill form may not be so good. For instance, antioxidants were thought to reduce the risk of cataracts, but a 2006 study showed no effects. Then a 2008 study tested whether taking a Centrum multivitamin daily could slow the development of cataracts. They did find a reduction in “lens events” but there was no significant difference in the rate of cataract surgery or moderate visual loss, and the number of posterior subcapsular cataracts (the worst kind) doubled.
Most multivitamins contain iron, but there is evidence that lowering iron levels might be advisable. Lower body iron stores may protect against malignancy by reducing iron-induced oxidative stress.
There are some promising studies on vitamin D, but they haven’t yet translated into consensus recommendations for the general population. I’m withholding judgment; meanwhile there doesn’t seem to be any downside to taking 800-1000 IU of vitamin D a day if you want to.
There are many other things we can do to “improve our health” that don’t involve taking pills, vitamins or any other supplements. Eating a healthy diet, exercising, getting enough sleep, reducing stress, and maintaining ideal weight top my list.
Critics of medicine often pick on Big Pharma for its profit motives. How much money do you think Big Vitamin makes? How much money is being spent on unnecessary vitamins that provide no real benefit? Any excess is promptly eliminated. Are we just producing expensive urine? Are our toilets getting the benefit? Are all those vitamins in our sewage good for the environment?
One could argue that multivitamins are good for healthy sewage bacteria and healthy profits for manufacturers. But I’d rather support my own health than theirs.
231 Responses to “Should I Take a Multivitamin?”
Last week I underwent PRK (corrective eye surgery), and my surgeon told me to take 1000mg vitamin C daily for 3 months to aid in healing. Seems like overkill to me… I’m trying to get most of it by eating fruit instead of in pill form. Strikes me that between bioavailability and possible interactions with compounds we haven’t yet isolated, getting micronutrients the “natural” way trumps taking pills.
Not a primary source, but check out this report on how the usefulness of antioxidant molecules may be contingent on the method of consumption: http://www.economist.com/science/displaystory.cfm?story_id=11662560
I had read about multivitamins a few years ago and it really illustrated the value of scepticism. Even without the obvious quack cues there are plenty of inflated claims out there.
What do you think about other supplements? I have a friend that is ga ga over Resveratrol (http://en.wikipedia.org/wiki/Resveratrol). I’ve tried looking around for info and it does seem to be positive but I’m reluctant to take this at face value since I’ve seen how positive or hype stories make the press and more sceptical ones don’t. Do you know anything about this in particular or maybe just have some advice in general for evaluating supplements?
Resveratrol has some shades of Pascal’s Wager – if it works you stay healthy longer and live a good life and if it doesn’t work, you aren’t harmed. “If a longer/healthier life is worth the cost, why shouldn’t you do?” seems to be the common argument.
Big Vitamin. So true. Great post.
Amen. It’s good that people are suspicious of Big Pharma — but the very same people are all too often completely oblivious to the *existence* of Big Vitamin. Not that there’s always a difference between the two. The big multinational conglomerates aren’t stupid; they’ll horn in on anything that promises high profit margins for minimal risk, and vitamin manufacturing is exactly that. Just look at all of the big food companies getting in on the gig! It’s pure gold. For a trivial increase in cost, they can double or even triple the sale price of many of their products.
And all this for no benefit at all to the consumer. It’s just marketing.
If there is money to be made, Big Vitamin and also Big Herb will soon be owned by Big Pharma. At least when this happens there is a good chance that what is on the label is in the bottle.
Science can be hard on one’s beliefs. My thyroid pills are beginning to get lonely now that one by one the unnecessary vitamins are no longer going into my pill carrier.
Thanks for the post!
Adrian,
I’m skeptical about resveratrol. It hasn’t been tested in humans, just in animals – mainly mice. Its big claim to fame is that obese mice can avoid the adverse health effects of overeating by comsuming an amount of resveratrol comparable to 1500 bottles of wine a day for a human.
And Pascal’s wager doesn’t apply. We don’t know whether taking high doses has any adverse health effects.
The Natural Medicines Comprehensive Database doesn’t give it a “SAFE” rating but rates it as “LIKELY SAFE …when consumed in amounts found in foods. There is insufficient reliable information available about the safety of resveratrol when used in supplemental doses in amounts greater than those found in foods.”
It has antiplatelet effects and preliminary evidence shows that it might inhibit the cytochrome P450 enzymes, CYP3A, CYP1A, and CYP2E1. So there are potential interactions with other drugs and herbs. There is concern that it might have estrogenic effects, with potential danger in hormone-senstive conditions.
There’s also the problem that the commercially available products are sold under DSHEA rules and have not been adequately tested for purity and may not contain the amount stated on the label.
I’d say it’s a gamble, and in gambles like this the odds are against winning.
Very nice article.
Regarding a Pascal’s wager type of situation, the actually is the possibility of harm from even modest supplements. All of the large, double blind, placebo controlled, long term trials of supplements have found no benefits and perhaps slight negative effects of supplemental anti-oxidants. Short term trials have found positive effects sometimes, but usually those are much smaller trials and looking at surrogate endpoints.
The motivation for these trials has been the very robust and very reproducible correlation between a diet rich in green leafy vegetables and good health. My interpretation of this data is that “oxidative stress” is not set at all by diet, but is instead controlled by physiology; that your body has an “oxidative stress setpoint”, and then controls physiology to achieve that setpoint. If you consume excess antioxidants, then physiology must destroy the excess by generating even more superoxide. That excess generation of superoxide is responsible for the slight adverse effects observed in the large supplement trials.
With this interpretation, the explanation for the very robust correlations observed in diet and health is due to diet choice being due to the state of oxidative stress. If physiology calls for a high oxidative stress setpoint, a diet devoid of anti-oxidants is “healthier” than a diet rich in them because then physiology doesn’t need to destroy them. All the diet effects have been observed in self-selected diets. Diet choice is under physiological control, people choose diets which contain approximately the proper ratio of fat, carbohydrate and protein, approximately the appropriate number of calories and the proper amount of water and electrolytes. Presumably there are physiological mechanisms that adjust appetite until the diet that physiology calls for is consumed.
Non-self-selected diets are extremely difficult for people to adhere to. I think that diet choice is mostly an effect of a state of health, not a cause of it.
With this interpretation, supplements beyond levels needed to prevent deficiency diseases are unlikely to be beneficial, and may be harmful. If this interpretation is correct, excess antioxidants from any source, including green leafy vegetables may cause the same adverse effects of supplements.
I agree with what Harriet said about resveratrol. Many phytochemicals are metabolized by the cytochrome P450 system (the Phase I system) where they generate superoxide and that activates the Phase II system to detoxify the superoxide and reactive species produced by the Phase I system. Short term positive effects may not translate into long term positive effects because physiology may compensate for the deviation from the “setpoint” caused by the intervention.
Does anyone know anything about the need or lack thereof for vitamin supplementation in high performance athletes. Although the overall nutritional requirements are more extreme than average (e.g., caloric intake), do they also have greater need for vitamin intake? Does the increased caloric intake usually accommodate any increased need for vitamins?
DavidCT writes:
Good point! That would be useful. Partly due to a discussion on a credible blog, I’ve started taking CoQ10 regularly, and I do wonder about the quality control. (And the dose. But that’s a different discussion.)
Well, sort of. Population studies carry largish cultural and availability components.
Otherwise, self-selection runs into the obvious confounders present when diet choices are part of an overall lifestyle that can include greater amounts of exercise etc. Of course if that exercise has a good bit of sunshine included the vitamin D that results …
Big Vitamin is already owned by Big Pharma. In the largest drug related settlement in history Roche Pharmaceuticals payed a half billion in fines after being convicted of a price fixing scheme involving vitamins with other manufacturers. They met yearly at a fancy resort and fixed prices, like OPEC. One of the Swiss execs had to do jail time in Texas. Serves them right.
Kudos no evidence of benefit of any vitamin or supplement, only possible harm. As for Vitamin D you can get your fix by taking a walk in the sun without being slathered in sunscreen. That is probably why the only study to show benefit of Vitamin D and calcium was in French nursing home residents who probably didn’t get out much.
Another scam is how we have to eat processed ‘fortified’ foods to get the vitamins we need.
If supplemental dietary antioxidants don’t change the state of oxidative health, then oxidative health is not regulated at all by dietary antioxidants. I think people just have a hard time believing that, so they make non-physiologic stuff about “natural” vitamins being good and synthetic ones being bad. They are the same molecules. Synthetic vitamins are the same as natural vitamins.
I don’t think there have been any studies to look at actual needs for vitamins in high performance athletes to try and distinguish those needs from sedentary adults. Such studies would be difficult to do.
A reasonable expectation would be that the vitamin need would be proportional to caloric intake, which is actually a fairly modest increase.
One of the most extreme aerobic sports is the Tour de France. Those athletes only need to consume ~6000 calories per day to stay in balance.
http://www.sportsscientists.com/2008/07/le-tour-de-france-2008-feed-them-well.html
For someone with a basal metabolism of ~2000 calories, that is only a factor of ~3 higher. What ever increased food is required will also supply increased vitamins along with that food. I can’t think of any mechanism that would increase vitamin requirements more than proportional to energy consumption. It probably isn’t even be that high.
james – Actually people at northern latitudes tend to be deficient in vitamin D during the winter because of location. It’s why cod liver oil are traditionally used (and was given to children to prevent rickets). You can also get vitamin D from various cold water fish and liver. Cod liver oil tends to be high in vitamin A as well though, and tastes very unpleasant, so there are many reasons why pill form is a better choice for some people. There’s been research into the impact of vitamin D on prostate cancer in Canadians, which indicates that taking vitamin D or a vacation in the sun during the dark winter months is preventative (from my understanding, which may be incorrect, it’s due to the increased bioavailability of calcium since calcium and vitamin D work in synergy).
During the summer or if you live nearer the equator, getting some sun before putting on sunscreen makes more sense.
Derek Lowe has some very nice posts about resveratrol and other compounds that may (or may not) extend lifespan. See here: http://pipeline.corante.com/archives/aging_and_lifespan/.
Very interesting stuff, but I agree with Dr. Hall. There’s not nearly enough information to judge whether resveratrol (or any other supposed anti-aging compound) is likely to be either safe or effective in humans.
James,
Here in Oregon it’s the standard of pediatric care to prescribe vitamin D supplements to all infants, particularly if they’re being breast-fed. Moreover, higher incidences of vitamin D deficiency/insufficiency among immigrant groups from equatorial countries are well-documented in northern latitudes. (one example: http://www.ncbi.nlm.nih.gov:80/pubmed/17388737?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum). There’s nothing about this that says ‘scam’–it’s a valid health concern that is easily addressed by supplementing the diet. I think the same might be said of the other ‘fortified’ foods you mention–research has showed that the population benefits from having these important nutrients added (back, in some cases) to processed food. I’m not saying corruption doesn’t exist in ‘Big Pharma’ or the business of dietary supplements, just that the specific examples you cite are more about societal health benefits than about ‘sticking it to the little guys’.
my ophthalmologist was insistent about taking AREDS formula multivitamins (which involve some pretty high dosages). I’m very curious to hear your views on this. Is the medical evidence convincing?
This posts points out the logic some people use to take vitamins and supplements: “if it helps sick people, then it should also benefit healthy people, like me.” That’s the reason people take ginkgo to improve memory, when studies really only show a small benefit for those with memory difficulties.
One argument to disabuse people of this misuse of logic is to ask them why they don’t take insulin since it helps diabetics. This usually works pretty well. I don’t recall where I got this analogy (where’s the ginkgo?) but wouldn’t be surprised it if were from one of Harriett’s writing from long ago.
“wouldn’t be surprised it if were from one of Harriett’s writing from long ago.”
Guilty as charged, and not so long ago. From my SkepDoc column on Ultrasound Screening, Fish Oil and Ear Candles: “People see that fish oil improves survival after a heart attack so they assume it should also help prevent heart disease in people who don’t yet have it. That doesn’t necessarily follow: insulin improves survival of diabetics, but that doesn’t mean healthy people should take insulin to prevent diabetes.”
http://www.skeptic.com/eskeptic/08-02-20.html#feature
A lot of the biochemistry of vitamins is well known and well documented so I hope the ‘posters” here aren’t going to start asking for studies to back up what has been in biochem texts for decades.
The question is whether or not our diets bring us enough of these vital supplements and how much is enough and how much is optimum.
For those of us who see patients regularly, we can probably say with all honesty, the state of nutritional health and exercise health in the US is staggeringly poor. I have patients who have been raised on chips and soda and don’t even know what is happening when they feel soreness after exertion. Some have literally never experienced it. Literally.
Most diets are inadequate and I think supplements would be very beneficial to those. In fact, the number of people who have a perfect diet is probably few to none, so why not supplement.
I would challenge anyone who has a poor diet, or even a good one, who is also in their thirities or forties, who are relatively active and experience aches and pains associated with activity to increase their vit C supplementation and see if a good deal of those aches and pains don’t deminish.
I could relate my experience but the skeptics would just call it anecdotal so I’ll spare you. But I can tell you that my debilitating low back pain was greatly deminished as a result of regular supplementation with vit C, basically throughout the day, 250mg at breakfast, same at lunch, mid-afternoon, dinner and bed time. The original reason I started taking it has remained but after a few weeks I noticed that my back was not a concern, I could stand on my feet the morning after a long run and lost every ache I ever had in my knees, ankles and hands which would occur after exertion.
Sure we all know people who lived to a hundred without one single supplement. But supplements are not necessarily about living longer, they are about improving quality of life.
The biochemistry of C is pretty basic and once I pulled my head out of my behind, I realized what had occurred. It is very simple in some examples of supplementation and not so obvious in others.
nwtk2007 said,
“the number of people who have a perfect diet is probably few to none, so why not supplement.”
We don’t know what a perfect diet is, but it’s probably true that a whole lot of people have a poor diet. Why not improve their diet instead of popping pills?
It intrigues me that some of the same people who discourage prescribing pills for medical reasons encourage prescribing pills to make up for poor eating habits.
nwtk2007 said,
“I can tell you that my debilitating low back pain was greatly deminished as a result of regular supplementation with vit C.”
No you can’t. You can only tell us that your symptoms diminished when you took it. You can’t know whether they diminished “as a result.” Correlation doesn’t prove causation.
I thought from your posts on another thread that you were a chiropractor, or at least believed in chiropractic. I’m wondering why you chose vitamin C instead of fixing your subluxations.
Harriett, Harriet, Harriett,
You are just looking for an argument aren’t you?
Well I don’t have one.
As to improving the diet, if I thought is might actually be possible to get optimum levels in todays foods with out the cost of an arm or a leg, then I would be there with you. And for some healthy individuals, it cold very easily be all that is needed.
But lets face it, there is little health in the US today and there is too little education from anywhere that can overcome the ignorance that exists about diet and nutrition.
Basically, to get optimum levels of any of the supplements, and not just the RDA levels, a person would have to eat a great deal to say the least. Foods are just too “messed” with, to put it bluntly. Most are old, too processed, too treated with all kinds of gook, too handled, etc to even carry the optimum levels of nutrients like vitamins. It just can’t be done.
Besides vitamins are easier to get and cheaper to boot.
Also, it wasn’t just my back pain. I was developing a great deal of generalized pain over the years which became pronounced after activities which I had been doing all of my life. Those aches are also gone. The gradual increase in pain associated with activity occurred over ten to fifteen years and within three weeks of C supplementation had dropped to levels which I experience today.
And believe me, my activity levels are just as high as they ever were. Yes, at 51 I feel like I have been hit by a truck after two and a half hours of hard racquetball, but recovery is quick to say the least. Since I was 15 I have run 15 to 20 miles per week. The aches associated with the running disappeared as well, and those almost completely.
“Correlation doesn’t prove causation.” It kind of does if backed by research. The effects and biochemistry of vit C are very well understood and documented, almost to the point of being common knowledge. Are you saying that when I take an antibiotic for my “killing me” sinus infection and it gets rid of the sinus infection, that I can’t assume the antibiotic did the trick?
On this point, you must be high.
Also, I AM a chiro, but I, like the vast majority of the ones I know, do not treat subluxations. Now, I am wondering why you chose to end your last post with such a “smart ass” comment.
nwtk2007 said,
“Are you saying that when I take an antibiotic for my “killing me” sinus infection and it gets rid of the sinus infection, that I can’t assume the antibiotic did the trick?”
Yep. Read my post on antibiotics for sinusitis. http://www.sciencebasedmedicine.org/?p=12
I apologize for assuming you were a subluxation chiropractor: the majority are.
I think we CAN get optimum nutrition from food, and so do most scientists and dietitians.
Vitamins are cheaper and easier than food, but there is evidence that taking vitamins in pill form can be hazardous to your health. Didn’t you read what I wrote about that? That was sort of the whole point of my article.
jamesdouglasbremner:
“Another scam is how we have to eat processed ‘fortified’ foods to get the vitamins we need.”
Actually, the introduction of fortified flours a few decades ago was responsible for one of the great health advances of the 20th Century — a dramatic reduction in neural tube defects such as spina bifida in newborn babies. It’s not difficult for most people to get adequate nutrition through diet alone, with one major exception: pregnant women. Insufficient folate causes neural tube defects, the problem that the March of Dimes was originally founded to tackle. Serious defects are very rare nowdays.
But the price of this is that we’re spending money to fortify even the foods of people who aren’t pregnant women. Given the dramatic improvement in birth defects without any negative side effects from the somewhat increased level of folic acid, I think it’s worth it.
That said, there are a lot of fortifications that aren’t worth squat. Some of the worst offenders are beverage manufacturers, who are pushing ever closer and closer to making actual medical claims for their products (and in some cases, actually *are* making medical claims while thumbing their noses at the FDA — cf. Florida orange juice).
nwtk2007 ” “Are you saying that when I take an antibiotic for my “killing me” sinus infection and it gets rid of the sinus infection, that I can’t assume the antibiotic did the trick?”
Harriett – “Yep. Read my post on antibiotics for sinusitis.”
I read it. It seems that you are saying that is possible for a sinus infection to clear up without any antibiotic treatment. I would agree. I defeat these things in my head from time to time without an intervention other than antihistimines, which keep my sinuses dry, and stop the bugs from growing. I can honestly say that I have never defeated a sinus infection without at least the drying effect of an antihistamine.
Back when I worked in a hospital as a med tech I was beset with these things that would go on for months at a time, break free through sheer agony of sinus headaches and finally sinuses which would eventually open up, once right onto a patient from whom I was taking blood, and then return.
One of the doctors there gave me erythromycin and the sinus infection was 90% gone by the next day. I was amazed and have had to periodically take something when I unable to defeat the bug by other means.
In your article, you emphasize the possibility of recovery without antibiotic intervention, you don’t actually say antibiotics don’t work. So I can say that they do (assuming it truly is a sinus infection) just as surely as I can say that Vit C has done for me what I have said it does.
What medical science is saying, is that we shouldn’t be instantly going to the antibiotic. But there are risks. What was the death rate of sinus related encephalitis prior to antibiotics?
Antibiotics are a tough subject. How many lives were saved by them only to have the immunological weakness passed on to the population as a whole over what is now multiple generations of use? How many people would not be alive were it not for antibiotics? I think medicine is dug in too deep to turn that clock back, or perhaps not.
I also understand what you are saying about the dangers of some supplements. Your mention of the link of beta carotene and smoking and ling cancer is one I am familiar with as are some of the others.
It is definitely a big unknown so I will just stick to C for now.
Are there any studies showing that consumption of up to 1250mg of C daily, spread out over the day (water soluble you know) has any harmful effects? How many fruits and vegies would one have to eat each day to achieve that level? And how could you know you are actually getting that level? If you could each that much, you would most definitely be getting a great deal of fiber, but what about calories?
