Facts, please

I have no data yet. It is a capital mistake to theorise before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts.
-- The Adventures of Sherlock Holmes

Even fictional characters know that.

Orac on Anecdotes

Orac on Anecdotes:

…

No one ever said anecdotal evidence has no value. However, anecdotal evidence as published in medical journals is far different from the sorts of anecdotes that homeopaths mean. to be an anecdote in a medical journal, a case report must be well documented beginning to end, with all history, physical findings, laboratory and diagnostic tests, interventions, and responses to interventions, all recorded as objectively as possible. This is far different than a homeopath's anecdote that she tried this super-diluted remedy or that and the patient got better. Even then, case reports are considered among the lowest, least convincing forms of medical evidence. Case series are only marginally better. As we say in the biz, the plural of "anecdote" is not "data."

…

… Anecdotal evidence, as has been discussed here so many times, is capable of seriously misleading patient and practitioner. Regression to the mean, confirmation bias, placebo effects, and a large number of other potential confounders can easily mislead. …

As alway, there is much more.

The Mayo Clinic scores high on the QDC

The Mayo Clinic tests "Amygdala Retraining Program" by Ashok Gupta (What's next? Thymus Retraining? Bone Marrow Retraining? Liver Retraining?) – time to put my QDC to use!

The study abstract says that "Of the 44 patients randomly assigned who completed baseline assessments, 21 patients completed the study (14 in the standard care group and 7 in the study group)."

This means that over half of the study participants dropped out of the study and only 7 people who were in the 'treatment' group completed the study. This means that the majority of the participants who were in the 'treatment' group didn't even think the study was worth finishing. I'm so sick of these crappy psychobabble studies not counting drop outs in their results, what a crock!

Posted by: beanier
Apr 19, 2012
http://www.prohealth.com/library/showarticle.cfm?LIBID=16932

Oh my, the QDC says the quack is strong in the Mayo Clinic and Ashok Gupta.

Give a man a reputation as an early riser, and that man can sleep till noon.
-- Mark Twain

I think the reputation of the Mayo Clinic as an early riser is not exactly founded in reality.

Anti-Vaxxers and the "Autism Epidemic"

The antivaccine movement resurrects the zombie that is the "autism epidemic"
from Respectful Insolence

If there's one thing that I've learned that I can always--and I do mean always--rely on from the antivaccine movement, it's that its members will always be all over any new study regarding vaccines and/or autism in an effort to preemptively put their pseudoscientific spin on the results. It's much the same way that they frequently storm into discussion threads after stories and posts about vaccines and autism like the proverbial flying monkeys, dropping their antivaccine poo hither and yon all over science-based discussions. If these commenters weren't there, I couldn't manage because dealing with the antivaccine trolls is so time-consuming. I can either lay down the near-daily dose of Insolence, both Respectful and not-so-Respectful, that you all crave, or I can dive into comment threads and refute all the antivaccine nonsense being laid down by some of my more prominent trolls. I can't do both.

In any case, antivaxers are also known for not respecting embargoes. They infiltrate their way into mailing lists for journalists in which newsworthy new studies are released to the press before they actually see print and then flood their propaganda websites with their spin on the studies, either attacking the ones they don't like or trying to imprint their interpretation on ones on which they can, all before the skeptical blogosophere has a chance to post about them. Such is the price of being honorable and honoring embargoes. So it was yesterday, when vaccine-autism cranks jumped the embargo on a CDC study released yesterday that announced new autism prevalence numbers. This is nothing new; it's the antivaccine movement's modus operandi, which makes me wonder why the various journals don't shut off the flow. The study, of course, was announced in press conferences and a number of news stories. No doubt many of you have seen them. They focus on the key finding of the CDC study, which is that the prevalence of autism in the U.S. has risen to approximately 1 in 88.

