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116 thoughts on “TIME Magazine, Dr. Oz, What to Eat, and Supplements

  1. pmoran says:

    Sorry about the misfire. I have to do other things, and will get back to this.

  2. pmoran says:

    Sorry about the misfire. Again –

    I am well aware of the many problems with pragmatic studies. Placebo-controlled studies are definitely the “gold standard” when testing for intrinsic medical activity, the main focus of medical scepticism.

    CAM poses different questions. Even many of its own practitioners are within an inch of allowing that they are mainly recruiting placebo and non-specific aspects of medical interactions.

    There is simply so much opprobrium attached to the slightest association with the P word that they have to resort to euphemisms e..g. “meaning responses ( Moerman, for one, is obviously thinking “placebo”)”. “the healing ritual”, “mind-body medicine”.. It’s all the same, mingled in with the generic benefits of sympathetic (indulgent?) human contact, and perhaps simple lifestyle advice that could be gotten anywhere..

    So how do we study CAM? As I have indicated, it is not so simple.

    Pragmatic studies in which different treatments are compared, or which compare “treatment” to ” no treatment”, dispose of one problem — that of illness variability over time.

    Keeping things simple, any apparent “benefits” that are left must be due to either placebo responses or biased reporting.

    The question is, are we prepared to ascribe the often quite substantial apparent “effects” of both placebo and CAM in published studies to biased reporting?

    I can find no scientific basis on which we can. It is not even clear how we can tease out those influences using present methods.

    Yet that matter is to me crucial in deciding how I will respond to some aspects of CAM. We cannot escape putting patient interests first, almost regardless of how they are served.

    The coal face of medicine may thus not be an entirely suitable ground on which to wage a war on pseudoscience. There may be collateral damage.

  3. weing says:

    “The question is, are we prepared to ascribe the often quite substantial apparent “effects” of both placebo and CAM in published studies to biased reporting?”

    Why would you ascribe it to biased reporting? I just consider it background noise. I am looking for the signal.

  4. Harriet Hall says:

    “We cannot escape putting patient interests first”

    It may be short-sighted to put a patient’s apparent response to a placebo first, as was demonstrated by the asthma study. I maintain that it’s almost always in the patient’s best interests in the long run to find out the truth to the best of our ability and to offer patients treatments with objective benefits whenever possible. And when effective treatments are not available, to sometimes offer untested or unproven treatments but to make their status clear rather than misleading the patient into thinking the evidence is better than it is.

  5. pmoran says:

    >“The question is, are we prepared to ascribe the often quite substantial apparent “effects” of both placebo and CAM in published studies to biased reporting?”

    Weing: Why would you ascribe it to biased reporting? I just consider it background noise. I am looking for the signal.
    —————————————
    Background noise should be largely controlled for by the comparison groups in the studies I am referring to. They compare placebo interventions or CAM to either standard medical care or to patients on a waiting list.

    Such studies regularly provide a clear and statistically significant signal of “benefits” with subjective complaints and psychosomatic condiitons, and sometimes quite substantial ones . Exactly the same methods and instruments are being applied as those used to detect efficacy of mainstream methods in the more usual placebo controlled trials.

    I was asking what are those results due to? To my mind they have to be due to either true placebo responses (the patients do feel better through psychological influences), patients saying they are better when are not really i.e. reporting biases, or most probably, a misture of the two.

  6. pmoran says:

    Harriet, I agree with everything you say and use “patient interests” in exactly the same sense as you.

    But, may I ask what you think my agenda is, if, as you imply, I am not seeking scientific truths?

    I may have a bee in my bonnet about wanting clarity on the placebo potential of CAM, but that is in the interests of fair, rational, medically appropriate responses to the various matters CAM raises in many different settings.

    I see you are planning to talk to Benedetti’s work on placebos. We can suspend this until then, if you wish.

  7. mali says:

    As much as I would love to believe that Dr Oz can come around to being somewhat sensible on a few topics, I have a hard time believing that this wonderful science based diet article is not related to his recent partnership with Weight Watchers. And until he takes back the shows he has aired featuring 500 calorie a day diets and hypnotism for dieting, I shall remain skeptical.

  8. nine_inch_hardon says:

    i’d like to take issue with the following here harriet:

    “The low carb diets change nutritional balance in ways that may not be desirable.”

    at this point, doesn’t most of the data on low carb diets show more desirable results than any other form of dieting?