“Basically, to get optimum levels of any of the supplements, and not just the RDA levels, a person would have to eat a great deal to say the least. Foods are just too “messed” with, to put it bluntly. Most are old, too processed, too treated with all kinds of gook, too handled, etc to even carry the optimum levels of nutrients like vitamins. It just can’t be done.”
You are definitely getting the wrong messages from somewhere. Look up the numerous studies, both interventional and observational, looking at health outcomes with vitamin intakes from various sources. Contrary to what you say there is a strong association of certain health benefits with a high consumption of (even today’s) fruit and vegetables, but there is no consistent association with supplement usage.
Clearly there is more to a good diet than a certain mixture of vitamins and antioxidants. “Alternative” medicine has been guilty of medical negligence in its promotion of supplement usage at the expense of healthy living in other respects, even sometimes promoting supplements to mitigate the ill effects of a poor diet, alcohol and smoking .
nwtk2007, when you said
“Antibiotics are a tough subject. How many lives were saved by them only to have the immunological weakness passed on to the population as a whole over what is now multiple generations of use? How many people would not be alive were it not for antibiotics? I think medicine is dug in too deep to turn that clock back, or perhaps not.”
I only agree with the first sentence. You had better clarify what you mean and back it up with some references, as it appears you are labouring under the whole ‘antibiotics weaken the immune system’ delusion, and combining this with some type of misrepresentation of epidemiology. I cannot make sense of it as it stands. Are you saying that the human species has lost its ability to handle bacterial infections since antibiotics were introduced 60-odd years ago ??
What about recommendations for HIV-positive folks? There’s plenty of recommendations swirling the web that we need much higher levels of micronutrients than the normal population. I fell for a lot of it initially, then I noticed that the few studies all involved people not taking HAART. I’m on a HAART regimen (Truvada, Reyataz, Norvir) that’s working very well for me — no side effects, I feel fantastic; my CD4+ is >500 and my VL is undetectable. So I cut out almost everything except the multivitamin, a Ca+D+K supplement (to counteract bone loss), and a fish oil (to keep triglycerides in check). I eat a well-balanced diet, with one or two servings of plants at each meal. Knowing that my body is still under much greater stress than a healthy person, should I stick with my supplementation, or toss it out? What does some of your research indicate for folks with HIV or other chronic diseases? Thanks for your article here, please continue writing.
lee said,
“my ophthalmologist was insistent about taking AREDS formula multivitamins (which involve some pretty high dosages). I’m very curious to hear your views on this. Is the medical evidence convincing?”
I mentioned the negative and contradictory evidence for cataracts in my article, with links to 2 studies. The evidence for age-related macular degeneration shows that it slows progression of established AMD, but there is no evidence that it prevents AMD, and the high dose of beta carotene is worrisome.
The ophthalmologists I know do not recommend AREDS or similar formulas unless the patient has a moderate degree of AMD.
nwtk2007,
You missed the subtleties of what I said. The research I cited was only for bacterial sinusitis diagnosed by the clinical criteria used by many primary care physicians. It doesn’t apply to more stringent diagnostic criteria used by ENT specialists. Some cases of sinusitis do require antibiotics.
Your story about erythromycin doesn’t ring true. When antibiotics work, they usually take longer than that.
“just as surely as I can say that Vit C has done for me what I have said it does”
Didn’t you understand my point about correlation and causation? You can’t be sure you’re not committing the post hoc ergo propter hoc fallacy.
“antihistimines, which keep my sinuses dry, and stop the bugs from growing”
I was taught that antihistamines are contraindicated in sinusitis, because they dry and thicken the secretions and impede drainage. Antihistamiines are certainly not effective in treating sinusitis, and they certainly do notohing to stop the bugs from growing.
“the immunological weakness passed on to the population as a whole ”
What on earth are you talking about? Is this some myth you’ve fallen for, or a garbled account of bacterial resistance?
As for vitamin C, there is no reason to think you can’t get plenty in a normal diet, and there is no evidence that taking higher doses has any beneficial effect. If you think taking that dose makes you feel better, taking up to 2000mg a day is probably safe.
May I suggest an N=1 trial? If you can get identical-appearing pills and set up a double-blind so you don’t know which you’re getting and the person who gives them to you doesn’t know which you’re getting, you might find you can’t distinguish the effect of your vitamin C pills from the effect of a placebo.
Calli Arcale said,
“we’re spending money to fortify even the foods of people who aren’t pregnant women”
Fortifying foods affects the whole population, not just those who stand to benefit. Extra iron may be good for women who are menstruating, but bad for people with iron storage diseases, and may do more harm than good for men. People who eat fortified food and also take vitamins may get an overdose. Adding anything to our food should be very carefully thought out and the risk/benefit ratio studied.
We still recommend folate supplementation for pregnant women and women who may become pregnant, because we can’t depend on them getting enough from fortified foods.
Ideally, I’d rather see nothing added to food, and patients monitored for adequate nutrition and given individualized supplements when needed.
Dr Hall: good article. I can remember being handed vitamins as a child and being told to take them because they were good for me.
Now I wonder how much money my mother wasted on such things.
Re Sinusitis: My own experience is that sometimes it just clears up, and sometimes it doesn’t without aid. (yes, I know.. Anecdotes…)
But then, we haven’t really found a cure for the common cold either, just palliative treatment.
PS:
Where’s Antivax with his Whale.to cites proving you’re wrong?
(grin)
Wicked Lad wrote:
I’ve started taking CoQ10 regularly, and I do wonder about the quality control. (And the dose. But that’s a different discussion.)
I would suggest looking at http://www.consumerlab.com. They do independent testing of vitamins and supplements. They might have tested the brand you use.
Fortifying foods affects the whole population, not just those who stand to benefit.
Exactly my point, of course. I think that in the case of folic acid, it’s worth it to fight spina bifida. For the other things that are added, like iron, perhaps it was meaningful when the fortification programs began decades ago (when meat was more of a luxury), but not any more. Meat is cheap enough now that iron supplementation for everybody don’t make a whole lot of sense, at least in my opinion*. Vegans can take iron and B12 supplements; the rest of us should be fine.
*I’m a software engineer, not a dietitian, so adjust the value of my opinion accordingly.
What has a long standing criticism of vitamin and supplement research is that the administration of numerous vitamins has been limited to one body route. A large study is necessary to test the efficacy of natural supplements as they are administered in the form of anal suppositories. A similar method has been proposed to test homeopathic remedies; the standard regiment of 6 – 10 times per day, using both sprays and the little white spheres.
ai, again I submit too fast: What has been a long standing criticism,…
nwtk trots out one of the most retarded sales pitches of Big Vita (in which I include all supplement manufacturers, including pig farmers turned supplement manufacturers) – that food just isn’t good enough. Good food is more than adequate (I’m not talking the preprocessed food products and fast food that some Americans mistake for food, but fresh whole foods). What makes this pitch so obviously ludicrous is that the people who promote it simultaneously promote the idea that “natural is better” and “synthetic is evil” while promoting vitamins – pills instead of food!
Vitamin C is the granddaddy of the mega supplement industry. Even though there’s more than enough evidence to show that megadoses of vitamin C don’t prevent cancer, the common cold or much of anything apart from scurvy (worth avoiding though if you’re planning to spend months at sea with no access to fruit since it leads to loosing teeth!). Not to mention that Linus Pauling, who first promoted this idea, died of cancer! Sure he was old at the time but cancer is cancer and clearly the vitamin C didn’t prevent it for him (despite all the excuses people make up who want to believe or sell supplements). Pauling is notorious for having gone on a witch hunt, and of destroying the research evidence, of scientists associated with him who did research that revealed his theories weren’t valid (even though this evidence emerged as a result of trying to prove validity).
Besides, magnesium is actually more effective for muscle cramps (if one is deficient in magnesium, that is). It’s pretty telling that the person promoting supplements – nwtk – isn’t even aware of this and promotes vitamin C as a panacea instead. (I’d think it’s more of a placebo, people seem to respond better to placebos if their pee changes colour so vitamin C is tailor made for the job!)
That might be true in some parts of the world but not in the UK and it seems to vary tremendously with the brand. One recent calculation estimated that the basic set of recommendations costed out at £5.80 per person per day or around $11.50. You could buy some very decent additions to the diet with that sort of money, never mind the cost of adding in the raft of other supplements that some enthusiasts advocate.
However, I accept that there are cheaper brands. It just seems that people who spend serious sums on supplements might be better off buying a better diet, in the absence of clinical need for supplementation and the raft of tests that many ‘nutritional therapists’ seem to recommend.
nwtk wrote “But lets face it, there is little health in the US today and there is too little education from anywhere that can overcome the ignorance that exists about diet and nutrition.”
Actually, no, the problem is people like yourself trying to spread misinformation for profit! Doctors have been advising people get up off the couch and exercise, and eat a moderate and healthy diet (lots of leafy greens, whole grains, etc) since I was a kid (and I’m in my 40s now). As for being “more expensive”, real food has always cost more than “food products” (but real food is certainly MUCH cheaper than vitamins and supplements, especially the brands sold by chiropractors and naturopaths which are attributed magical properties). Where I live in Canada enrolling with a farm that is part of the local CSA (community supported agriculture) and getting a weekly box of organic fruit and veg from June through early November is actually cheaper in the long run than buying non-organic from the big supermarkets. But best of all, I get fresh picked, plant ripened fruit and veg that is much more tasty and interesting than anything that can be bought in a supermarket. And I get to know who grows my food and improve my local environment. But, really, the best thing about it is the vine-ripened, heirloom tomatoes that have as much flavor as the ones I ate as a kid!
And let’s not forget the overloading of the kidneys when they’re required to process unnaturally high levels and any vitamin. Just because something’s water soluble doesn’t mean that it flows right through one like water (though even too much water can cause death, more is NOT better than enough or even not enough sometimes!)
Yes Linus Pauling truly was a nutcase and the fact that he put medical faith ahead of empirical truth means that we should stop taking him seriously as a scientist, whatever his “real” scientific contribution was.
Folate: less than 1% of the female population has a genetic defect that makes them susceptible to having babies with spina bifida. This can be prevented with folate supplementation, but only if they are taking at the time of conception, not after. Yes we had vitamin deficiencies 100 years ago (e.g. pelagra here in the South, when the diet for most consisted of fatback, corn bread and molasses). The invention of the refrigerated train car meant that we can now eat fruits and vegetables all year round. We don’t need to take pills, unlike what Ray what’s his name quoted by the author says, that modern agriculture depletes vitamins from natural foods so you need to take pills. As for RDA you may not know it but this is set by USDA and is based on requirements for a young active male, and then doubled for good measure (see ‘The Vitamin Book’). If anyone actually followed this garbage they would become obese. Which is what Big Food wants– for you to keep eating their breakfast cereals, and other packaged/frozen/processed crap.
Vitamin C: most of it gets peed out so not toxic, unlike fat soluble vitamins (A,D,E,K) which can store up in the body and become toxic.
Studies of vitamins and alternative treatments in general: Only positive study yet from NCAM is chinese herbal medicine for IBS (need replication for that one!). Otherwise negative for black cohash, palmetto, ginkgo, etc etc. Whenever a trial is negative we change the criteria (i.e. they used the wrong dose, etc etc). Don’t we have anything better to spend our money on?
Physicians: don’t want to be seen as “against” alternative treatments. I read the reviews on alternative medicine by the American Family Practitioners journal and then went and read the primary sources and all of the “positive” evidence cited was highly flawed or not actually positive (e.g. statistically negative but authors made conclusions anyway).
eh, correction for clarity – let’s not forget the overloading of the kidneys when they’re required to process unnaturally high levels OF any vitamin.
[...] Original post by Comments on: Should I Take a Multivitamin? [...]
Man FiFi, you must know everything.
I have one comment about vit C and all of the sudden I am thrown into the Big Vita group. What a conclusion jumper.
And you say, “let’s not forget the overloading of the kidneys when they’re required to process unnaturally high levels OF any vitamin.”
Do you even know what is going on in the kidney. Processing? “Unnaturally high” levels. If I were touting natural versus synthetic you would probably jump onto that band wagon critisizing those in favor of “natural” as opposed to synthetic.
And then FiFi says “Actually, no, the problem is people like yourself trying to spread misinformation for profit! ”
What do you mean people like me? I don’t sell vitamins and I don’t promote the use of all supplements. Vitamin C yes, but not necessarily any others. The fact is you don’t know yet.
Don’t be so quick to attack and accuse and condemn FiFi. A great deal of what you say and the way you say it shows the level of your expertise and involvement.
Also, if you think poor health is not a problem, then you are truly blind. You don’t think there is a lack of education about nutrition in the US? Then how is the general public so ignorant about the subject? They know practically nothing about it. Whose fault is that anyway?
Most would not know a nutrient from a mineral just as they wouldn’t know a Motrin from an Advil from an ibuprofen, and it is because they are not being educated, but that is another story.
And wertys, I am not saying that antibiotics weaken the immune system, although there is evidence to suggest it and a vast number of medical opinions agreeing with that assumption. But I am not saying that. People are born with varying degrees of immune “strength”, so to speak, with some having high levels of factors present and some with low levels. What I am saying is that with the advent of antibiotics and their extensive use, the population as a whole has a greater number of individuals with deficiant immune systems and they are passing these “weaknesses” to their offspring. It is just natural selection and genetics. More weak survive and pass on their weakness.
And you shouldn’t be so critical of Linus Pauling, his original work in atomic structure still stands. He did go a little off the deep end with vit C, but when you see the diff with supplementation of C, then I can understand it, in a small way.
Pretty pretentious to think anyone on this forum is the better of him.
nwtk wrote “Most would not know a nutrient from a mineral just as they wouldn’t know a Motrin from an Advil from an ibuprofen …”
I have not finished your post; but I gotta be first to ask- what is the difference between Motrin, Advil and ibuprofen?
nwtk2007 said,
“when you see the diff with supplementation of C, then I can understand it, in a small way.”
Interesting. We offer him scientific information about vitamin C, suggest an N=1 trial, and explain that he hasn’t ruled out the possibility that he has fallen for the post hoc ergo hoc fallacy.
In return, he offers another unsupported claim (testimonial) that supplementation makes a difference.
He said, “How many lives were saved by them only to have the immunological weakness passed on to the population as a whole over what is now multiple generations of use?”
Then he said, “I am not saying that antibiotics weaken the immune system, although there is evidence to suggest it and a vast number of medical opinions agreeing with that assumption.”
Now I think I understand what he means. Antibiotics have saved lives and interfered with natural selection, allowing some individuals with “weaker” immune systems to survive. I hope he’s not advocating we abolish modern medicine to allow only survival of the fittest.
I don’t know of any evidence that antibiotics weaken the immune system and I have never heard that opinion from a reputable source. Where’s your evidence?
FYI, Motrin and Advil are brand names for ibuprofen.
Consuming vitamin C does increase oxalate formation. Calcium oxalate is the major cause of kidney stones. Consuming large quantities of vitamin C could exacerbate kidney stones.
http://jn.nutrition.org/cgi/content/full/135/7/1673
[...] bloggen Science-Based Medicine skrev hun i går om multivitaminer og fiskeolje. Her tar hun for seg hva vitenskapen sier om disse kosttilskuddene, noe hun har skrevet om også i [...]
When I wrote “what is the difference between” I think it should have been “what are the differences among;” although that, too, is lacking (from a certain point of view).
nwtk, do you have any reliable sources for the speculation you offer to wertys? … I didn’t think so.
nwtk wrote “And you shouldn’t be so critical of Linus Pauling, … He did go a little off the deep end with vit C, but when you see the diff with supplementation of C, then I can understand it, in a small way.
Pretty pretentious to think anyone on this forum is the better of him.”
Pauling went way off the deep end with his “orthomolecular” therapy. Pretty pretentious to think a chiropractor can evaluate that nonsense as, further, demonstrated by your confusion about your own use of vitamin C.
As for anyone on this forum thinking we are better than Pauling- where did you read that? Can you say “straw man?” I knew you could.
nwtk, and you know what the best part about homeopathic vitamin C in the 200C strength? You can use it as an anal spray 15-20 times per day and expect an excellent outcome. Just check whale:to for more information about homeopathic anal vitamin sprays.
Firstly, I certainly don’t know everything and make no claims to but I have bothered to educate myself about the things I speak about – clearly I know a bit more about which vitamins do what than you do.
Secondly, as a regular on these blogs any opinions about you and what you say are based on the entirely of your posts not just this one. I’ve taken my time coming to the conclusion you’re here to defend chiropractice and associated non-evidence based beliefs. I did note that you say you don’t believe in subluxations, however you have been consistently hostile to EBM (not questioning, just hostile and lacking in an understanding of science) in your posts here so it does make it appear as if you’re here to try to demean science and promote woo. Your beliefs about vitamin C seem to confirm that, as does your refusal to see that your subjective experience isn’t a form of evidence.
As for Linus Pauling. I don’t question his earlier work at all, only his work after he became so obsessed by proving vitamin C cures cancer that he started destroying evidence and going after researchers (that he himself had hired because they shared his beliefs) whose research showed that his ideas were wrong. This was a prime case of in-fighting between people who promote odd ideas of this kind.
I was reading a book titled “Homeopathy, scientific proofs of efficacy” by guna edditors. There are some very interesting studies they quote there. For example a homeopathic remedy was equal to non-homeopathic remedy in the treatment of common cold symptoms. Specifically, 6 weeks after the initial appearance of symptoms, there were no significant differences in the two treatment groups. They achieved equally impressive results during their treatment of other self-limiting conditions.
Linus Pauling: the looniness of his later “work” and lack of ethics calls into question the validity of what he did earlier. He did a tremendous amount of harm and wasted a great deal of resources on negative trials based on his “name” which people took to say “good scientist, whatever he says must be true” (i.e. take it on faith). What a great representative of the scientific profession. Waying the benefit versus the damage might be interesting. I for one don’t have time to do that analysis.
Antibiotics and inflammation: posters may not be as looney as some might think. Antibiotics decrease natural gut flora which affects leptin (neuropeptide that affects appetite) which may cause obesity (sorry saw this presented but not sure if it is published yet), there is some evidence for a link between obesity and impaired immunity.
http://www.ncbi.nlm.nih.gov/pubmed/12119664
I have never seen such defensive people. One little contradiction or even an offer of additional info and man, you too like Pauling, are off the deep end.
Instant assumptions and out of context interpretation of what I have posted. Is this typical? Read carefully please and try to get by your biases related to anything anti-chiropractic and evidence based anything.
I love your educating us about the diff between Advil, Motrin and ibuprofen. Duh! The point is that most people don’t know they are the same. Get it?
FiFi, you are a hoot. You say – “Firstly, I certainly don’t know everything and make no claims to but I have bothered to educate myself about the things I speak about – clearly I know a bit more about which vitamins do what than you do. ”
Clearly? Really? I hate to provide a resume just to counter this remark. So I won’t.
Daedalus – “Consuming vitamin C does increase oxalate formation. Calcium oxalate is the major cause of kidney stones. Consuming large quantities of vitamin C could exacerbate kidney stones.”
Yes, as does a high protein diet, and anything with elevated levels of phosphate. Are you familiar with the physiology of calcium and phosphate in the blood. The blood level concentrations of calcium and phosphate are altered, partially by kidney function such that the product of the concentrations remains a constant value, within physiological ranges. Totally another topic.
Harriett, yes you finally see my point. No I wouldn’t abolish medicine to prevent evolutionary changes or adverse genetic shift towards defecient immune systems, but it is a factor in medicine to always be considered.
Finally, many here apparently say, as did FiFi above, “subjective experience isn’t a form of evidence. ”
It is when coupled with good background knowledge and years of experience. The early humans came up with pharmacopia and “treatments” based upon just that, some of which still dominate today. Not many but some.
Research is good, but in most fields, there is as much for a “thing’ as there is against a “thing”. The ones against have their reasons for believing the “for” part and the ones against have their reasons for believeing the “against” part.