…

Before I dig into the report a bit more and discuss the reaction of the antivaccine movement to it, let's first note one thing that you will not (and I did not) see in the various hysterical reactions to the study that I've seen thus far. You will not see any of the usual suspects emphasize mercury in the thimerosal preservative that used to be used in vaccines in the context of the report (although one does foolishly mention it, see below). The reason is obvious. If autism prevalence is still rising (or even if it's staying the same), it's yet another death blow to the hypothesis that mercury in vaccines causes autism. After all, thimerosal was removed from nearly all pediatric vaccines back in 2001. …

As always, it's worth to read in its entirety.

Maarten Maartensz on the Vitamin B12 Methylation Protocol for CFS

Maarten Maartensz is collecting some resources on the Vitamin B12 Methylation Protocol for CFS.

Here are three of his most recent posts on this topic (I guess more will follow over time):

1. Here about his mB12 protocol
2. Here a bit more on the the mB12-protocol
3. And here video from Dr. Rich van Konynenburg

Well, the last time I followed a protocol (cpnhelp's Vitamin D and N-Acetylcysteine NAC) I got worse – so I am a bit hesitant to try any "protocol" at the moment.

And firstly, I need to understand WHAT and how much I should take under this protocol. There are so many B-vitamins (and related compounds) that it is a bit difficult to keep an overview on what exactly to take. There seems to be a lot of fine tuning involved and considering that I feel sometimes better and sometimes worse it is easy to fool oneself. And there seem to be different "schools of thought", which worries me a bit, that there a people "fine tuning" a protocol that does little or no good.

The second thing is I want to understand WHY. I want to know the rationale behind it all, I want to understand the mechanisms, I want to understand the metabolism pathways, I want to see (at least) partial evidence, objective measurable values. As far as I know, the mechanisms behind the "methylation block" are purely speculative – the protocol may (or may not) help, for a few or some (or even most) of the ME/CFS patients, but I call quack BS on the putative mechanisms. Without a proper test that can distinguish ME/CFS patients without methylation blockage from ME/CFS patients with methylation blockage – and subsequential test whether the methylation protocol helps this subgroup! – I am a bit worried about this "one size fits all" approach.

PS: He made a new version of his collection of ME/CFS resources, were he tries to exclude pseudo-science (like XMRV), for which I applaud him. Personally, as I consider all currently proposed disease mechanisms for ME/CFS to be – regardless who proposed them – as either pure unsubstantiated speculations, unscientific delusions or even fraudulent falsehoods, I would either label the bits about mechanisms (like mitochondria or methylation blockage) as speculative hypothesis, or move them to a separate document.

Cordain on Grains and Vitamin B

Loren Cordain writes (among others) on B-vitamins in his masterpiece Cereal Grains: Humanity’s Double-Edged Sword:

B Vitamins
Diets based primarily or wholly upon plant food sources tend to be either low or deficient in vitamin B12, since this nutrient is found exclusively in animal products [40]. …

Many nutritionists consider cereal grains to be good sources of most of the B vitamins except for vitamin B12. Inspection of table 4 generally is supportive of this concept, at least in terms of the % RDA which cereal grains contain. However, of more importance is the biological availability of the B vitamins contained within cereal grains and their B vitamin content after milling, processing and cooking. It is somewhat ironic that two of the major B vitamin deficiency diseases which have plagued agricultural man (pellagra and beriberi) are almost exclusively associated with excessive consumption of cereal grains. …

Although table 4 suggests that most cereal grains except for oats are relatively good sources of vitamin B6, the bioavailability of B6 from cereal grains tends to be low, whereas bioavailability of B6 from animal products is generally quite high, approaching 100% [60]. Vitamin B6 exists in foods as three nonphosphorylated forms (pyridoxine, pyridoxal and pyridoxamine) and two phosphorylated forms of pyridoxal and pyridoxamine. An additional glycosylated adduct of pyridoxine, pyridoxine glucoside, occurs widely in cereal grains and has been shown to reduce the bioavailability of both nonphosphorylated and phosphorylated forms of vitamin B6 by 75–80% [60, 61]. The presence of pyridoxine glucoside in cereal grains has an overall effect of depressing the vitamin B6 nutritional status [62]. …