    “Fad diets work by restricting food choices: they result in fluid loss and decreased calorie intake, and the weight lost comes right back when people stop the diet.”

    the weight comes right back after every single form of weight loss the world has ever known. whether people call it “a lifestyle change, not a diet” which is the latest meaningless mantra where people eat more austerely for awhile before getting fat again, or whether people get invasive weight loss surgery making their stomach the size of a thimble, they put the weight right back on (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856611/) is bariatric surgery a fad diet now? there are no “fad diets”. by and large almost no one can change their eating behavior even in the face of negative consequences, even 50% of people who get bariatric surgery can’t do it. outside of bariatric what is the average failure rate of all diets ever studied, 90%? 95%? 97%?

    and what the hell is a “food group”? how did we make it this many hundreds of thousands of years without food groups, and now not just our happiness, but our very existence depends on them? we’ve reached over-nutrition, i think we can do without a “food group” or two, like most of the rest of the planet does. like all humans have basically forever.

    what is “moderation”? this word means nothing to anyone. show me a fat person who knows what eating moderately means. it’s literally the worst advice you could ever give someone on eating. how many decades are we into moderation talk now while everyone keeps getting fatter?

    if berries have a ‘profound impact’ on longevity then why are there no superfoods? sounds like berries are a superfood to me.

    how do we know the stature and longevity of ‘cavemen’ had anything to do with their diet? why would we even be inclined to think that? which cavemen? which paleo diet were they eating (can be drastically different depending where they were). sounds totally meaningless. the paleo diet means not eating legumes, grains, or dairy, and instead eating meat, fish, foul, vegetables, and fruit. who thinks this will kill you or make you a midget?

    with that out of the way:

    that dr oz wrote this article is highly bizarre. his intervention for EVERY person i’ve ever seen on his show has been a drastic low fat vegan diet, he’s preached low fat veganism extensively and even explained the (debunked) 7 countries study on his show. he had one show about a ‘meat loving cowboy’ who he had go vegan (looked like with an emphasis on ‘raw foods’) to improve his health and lose weight, complete with a 2 month followup, and then another one where he made an entire firehouse go vegan lead by rip esselstyn (caldwell’s son).

    i think he has been somewhat influenced by gary taubes recently, but this kind of reversal so fast is pretty boggling. it’s hard to know where he’s coming from or what his agenda is because the amount of quackery he spews can be immense. remember on top of his tv show and guest appearances and magazine articles he has also written multiple books full of health bullshit that i suspect none of the authors of this blog have bothered to read.

    the bottom line is when it comes to non-specific health and wellness theres almost nothing that can be said yet this idiot never stops talking.

  9. Larryndallas says:

    We need to cure our physicians of nutrition amnesia. Secondly, as atrocious as our food supply is and a fast food industry gone wild, we don’t need a multi vitamin…we need one that is not full of fillers, toxic metals, and other contaminants.We need to stop doing retrospective studies involving supplements because without and quality and purity control, it’s bad science! You can’t control for supplements much less diet unless subjects are in a research lab and there is hardly a dime that will be spend on nutrition. There is no money in it. People that take quality whole food supplements are on fewer medications by age 70 according UC Berkley prospective study by Gladys Block MD. It is called The Landmark Study. Third, there are over 2000 clinical studies on resveratrol. When combined with other polyphenol, there benefit on mitochondria function, DNA repair, and AGE protein build up in the cell. Forth, If berries are in question, it is because the mass chemical spraying of our foods. We don’t have real food for the majority, we have a chemical soup in low consistant doses that are forgiven by regulators because they only look at a single dose exposure and not life-long impact. Cancer could be cut in half (my assertion) if our food, water and air weren’t so polluted, not to mention our homes that are 2-5 times more polluted than the outdoor air according to the EPA. I’ve seen enough to know that we are over medicated, which leads me to believe physicians poo poo supplements in favor of medication, that their interaction is now the 4th leading cause of death. Physicians do more to kill people than a supplement ever did. I’ve seen the majority of diabetes patients I’ve worked with on up to 15 medications. Their appetite is dead, most of the time. There is very little screening for drug-drug interactions. If any industry that has served a huge death bullet to a civilization, that would be the pharmaceutical industry.

  10. Chris says:

    LarrynDallas, you need to read this blog more. All of those points have been addressed multiple times, with much more clarity than your rant of statements without supportive evidence.

  11. lilady says:

    @ Larryndallas: So many of the “issues” you raise have been covered in this blog. Your silly statements about indoor pollution could be checked-out at the EPA website. Your statements about “nutrition” could be checked out at the American Dietetic Association website, as well.

    You have an opportunity to use the internet to check into these issues and, (hint) if you hang out out websites where they are selling you “natural supplements and natural vitamins”… is not a great website.

    I’ve “survived” 68 years on this earth and have never taken a vitamin or mineral with the exception of the two times I was pregnant and the last few years in my “dotage” when I take 1 calcium/vitamin D supplement each day. (I have been diagnosed with osteopenia…very common in post-menopausal women.)

    Any “self-styled nutritionist” is unqualified to offer advice about balanced diets and any blogger who has gotten his/her “education” through an internet distant learning college is totally unqualified to offer up advice on the internet.

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