FiFi says I am hostile, but from just one post, I have been lightly assaulted and a bit insulted. But that is the fun of it.
I do not promote woo, what ever that is, or magic or what ever. I try to look without bias and objectivity, but, of course, personal experience makes me a bit like that also. But only a bit.
You say I demean science. Horse crap. I have been “in” science most of my life and ALL of my multi-faceted career. To argue against YOUR point, is not a strike against science, it is an argument against your point, to provide you with an opportunity to clarify your position, just as I am trying to clarify mine.
nwtk – You make claims to have credentials as a scientist yet you claim to also be a chiropractor. Chiropractors often sell overpriced supplements as part of their “practice”. Is your “science” this “alternative science” that I keep hearing about from people who consider personal experience to be reliable evidence, don’t seem to understand their own subjective biases which influence the explanations they give themselves about their experiences and who believe in things DESPITE the evidence?
jdbremner wrote “Linus Pauling: the looniness of his later “work” and lack of ethics calls into question the validity of what he did earlier.”
No! Your ad hom argument is uneducated and misguided. I do not know whence you derive your derision for his early work in chemistry, my field, but your complaint is unsupportable. I know that his orthomolecular therapy is nonsense, and you should stick to things that you know.
nwtk wrote “I hate to provide a resume just to counter this remark. So I won’t.”
We know (your resume) that you went to a cult “school” and studied fantasies (subluxation, Innate). That is sufficient for us to recognize that you are a fool.
If you eschew the subluxation, today, what do you think of the Innate? Do you accept that spinal adjustment cannot have any effect on visceral disease?
nwtk wrote “You say I demean science. Horse crap. I have been “in” science most of my life and ALL of my multi-faceted career.”
No! You clearly have no understanding of science; otherwise, you would not have gone to chiropracty school, nor profer your anecdotes.
I note that you haven’t answered my inquiry concerning your rhetorical question about Advil, Motrin and ibuprofen. Dr. hall gave the answer, do you think your ignorance about that has been forgotten? Your ignorance is noted.
Joe – “I note that you haven’t answered my inquiry concerning your rhetorical question about Advil, Motrin and ibuprofen. Dr. hall gave the answer, do you think your ignorance about that has been forgotten? Your ignorance is noted.”
Can you not read Joe? Are you really that dense? How utterly dumb you are.
Do you honestly think you could educate me on the “differences” between Advil, Motrin, and ibuprofen? You say they are the same. Well in the words of leutenant Dan when Forrest pointed out that he had no legs, “YES, I know that!”
You call me a “fool”. Joe, you remind me of a guy I refer to as “Wisdumb”. I’d almost be willing to bet you are him as you troll around the forums looking to put in your two cents worth against anything chiropractic. I thinkyou are caught again.
And Joe, what exactly is an ad horn argument.
And FiFi, the answer to your question is “no”.
And in this subject in particular, your reference to evidence should be tempered with the understanding that, in this field of nutrition and supplements, there is a staggering amount of evidence for every position possible. The proof in the pudding then, for supplements, becomes biochemistry and plausability.
Additionally, in this discussion I have given you nothing to assert that I am promoting anything chiropractic or alternative. Your bias has made you myopic.
nwtk – I didn’t realize “supplements” was a “field” of science – it must be that “alternative to science” I keep hearing so much about. Nutrition, however, I am familiar with and follow the research. Apparently you don’t.
I am also familiar with the supplement industry and aware if what often passes as “evidence” (none of it up to scientific standards of evidence), much like in the food industry (the giant corporations that add soy or omega3s or whatever is trendy at the moment to try to sell their foods as “healthy” – this is distinct from required supplementation of flour and milk, which was a public health initiative).
Your promotion of vitamin C gives a fine example of your bias. If you believe there is a “staggering amount of evidence” what alternative sources to science are you getting your “evidence” from? Is it based on anecdotes such as your “feeling better” being evidence for your claims about vitamin C?
nwtk – So what DO you believe as a chiropractor if you don’t believe in subluxations? What do you tell the people who come to you for help and based on what evidence? What does your practice consist of? Do you give advise about supplements? And how did you graduate from chiropractic school if you don’t believe in the basic tenets of chiropractice? Why DON’T you believe in subluxations?
And if you are confused and overwhelmed by the “evidence” about supplements, doesn’t it make sense to at least listen to someone who ISN’T confused and overwhelmed like the doctors who write here and pay the most attention to the best research?
nwtk2007 said,
subjective experience isn’t a form of evidence. ”
It is when coupled with good background knowledge and years of experience”
That is an antiscientific attitude. By that definition, subjective experiences of bloodletting were evidence. They were supported by centuries of experience and they fit with the best background knowledge of their day and the existing medical textbooks.
When I graduated from medical school, it was acceptable for a doctor to say, “In my experience…” No longer.
Okearnyshire asked about patients with HIV. That’s an area I know very little about. I pointed out in my article that there are specific indications for supplementation in patients with various health conditions. AIDS specialists would know the research in that area, and the doctor who prescribes your meds would be the one to ask.
FiFi, either you really don’t know or are playing ignorant. I will assume you know, there are probably 15 or 20 journals of nutrition or related peer reviewed journals. It is literally a plethra of information about ongoing research and studies by med schools, universities, etc.
Now then:
1. So what DO you believe as a chiropractor if you don’t believe in subluxations?
Too broad a question. There is so much more to physical medicine I would not know where to begin. I will tell you that I don’t do much different than a PT except that I have the responsibility for diagnosis and I manage patient treatment as a provider and accept the responsibilities as defined for providers in the state of Texas. I can also see patients without a referral.
2. What do you tell the people who come to you for help and based on what evidence?
I have never ever been asked by a patient about evidence for anything. When they ask for help, I listen to their problem and if I can help them, then I do.
3. What does your practice consist of?
I treat musculoskeletal injuries.
4. Do you give advise about supplements?
Nope, unless specifically asked.
5. And how did you graduate from chiropractic school if you don’t believe in the basic tenets of chiropractice?
The basic tenets are changing and thus do not require belief in what you claim chiropractic is. Sorry. Those who seem to know all about chiropractic simply do not know all there is to know about it. I don’t believe the bible is literally true and believable, but that didn’t stop me from being raised in the (a) church or going to a christian university. Not so myopic as you.
FiFi also said, “doesn’t it make sense to at least listen to someone who ISN’T confused and overwhelmed like the doctors who write here and pay the most attention to the best research?”
I am listening dear. But how do you know they are not confused? Do you take it on “faith”?
Being a doctor doesn’t mean they are all knowing or the guiding light of science. Does it?
I have given reasonable points of discussion. Why are you so touchy about it? Are you all knowing?
nwtk wrote “Do you honestly think you could educate me on the “differences” between Advil, Motrin, and ibuprofen? You say they are the same. Well in the words of leutenant [sic] Dan when Forrest pointed out that he had no legs, “YES, I know that!”
Are you saying they (advil, Motrin and ibuprofen) are not the same, or are you admitting your rhetorical question was based in ignorance? … No, I don’t think you are educable.
nwtk wrote “And in this subject in particular, your reference to evidence should be tempered with the understanding that, in this field of nutrition and supplements, there is a staggering amount of evidence for every position possible. The proof in the pudding then, for supplements, becomes biochemistry and plausability [sic].”
Every position possible?? I should eat fruit, or avoid it, it’s all good?
nwtk wrote “Additionally, in this discussion I have given you nothing to assert that I am promoting anything chiropractic …”
Except, that you are a chiropractor … Don’t you promote what you do? I don’t recall anything specifically chiro; but, you do (mistakenly) offer yourself as a health professional.
On that, ladies and gentlemen of the jury, I rest my case.
Harriett – “When I graduated from medical school, it was acceptable for a doctor to say, “In my experience…” No longer.”
You couldn’t be more wrong.
Antiscientific? Only by the EBM standards.
I will take an experienced doctor over a rooky with evidence any day of the week.
Joe, you are tooooo funny. If you are going to put words in my mouth, please, at least know what you are talking about.
And Joe, I take it back, you are Jim the Pizza boy. I should have known.
Got any achovies buddy?
I think nwtk was trying to make the point that patients don’t know that Motrin, Advil and ibuprofen are the same. But he worded it very clumsily and gave us all the impression that he believed they were different.
It took me a while to figure out what he was trying to say about antibiotics and immunity, because he worded that very clumsily too. He didn’t say what he thought he was saying.
Clarity of thought is a prerequisite for clarity of language. It seems to me nwtk is confused about some things, especially about the true meaning of “correlation doesn’t mean causation.”
nwtk wrote “5. And how did you graduate from chiropractic school if you don’t believe in the basic tenets of chiropractice?
“The basic tenets are changing and thus do not require belief in what you claim chiropractic is. Sorry. Those who seem to know all about chiropractic simply do not know all there is to know about it. I don’t believe the bible is literally true and believable, but that didn’t stop me from being raised in the (a) church or going to a christian university. Not so myopic as you.”
http://www.chirocolleges.org/paradigm_scopet.html
“Chiropractic is Concerned with the preservation and restoration of health, and focuses particular attention on the subluxation.”
That official position sounds like it hasn’t changed in 118 years. What do you imagine has changed? Oh, oh, I know- nothing. I can also cite articles in recent issues of your Dynamic Chiropractic magazine that show there is nothing new since DD Palmer.
If you realize that this chiropracty is nonsense, why aren’t you angry about the time and expense your school scammed you for nonsense? i know, you are too busy scamming the gullible.
nwtk wrote “Being a doctor doesn’t mean they are all knowing or the guiding light of science. Does it?”
Straw man.
nwtk wrote “I have given reasonable points of discussion. Why are you so touchy about it?”
No, you have only offered irrational bluster- no data.
nwtk “Are you all knowing?” Another straw man. We know that you are little-knowing. There are a few chiros who burst out of that ; but you are not one.
You miss the point by your bias. Thus your defensiveness and inability to see the point.
Since I disagree yo feel the need to “get the last word in”, so to speak.
I’ll get back to correlation and causation. But I will tell you that it wasn’t philosophy or a lack of understanding about correlation and causation that caused the changes I saw and still see by taking the vit C just as it is not what allowed the antibiotics to get rid of my sinus infections.
Getting back to that, are you saying that antibiotics should not be used because the sinus infections will go away on their own and thus they were never needed and represent an un-necessary risk to patients being exposed to the side effects of anti-biotics which they should not have been exposed to because the treatment has no benefit?
Probably not.
nwtk2007,
Your last comment shows you can’t read. Or at least can’t understand what you read. Sad.
Please go back and read what I wrote about your vitamin C experience and what I wrote about antibiotics for sinusitis.
Sarcasm Harriett.
I see what you are saying, I just don’t agree with you.
I did say “Probably not”.
And Joe, being retarded does not excuse your dim-witted comments. And you started it…. Go back to your anti-chiro web site.
And like I said Harriet, I’ll get back to you on correlation and causation.
Lets see if I have this right.
Harriett says that just because my sinus infections go away when I take an antibiotic (and have done so every single time I have finally resorted to one) I cannot assume that this correlation between the antibiotic and the disappearance of the sinus infection shows that the antibiotic caused the sinus infection to go away.
Now, over the course of about thirty three years of getting these things, which, I guess, coincidentally started when I worked as a medical technologist in a very busy county hospital, I have been able to defeat these things on occasion by using nothing more than antihistamines which keep my sinuses dry and slow the drainage. (Harriett said she thought the use of antihistamines was not appropriate but when I did not use them the drainage would set up further infection in my upper chest, mainly bronchi and larynx.)
It seems to me, that if the antibiotics worked every single time, whether I began them early in the infection or late, that I could reasonably assume that the antibiotic worked to kill the infection and could not be attributed to a placebo effect or some other confounding factor.
The infections were pretty random as to the time of the year they would occur, they did not seem to be related to anything dietary as my diet has been very consistent (not a bad diet but not rich in fruits and green vegetables) and really don’t seem to be linked or related to anything. They occur about once to sometime twice a year and occasionally skip a year.
But you say that I cannot link that this correlation between antibiotic use and elimination of sinus infection implies causation.
I went to a resp specialist who made me take the antibiotics for six weeks continuously. According to him, the ten day rule was a good recipe for resistance. He felt very confident that the antibiotic was killing the infection. Through him we determine it was staph and his final conclusion about the whole thing was that I was colonized, a carrier, of staph. He said I would probably never be completely rid of the things and that the sinus infections would recur.
But you say there is not enough scientific evidence here to link correlation with causation.
With all due respect, I would have to disagree.
I’ll have to get back to yo on the vit C thing.
nwtk – If your diet isn’t “rich in fruits and vegetables” then it’s not a good diet (even if you think it’s not “bad”). Why would someone who claims to be knowledgeable in nutrition not take the minimal steps required to eat a healthy diet? It seems rather hypocritical considering you’ve been talking about how unhealthy and ignorant other Americans are. It also suggests that you may have a vitamin C deficiency. Personally I’d be concerned for any of the people who come to see you who trust your diagnostic skills and “expertize” if you can’t nourish yourself properly!
When you first described it, it sounded like a one-time-only event — sinusitus, got antibiotics, sinusitus went away. Indeed, without any outside information other than that, it is not possible to tell whether the antibiotics caused the infection to clear up. A lot of people don’t realize that, and it has led to an overuse of antibiotics. They had the sniffles, they took antibiotics, their sniffles went away. But if they weren’t tested, or if their symptoms were not very conclusive, it’s just as likely that they had a viral infection which their immune system dealt with, totally apart from the antibiotics.
I know a woman who swears by antibiotics. She buys them bulk in Mexico and takes them at the slightest sign of a sniffle. That’s a fairly egregious example, but that’s the sort of thing I think most of us were thinking of when you brought up antibiotics.
Now, in your most recent post, you’ve elaborated considerably and given plenty of good reason to conclude in your case that the antibiotics were responsible for clearing up the infection. You didn’t just go by the fact that a single infection went away when antibiotics were used; no, you have plenty more to go on. It’s perfectly reasonable to conclude that the antibiotics were a good choice.
Incidentally, I suspect that your use of antihistamines and such doesn’t defeat active infections but rather reduces the risk of them taking hold in the first place, by reducing inflammation in your airways. I’m no expert of course; I’m a software engineer. But from what I’ve read, and from what I’ve learned from my own asthma management, it might be a factor.
Vitamin C, though, is bunk in my opinion. It’s a very important vitamin, but the human body fiercely regulates the amount in the blood at any time, and stores up to a 30 day supply. Any surplus beyond that amount is excreted by the kidneys, so as long as you’re eating a healthy diet, supplementation isn’t going to really achieve anything. Linus Pauling was a brilliant man, but he had some nutty ideas too, and this was one of them. Sort of like Tesla in that regard.
Well it looks like I have this blog all to myself about this time of night. Cool.
I did read the suggestion about the vitamin C N=1 experiment you suggested. This would be difficult in that I would probably suspect any difference in pills and to be honest, I would have to be on the placebo for a few months to notice any change, and I would not like to put my bod thru that. One degree of freedom just would not be suitable anyway. I would be hurting and you would then discount it for just that.
This thing with vitamin C is a gradual change. It has to be. The effects on connective tissue would not occur within days but weeks.
The biochemistry is this, as you probably know: Vitamin C is a reducing agent and with respect to collagen, aids in hydroxylation of, I think, five specific amino acids, which participate in hydrogen bonding between sheets of collagen proteins. The higher the number of hydrogen bonds, the greater the strength of the connection between the sheets of collagen. Thus in deficiency, too few hydrogen bonds results in weak connective tissue and thus scurvy and all of it’s S/S.
Just enough vit C will prevent scurvy but how many hydrogen bonds are needed for optimum collagen strength is the key. There has to be a spectrum of hydrogen bond numbers beyond which there is no scurvy, but which represents a spectrum of collagen strengths.
In activities which require repetitive movements and, lets face it, pounding, of connective tissues in joint capsules and ligaments, these repetitive actions represent repetitive traumas, aka, micro-trauma. And like a wire bent over and over repetitivly, it weakens form the abuse. Increased vit C with it’s resultant increased number of hydrogen bonds between sheets of collagen would fortify the proteins and thus reduce the damage. Elevated Vit C would continue to “do it’s thing” and repair this damage that much quicker. I have seen this senerio in a bio-chem book, but I do not remember which one.
This is just the biochemistry, not really an arguable point. Now just common knowledge.
Thus it stands to reason, that elevated levels of vit C strengthen connective tissues to a point where they experience less damage and repair more quickly. There may already be clinical studies as this is old science.
This is obscured by the notion that vit C strengthens the immune system, which as far as I know, is based on only two studies which were appropriated by big vita, as FiFi would say, and is now the driving force of vit C marketing.
It seems obvious to me. The research would be simple enough, but would have that subjective essence about it.
My experience with it at least forms the basis for hypothesis which is testable and possibly verifyable. But what harm could come from trying it. I am convinced.
I get 250 or 500mg tablets, I take one with breakfast, lunch, mid afternoon snack, dinner and before bed. It’s not mega-doses and I would challenge anyone to try it for them selves.
And it ain’t Big Vita either. It is limited supplementation. The only thing about it is that the vit C needs to be spread out over the day due to the water sol nature of it and it’s subsequent loss in the urine. (Not processed FiFi)
FiFi – “It also suggests that you may have a vitamin C deficiency.”
Not any more FiFi. Thats the whole point.
And as to the diet, it boils down to life style and laziness.
But simple to over come.
Another thing I think is that I could not achieve the levels I am at through diet. I will do the math. But in between patients, I don’t have time to eat an orange or two you know.
Hypocrite? Absolutely. Wee ALL are! Most definitely.
Dear Calli Arcale,
Thanks for reading.
And you might be right about the vit C.
With respect to Pauling, in my Masters work some of my instructors knew him well and had many stories. They are mostly old now and probably dead.
I only knew him thru them as a break through atomic structure giant – thus two Nobels.
A nutrition nut friend of mine used his Nobels to defend Paulings vit C beliefs. He was a bit put off by the fact that the Nobels had nothing to do with vit C.
nwtk2007,
Your experience with antibiotics and with vitamin C may seem very convincing to you, but others have been equally convinced about other things and have been wrong.
There are many things that can make it seem like a treatment worked when it really didn’t. The natural course of illness, regression to the mean, conditioning, reinforcement, distorted perceptions, confirmation bias, expectation, and many other factors can mislead us.
Please think about bloodletting. Doctors and patients used it over and over and it “worked” repeatedly and they were just as convinced as you are. And they had plenty of theory to back them up. But they were wrong, and there is a possibility that you could be wrong too.
A friend of mine tells me she takes Echinacea at the first sign of a cold, and she hasn’t had a cold in several years. She believes taking Echinacea prevents colds. I “don’t” take Echinacea at the first sign of a cold, and I haven’t had a cold in several years either, so I could just as well believe that “not” taking Echinacea prevents colds.
Most sinus infections as diagnosed by GPs on the usual clinical grounds will resolve without treatment: the symptoms gradually get worse, then they subside. When symptoms increase, that’s when people tend to try a treatment, and often that is the point at which the symptoms were about to decrease anyway, so the treatment unfairly gets the credit. That fooled both doctors and patients for decades, and we have now learned we were overtreating.
I’m not saying you’re wrong; I’m just saying you can’t know you’re right. It is considered safe to take up to 2000 mg of vitamin C a day, so I don’t see any problem with you continuing to use it. There may be a problem with continuing to take antibiotics for sinus symptoms: antibiotics have side effects and lead to antibiotic-resistant strains of bacteria.
I said “When I graduated from medical school, it was acceptable for a doctor to say, “In my experience…” No longer.”
nwtk2007 said “You couldn’t be more wrong. Antiscientific? Only by the EBM standards.”
What other standards are there? Is there any kind of science that doesn’t go by evidence?