Perhaps the least studied of the B complex vitamins is biotin. Animal studies have shown that most cereal grains except maize have very low levels of bioavailable biotin [65, 66], whereas foods derived from animal sources have a high biotin digestibility [66]. Both wheat and sorghum not only have a low biotin bioavailability, but seem to have elements within them which seem to elicit a depression of biotin metabolism [66]. The enzyme, biotinidase, recycles the biotin derived from the turnover of the biotin-dependent carboxylases and from exogenous protein-bound dietary biotin (fig. 1). Whether or not antinutrients present in cereal grains interfere with biotinidase is not known. …

This is now more than a decade old – one would think that our knowledge has improved in the meantime.

Quack Diagnostic Criteria (QDC)

This document represent an unfinished attempt to collect criteria for the diagnose of quacks. I had most of it done a couple of weeks ago, but I don't have the energy to properly finish it. So here it is, unfinished work in progress, to be refined over time:

The Quack Diagnostic Criteria (QDC)

As a simple definition, a quack is someone:

• who practices medicine (tries to treat diseases/illnesses/ailments/etc.)
• and postulates disease theories and treatment mechanisms which are not rooted in reality
• and does provide no actual evidence for his disease concepts

To differentiate, someone postulating a hypothesis to be tested – while making clear that it is only a unproven hypothesis – is not a quack.

As well, someone treating people while aware of the insufficiency of the available information, and communicating this fact clearly, is not a quack either.

And, for our definition, a quack shall not be someone who provides knowingly faulty evidence for disease theories and treatment mechanisms, because, in contrast to a quack, someone providing knowingly faulty evidence is a fraud. However not all frauds know that they lie: some frauds delude themselves and think – just like quacks – that they are right. The distinction between a fraud and a quack is a difficult one, as we can't look into someones head.

And someone providing unknowingly faulty evidence (e.g. gathered by other people) is a fool (at best), but might be a quack as well.

Please note: Not every unscientific doctor is a quack! A quite distinct subgroup of unscientific doctors can be well characterized as "psychiatrist" or "psychologists". Same as in the quack discipline of Ostheopathy there are tendencies for reformation and adherence to scientific principles (cf. Evolutionary Psychology), but until today these are far from sufficent.

The typical quack is a loner. He or she is in most cases only loosely associated with a few select other quacks, unlike the organized quackeries of psychiatry, chiropractic "medicine" and (the unreformed) Ostheopathy. Yet conversely, most of the people a quack associates with are quacks as well.

One problem in diagnosing quacks is that they tend to "borrow" terms form proper medicine for their purposes. They may seemingly talk about "allergies" or "toxins", yet when quacks use terms like these they remain vague with their assertions. So one doctor says "allergy" and means an concrete pathological process, which can be tested for with proper tests – and another doctor says "allergy" and means this and that, and uses tests that are not worth the postage paid for them (if doctor does test at all).

Another problem is that an – otherwise reasonable – doctor may fall victim to the trends of our time and include one or two methods that should be avoided. The difference between a reasonable doctor and an quack usually is the amount of BS, woo and quackery included. An otherwise reasonable doctor may for example resort to acupuncture, because he does not know better. If a doctor however prominently advertises woo – e.g. the holy trinity of quackery: homoeopathy, acupuncture and holistic naturopathy – he usually is an quack.

And as a corollary, the quality of the total argument by the doctor should help to differentiate quacks from proper medical doctors.

Following are four areas, where one can rate someone if he/she is a quack.

What a Quack says about his/her field:
Add a point for each one applicable, add additional points for each asterisk (*).