“I will take an experienced doctor over a rooky with evidence any day of the week.”
Sure, me too, but that’s not what I meant. I was referring to doctors who say “In my experience, X works well for condition Y” when all they have is personal experience. That’s testimonials, not evidence. The bloodletters all said, “In my experience, bloodletting works well and saves lives.” In reality, it was doing more harm than good.
Personal experience used to be all we had to go on. Now we have something better: the scientific method. If you don’t accept the scientific method, you’re reading the wrong blog.
nwtk,
Your reasoning power, inre vitamin C, is on a par with DD Palmer’s reasoning about subluxations. We have experimental/clinical data concerning both; which invalidates both claims.
We try to teach college students to work from data, instead of speculation. Speculation is only a basis for research, not a conclusion. As you noted, there has been a lot of clinical research on vitamin C, and the conclusion is that your speculation is silly.
Your assertion, above, that you act like a PT except that you “include diagnosis” is laughable. Where is the evidence that you learn as much as a PT in chiropracty school, or that you learn diagnosis. You certainly don’t learn diagnosis when your “education” is centered on subluxations and your “clinical” experience consists of a few healthy friends that you cajole, or bribe, to attend your clinic.
You are a masseur/euse with delusions of grandeur.
[...] Posted on July 17, 2008 by estherar Dr. Harriet Hall of Science-Based Medicine has an excellent post about whether people should routinely take vitamins. The short answer from the American Association [...]
nwtk – The point was that you ate such a poor diet that you were suffering from vitamin C deficiency and couldn’t identify that vitamin deficiency in yourself. To me this says you don’t know anything about basic nutrition or about the benefits of diet, and you’re basically not even knowledgeable enough to feed yourself properly. Anyone who chooses a supplement over leafy greens and cruciferous veggies isn’t getting the cancer prevention benefits of leafy greens – on all fronts supplements just aren’t nearly as good as food.
Though, of course, you pretend that food isn’t nearly as good as the pills you’re pushing – it seems to me that for all the talk of being “natural” and so on that chiros do on this blog, very few of them seem to actually promote natural sources! Bit Vita is just as much a pill pushing industry as Big Pharma – but without nearly as many safeguards or ethical restraints. Of course, despite all the accusations of medicine playing politics, supplement manufacturers are well known lobbyists – and have resorted to distorting the truth to try to fight legislation. It seems that Big Vita/Supplement is VERY political. While Big Vita and CAM constantly frame themselves as being some groovy “alternative”, there are actually a shocking amount of right wing and fringe Christian types involved in Big Vita/Supplement. Where the new agers and the right wing/Fundamentalists meet is their common war on “reality based thinking” and their constant attempts to use fear to manipulate people.
So, ultimately, you’re not really promoting or advocating living a healthy lifestyle, which includes the basic building blocks of prevention and health – diet and exercise. You’ve said that you don’t live a healthy lifestyle yourself and pop pills rather than modify your diet so you’re eating healthy food (not something that’s very hard to do!). You claim to be knowledgeable but your own stories constantly belie your ignorance (I know, when caught in the web of your own ignorance you claim to be sarcastic but you’re only fooling yourself).
If you think you need to eat two oranges every hour to get adequate vitamin C, clearly you’re misinformed about nutrition. The other thing about taking pills instead of getting vitamin C from food sources is you’re not getting any of the other things in an orange that are good for you and part of a healthy diet.
Taking megadoses of vitamin C is also potentially dangerous for anyone who has metabolic problems with iron. So while one can’t overdose on vitamin C per se, megadosing can potentially have other undesirable side effects (including the increased risk of kidney stones). Vitamins and minerals, like anything that’s bioactive, have side effects. It’s yet another reason why anyone with an ounce of sense wouldn’t take nutritional advice from someone who doesn’t maintain a healthy lifestyle, who didn’t recognize something as obvious as a vitamin C deficiency in them self (and who is silly enough to be one of those people who demands antibiotics when they aren’t necessary) and who can’t discern credible evidence from propaganda from supplement manufacturers.
I’d also like to bring up an environmental issue here. All those vitamins that are water soluble get flushed down the drain into the water system and back into the environment. Anyone who’s taking unnecessary vitamins and supplements is also contributing to unnecessary pollution of water supplies and the planet. (Not to mention the pollution created making the “natural” vitamins – often done in unclean and polluting factories in China – the plastic packaging created and then discarded, the energy and pollution created by transporting them to a store near you, etc).
Anyone who claims to have a genuine holistic interest in health wouldn’t ignore the environment and contribute to gratuitous polluting of our waterways and environment.
FiFi – “Taking megadoses of vitamin C is also potentially dangerous for anyone who has metabolic problems with iron. So while one can’t overdose on vitamin C per se, megadosing can potentially have other undesirable side effects (including the increased risk of kidney stones).”
You gotta reference on that FiFi?
I will say that you are brilliant in your conclusion that I was vit C deficient. That was, essentially, the first point I was trying to get across. The other point is that most people are, but at lower activity levels, it doesn’t show up.
As to the levels I recommend, they are only in the 1250 to 1500mg/day range, could be potentially less for smaller individuals, and is spread out over the day. The equivalent in fruits and oranges would amount to at least 4 – 5$ per day in cost, not to mention the time involved in consumption, excesses in sugar intake and even refrigeration costs, gas (car), shopping time, etc.
You are also right that my diet was pretty poor, even though I eat better than probably 90% of the population in this country at least. But diet is a very difficult thing to change and to get people to change. I think it is easier to get people to change their religion than it is to get them to change their diet.
Supplementation might be the only way to even come close to getting vit C levels up in the population as a whole. In reality, it will never be done.
You also said – “To me this says you don’t know anything about basic nutrition or about the benefits of diet,”
Thanks for that bit of an insult. But, again, in reality, and to a small degree, you are right. I should have known, but in the hustle and bustle of life and all the complexities there-in, we sometimes don’t see the forest for the trees. Your knee jerk responses to comments perceived out of context (poorly read) indicate that you also might be missing a bit of the forest.
nwtk – You’re welcome for any insult I offered and you took, it was well earned on your part.
Here’s some info on the dangers of excess iron (which, no doubt you’re aware, vitamin C enhances the absorption of…though since you didn’t recognize a vitamin C deficiency in yourself you may not be aware of the synergy between iron and vitamin C – or other vitamins and minerals for that matter). Vitamin C supplementation is also not advised for people with diabetes, so it’s a poor choice as a supplement for people who have “bad” diets.
http://www.cancer.dartmouth.edu/iron/managing.shtml
http://www-ksl.stanford.edu/people/kpfleger/multivitamins/cached/my.webmd.com_content_dmk_dmk_article_58947.html
Wacky that you’re handing out nutritional information to your patients when you don’t know about the relationship between C and iron, the dangers of excess iron and can’t recognize a deficiency in your own diet and body!!!
If you were eating a healthy diet to begin with, you wouldn’t need supplementation. That you’re too lazy and unmotivated to even look after your own health in the most basic way – yet claim to be a health professional and complain about how lazy, ignorant and unmotivated others are – is pretty dazzling. People who don’t know any better eat poorly out of an ignorance born of innocence. You’re actively choosing unhealthy choices in favor of popping a pill. I really don’t see how you can castigate “Big Pharma” when you show exactly the same kind of pill-popping, magic bullet kind of beliefs about supplements!
If your diet isn’t rich in fruits and vegetables, what is it rich in? Meat? Carbs? Sugar? Fats? You’re really setting yourself up for quite a raft of health problems via your diet, and getting none of the cancer preventative benefits of eating leafy greens (since supplements don’t provide the same benefits).
I’m sorry Fi Fi, but I just couldn’t help it.
There are much better sources related to vit C and iron. But I will tell you, in all cases thus far documented that shows any harm from vit C supplements and harmful iron overload , the persons involved were taking iron supplementation, which is rarely indicated.
And there are no “EBM like” studies supporting even that.
By that I mean any studies which would hold up to this forums definition of EBM.
And really, you have been the most insulting person I have ever run into on a forum. Even when people agree with you, you insult them. Amazing.
You do know the anti-cancer and anti-heart disease benefits of anti-oxidants (we called’em free radical traps) are now coming into question. A very complex picture indeed.
nwtk2007,
In patients who do not take iron supplements there is some evidence suggesting that lower iron levels may be better for health. And some people are very susceptible to iron overload just from normal dietary sources, especially people with hemochromatosis that may not have even been diagnosed yet.
Just as vitamin C increases iron absorption, it decreases copper absorption. It has a whole lot of other effects you may not be fully aware of. The Natural Medicines Comprehensive Database has 2 whole pages on vitamin C’s interactions with drugs, foods, lab tests, diseases and conditions.
If these interactions happened with a prescription drug, we might worry more about them, but since vitamin C is “natural” we tend not to even ask about them.
nwtk – Why would my opinion of you change just because you “agree” with the obvious rather than deny it? Does your opinion of people change merely because they agree with you or confirm your beliefs? Do “like” and act respectfully to those who do? And do you dislike and act insultingly to those that don’t? You have been neither polite, compassionate or pleasant for the most part – and your main objective here is to troll, try to diminish EBM and promote chiro and supplements – I see no particular reason to change my opinion of you merely because you’re sucking up since you got caught out saying a number of things that reveal your ignorance.
Yep, I do know that antioxidant supplements are now appearing to not be the miracle supplement they’re touted as by the very same people who tout megadosing on vitamin C. That doesn’t mean that the studies showing that a diet rich in leafy green vegetables is preventative for cancer, though it does indicate once again that eating food (which provides a broad range of nutritious compounds not just one) is preferable to seeking a magic bullet in pill form.
FiFi – “and your main objective here is to troll, try to diminish EBM and promote chiro and supplements”
You are so full of it FiFi. Show me where I ever promoted chiro on this forum. I speak about one single vitamin, C, and you say I am promoting supplements.
These posts are numbered and date. Show me.
I also never even implied that the vitamin C had to be natural or that natrual was better than anything,. I don’t think I ever even used the term.
Check your nwtk2007 posts. Don’t be so defensive and act so all knowing and pretend to be so perfect.
And this for example, – “I see no particular reason to change my opinion of you merely because you’re sucking up since you got caught out saying a number of things that reveal your ignorance.”
What did I get “caught out” saying that revealed my ignorance. I fully admitted that I should have suspected the vit C deficiency from the beginning. Read my first post. And what ever gives you the idea that I am “sucking up” now?
Pretty funny.
And 1250 to 2000mg of C a day is not mega-dosing.
I recall reading reports of kidney stones in susceptible people when they took 1000-2000mg.
nitwit2007 wrote “What did I get “caught out” saying that revealed my ignorance.”
Well, there was the part about “simple biochemistry” supporting your excess dose of vitamin C. That was pretty ignorant. Of course, it makes perfect sense to a chiropractor.
So, you claim to deny subluxations. What about Innate? You spent a lot of time and money studying that foolishness, too.
Do you mangle children, or schedule customers for “maintenance” treatments? What makes you think you are as competent as a PT; let alone imagining you have the ability to diagnose?
Your notions about vitamin C tell us you are not very bright. Your attendance at chiro college reinforces that.
weing on 17 Jul 2008 at 6:38 pm wrote “I recall reading reports of kidney stones in susceptible people when they took 1000-2000mg.”
You seem to forget that disciples of DD Palmer have highly-refined diagnostic procedures and they can avoid such problems.
Hey there Weing, how about some EBM qualified links to your claim of reports of kidney stones and Vit C?
Joe, what part of the biochemistry of vit C did you not understand? Care to elaborate or just picking a fight? What specifically was wrong with the biochemistry as I described it in relation to strengthening collagen by increasing hydrogen bonding between sheets of proteins? Are these notions about vit C?
And Joe, for what it’s worth, I treat injured people so what I do is go around causing accidents and leaving my card at the scene. Or just throw a little water on the floor at Walmart, drop some grapes or something like that. Then when they come to me, I basically ring their necks until they pay me all they have, sell them supplements out the wazzoo on their credit card and shuffle them off to Fannie Mae for a loan to cover their life long maintenance care.
Gosh, What’da ya think I do silly?
http://jn.nutrition.org/cgi/content/abstract/135/7/1673
That’s the most recent one I could find. I originally looked into this back in 1983-4 and it appeared a subset of patients had increased risk of renal stones from it and I made it a point not to prescribe over 1000 mg a day for wound healing. It also would give false negative tests for occult blood in stools. I would have to clean out my basement to find the original references.
Previously Weing said – “I recall reading reports of kidney stones in susceptible people when they took 1000-2000mg.”
I have been roaming around the internet looking for sources indicating that Vit C is related to kidney stones and low and behold, I could only find studies and articles by MD’s, refuting any connection except that the elevated Vit C levels actually decreased the incidence of kidney stone or had no effect on it at all.
More articles than not report that elevated Vit C levels decrease the stones and a few of the MD’s stated that they use Vit C to treat kidney stones.
One pointed out how in the past it had been seen that Vit C increased oxalate levels and thus was born the recommendation to avoid high levels of C for fear of developing stones. This guy, an MD, was quick to point out that there has been no studies showing any increase in stones with inc Vit C levels or even increased oxalate levels.
hmmm. Probably just a bunch of anectodal non-sense and not EBM.
I saw that one. It is sited by others as incorrect in the assumption that elevated levels of oxalate means increased stones.
As Harriett says, correlation does not mean causation.
The current consensus is that it’s safe for most people to ingest up to 2000 mg of vitamin C a day. There are concerns (see the Natural Medicines Comprehensive Database) and it may not be safe for every individual. And dietary sources must be added to the dosage from the supplement pills.
I think we can assume that nwtk2007′s use of vitamin C is not very likely to harm him. We can’t assume that it is absolutely safe, and we can’t assume that it is more effective than adequate diet and placebo.
Well, I don’t think it’s worth cleaning out my basement to find the original article.
weing wrote on 17 Jul 2008 at 11:22 pm “Well, I don’t think it’s worth cleaning out my basement to find the original article.”
You are right, when dealing with a chiro- the chiro imagination trumps facts.
nwtk2007 wrote on 17 Jul 2008 at 10:28 pm “I saw that one. It is sited [sic] by others as incorrect”
You see, weing, nitwit2007 doesn’t even have to cite sources, you are simply incorrect.
nwtk2007 huh? didn’t you read the study linked to above (which is available for free download), where they measured how increases in vitamin C intake caused increases in oxalate and in a “stone forming” population there was an increase in calcium oxalate saturation from below where stones could form to where they could form?
http://jn.nutrition.org/cgi/content/full/135/7/1673
If we do a search on Google Scholar, we find that the article has been cited 18 times.
http://scholar.google.com/scholar?hl=en&lr=&cites=5759871201307082276
One of the citing articles, this case report, directly attributed kidney failure to excess vitamin C, which resolved when the excess was eliminated.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2235877
So which of these citing articles dismiss the finding? All the ones I read didn’t dismiss it and said it might be important in some individuals.
There are studies showing inc vitC results in inc oxalate formation, there are just none that show inc oxalate cause inc in stones.
Once again, in the words of this forum, correlation does not mean causation.
I only have a few minutes here so here is a quick one from a peer reviewed medical journal,
Simon, Joel A. and Hudes, Esther S. Relation of serum ascorbic acid to serum vitamin B12, serum ferritin, and kidney stones in US adults. Archives of Internal Medicine, Vol. 159, March 22, 1999, pp. 619-24
In fact, there is some evidence that vit C acidifies the urine which aids in dissolving most stones.
Heres a couple more:
Intake of vitamins B6 and C and the risk of kidney stones in women
Curhan, G. C., Willett, W. C., Speizer, F. E., Stampfer, M. J.
J Am Soc Nephrol 10:4:840-845, Apr 1999
J Urol. 1996 Jun;155(6):1847-51.
nwtk,
You tell them, sister! Btw, how good is chiropractic treatment of kidney stones? Which subloxation is most commonly involved?
Pook, that would be the P1 subloxation. When innate is blocked at that level the result is stones, as opposed to getting stoned, which is required to find the illusive P1 subloxation.
nwtk2007, you said
“I saw that one. It is sited by others as incorrect in the assumption that elevated levels of oxalate means increased stones.”
Now it turns out that you didn’t actually see any articles that cited it, you just found some articles from many years earlier that didn’t report a correlation. They did find a odds ratio of 1.06 (95% CI 0.69 to 1.64) in women, which is completely consistent with a subgroup being susceptible to oxalate kidney stones from excess vitamin C.
The Archives of Internal Medicine article specifically excluded from analysis individuals with the highest vitamin C blood levels. Those individuals with levels in the highest 0.5% were excluded from analysis. Presumably those were the individuals taking the highest levels of vitamin C supplements.
This more recent large study did find a strong correlation in men, 1.41 (95% CI 1.11 to 1.8).
http://jasn.asnjournals.org/cgi/content/full/15/12/3225
Quite the cantrare dadelus, your first reference has been sited many times. Just for a quick look, look at the orthomolecular medicine site. Your other reference is a case study (essentially anecdotal) regarding nephritis and kidney failure.
You are still equating increased oxalate levels with kidney stone formation which is just not documented and has been pointed out as being a misunderstood myth.
Your article is sited along with others for just that point.
What the hell is a “cantrare”? Did you mean to say “Au contraire”, as in the French expression that’s commonly used in English? Nwtk, for someone who berated people here as being pseudo intellectuals, you’re doing a hell of a lot of rather pretentious (and incorrect) siting [sic] and “cantraring” [sic]. It doesn’t get much more pretentious than misusing a foreign language in an attempt to sound sophisticated and intellectual!
Now, even though I’m a writer and love words and language, that doesn’t mean that a well turned, simple piece of writing that expresses itself clearly is any less beautiful to me than a highly embroidered and embellished text. Personally I have more respect for someone who can explain a complex idea in simple language than I do for someone who dresses up a simple idea in complex language as a means to divert from the innate lack of substance…. Speaking about innate substances (and lack thereof), you still haven’t really explained to us what you base your practice as a chiropractor on since you claim not to believe in subluxations…so do you believe in this “innate” that you keep dodging questions about?
Btw, here’s my definition of “siting” – people who get all their information from websites and wouldn’t know their way around a library if their life depended upon it. You do indeed seem to be a “siter”, as in someone who just googles and posts links with attractive headlines without even reading the attached information.
FiFi, you’re cute.
Sarcasm, slang and poor spelling just don’t suit you do they.
Us white trash southern dudes just tawk like that. (Did you know there is an inverse relationship between spelling ability and intellegence quotient?)
If you will check my above post I explained my practice. I treat musculockeletal injuries: neck, back, shoulder, knee, etc.
I take patients in as an entry level provider (history, exam, diagnostics and formulation of treatment plan) managing their care and providing treatment and referrals as needed.
I employ both passive and active modalities as well as chiropractic manipulative treatment, if needed. I also work hand in hand with PT’s and ortho/neurosurgeons on a case by case basis, both pre- and post surgical as is required.
You are right about using the internet. It is very handy and convienient. Libraries are inadequate, a long way away and essentially outdated. I am good about reading the studies when I can get access to them. In fact, I am currently reading the last posted reference by dadelus. I actually printed this one out so I could move around and read it in the clinic.
Funny, you say I am pretentious yet to me it is you who is very full of herself and quite taken with your perceived intellegence.
Believe me, I am neither sophisticated, cultured or all knowing. I have a deanky vocabulary and can’t spell worth beans. You are much the superior to me. Enjoy.
I know I’m cute but my attractiveness is beside the point.
I take no issue with people who just don’t know how to spell – it’s just pretentious language use that’s also incorrect that I find to be pseudo intellectual. I have no problem with people using slang – in fact, I’m a big fan of slang, patois and regional dialects). I just find it entertaining that you accuse others of being pseudo intellectuals while so obviously revealing a desire to be considered an intellectual yourself!
nwtk – You keep avoiding HOW you treat patients. How DO you treat patients? You’ve said you don’t believe in subluxations (which most chiropractors do believe in because it’s what is taught in chiropractic schools), what DO you believe in? Do you believe in Innate? Do you condone doing neck adjustments?
Do you base your diagnosis on what you learned in chiropractic school? What is “chiropractic manipulation” once you remove the concept of subluxations? What do you mean specifically when you say “passive and active modalities”?
Btw, you come across as pretentious because you’re pretending to be something that you’re not, you clearly aspire to be intellectual but can’t quite reach that far. Just as you clearly aspire to taken seriously under the guise of EBM, even though you keep revealing your misunderstanding of EBM. I wouldn’t consider your language use pretentious at all if you stuck to what you know (be it white trash slang or colloquial) and didn’t put on your pseudo intellectual hat to try to elevate yourself (when you decry others as being pseudo intellectuals). You are both the pot AND the kettle it seems!
Huh? You call a prospective cohort trial of 45,619 a “case study”?
http://jasn.asnjournals.org/cgi/content/full/15/12/3225
Who is saying “increased oxalate levels with kidney stone formation which is just not documented and has been pointed out as being a misunderstood myth”? No one that I have been able to find. You say it, with no citations, or from citations that don’t actually say what you are saying they say.
If you applied the same “standard” of what is a myth to chiropractic, you would have abandoned chiropractic as a myth long ago.
Just a little reminder of nwtk’s perspective on subluxations…
“# nwtk2007on 04 Jul 2008 at 4:12 pm
Chiropractic subluxation theory is only theoretical and as such is continually evolving and changing. When I was in school in the 90’s it was taught more as a motion restriction than as a “bone out of place” sort of thing. Obviously the motion of the joint will have tremendous impact on any associated structures and functions, including neurological structures.
Physiological changes associated with movement are well documented but are also not fully understood or appreciated so we should not dismiss the “subluxation” theory quite so quickly.”
daedalus,
The reference you are referring to is a four year followup with a questionaire. A survey of sorts. It is interesting and I have not gotten all the way through it.
The case study is this one:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2235877
The other link you gave was a list of links. I haven’t gotten to that one yet.
Working on it.
FiFi,
Why are you so interested in my practice? Not all chiropractors treat the subluxation to free the flow of innate “energy” thru the nerves to heal the body, so to speak.
You seem to think that all chiropractors think and do the same things because of the oral history of the field or some of the things taught in the schools. It just isn’t so.
Daedalus, the ones who called it a myth I think were the MD’s at the orthomolecular web site and it was also a term used by an MD who was writing for a journal of nephrology. I didn’t wrtie it down. Keep looking and reading, you’ll come across it eventually.
If I can get a chance I will hunt them up again for you.
FiFi, if you want to learn the diff between passive and active modalities, just google the terms. I will detail for you my practice later.
And you are right FiFi. That is exactly what I said. Just trying to be objective about it is all.
mwtk – Actually I’m interested in your definition since, as you propose yourself, there’s no actual consensus or agreed upon meaning for terminology amongst chiropractors. I’m interested in what your practice consists of specifically since you dismissed the connection between neck “adjustments” and stroke (and claim to treat neck injuries) – and showed no compassion or criticism of your fellow chiropractors for treating “subluxations”. I find it rather suspect that you avoid being clear and specific about what you actually do and believe.
nwtk – From what you say, chiropractors sound like they just make up whatever they want and claim it’s chiropractice – aren’t there any professional standards at all? What chiropractors school did you train at?
nwtk – If you were truly trying to be objective you wouldn’t base your beliefs upon your subjective experiences. To me it sounds more like you actually believe in subluxations but just don’t want your beliefs to be associated with the terminology of chiropractic theory. You want your magic cake to be a science cake and think changing the name will make it so!
Funny you should say that. The courts call EMS physical therapy if done by a PT but they call it chiropractic if done by a DC.
Wierd. The way they displayed the last two posts makes it look like you responded to me before I said anything.
Well, you think I “believe in” subluxations and just don’t want to admit it. Hmm.
Not true. But at Parker College in Dallas the “theory” of the “subluxation” was much more than just a vertebrae being “out of place”. In fact, we heard quite a few views of what the “subluxation” is or isn’t. The basic science guys would occasionally throw in some bits and pieces of anatomy, physiology and neurology that would, at least partially, substantiate or support some of the differing views of the “subluxation”.
Some of the old timers talked about innate intellegence and some of the essoteric silliness that you guys associate with chiropractic as all encompassing the profession, but it was all phylosophy, not practical or applied to diagnosis, therapeutics or treatment.
Now if you call a fixated joint a subluxated segment, then maybe in that sense manipulation does “remove” subluxations. It’s mainly semantics for those of us who were not religiously devoted to “belief” in something or other and viewed things from a more scientific position.
I’m not sure “beliefs” is a term I would use for what I do in chiropractic practice.
Fifi on 18 Jul 2008 at 4:27 pm wrote “nwtk – From what you say, chiropractors sound like they just make up whatever they want and claim it’s chiropractice …”
That is essentially correct. They have no standards. Even if a chiro eschews subluxations- one has no idea how s/he treats customers. the chiro license offers few constraints.
They certainly don’t learn medical diagnosis in their schools. They have been known to treat joint pain, due to cancer metastases, with “manipulation.”
Now, it is time for nitwit2007 to invoke his tuo quoque argument. However, substandard diagnostic ability is just that for MDs; whereas it is par for the course for chiros. Subluxations or not.
nwtk – So are you claiming that what you do is based upon scientific evidence? Are you claiming to practice EBM?
Parker School’s version of what chiropractic is…do you disagree with our alma mater or agree?
“The chiropractic adjustment is intended to remove any disruptions or distortions of this energy flow that may be caused by slight vertebral misalignments called subluxations. Chiropractors are trained to locate these subluxations and then to remove them to restore the normal flow of nerve energy, in terms of both quality and quantity.
The idea is that if the master system (the nervous system) is healthy and functioning well, then other systems under its control will also function in a more optimal fashion. Chiropractic is based on the belief that the same innate intelligence that can grow a single cell into a complex human being, made of billions of cells, can also heal the body if it is free of disturbances to the nervous system.”
http://www.parkercc.edu/Chiropractic_defined_by_Parker_College_of_Chiropractic.aspx
I notice that the store also sells “nutritional products”…
http://www.parkercc.edu/parker_Share_products_bookstore_welcome.aspx
nwtk2007,
Whatever you want to call it, subluxation or vertebral subluxation complex or subluxated segment, the definition is vague enough to allow chiropractors to call practically anything abnormal and use it as an excuse to manipulate anything they want to manipulate.
Diabetes can be defined in terms that allow anyone to divide patients into diabetics and non-diabetics, and everyone can agree about it. Real subluxations can be seen on x-ray and measured so that all observers can agree on who has one and what the degree of displacement is. Whatever chiropractors are treating, it is not possible for anyone to divide patients into normal and abnormal so that everyone can agree.
There are numerous accounts of the same patient going to different chiropractors and being told he has subluxations in different parts of the spine, or being told by 2 successive chiropractors that his left leg is longer and his right leg is longer.
From supplements to subluxations.
Is it vitamin subluxation or vertebral C?
nwtk – Yes, apparently your alma mater is quite involved in selling and promoting supplements as well as subluxations. You keep claiming you don’t engage in any of the practices that your alma mater promotes! This is one reason why I’m so curious as to what you actually DO since you claim not to believe or practice what your alma mater teaches and promotes!
Apparently your alma mater does base what they teach on beliefs…
“To become a doctor of chiropractic means accepting a focused philosophical stance – believing in the power of the body to heal itself, the right of the patient to receive comprehensive, wellness care and the expertise of the chiropractic physician to guide the way.”
http://www.parkercc.edu/Index.aspx?id=201
FiFi, I hate to be an ass but I have quite a few Alma Maters.
One promotes low cost education for urban students, one promotes the belief in Biblical Strict Interpretation even to the point of needing to be baptized for remission of sins, the other is a leader in molecular biology which was established by colleague’s of Delbrook (the father of molecular biology-not the father but the son), one promotes all disciplines, one once was a military college of agriculture and the one you mention, was Parker College of Chiropractic.
Don’t quote their beliefs, even if, at all, they are the majority beliefs of the faculty. That is just stupid.
Shall we look at all alma mater’s represented here?
Get real.
But since I am here, when PT’s do manipulation of the spine, what is it they are doing and why? What are the changes illicited by the manipulation? Is it effective as most would admit that CMT is effective for low back pain? What is going on physiologically when they do manipulation? Do they manipulate the cervical or thoracic spine? Have they not lobbied lawmakers for the right to do manipulation of the spine?
Come on FiFi, can YOU answer this? Google is just a keystroke away.
nwtk – You still haven’t answered whether you support the beliefs promoted by the school where you studied to be a chiropractor. Do you?
Clearly it’s also relevant whether you believe in the “Strict Biblical Interpretations” of the other school you say you’ve graduated from (but don’t identify) since “strict bible interpretations” tend to include anti-evolution and anti-science beliefs.
You also don’t identify the school where you claim you studied molecular biology. I will indeed unleash my google-fu to educate myself more fully about molecular biology and I will also discuss it with the biologists I know so as to profit from the expertize of people I know I can trust due to experience. The most cursory read of the info on Wikipedia (obviously not an entirely reliable source but a good place to start) doesn’t even mention Delbrook. Did your education in “molecular biology” come from a school that teaches “alternative science”? Is that why you won’t identify where you studied? C’mon, get real and be honest about where your credentials come from and the beliefs you hold!
Sorry FiFi, I misspelled it.
Max Debruck, father Hans, (the brain of which Igor was sent to get for the monster in Young Frankenstein), was considered the father of molecular biology, specifically he is credited with the establishment of the, then, central dogma of molecular biology, about “information”, so to speak, flowing from DNA to RNA to Protein.
We know it is more complex than that but that was then.
I graduated with a masters in molecular biology from the University of Texas at Dallas in 1982. The Christian college was Abilene Christian Iniversity, bachelors, 1978. Getting old.
ACU was interesting, freshman girls were the best (all preachers daughters) and I played a lot of tennis and studied while everyone was at church on Sunday mornings. In Abilene, Tx, you can do absolutely nothing all weekend and come Monday, feel like you didn’t miss a thing. Pretty good school but not as rigorous as UTD was back then.
Initially, UTD was the Research Center of the Southwest, I think, and then became incorporated with UT and was mainly a grad school when I was there.
Google on girl.
FiFi, I just ate so am energized, but tired from the heat of yard work. Fun though.
Some of my instructors at UTD were very linked, so to speak, with many of the early greats. They all worked with Watson and Crick, although, they did not like Watson.
Bremmer, was big on RNA polymerase. He claimed to have gotten fired by Delbruck, did his work on RNA polymerase, was approached by Delbruck for teaming up, but turned him down.
Plasmids bear his initials, for example, pBr322 is a plasmid which carries resistance to ampicillin I think. The Br in the name stands for Bremmer.
An Englishman named Clause, spelled wrong probably, was the first to clone a gene on to a plasmid, something related to insulin.
Rupert was a physics guy who mathematically predicted that there must be something repairing DNA damage due to UV damage. He and another prof there, Harold Werbin, were the first to isolate a DNA repair enzyme, photolyase. It repairs thymine dimers formed by UV exposure, which lead to alterations in transcription and replication.
Another was Demitri Lang, a german who worked with Kleinschimdt, an electron microscope pioneer. Most early micrographs linked to Kleinschmidt were actually done by Dr Lang. He is also credited with developing radar jamming for the Germans in WW II.
Others were there also from the beginning. Amazing dudes to say the least.
The story is that they came here because of massive funding from Texas Instruments and freedom to do what they wanted.
Very hard school with unbelievable testing procedures. Some exams lasted over twelve hours.
The Christian school was the result of being raised in the Church of Christ. All of my friends went there so I did. Just my junior and senior years. You really weren’t hammered with biblical belief though. They strived to be as thorough as any school in their science education. At the time, they claimed to have the highest acceptance rate into med and dent schools of all Texas universities.
The belief thing has always been a struggle. Not really worth mentioning in this forum. I dealt with it pretty much the same way I did at Parker. But really, the faculty at Parker were much more “liberal” in essence, than the then president. Much more science oriented. Their basic science program was very good.
What else you want to know?
I am not into beliefs. Just what I think or others think. When someone says they believe, I pretty much don’t buy it. They never truly believe what they say they believe. If there was true belief, they would be very much different, no matter what it is they believe in.
nwtk – Thanks for clarifying your previous misdirection. Sure your beliefs are worth mentioning in this forum since you advocate for non-EBM. It helps us to understand what you DO base your beliefs about medicine and clinical practices on if it’s not scientific evidence.
Did the Christian school you attended that believed in “strict Biblical interpretations” apply that to science as well? Did you attend the school before the attacks on science and evolution by Christian schools began? Or do you consider creationism to be science?
Those professors sound like really interesting guys, I’m sure I’d find them fascinating to talk to and their research sounds well worth reading up about. Clearly they’ve employed the scientific method to great benefit and do really interesting research. I notice you only speak about their experiments and achievements though, I’m not sure how that really relates to you or you having authority. What are your achievements in the field? Why did you give up science to pursue magical thinking? Thanks again for clarifying your misdirection, between the google-fu and discussing what I dig up with the biologists I know, I’m sure I’ll learn some interesting things.
FiFi, I do not intend to misdirect, as you say or to mislead.
I am in favor of EBM but it should not be the end all to end all, nor does all in health care have to be grounded in science to the exclusion of all else. EBM is corrupt as well as much of what people call science is. Research should continue and new ideas investigated but there is more to health care and science than meets the eye.
I have heard too many who claim to know what science really is only to contradict themselves and cannot be convinced otherwise. My parents and most of their friends are the same way about their religious beliefs and won’t look beyond those beliefs even one little bit.
I don’t even like the word “belief”. When people “believe” something, they will listen no more.
The christian school I went to taught the same biology and chemistry as you would find anywhere and kept their “belief” separate from the curriculum. You asked about creationism, they did not teach it in the school but it probably came up on Sunday morning in church. It is hard to know what the overall faculty “believed”. I think they just knew that we don’t know.
And what makes you think I gave up science and now pursue magical thinking. I am not an extremist and shouldn’t be judged as one.
You never answered my question, nor did anyone else. What is it that is going on physiologically when a PT or a DO or an MD performs manipulation and why would PT’s be so hot on making it a part of their package, so to speak.
What I mean is, in the little that most will agree on, that manipulation of the lumbar spine is beneficial, what is going on there? Why do great pianists “pop” their knuckles. (Go to the Van Cliburn competion and witness the manipulations.) I would imagine they consider their hands to be solid gold.
It’s just food for thought. The issue of spinal manipulation will not be settled by debate and hopefully chiropractic will expand their research. They have more than you know but it is never considered and is not a Google thing that one can find on the internet readily.
nwtk2007 said,
“manipulation of the lumbar spine is beneficial, what is going on there?”
How about stretching tight muscles, relieving muscle spasm, improving restricted range of motion? Is there any need to posit anything more?
nwtk2007 said,
“EBM is corrupt as well as much of what people call science is.”
Yep! That’s why we started this blog!
I disagree that EBM is “corrupt,” at least no more so than any other human endeavor and arguably less so.
Is it imperfect, yes. Inadequate? Certainly. Not always well applied? Of course. Flawed at its very core in that it all too often discounts scientific plausibility? Absolutely. But “corrupt”? No, I can’t go along with that. And EBM is certainly better than the alternative, which is, ironically enough, the same sort of unscientific nonsense that goes under the rubric of “CAM.”
[...] skepticism is best expressed in a post written by another blogger. Enthusiasts misrepresent the science. For instance, they are selling products to “prevent” [...]
The concept of EBM has been corrupted by true believers who have made up their own definition of “evidence” to suit their own purposes. A prime example is a chiropractic textbook entitled “Somatovisceral Aspects of Science: an Evidence-Based Approach.” There isn’t a word in the book that you or I would accept as evidence.
Science is being misused by true believers: instead of doing science to find out IF their pet methods work, they are co-opting science to try to demonstrate THAT the methods work.
What this blog is trying to do is stick to the original uncorrupted meanings of EBM and SBM.
nwtk – Having worked with some physical therapists as part of a team in a pain clinic – I’d say that, in my experience, the difference between a physiotherapist and a chiro (I’ve visited a chiro as a patient on the suggestion of a friend) is that physiotherapists ground their actions in the real world. They’re treating very practical, real world conditions – not “energy blockages”, not “subluxations”, not ambiguous “it could be a subluxation by any other name” stuff, no “kineosiology” or dowsing muscles (not to be confused with the legitimate study of motion called kineosiology), they’re not proposing themselves to be nutritionists and they have a consistent professional standard not some sort of Wild West where they’re not responsible for their actions. They don’t do neck adjustments that result in stroke either.
So, while you’d like to be considered as legitimate like a physiotherapist even though you haven’t undergone training based in science (but rather in the philosophy espoused by your and other Chiro colleges that promote all kinds of questionable practices), that’s an unrealistic desire and ambition to have simply because you employ one or two of the same methods amongst the many others that are dangerous when the risk/benefit ratio is looked at, or just useless and based in magical thinking. If you want to be considered a physical therapist – get the education and accreditation same as physiotherapists have to do. There’s no reason you should be riding on their coattails or considered equivalent when you’re not the equivalent for the reasons noted above. It’s just one more way for CAM to try to sneak in as a legitimate therapy and you haven’t earned the right or attained the accreditation to be considered a physiotherapist.
Thank you for your clarification, because your original comment certainly sounded as though you thought the whole concept of EBM, not just the bastardization of it that we all too frequently see, is corrupt.
nwtk – Interesting that you accuse EBM of being corrupt when you’re busy trying to corrupt it! There’s certainly corruption in medicine as there is any any human endeavor, generally that’s not actually medical practice that’s based in evidence (so, medicine but not evidence based), that’s why there are various ways to hold doctors and medical institutions responsible for their actions. Chiropractice is corrupt from the roots on up (which ethical chiropractors who practice EBM seem quite able to acknowledge and question), it’s not based in science and it attempts to distort evidence and corrupt the definition of science, it promotes all kinds of questionable non-EB medical practices, and so on.
It seems that you’re going the Tu coque route again (which I’ve probably misspelled), what I personally like to call the “you’re a dick too” defense (though coming from a dildo that’s a claim of authenticity that falls flat).
That should have read…pardon the early morning punctuation issues!
“So, while you’d like to be considered as legitimate as a physiotherapist – even though you haven’t undergone training based in science (but rather in the philosophy espoused by your and other Chiro colleges that promote all kinds of questionable practices) – that’s an unrealistic desire and ambition to have simply because you employ one or two of the same methods amongst the many others that are dangerous when the risk/benefit ratio is looked at, or just useless and based in magical thinking.
That’s perhaps the most hilarious retort to that particular logical fallacy I’ve heard. (It’s Tu Quoque, by the way.)
Thanks for the correct spelling Dr Gorski (and glad you got a chuckle, I do each time I see Tu Quoque!).
nwtk – “The christian school I went to taught the same biology and chemistry as you would find anywhere and kept their “belief” separate from the curriculum. You asked about creationism, they did not teach it in the school but it probably came up on Sunday morning in church. It is hard to know what the overall faculty “believed”. I think they just knew that we don’t know.”
Really, you’re the one that claimed you went to a strictly dogmatic Christian school and you’re now claiming that the strict dogma had no influence upon the curriculum!!! You’re saying “it probably came up Sunday morning in church” – so exactly how do you “know” it’s a strictly dogmatic Christian school but “think it probably came up in church” and “think they just knew that we don’t know” (when clearly from the fact your using conjecture means you don’t actually know what your teachers believed or knew even though you have no evidence!). I’m highly skeptical about your ability to discern the difference between science and “alternative science” (meaning faith or belief based ideas).