Dislikes "Western" Medicine
Tries to "integrate" BS into Medicine *
Never talks about Evidence Based Medicine
Or, tries to give medicine based on actual evidence a bad name (What's the alternative? "Believe Based Medicine"?)
Adherent of "Traditional" Medicine (Chinese, Indian, Whatever) **
Adherent of Ayurveda **
Adherent of "Alternative" Medicine **
Adherent of "Complementary" Medicine **
Adherent of "Integrative" Medicine **
Adherent of "Naturopathic" Medicine **
Adherent of "Functional" Medicine **
Adherent of "Holistic" Medicine (whatever that is) *
Adherent of "Environmental" Medicine
Adherent of "Nutritional" Medicine *
Adherent of Herbalism **
Adherent of "Neuro-Immune" Medicine *
Adherent of mind-body dualism **
Adherent of Chiropractic "Medicine" **
Adherent of Osteopathic "Medicine" **
Adherent of Aromatherapy *
Talks about "Allopathic Medicine" **
Seeks the company of other quacks **
Sees drug companies as the root of all evil
Others are doing it for the money! (while ignoring his/her own financial interests)
Sees "The Establishment" as the root of all evil

The method a quack uses:
These are the methods used (or not used) by the individual to be tested for quack tendencies.

Displays displeasure towards the scientific method *
Never talks about "regression toward the mean"
Does studies that are not reproducible *
Likes non-blinded studies **
Likes studies without proper control groups
Likes studies with very small sample sizes
Likes case studies *
Loves anecdotes *
Loves tests without diagnostic value **
Loves speculation without evidence **
Ignores studies that contradict his speculations *
Likes weasel-words *

What a quack says about disease causes or mechanisms:

Speculates about disease mechanisms without evidence *
Speculates about undetectable persistent pathogens *
It is unmeasurable "chronic low grade" or "persistent" infections! **
It's an allergy!
It's the mitochondria!
It's vaccines! **
It's Lyme! **
It's XMRV! **
It's HIV-negative AIDS! **
It's mold! **
It's candida/yeast! **
It's heavy metals! **
It's mercury! ***
It's "toxins"! (Generally unspecified "toxins") *
It's pesticides!
It's radiation/electrosmog/microwaves! *
It's electromagnetic field (EMF) hypersensitivity (EHS)! *
It's inflammation!
It's free radicals!
It's oxidative stress!
It's the amygdala! **
It's the hypothalamus! **
It's the neuro-transmitters! *
It's the endocrine system / hormones!
It's the adrenals! *
It's the thyroid! *
It's thyroid hormone resistance! **
It's metabolism blockage! *
It's Th1/Th2 immune imbalance! **
It's the acid/base balance! It's too much / too little acid! It's too much / too little bases! **
It's energy blockage! **
It's (bio-)energy! **
It's vibrations! **
It's malabsorption!
It's the gut!
It's an leaky gut!
It's the subconscious! *
It's qi! **
It's "balance" (or lack thereof)! **
It's "harmony" (or lack thereof)! **
It's "dysfunction"! **
It's some other newfound fancy mumbo-jumbo! (e.g. Gene Instability)

What a quack prescribes:

Again, add a point for each. Add another point for each asterisk (*).

Recommends vitamin supplements
Recommends mineral supplements
Recommends magnesium supplements
Recommends trace element supplements
Recommends enzyme supplements
Recommends protein supplements
Recommends probiotic supplements
Recommends micronutrient supplements
Recommends anti-oxidant supplements
Recommends daily intake of OTC drugs like aspirin or NAC
Recommends "natural" remedies *
Recommends herbs and plant extracts *
Recommends homeopathy **
Recommends acupuncture **
Recommends reflexology **
Recommends fire cupping **
Recommends reiki ***
Recommends biofeedback/neurofeedback ***
Recommends neuro-linguistic programming (NLP) ***
Recommends hypnotherapy
Recommends "emotional healing" **
Recommends oxygen (e.g. hyperbaric oxygen therapy HBOT)
Recommends "desensitisation"
Recommends long-term anti-biotics **
Recommends GcMAF
Recommends "detoxification" **
Recommends "chelation" **
Recommends something with a "Detox Reaction" ***
Recommends something with "Die-off or Herx/Herxheimer reactions" ***
Recommends expensive tests not covered by insurance, available only at special labs *
Has an proprietary treatment "protocol" **
Has an "one size fits all" treatment protocol **
The treatment "protocol" is an erratic collection of woo**
Has an extensive treatment protocol were he/she throws everything but the kitchen sink at a patient
Call his protocol "individualized" medicine despite his/her "one size fits all" approach **
Claims to have a better cancer treatment than evidence based medicine **
Claims to cure cancer **
Claims to cure autism **
Talks about "healing" outside the context of flesh wounds
Talks about "mobilizing the body's healing capacity" or some such
Sells any of the above **
Can't be bothered to recommend something that has been tested, because testing if something actually helps (or harms) people would be "too expensive"