Eh, fingers type too fast for keyboard…damn technology! Punctuation errors, damn brain!
“(when clearly the fact that you’re using conjecture means you don’t actually know what your teachers believed or knew and are speculating and asserting even though you have no evidence!)
FiFi, you’re too funny. Once again you are extrapolating on what I have said and incorrectly so.
Certainly some of the faculty at ACU were creation believers and followed the strick interpretation of the bible. I am just saying that I don’t know what the majority of the faculty believed and that the subject of creation never came up in a science class. So yes, I am saying that it did not influence the curriculum.
You say – “I’m highly skeptical about your ability to discern the difference between science and “alternative science” (meaning faith or belief based ideas).”
Why, because I went to a Christian school? Find out for yourself. Write the faculty and ask them. They have graduated many who have gone on to become scientists and doctors. Based upon how it appears that you are viewing this, then they must not know the difference between science and alternative science. Check out their research programs, not that I was involved in any research there.
As to it being a strickly dogmatic school, I didn’t say that, only that the school is essentially a Church of Christ affiliated school and the C of C is definitely into the strick interpretation of the bible. Don’t read too much into this.
As to how do I know, I was there.
SMU in Dallas is a Methodist school so do you think everyone who graduates there is Methodist or believes everything the Methodist church believes and teaches? What about other private universities?
And thanks for your comment Harriett, about the benefits of spinal manipulation,
“How about stretching tight muscles, relieving muscle spasm, improving restricted range of motion?
I was wondering if the physiology behind the releif of muscle spasm is understood. How could manipulation stop or relieve a muscle spasm? Would it only apply to the lumbar spine? Also, what would be the importance of unrestricted range of motion in the health of the spine or recovery from an injury?
nwtk2007 said,
“I was wondering if the physiology behind the relief of muscle spasm is understood. How could manipulation stop or relieve a muscle spasm? Would it only apply to the lumbar spine? Also, what would be the importance of unrestricted range of motion in the health of the spine or recovery from an injury?”
Gee, isn’t it interesting that a chiropractor is asking those questions a century after chiropractic was invented? You are the supposed expert in all things musculoskeletal.
Worth checking of vis a vis nwtk’s claims about his alma mater, written by another graduate of the school a couple of years ago…
“…these issues and feelings are very much a part of the school where I did my undergrad, Abilene Christian University. I remember my general biology 2 class where the professor introduced our study to evolution. He did so sensitively, and also discussed briefly some theological issues, saying that his faith wasn’t conflicted by his understanding of science. One student, who sat right on the row in front of me, angrily asked a few questions and then sulked the rest of the class. It wasn’t easy for him to hear something which he viewed as incompatible with his faith.
I think many Christian colleges and universities have really come a long way in how we approach the topic of evolution. Twenty years ago, Abilene Christian and many of these other places would not openly teach evolution in science classes (which shows just how sad things were). Today, there are lots of Christian institutions that have no problem with it.”
http://www.ocellated.com/2005/12/19/christian-schools-and-evolution/
As for your “I was there so I know” response – you didn’t say you “knew” anything – you said “I think” in such a way that it indicated you didn’t really know and seemed very much to be a way to give a wishy-washy response that skirted the question.
Certainly all schools that adhere to strict biblical, koran or torah explanations of the world – including creationist myths – would also be suspect in the area of their science classes, particularly evolution and biology – particularly in the US where evangelical and Fundamentalist Christians have made a concerted effort to promote ID over evolution. Many of the pseudoscientific chiropractic philosophies (particularly the one about the Innate promoted by the chiropractic college you graduated from) dovetail quite nicely with ID – if not openly echo this idea.
Harriett,
You don’t have to answer, but I have yet to meet a PT who could explain the physiology and neurology about manipulation and (or exercise) and their benefits. Sure they can give some pat answers, but nothing remotely close to anything beyond jargon. Especially nothing at the molecular level.
Since PT’s are EB, as you say, then I thought their explanation about it, or yours, might be more credible. I also like hearing other points of view.
FiFi, thanks for the link. I will check that out. And who knows about ID. I don’t really think it will fly for long. One thing I have never understood is why “beliefs” are such a big thing to people. Just believing doesn’t make it true, even subluxation theory or innate intel or religious doctrine, etc.
People act like it is an afront that someone else would have the gaul to believe diferently. They become “offended”. Strange.
nwtk2007 said,
“Since PT’s are EB, as you say, then I thought their explanation about it, or yours, might be more credible”
Some PTs, DOs and some MDs use spinal manipulation therapy. There is evidence that it is as effective as other methods for relieving some types of back pain. We don’t know “how” it works, although there are at least 3 hypotheses. I certainly don’t presume to have an explanation: I was just giving you my best guess. I think we can pretty well rule out the explanation that it removes subluxations that impair the flow of Innate.
When evidence-based practitioners don’t know how something works, they say so. Chiropractors have an explanation for everything, usually a wrong one.
nwtk – Clearly you do have beliefs by your own admission. You believe that antibiotics are what cured your sinus infections, even when informed that most sinus infections clear up on their own. You believe that the treatments you offer your patients work – you’re unclear about HOW they work but you do believe they work (despite it just being your subjective observation that they do, not any objective evidence). Putting aside the beliefs that you’ve admitted you hold here and pretending for a moment you don’t actually have any beliefs (you are undoubtedly unique amongst humans) – if you don’t hold any beliefs but believe that science is too corrupt to be trusted (and don’t believe or adhere to your chiropractice alma mater’s philosophy or beliefs), exactly what ARE you doing and BASED on what when you treat a patient? So far you seem to go with “it looks like it’s working to me, that’s proof it works!” – which seems pretty much to be based in a personal belief.
Harriet – Have there been any studies showing that spinal manipulation does actually improve or relieve back pain? (Keeping in mind that placebo treatments are also often effective in treating pain and that some chronic pain patients quite enjoy dramatic procedures!)
nwtk – Well I do speak like a Gaul sometimes, being bilingual. No doubt I also act like one too sometimes, or at least a Quebecoise. I’m not sure why you’re so galled by Gauls!
I take no issue with people having different beliefs than me (and I make no outrageous claims to have no beliefs), I find it interesting and investigate all different kinds of belief systems. What I do take issue with is people proposing their beliefs are facts based upon no objective evidence or their subjective experience – or people trying to insert their religion into secular government and institutions (whether that be trying to legitimize Sharia law in Canada, enshrine Fundamentalist Christian beliefs in the US constitution or ban abortion). As long as you’re not hurting others with your beliefs and practices, it’s really none of my business if someone gets off on dancing naked in their backyard in homage to the moon goddess (or using their own money to pay for reiki or even a chiro – as long as they’re informed of the stroke risk in advance so are consenting to the danger). Hell, I may even join them since dancing naked in the moonlight sounds like quite a bit of fun if there aren’t too many bugs!
Previously -
####### Calli Arcaleon 16 Jul 2008 at 10:21 pm
When you first described it, it sounded like a one-time-only event — sinusitus, got antibiotics, sinusitus went away. Indeed, without any outside information other than that, it is not possible to tell whether the antibiotics caused the infection to clear up. A lot of people don’t realize that, and it has led to an overuse of antibiotics. They had the sniffles, they took antibiotics, their sniffles went away. But if they weren’t tested, or if their symptoms were not very conclusive, it’s just as likely that they had a viral infection which their immune system dealt with, totally apart from the antibiotics.
I know a woman who swears by antibiotics. She buys them bulk in Mexico and takes them at the slightest sign of a sniffle. That’s a fairly egregious example, but that’s the sort of thing I think most of us were thinking of when you brought up antibiotics.
Now, in your most recent post, you’ve elaborated considerably and given plenty of good reason to conclude in your case that the antibiotics were responsible for clearing up the infection. You didn’t just go by the fact that a single infection went away when antibiotics were used; no, you have plenty more to go on. It’s perfectly reasonable to conclude that the antibiotics were a good choice. ################
Well, at least someone here agrees that I have adequate reason think the antibiotics have, on multiple occasions, cleared up sinus infections. I “believe” they do and should be used in situations where the infection seems to be persisting and causing increasing complications or potential risk to the patient based upon med history and disease progression.
But you now say that you do not “believe” anti-biotics cure sinus infections? Now I would ask the same of you that you have asked the subluxation chiro: if they have no effect then why subject the patient to the risks of adverse side effects?
#####I’m not sure why you’re so galled by Gauls! #####
Very good. Got me.
nwtk – “if they have no effect then why subject the patient to the risks of adverse side effects?”
Good question. One reason is that patients (such as yourself) become convinced that they NEED antibiotics – this led historically to doctors over-prescribing. A medical practice not based in evidence that’s no longer done because the evidence has shown it’s a bad idea. Some people just love pills and don’t feel as if they’ve been treated properly if they’re not prescribed something. Clearly you fall into this category!
In your case you may or may not have needed the antibiotics – whatever the case, you BELIEVE they worked and kept repeating your actions based upon this belief thereby reconfirming to yourself your belief. Your inability to see how anecdotal, subjective evidence isn’t the same as solid evidence is really odd for someone who claims science is corrupt since it’s the most basic and common corruption out there. Anecdotes, myths and subjective observations can serve as inspiration or the basis of a hypothesis, they’re clearly not the same as properly researched evidence and fall more into the category of beliefs or ideas until proven or disproven.
nwtk – Um, you’ve kept repeating “gaul” for “gall” (which is kind of hilarious considering that it’s related to biology!) even though it’s been pointed out to you before.
ntwk2007
Well, at least someone here agrees that I have adequate reason think the antibiotics have, on multiple occasions, cleared up sinus infections. I “believe” they do and should be used in situations where the infection seems to be persisting and causing increasing complications or potential risk to the patient based upon med history and disease progression.
But you now say that you do not “believe” anti-biotics cure sinus infections? Now I would ask the same of you that you have asked the subluxation chiro: if they have no effect then why subject the patient to the risks of adverse side effects?
Perhaps I wasn’t very clear. I’m not saying I “believe” antibiotics cure sinus infections. I’m saying it’s reasonable to conclude that the antibiotics helped you because you have a significant amount of evidence to support that case. So it’s not comparable to a patient saying they believe that chiropractic helped their sinus infection just because the sinus infection went away after they had an adjustment.
If an antibiotic has no effect, then absolutely there is no reason to subject the patient to it. Most colds are viral, and so antibiotics will do absolutely nothing to help. But antibiotics, like practically everything, have risks. The most common include diarrhea and fungal infections, neither of which are much fun. (If nothing else, it’s a waste of money to take antibiotics for your average run-of-the-mill rhinovirus.)
Physicians vary, and fortunately, awareness has been improving. But some are still all too willing to hand out antibiotics prescriptions, for a variety of reasons, most of them well-intentioned.
I know that Calli. But you did agree it there was enough done in my case to reasonably conclude that the antibiotics helped get rid of the infection.
As to the viral thing, I think most people know not to treat viruses with antibiotics. Most, by sinus infection, mean a bacterial infection. We definitly confirmed mine was bacterial.
nwtk – How or why do you believe that antibiotics treating a bacterial infection you had is somehow equivalent to your belief that what you do as a chiropractor works because you have subjectively observed that what you do to make your living is “working”?
Fifi asked,
“Have there been any studies showing that spinal manipulation does actually improve or relieve back pain?”
Yes, that’s what I said: “There is evidence that it is as effective as other methods for relieving some types of back pain.” There is no evidence that it is superior to other treatments, but for patients who prefer it it is a perfectly reasonable option.
A Cochrane review concluded: “This review of 39 trials found that spinal manipulation was more effective in reducing pain and improving the ability to perform everyday activities than sham (fake) therapy and therapies already known to be unhelpful. However, it was no more or less effective than medication for pain, physical therapy, exercises, back school or the care given by a general practitioner.”
nwtk2007 said,
“We definitly confirmed mine was bacterial.”
How did you confirm it? The study I cited was about bacterial sinusitis as diagnosed on clinical grounds by general practitioners. For those cases, antibiotics were not superior to placebo. For other cases of bacterial sinusitis diagnosed by more stringent criteria by ENT specialists, antibiotics are effective.
I saw a resp specialist, as I previously stated, who had it cultured. He did a swab of some drainage flowing down the back of my pharynx and I “produced” some really fowl looking and ultra fowl smelling “yuck” for him. He said he could tell it was staph just from experience, and I guess the culture he had done confirmed it.
He put me on cipro for six weeks. He said the 10 day plan doctors were using back then was a prescription for return infections and bacterial resistance. That was in 1984 I think. It was a good two years before I had it again.
He also felt that one could also distinguish between rhinitis and sinusitis by the clearance of the nasal passages in sinusitis. He took X-rays also although I did not get to see them and was not told the results.
FiFi asks – “How or why do you believe that antibiotics treating a bacterial infection you had is somehow equivalent to your belief that what you do as a chiropractor works because you have subjectively observed that what you do to make your living is “working”?”
I never ever implied that there was any connection between antibiotics and what I do in any shape, form or fashion.
I started out by being pro – One Single Vitamin , Vit C, and that apparently made me pro Big-Vita.
The subject of antibiotics came up and I suggested it might be too late to undo the damage to humanity because of the selection pressure producing more people with less natural immunity to bacterial infections and thus, I became pro Big Pharma.
Harriett pointed out that I was a chiro and asked why I didn’t just eliminate the subluxations from my spine and I pointed out that I don’t treat subluxations.
I then, according to this forum, became incapable of distinguishing good science from voodoo science, was directed that correlation is not causation, asked about my “beliefs” and to be honest, roasted for being a chiro, anti-biotic beneficiary and vitamin C promoter. Accused of various things like not caring for my patients, not knowing how to treat them, giving bad advice to them, running a faith based practice, etc.
It is interesting, in that I think antibiotics are good for infections and that sometimes are very necessary, this forum has all but stated that any success from treatment with antibiotics was unnecessary exposure to the drug’s side effects and not needed; that bacterial sinus infections will resolve on their own with out antibiotic intervention.
If I state support for other medical treatments will this forum counter that they are really not necessary treatments; their counter argument as much from their anti-chiro and anti-Alt bias as from their deep knowledge of the EBM that supports that medical treatment’s use?
Previously –
######nwtk – “if they have no effect then why subject the patient to the risks of adverse side effects?”
FiFi – Good question. One reason is that patients (such as yourself) become convinced that they NEED antibiotics – this led historically to doctors over-prescribing. A medical practice not based in evidence that’s no longer done because the evidence has shown it’s a bad idea. Some people just love pills and don’t feel as if they’ve been treated properly if they’re not prescribed something. Clearly you fall into this category! ##########
I must have missed this one. Again, I have benefitted from antibiotics and am convinced, with good cause, that they have prevented me from extreme illness and who knows what else. Admitted to resorting to antihistamines in an effort “not” to have to resort to the antibiotics, have not had to use either for well over a year now, I like and have gotten good benefit from vit C supplementations and thus:
——– I clearly fall into the category of a pill lover. ———-
OK, fine.
Previously –
######Harriett said- “Some PTs, DOs and some MDs use spinal manipulation therapy. There is evidence that it is as effective as other methods for relieving some types of back pain. We don’t know “how” it works, although there are at least 3 hypotheses.”#############
I would like to hear what those hypotheses are.
Do you really “not” know how it works?
Is there any reason to think that it would not have the same physiological effects elsewhere in the spine or the appendicular skeletal system?
Modifying the technique and eliminating extension combined with flexion, could we reasonably expect the same results from manipulation in the cervical spine as we have found in the lumbar spine?
nwtk2007 said,
“It is interesting, in that I think antibiotics are good for infections and that sometimes are very necessary, this forum has all but stated that any success from treatment with antibiotics was unnecessary exposure to the drug’s side effects and not needed; that bacterial sinus infections will resolve on their own with out antibiotic intervention.”
That is not at all what I said. Go back and read the article I cited. Some infections require antibiotics; others don’t.
Most children’s ear infections will resolve without antibiotics, but some won’t. There are published guidelines about when it’s safe to withhold antibiotics and observe the child and when it is important to prescribe them.
nwtk2007 said,
“I would like to hear what those hypotheses are.”
You ought to know far more about that than I do. They are described in the chiropractic literature.
As for why spinal manipulation treatment might work better in the lumbar spine than in the cervical spine, the muscles and bones are different sizes and shapes, and there are a lot of other possibly confounding factors. I can only guess. As a chiropractor who does those manipulations, you ought to have a better idea than I do as to why the literature supports lumbar adjustments but not cervical adjustments.
Harriett – “You ought to know far more about that than I do. They (hypotheses of how spinal manipulation does what Harriett has said it does) are described in the chiropractic literature.”
I doubt if PT’s, DO’s or MD’s use chiro literature as reference for how something they do works.
Therapeutic exercise works for literally all areas of the spine and musculoskeletal sytem, despite the possible “confounding” factors you mentioned. Why would one think that it would be different for manipulation?
nwtk2007,
Cipro wasn’t available in 1984. Methinks your memory is playing tricks on you.
You could be right. It was a long time ago.
nwtk2007 said,
“I doubt if PT’s, DO’s or MD’s use chiro literature as reference for how something they do works.”
They can’t, because the literature doesn’t show how it works. All it can offer is hypotheses.
“Therapeutic exercise works for literally all areas of the spine and musculoskeletal sytem, despite the possible “confounding” factors you mentioned. Why would one think that it would be different for manipulation?”
You’re the manipulation expert – you tell me. The fact is that the data support lumbar manipulation but not cervical manipulation. What matters is whether it works, not what we think or whether we understand why.
I can apprectiate your position Harriett. If you admit that we know how it works then it would be hard to deny that it is effective when applied to the cervical spine and the rest of the appendicular skeleton.
nwtk – The physiotherapists I worked with – who specialized in chronic pain related injuries and treatment – didn’t consider exercise and any hands-on treatment they provided as being the same thing. Clearly they’re quite different in many ways – this is obvious even to someone without training – do you not understand this? Or is this yet another situation where you’ll claim you’re “testing” the doctors here when you say something that’s incorrect or misleading, or propose something silly? And, of course, slither around actually stating your beliefs and what they’re based upon…so far you’ve denied you base your practice on your education as a chiro (or pretended you were taught something different than what the school proudly declares as their driving philosophy!) and you’ve claimed EBM and science are corrupt (apparently because they don’t support the beliefs you claim you don’t have), so what DO you base your treatments on?
The reality is that Physiotherapists have a different training that Chiropractors do – no talk of the Innate and magical philosophy and attributing disease energy blockages, no shifty “subluxations by any other name” kind of dancing around definitions and trying to leave the door open for mystical energy medicine under the pretense of being “open minded” or “objective” (it’s odd you don’t recognize and can’t even acknowledge your own bias!), no sketchy pretending that what they do is something other than what they do (or is just like what someone with different training does!). In my experience physiotherapists are extremely practical and down to earth people – though I’m sure they come in all flavors – they also don’t try to pass themselves off as doctors or do diagnoses or treatments outside of their specialty (nor do they sell supplements). For all your talk and bluster you’re not actually dropping any knowledge! (That would be colloquial for “you’re not actually sharing or showing any knowledge”.) Physiotherapists who treat chronic pain and injuries also don’t usually work in isolation – nor are they the diagnostician (though their observations of the patient are taken into consideration). I’m curious, do you call yourself a doctor?
nwtk2007 said,
“If you admit that we know how it works then it would be hard to deny that it is effective when applied to the cervical spine and the rest of the appendicular skeleton.”
That’s nonsense. You don’t know how it works. The subluxation/Innate hypothesis has been rejected, and the chiropractic literature is looking for a better one and has at least 3 competing hypotheses with no good evidence to support any of them yet.
I don’t deny that manipulation is effective in the cervical spine. I showed the evidence that it is no more effective than gentle mobilization. Since gentle mobilization is safer, there is no justification for neck manipulation.
FiFi, I am referring to therapeutic exercise, not just exercise. Obviously quite different from exercise.
I do find it interesting that Harriett says it doesn’t matter how something works and even says we don’t know how manipulation works to do the things she says it does. EBM is fine and I really don’t contest it (except to say that it should not be the end all to end all), but I would think that there would be some consensus about how things work at a physiological and molecular level before employing it even if it appears to be EBM.
Even EBM supported treatments have to have some science behind them.
To me harriett is contradicting herself.
And Harriett, you keep referring to me with comments about innate and subluxations. I don’t treat subluxations nor do I do things to release innate intellegence, what ever that means.
FiFi, you’ve given me a lot about PT’s for what ever it’s worth. Why, I don’t know.
What do I base my treatments on? Medical necessity. In order to do that, I have to understand why something works and why I would think a patient would benefit from it. So, always, medical necessity and what is in the patients best interest to treat their injury.
You know, just speaking from a physiological stand point it is not really hard to understnd why therapeutic exercise is benefitial and it is equally clear how manipulation benefits the recovery of the injury and how it does so.
I guess yours and Harrietts response to some of my questions indicates that you might actually be afraid of stating a case for manipulation of other parts of the spine and are thus reluctant to admit what you should actually know about the subject.
nwtk2007 says,
“I would think that there would be some consensus about how things work at a physiological and molecular level before employing it even if it appears to be EBM.”
Not at all. When we adopted penicillin it was because it clearly worked, although we had no idea what was happening at the molecular level.
“Even EBM supported treatments have to have some science behind them.”
Yes, they have to have science showing THAT the treatment works, but they don’t have to have science showing HOW they work. That can come later.
nwtk2007 said,
“And Harriett, you keep referring to me with comments about innate and subluxations. I don’t treat subluxations nor do I do things to release innate intellegence, what ever that means.”
I mentioned subluxations and Innate only as previous hypotheses that were no longer viable. There are at least 3 other hypotheses currently under consideration in the chiropractic literature. Do you know what they are? Which one do you think is the most likely?
nwtk2007 said,
“I guess yours and Harrietts response to some of my questions indicates that you might actually be afraid of stating a case for manipulation of other parts of the spine and are thus reluctant to admit what you should actually know about the subject.”
This is reprehensible ad hominem bull spit.
I’ve told you what the evidence says. You’ve offered nothing to show that my interpretation of the evidence is wrong.
“This is reprehensible ad hominem bull spit.”
Dang it, now my kids can’t read this.
What are these 3 other hypotheses that are in chiro texts. What the heck is a chiro-text?
I am talking about the physiology of why manipulation works. It does, you said so your self. There must be some physiology behind it or it must be magic.
We know the physiology now don’t we Harriett. My question is, despite those “confounding factors, why wouldn’t we expect manipulation to work in the cervical spine as well as in the extremities. In terms of physiology, why would you think those “confounding factors” would be confounding and result in less or no benefit from manipulation in those other areas?
We’re not talking penicillin here or about something that is not fairly well understood. We are talking about some basic human physiology thats been around since the 80′s or even before. Based upon that and what we know, why does it work in the lumbar spine and why would you think it wouldn’t in other parts of the spine and extremities?
nwtk2007, a large part of the physiology at work is the physiology of the placebo effect. This is not well appreciated because what is a placebo and what is not a placebo can be difficult to ascertain. It is difficult to separate the physiology of the placebo effect from other aspects of physiology because the placebo effect is mediated through nitric oxide and it is primarily nitric oxide that couples all of physiology together. NO is the signaling molecule that cells use to broadcast their metabolic state to adjoining cells. Neighboring cells pick up that NO signal and modulate their activities such that they are in sync with neighboring cells.
Neurogenic production of NO and of superoxide allows the CNS to modulate the physiology of the peripheral tissue compartments. Low NO turns on the “fight or flight” state and turns off healing. High NO turns off the fight or flight state and turns on healing. There is a very wide range of different physiology involved in both of those states; they are a diverse spectrum, different in each tissue compartment.
Because NO physiology is what causes all of physiology to work together in sync, a disruption to NO physiology can cause virtually any symptom in virtually any organ or tissue compartment. The usual disruption to NO physiology is low NO. Low NO mimics the effects of stress, which are well tolerated in the short term, badly tolerated in the long term. High NO is only seen very rarely. Essentially the only example is septic shock. Septic shock is poorly tolerated in the short term, and (if you survive) well tolerated in the long term (if proper NO physiology can be restored).
Because NO is what keeps tissue compartments “in sync”, disrupted NO physiology eventually involves multiple tissue compartments. Which tissue compartment fails first is a detail of that individuals idiosyncratic sensitivity to low NO.
No one pretends to understand physiology enough to be able to explain things such as healing rates and why low stress aids in healing. The answer is as complex as physiology, which is vastly more complex than we understand. As limited as our knowledge is, we do know that some ideas are incorrect. As Harriet has pointed out numerous times, the idea of subluxations as chiropractors use it is wrong. The idea of 4 humours was wrong too. When scientists find an idea is wrong, they modify it until it is correct, or if it can’t be modified to correspond with reality, they abandon it.
That is the difference between EBM, SBM and CAM. When EBM and SBM find a treatment modality doesn’t work, they modify it until it does work, or they abandon it. When CAM finds a treatment modality doesn’t work, they look for an uncontrolled anecdote where it seems to work and ignore the well controlled studies which show it doesn’t.
nwtk2007,
I am really losing patience with you.
You are the chiropractor, yet you keep asking ME what the hypotheses are for how manipulation works. You are the one who should be telling us what they are and which one you think is most likely.
You seem not to be familiar with the chiropractic literature, and when I mention it you ask what a “chiro-text” is. (!?)
You say there must be some physiology behind manipulation. Of course! I completely agree! But I don’t think anyone understands that physiology yet. Do you? If so, please share your knowledge with us.
I said that manipulation iS effective in the neck, just not as safe and not more effective than gentle mobilization. Yet you appear not to have registered that, and you continue to ask “why does it work in the lumbar spine and why would you think it wouldn’t in other parts of the spine?”
You keep making the ridiculous argument that we have to understand “how” something works before we can use it.
I don’t think you are reading carefully or thinking clearly. This discussion is going nowhere and is not pertinent to the topic of vitamins.
nwtk2007 on 22 Jul 2008 at 7:05 pm wrote “We know the physiology now don’t we Harriett.”
Apparently, we (as in: nwtk) do not. Lurking somewhere inside me is a course called “Quackery 101″ which teaches quacks how to dodge reality. One principle is to raise questions rather than making concrete statements. Another is plausible denial (e.g., “I don’t believe in subluxations”).
Any chiro advice on health care is dubious, that includes vitamins. The minimum requirements for a DC do not include a real education in health, and I do not trust them to learn it on their own.
In Harriett’s own words – “This is reprehensible ad hominem bull spit.”
Joe, having failed at trying to be a chiro, now spends his days “trolling” about looking for any opportunity to take a jab a the profession which he was too stupid to succeed at.
And Harriett, you are the one who brought up chiropractic in this forum about supplements, not me.
I came in with a bit about vit C, someone said it was essentially placebo, somehow antibiotics came up and someone said I really hadn’t been helped by antibiotics and then you came up with some analogy about chiropractic. I am just following through with that, but I’ll drop it. I am beginning to think you really don’t know the physiology associated with manipulation.
Daedulus says it’s all about NO, which apparently is lost through the washing of bacteria from the scalp and provides the essence of the placebo effect.
As far as supplementation goes, I see a lot of your points, but the benefits of vit C supplementation, beyond what can be gotten from the diet, is pretty clear to me and far an away out weighs the questionable, minuscule risk that has been suggested here.
nwtk2007 on 23 Jul 2008 at 7:46 am wrote “Joe, having failed at trying to be a chiro, now spends his days “trolling” about looking for any opportunity to take a jab a the profession which he was too stupid to succeed at.”
Even if you are a woman, I am not flattered that you fantasize about me (but, when you obsess about me, I hope you imagine a man who is 6′ tall, blond with blue eyes and washboard abs).
I don’t know who you are, and I do not care. When you promote your ignorance in particular, or chiro in general, I respond to that.
nwtk2007 on 23 Jul 2008 at 7:46 am wrote “… the benefits of vit C supplementation, beyond what can be gotten from the diet, is pretty clear to me …”
So, you clearly do not understand what you have been told.
Joe – Yes, you sure are a troll hanging out here to discuss EBM, medicine and science on a science-based medicine blog!!! Unlike the chiropractors who come here to promote non-evidence based whatever-the-hell-it-is-they-do (nwtk apparently can’t actually describe what he does or what evidence/beliefs it’s based upon) and to “troll about looking for any opportunity to take a jab at the profession which they were too stupid to succeed at”. Clearly nwtk desperately wants to be considered a doctor, or at the very least a physical therapist. Oh, and an expert on vitamin C even though he revealed a woeful ignorance about the synergistic effects of vitamins and minerals on each other (you know, basic biochemistry…kinda odd since he claims to be molecular biologist as well as a chiro! Almost as odd as pec’s claims to have a PhD in Cog Sci even though she considers her subjective experiences to be acceptable scientific evidence – as does nwtk!).
So shame on you Joe! How awfully trollish of you to hanging out on a science blog, gasp, to discuss science!
FiFi, your just mad because I represent a group of chiropractors who do not do what you think ALL chiropractors do.
Too bad girlfriend.
I did look into PT school but was talked into chiropractic by, of all people, a practicing PT.
Do I desparately want to be considered a doctor? Well unfortunately for you and Joe, I am, but I would rather teach. There’s just not enough money in it with two kids and one income.
When did we ever discuss the synergistic effects of vitamins and minerals? Are you talking about that extremely weak link between kidney stones and vit C? Near as I can tell from the “big” paper/study sited (a survey), low levels of vit C have a very weak connection (not cause of) with kidney stones. An increase of less than two per thousand. The “connection” drops off and disappears at levels above 400 mg per day or there abouts (doing this from memory from the pape and too lazy to get up and get it), beyond that no correlation at all and never even that correleation in men above 60yoa.
Is that what you were talking about?
And yes, I am a molecular biologist and a chiro.
In fact, we were probably one of the first to show any type of antioxidant activity in vit C and E. We didn’t pursue it too much. We called them free radical traps back then.
And since you keep asking FiFi, I also teach college A & P for science majors (pre-med, pre-dent, pre-PT and pre-nursing) and have written more than a few letters of recommendations for prospective PT students and med students.
How about you FiFi, and you too Joe? What do you guys do and beleive?
nwtk – What I’m talking about is your ridiculous claim that Joe is a troll for bringing up science on a science-based medicine blog. A claim made all the more ridiculous when coming from a chiropractor who won’t define what they do and believe (though you claim it’s not what your Alma Mater promotes so it ain’t chiro but it ain’t medicine…who knows what he’s doing!), who still doesn’t understand (or acknowledge obviously!) the synergistic nature of vitamin C and iron, and who can’t even acknowledge that subjective observation isn’t scientific evidence (though it may be something to base speculations upon), not to mention that the fact that you make a living providing chiropractic services so there’s clear bias and conflict of interest issues!
Since I don’t provide health care treatments, what I do and believe isn’t particularly relevant since it doesn’t put anyone’s health at risk. Even when I did work in a pain clinic, my personal beliefs weren’t particularly relevant since I wasn’t diagnosing people or providing medical treatments, I was merely facilitating various lifestyle changes (and helping people understand the mind/body connection) and worked as part of a team that included doctors, psychologists and physiotherapists (and under their supervision and guidance).
You’re the one making claims to expertize (above and beyond the seasoned professionals who blog here) and to have some mysterious knowledge (unknown to science) so it’s up to you to provide evidence since you’re making the claims. As someone who makes claim to be a scientist, surely you’re aware that the burden of proof lies with the person making the claims!
All of this is, of course, irrelevant to the fact that you’re the one trolling a science-based medicine blog so your accusations that Joe is a troll are really ludicrous. Or do you live in some “alternative” reality where you consider Joe a troll for talking about science on a science-based medicine blog?
As for being a representative of a group of chiropractors who practice EBM – I have seen this group discussed here but you hardly seem to be one of them or to reflect what they promote via their group or website (since you promote the kinds of neck adjustments that can cause arterial tearing and stroke!). Please do inform us of what group of chiropractors you do represent because it really would be a shame if people confused you with the group of EB chiropractors who speak out about neck adjustments and recognize the stroke risk!
FiFi,
Joes not bringing up science, he is chirobashing because he hopes to get out of his student loans if chiropractic goes away.
Joe has utterly failed at chiropractic and wouldn’t know science if it kissed him on the ass.
And I don’t think you actually read all of my post above before you posted your knee jerk response.
Sure I read your post (please stop projecting your own reading habits onto me). Joe brings up plenty of science and even if he didn’t it wouldn’t change the fact that you’re not only a troll but perhaps a professional one (since you now claim to represent a group of chiropractors who share your beliefs – which apparently aren’t based in EBM OR chiropractice! – though your refuse to be open about what you DO believe and actually practice – apart from saying you’re the equivalent of a physiotherapist!).
The fact that your only response is to claim Joe is a failed chiropractor is just silly since it has no bearing on your being here to be a troll. Particularly since you’re the one that seems to have a problem grasping the basic premise of what is and isn’t scientific evidence (not that I doubt this would get in the way of teaching “science” in the US, or “alternative science” and ID at some Fundamentalist or chiro school).
This post is about supplements, right? I brought up a point about vit C when I first posted here, right?
Is that trolling FiFi?
The forum shifted to antibiotics and I commented on that.
Harriett brought up the chiro crap.
I am just staying up on the forum topic.
That is not trolling.
Disagreeing is also not trolling FiFi.
Popping in from time to time to bash chiro is trolling, no doubt about it.
nwtk,
Many years ago, a boy (living in a home for retarded children) asked me to help with a science project. (I will help any student interested in science.) When the project was concluded, he asked the critical question- how we can assure that it was, in fact, successful. So, I took him to my college and ran a test using a $250k machine, which verified his claim.
The difference between you and that boy is that he was a critical thinker. You haven’t asked the simplest question- how can you verify your claim about vitamin C.
nwtk – You don’t just disagree or question (I’d have some respect for you if you did but you’re not an inquiring mind!), you’re here representing a group of chiropractors (or so you claim) and being disruptive to discourse (including calling other members “trolls” because they don’t agree with you and are here because they have an interest in science-based medicine). You are also downright rude to the authors of the blog and evade direct question. You also consider your subjective opinion and observations about what you make a living doing is scientific evidence! Your words and actions really speak for themselves!
nwtk – So who is this shadowy group of chiropractors you represent? And what do you believe and based your practice on if it isn’t what your chiropractic college promotes and it isn’t EBM?
Funny story Joe.
You know, earlier on this thread, I was asked essentially the same thing about my experience with antibiotics and sinus infections.
Calli finally read carefully enough to admit that I was atleast reasonable in my conclusion that the antibiotics had helped the sinus infections.
Bearing that in mind, I have essentially the same verification about vit C. OK, maybe not quit that much.
Antibiotics are backed by a great deal of evidence showing what they do. It is essentially the same for vit C, at least in terms of it’s need in maintaining the strength of connective tissues, which will break down if over stressed repetitively. The result of the break down is microtrauma, low levels of inflammation (swelling, tenderness and pain).
Since supplementing with vit C, those S/S associated with microtrauma lin tissues stressed during activities like running and racquetball have greatly deminished and all but gone away.
Harriett said correlation does not mean causation. I suppose she is right. She said the same thing about antibiotics.
I can only “verify it” based upon what is known and my experience. I would personally rather not stop taking the vit C just to see if the S/S I have related to you come back.
FiFi – “You are also downright rude”
I have jsut reread a few of your responses to me in the past few days. You should talk.
Did I really say I “represent” some group of chiropractors?
nwtk2007 said,
“I can only “verify it” based upon what is known and my experience. I would personally rather not stop taking the vit C just to see if the S/S I have related to you come back.”
I think it’s entirely reasonable for you to keep taking it, as long as you recognize the possibility that it might not really be doing what you think it is.
You can say you feel better when you take it.
You just can’t claim it works better than placebo unless you have real evidence. All you have given us is a testimonial and a hypothesis.
“nwtk2007on 23 Jul 2008 at 2:29 pm
FiFi, your just mad because I represent a group of chiropractors who do not do what you think ALL chiropractors do.”
So what group of chiropractors do you represent and what are your collective beliefs and practices that are different from what most chiropractors do, different from what EB chiropractors do, different than what’s promoted and researched by the chiropractic college you attended, and different from EBM and science-based medicine (which don’t respect or adhere to in theory or practice)?
correction: (which YOU don’t respect or adhere to in theory or practice)?
OK, you got me there. I did say represent. I should probably check with them before you take me to the bank on that one.
I can’t say what their beliefs are. But the chiro’s I know do basically what I do, which is treat injuries. I have already told you that. We are forced into EBM because we are forced to adhere to treatment guidelines which are, so they say, based upon studies of patient treatment for their specific injuries.
I have told you that. There is nothing about subluxations that ever come up in these types of practices, at least none that I have seen.
I really don’t think the guidelines are EB however. The guidelines might be based upon studies, mostly studies funded by insurance carriers, but I don’t think EB could really be applied to them. Even the medical providers who treat the same patients are locked into the same treatment guidelines.
Also, manipulation is only a small part of what we treat our patients with, so, if PT treatment is EB then at least we, the chiro’s who practice like this, can say that most of what we treat our patients with is EB
So you base your treatments upon whatever insurance companies will cover? And you don’t know if those guidelines or treatments are evidence based?
FiFi – “So you base your treatments upon whatever insurance companies will cover?”
No dear, that would be fraud.
The guidelines do not say what an insurance company will cover and/or pay for. Not in the least. In fact, they are used by insurance companies to justify NOT paying for services.
For example, lets say the guidelines give an average for therapeutic exercises at 6 visits for a low back injury with confirmed HNP with radiculopathy. The 6 visits is an apparent AVERAGE, found by who ever it was that wrote the guidelines and their search of the “literature” and the average billed by providers.
If the provider treats a patient for more than 6 visits of therapeutic exercise, then the insurance company will use the “guideline” to deny payment or to deny any request for treatment beyond that 6 average visits, no matter what the situation or the need of the patient may be.
Although much more complex than this example, this is a simple example. Most doctors and clinics won’t do anything beyond what the insurance pre-authorizes and thus not only do they use the guidelines to deny payment, they will also, in many cases, be determining care, no matter what the medical necessity documented by the doctor.
The “literature” used by the writers of the guidelines, is, according to them, EB.
So you ask if we know if the guidelines are based upon EBM? No we don’t know.
Also, the guidelines specifically state that they are not to be used like this, but that is what happens. There are ways to challenge the insurance companies but the ones who decide are not doctors but are administrators and lawyers.
This is, from what I have seen, the end result of EBM, at least as it is applied to injured people.
nwtk dear, you seem to be forgetting what you yourself wrote yet again!
“But the chiro’s I know do basically what I do, which is treat injuries. I have already told you that. We are forced into EBM because we are forced to adhere to treatment guidelines which are, so they say, based upon studies of patient treatment for their specific injuries. I have told you that. There is nothing about subluxations that ever come up in these types of practices, at least none that I have seen. I really don’t think the guidelines are EB however. The guidelines might be based upon studies, mostly studies funded by insurance carriers”
Here you just said that what you do is based upon studies funded by insurance carriers (while trying to imply EBM is too). I’ll let the American MDs here speak to that claim but it seems pretty weird. Insurance carriers have no say in treatment in hospitals or clinics in countries in the rest of the world and don’t fund any research. Who is “forcing” you to adhere to WHAT treatment guidelines? And what are the repercussions if you don’t conform to these guidelines?
So not getting it FiFi.