Closing remarks

The higher the score, the more likely you are dealing with a quack – again, some of these talking points might be used by real medical doctors. The score-values for each area will have to be determined empirically. If someone's talking points are more than 80% from this QDC, you can be certain to have a quack.

And unfortunately, if someone is not a quack, that does not make him/her necessarily an good medical doctor…

Using RNA to detect drug resistance in pathogens

New ways to detect pathogen resistance to drugs:

The search for new treatments for infectious diseases gets a lot of attention. But to treat something, we first need to know what we’re dealing with. That’s not always easy. The backbone of diagnosis is still built from old methods that include growing mystery germs in lab cultures, or checking how they react to specific chemicals. These techniques require special training and can be time-consuming. Unlike medical dramas, where diseases can be diagnosed between quips, the real-life work can take days.

Amy Barczak from Massachussetts General Hospital is developing a diagnostic technique based on RNA, a molecule that is closely related to DNA. Her method can detect a wide range of infections microbes (‘pathogens’), from bacteria to viruses to parasites. At the same time, it can tell if they are resistant to drugs. Barczak has now published an early “proof-of-principle” study showing that her method has potential, but she says that “considerable additional work will be required” to create a test for doctors to use.

It seems odd that diagnosis should be a problem for the age of modern genetics. Surely you could just sequence the DNA of whatever it is that’s causing an illness? That’s true, in principle. In practice, you need to know the genome of the pathogen in question, and you need to boost the amount of DNA in your sample. …

"Mental health care: designed for evil"

Mental health care: designed for evil

The following is a storified version of events that led up to the way mental health care is organised in the UK today. It should be familiar to all mental health professionals, and shows, I hope, just how evil - and I do not use the word lightly - care provision truly has become.

Institutional care brings to mind horrific scenes. Whether it's the iatrogenic madness of Crispina at the end of The Magdalene Sisters, gossip about the Rosenhan experiment, Broadmoor, or a fondness for Foucault, mental health institutions bring to most people's minds padded walls, straitjackets, isolation, forced injections and unheard screams.

The truth, in some institutions, was certainly not very different from this, and many were the rich families who felt it too cruel to let relatives rot there as if imprisoned. Their alternative though, was the provision of private nurses working in the home, and as this was expensive it was the privilege of a select few. Institutions were expensive, too, for the state - more so even than prisons. And so the dream of mental health care outside internment grew as the number of institutions grew, in some circles because of love, in others because of profit.

Enter Roy Griffiths. Griffiths made his bones in Monsanto (director, 1964-68) and then Sainsbury’s (1968-91), and naturally, this gave him uniquely brilliant insight into mental healthcare. Thatcher had commissioned Griffiths in 1983 to write a diagnosis of the problems of the NHS. What he decided the NHS really needed was more managerialism and internal markets (ask anybody that works in the NHS today what the biggest problem and waste of money is, and they'll all tell you, too many managers and markets), and this seemed to set him up as the best possible person to respond to the media crisis brewing around the terrible quality of institutional care in the UK.

…

Haven't read it all yet, but it might be an interesting and different view on affairs.

I have read it now and it is a interesting and more general view on affairs and the general use of CBT on the general public in the UK, including two interesting links about CBT.