The studies are gathered, apparently, from research literature, not funded by insurance carriers, at least as far as we know, and average treatment for various conditions as reported in the billing by doctors, although we do hear that some studies are funded by the insurance companies..
The insurance carriers fund the formation of the guidelines, either directly or indirectly thru contributions to legislators to get them to mandate the writing of these “guidelines.
The “forcing” as you say, is that doctors will not treat beyond any guideline because the insurance carriers use the guidelines to deny payment by reason of exceding the “guidelines”.
Since the “guidelines” are based upon averages on many levels, then the half of the injury treatment from past studies is canceled out. The next guidelines, also being based upon averages of treatment, will have lower averages and thus be even more limiting.
For example, if a guideline is based upon averaging and the ranges are from 20 to 100, then the average is 60. Since nothing over 60 will be pre-authorized, then when the next guidelines are written, the new range will be 20 – 60, the new average will be 40 and thus, with the new guidelines, nothing over 40 will be preauthorized. When the next guidelines are written, the range will be 20 to 40 and the new average will be 30, and thus nothing over 30 will be pre-auth’ed.
The guidelines will be used by insurance carriers to systematically reduce treatment to patients.
So, the doctors, since they cannot get paid for services, will not offer the services and patients will not be treated adequately.
The entire picture here is, in reality, much, much more complex with little subtleties that would prevent it from being obvious that this is going on.
nwtk2007 on 23 Jul 2008 at 4:14 pm wrote “I can only “verify it” based upon what is known and my experience.”
What part of “your experience is worthless” don’t you understand? It may seem a complex, four-word phrase; but you have had time to mull it over.
nwtk2007 on 23 Jul 2008 at 5:05 pm wrote “I really don’t think the guidelines are EB however.” And “… so, if PT treatment is EB then at least we, the chiro’s who practice like this, can say that most of what we treat our patients with is EB.”
Which is it? Wait, I know- you don’t care as long as you get paid. PTs learn EB methods and DCs learn subluxation fairy tales- but it is all good if you can take it to the bank.
A DC is a masseur with delusions of grandeur. If you have managed to raise yourself to the level of a PT, how are your customers to know? Rather than take a chance, it is simpler to just go to a PT.
nwtk2007 on 23 Jul 2008 at 8:02 pm wrote “The studies are gathered, apparently, …”
Apparently!!?? You don’t know? (wait, that is believable).
Hey Joe Wisdumb,
When I say “apparently”, in this context, I mean that is what is being implied by the guideline writers and insurance companies. The actual research studies them selves have to stand on their own merits.
Hey Joe Wisdumb,
I don’t do massages, back rubs, neck rubs, or anything resembling such. The closest thing would be some myofascial release which patients find extremely painful if done properly.
Hey Joe Wisdumb,
When I say the guidelines are not EB, I am referring to the extent of care, which is what the guidelines most often comment on. When I say ” Pt treatment” I am referring to the specific types of treatment often employed by PT’s as well as chiro’s which are shown to be EB medically effective.
Hey Joe Wisdumb,
All providers want to get paid for their services and will not treat if they aren’t going to get paid for their services, but ethical providers only recommend that which they feel is medically necessary.
Hey Joe Wisdumb,
You can’t just go to a PT in Texas. Duh.
Hey Joe Wisdumb,
Your comments are worthless, is there any part of that which you don’t understand?
nwtk – I’m really interested in what you do and what it’s based upon. So far you’ve said EBN and science are corrupt (but you also say you base your treatment of injuries on what insurance companies say you’re allowed to do and this is EBM!), you’ve said you don’t practice chiropractice or follow the philosophy of the chiropractic college that you graduated from and you claim to represent a group (though you seem to be backpedaling on that pretty fast!)
Since you’re not an MD and hostile to MDs, what you claim about MDs’ practices in the US is pretty meaningless to me. I’ll let the MDs say what they base their treatments on.
Whatever the case, in most of the world medicine isn’t practiced under an insurance scheme and insurance companies have nothing to do with research. It sounds to me like you’re confused again – or trying to avoid what you actually do and what it’s based upon. So far you’ve said it’s based upon what insurance companies will pay you to do and research done by insurance companies (you apparently consider insurance companies some arbitrators of research when they’re the arbitrators of what get treatments get paid for and cherry pick research they base their conclusion on – kind of like how CAM and supplement manufacturers abuse research). It really does sound as if you know NOTHING about research or EBM and science-based medicine as practiced by doctors.
nwtk – The fact that you’re making all kinds of wild claims and can’t even remember what you write and claim from one minute to the next indicates you’re, well, a liar who can’t keep track of their lies. Apparently the best you can do to try to divert people from the fact that you lie so much you can’t even keep your lies straight AND that you’re being evasive about what you actually DO (and keep trying to pretend it’s what MDs or physiotherapists do) and what your “treatments” are based upon – which are all relevant to the “health care” you provide – is to start calling Joe names that sound like a kindergarten kid make them up. It’s doubly ludicrous that you’re calling Joe a troll when you’re only here to promote your non-evidence based health care practices (based upon whatever you make up in the moment and keeps patients flowing through your doors and insurance cheques coming in!) and to try to divert people from understanding the risk of dangerous chiropractic.
Joe may be acting like a troll on a chiro board if he acts there like you do here. That’s pretty irrelevant to the fact that you’re the troll on these boards. A la Tu Quoque – calling Joe a troll doesn’t make you any less of one.
nwtk – “The closest thing would be some myofascial release which patients find extremely painful if done properly.”
Ah, at least now we’re getting some idea of what you do finally. Any evidence to back up the effectiveness of this painful treatment? Or is the pain you observe in your patients a pleasing sign to you that it’s “working”?
Oh FiFi, is everything in the world as black and white to you? Are you so naive as to think that insurance companies aren’t influencing research in healthcare both indirectly and directly? You don’t see the benefit to them in promoting the need for treatment guidelines through their influence on legislators thru campaign contributions and guideline funding?
Well they do. It is not some big conspiracy it is just them trying to pay out less money on medical claims while collecting premiums from individuals and businesses.
Anyway, let me clear up a few things that you are trying to extrapolate from what I have said.
First, I am not hostile to MD”S. I am hostile to those self-righteous individuals who point the finger at others while ignoring the problems in what appears to be their “good guys” group, namely, medicine and it’s harm to the public by making tremendous numbers of fatal “mistakes”. (And I am very mindful of Harriett’s comments on this just yesterday on the other thread.)
Second, what I do is not based upon what insurance companies will pay for. No way. When a patient comes to me with an injury, I examine it, diagnose it and formulate a treatment plan that I believe is medically necessary for the patient to recover as best they can. I also make recommendations ancillary to that plan in order to clarify the diagnosis and further modify the treatment plan as it is carried out.
These guidelines do not effect my treatment plans or my recommendations, but they do limit what a patient can receive. In most arena’s a patient is responsible for payment for health care services. Therefore, if an insurance company denies payment for services, based upon what ever they decide to base the denial on, then the patient either arranges for the payment or doesn’t receive the services, and thus is only able to partially comply with the my treatment plan, thus compromising recovery.
For example, if I recommend a service based upon medical necessity, and the insurance company denies payment for that or denies pre-authorization for that service, then the patient either pays for it or it doesn’t get done. Since most people cannot afford health care services, then, in an indirect way, the insurance company is influencing the patients care and through treatment guidelines, they are in essence, directing patient care.
In Texas, in the arena of work injuries, this is actually what is going on. This is further complicated by laws that say a worker in Texas cannot be billed for treatment of a work injury unless it is adjudicated and found not to have occured while in the course and scope of their employment, a very long process if pursued at all.
The treatment plan and recommendations I make are based upon patient history, examination and medical necessity only. The insurance companies and these treatment plans limit the patients ability to comply with those recommendations and the treatment plan.
Your last comment is nothing more than goofy at best and a bit insulting, but you have made a lot of those comments before. It really points to what little you know about the entireity of the health care situation and research.
Yes, insurance companies DO cherry pick the research that they want to site as reason for paying anything. They even hire doctors to say that services and treatments are not necessary. Also, a lot of doctors DO let the insurance companies dictate care by basing their treatment plans and recommendations on what the insurance plans will allow and what they won’t allow. So, yes, they are arbitrators, as you say, of patient health care and they shouldn’t be.
Is the system 100% like this? Of course not. But most doctors, if they are honest about it, can come up with examples like this that complicates and limits their patients ability to be treated properly.
FiFi, based upon your last two comments, you are beginning to bore me.
I have pointed out how un-troll like my comments have been on this particular thread and I am correct.
It is almost impossible to actually reply to many of your comments because they are so convoluted with mis-interpretation and accusation.
Are you now going to say that myofascial release is not done by MD’s, DO’d and PT’s and that it is not an evidence based form of treatment? I doubt if I have done it in 2 or 3 thousand patient treatments but I think is an acceptable treatment when it is medically necessary and there is not another better alternative. I merely sated that it is as close to a massage that I have ever done for my patients in response to Joe’s idiot comment that DC’s are essentially massage therapists.
nwtk – Are you so ignorant that you don’t realize that research goes on in countries other than the US where medicine isn’t profit-driven? (Most other countries don’t have governments that are anti-science, like in the US.) Do you believe all CAM research is being manipulated by insurance companies too?
It really is entertaining that you claim to not be a troll while engaging in troll-like behavior such as calling other posters names in exactly the way a child in kindergarten does – particularly since you’re hostile to the focus of this blog and the authors of this blog. Do you really think people who read this blog are that stupid and blind to your lies and attempts to claim the authority of EBM and science while denigrating them at the same time? Let’s face it, most people who visit a blog named science-based medicine are interested in science and science-based medicine – the only person you’re fooling by trying to pretend you’re the equivalent of an MD or a scientist is yourself. And just maybe this shadowy, perhaps imaginary, group of chiropractors you claim to represent who don’t practice EBM; don’t adhere to chiropractic conventions, practices and philosophy as promoted by the college you got your chiropractic credentials from (making your credentials essentially worthless and meaningless) but do offer treatments that insurance says they’ll pay for (which only “work” if they’re painful, as if you believe pain is evidence of something being effective!).
Fifi, do you have a blog? I would like to discuss some of your earlier comments on the role of the profit motive in medicine, but it is somewhat off topic.
###t really is entertaining that you claim to not be a troll while engaging in troll-like behavior###
Disagreement does not a troll make, nor name calling and insults. Thus you would be the troll. A troll lurks in the shadows looking for an opportune time to inject an insulting and off topic comment in order to promote his/her agenda and to illicit a response, essentially for entertainment purposes. I have been on topic with the the ongoing discussion since the beginning. I’ll not summarize it for you again.
###particularly since you’re hostile to the focus of this blog and the authors of this blog###
Disagreement, of which I have only been partially in disagreement, the rest of the time defending your insulting attacks, is not trolling and not hostile. It is discussion. What good is a forum where everybody is all for one and yippy skippy, ooooh you’re so right!? How boring. I wonder at the defensiveness of your responses.
###Do you really think people who read this blog are that stupid and blind to your lies###
I haven’t lied one single time other than, twice sited now by you, saying I represent a group of chiro’s who have particular kinds of practice. And the only thing I meant by “backing off” that one, as you put it, is that I have not been elected as representative of the group, but I am a part of that group of chiro’s who don’t treat subluxations or work to free the innate as it would seem you wish we all were so that your anti-chiro tendencies could be all encompassing, which, of course, that cannot be.
###attempts to claim the authority of EBM and science while denigrating them at the same time?###
Absolutely right. I can practice it and criticize it at the same time. Can’t you? Are you so full of yourself that you can’t be objective and challenge your own “doctrine”? (If indeed it is yours.)
###the only person you’re fooling by trying to pretend you’re the equivalent of an MD or a scientist is yourself. ###
How utterly stupid. I have not and do not claim to be the equivalent of an MD. Never have. It is you who have claimed that I have. What evidence do you have that I have claimed to be equivalent of an MD? None. Just your defensiveness and inability to cope with opposing points of view that are not total black or white, but fall into the gray areas where discussion can occur. YOU, sound religious to me. And the key word here is that you SOUND religious. I certainly am not calling you that.
Scientist, absolutely. I don’t need to defend that.
###ust maybe this shadowy, perhaps imaginary, group of chiropractors you claim to represent who don’t practice EBM; ###
I have covered the “represent part but, once again, your “don’t practice EBM” is off the mark and another of your misrepresentations (brought on by bias). You must do it subconsciously because it is disjointed and illogical and occasionally non-sequeter.
###; don’t adhere to chiropractic conventions, practices and philosophy as promoted by the college you got your chiropractic credentials from (making your credentials essentially worthless and meaningless) ###
Once again you try to insult and are not very specific about it. Which credentials? All of them? Just the chiropractic degree?
And yes, a lot of us deviate from what you say is “chiropractic convention”. Hun, people deviate from their roots all the time. That is change. I don’t pass judgement on religious groups because they are not consistent with the book they say they base their practices on. Man made “conventions” as you put it, are going to change and eventually be rewritten and modified. There is nothing wrong with that and nothing hypocritical about it. Continually referring to these “conventions” is a waste of breath and is part and parcel of why I continue to point out the incredible amount of damage done to the public by medical mistakes and errors. You seem to want to bring down the thunder on chiropractic. Bringing it down on them will most certainly bring it down on the medical community and their big Vita and big Pharma relationship, especially how their “tools” so easily are mishandled and mistakenly harmful to so many everyday. Or is it just poor training that results in so much harm?
###but do offer treatments that insurance says they’ll pay for (which only “work” if they’re painful, as if you believe pain is evidence of something being effective!).###
How stupid.
One final thing FiFi,
You also said, “(Most other countries don’t have governments that are anti-science, like in the US.)”
Is that right? I’ll agree that research goes on in other countries. Sure.
But what is your evidence that other governments are not anti-science? This is an EB blog, so what is your evidence?
Which countries specifically are not anti-science and what is your evidence? If you list the ones that are not anti-science then I guess we will know the ones that are.
I’ll give you a hint. Most EU countries are very pro-science. The magazine Scientific American does a special report on various countries around the world and their science interests. The most amazing are the USSR block countries which are now independent to pursue their scientific interests. Based upon what I have read, I would say they are nearing or have surpassed us in almost all areas of research.
nwtk2007 on 24 Jul 2008 at 8:17 am “… Joe’s idiot comment that DC’s are essentially massage therapists.”
You are quoting me out of context. I said DCs are masseurs with delusions of grandeur.
nwtk – Ah, I see you go in for bluster and righteous indignation – I don’t consider personal observation of people one makes a profit from treating to be “evidence” (and it’s not as defined within the context of this blog). I’m not anti-chiro – I’ve been to see a chiropractor a couple of times at the recommendation of a friend (work health insurance covered it) – I just found it didn’t do much (certainly not as good as a massage for me!) and the “diagnosing” using muscle dowsing and the neck twisting seemed weird, though I
was willing to give it a try. (The neck twisting thing seemed more like a trust exercise, actually,….relax and trust me so I can twist your neck. I didn’t learn about the stroke risk until after the fact, which was somewhat alarming as strokes run in my family. Fortunately I only let her do it once since I found it creepy and unnatural, and the whole “trust me” element seemed manipulative.) Your responses in the thread about Sandy Nette – the Canadian woman who suffered a stroke and paralysis due to a chiropractic neck manipulation – wasn’t to critique your fellow chiropractors who do a potentially dangerous thing (that you claim you don’t do) but to go into Tu Quoque mode.
Not everyone who disagrees with your claims is anti-chiro – which is your default claim and way to protect your beliefs. This is a science-based medicine blog – show me real evidence and I’ll accept your claims. (Harriet isn’t anti-chiro, and I noticed that yesterday you finally were able to acknowledge that, maybe you’ll actually respect her enough to read and acknowledge some of the evidence she presents rather than pretending it’s all corrupt science and some big anti-chiro plot, etc). nwtk, I’d take no issue with you – chiropractor, shaman or Luke Skywalker acolyte – if you didn’t try to claim science is corrupt when it doesn’t support your beliefs or if you didn’t wave a Tu Quoque argument around when the danger of neck manipulation is brought up.
As for vitamins – to bring it back to topic – both I and Harriet pointed out to you that vitamin C is synergistic with iron and the potential health risks. I think it’s a shame that science blogs are constantly full of people trying to denigrate science – not to improve medicine but in an attempt to water it down to affirm philosophical and personal subjective beliefs. Like pec, I’ll leave you to Harriet and the blog authors to deal with from this point in.
daedelus – As you say, it would be off topic and it’s a big conversation (it’s been going on in Canada for a couple of decades and I grew up with it being discussed around the dinner table) – it’s also about the politics of medicine (and insurance lobbyists and corporate medicine) and, like all politics, has a number of different dimensions and is integrally linked to time and place. Americans have gotten a slight taste of this conversation since the idea of universal healthcare was (is?) being floated. At its core it’s about politics and social philosophy so probably not an appropriate discussion for this blog unless one of the authors brings it up.
So FiFi, you’ve been to a chiropractor and his exam was creepy and un-natural.
This sounds strange to me also. The exam that “us” non-creepy chiro’s do is a regular orthopedic/neurological exam. We do some ROM evaluations, palpation of the injured area noting tenderness, redness, swelling, fixations, muscle tightness or spasm, muscle testing for strength or weakness, orthopedic tests, cranial nerves, reflexes, dermatomal sensation, Bp, pulses, resp rates, etc. The exams run from problem focused to comprehensive and are very thorough. This is, of course, accompanied by a thorough history, both related to the complaint and not related.
Nothing strange, just the usual that you should receive from any provider if you have a musculoskeletal complaint. Pretty standard really.
If you get hurt, you just give me a call and swing down here to Dallas and I’ll have a look.
I do remember the synergy of vit C with iron, but if not taking iron supplements, which virtually no-one needs (with exceptions of course) that would not be a problem. Although I did see a comment by an MD who had said that the increase in stored iron with vitamin supplementation could be enough to cause cardiac arrest. Pretty wild if true, but no evidence was sited.
The big study sited earlier I mentioned shows only very slight increase in kidney stones associated with low levels of supplementation but above certain levels the increase (however slight) disappears.
But maybe your right, maybe there is absolutely no need for supplementation if the diet is “good”. I personally will continue with my vit C supplements, but will also increase my intake of vit C rich foods.
As far as denegrating science goes, well, I really haven’t denegrated science. I am critical of some things, but they are not all encompassing of science. Besides, I have been in science all of my life and heck, I will denegrate it if I choose or if I feel it, or some part of it, needs denegrating.
I and a fellow teacher were trying to estimate the number of people we have influenced who are now in some science related field. The number is huge. He pointed out the ones who have openly come back and told us and others about how we influenced their lives. They would say that it was our demand on them to maintain scientific standards that helped them to develop into the successful “scientist” that they have become, be it doctor, nurse, PT, radiologist, med tech, engineer, environmental specialist, research scientist, RA, teacher, professor, house wife, etc.
Unfortunately, the one who just won’t let me go a semester with out teaching something just died. Hopefully I will get to continue.
*Like pec (and quackdoctor), I’ll leave you and other trolls to Harriet and the blog authors to deal with from this point in.*
Ok FiFi, you can back down. But don’t use an excuse that I am a troll on this thread.
I did not come onto this thread to illicit a reaction from you or anyone else. Go back and read it.
It was your assumptions about me that were wrong and I just gave back what I was getting.
Oh and finally, Harriett mentioned NACM. They pretty much express the way I see the subluxation. But to me, they are also a bit too closed minded about possibilities and frankly, I have seen some things that would not permit me to take the oath they require to join.
Later Baby Cakes. See you in the funny papers.
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What study or paper is this to which you refer?
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http://www.thewellnessdoc.com/custom/dr.ungar/videos/video.asp?Video=vitamins&VideoPart=1
[...] a day? Posted on January 3, 2009 by bluelyon Dr. Harriet Hall