Medical

A reminder on anti-oxidant supplements – they don’t do what you think they do.

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A while back I did a piece on the anti-oxidant rage, here.

I’m not sure if I’ve tuned them out, or the media has actually gone a bit quiet on anti-oxidant supplementation, but it’s worth reinforcing because we continue to see a whole lot of misinformation and misleading nonsense in the nutrition industry – you know, berries of various sorts, herbs, teas and such. I’m actually surprised there isn’t a brand of cigarettes boasting anti-oxidants.

The point of my original story is that the body is a lot more complicated than the simplistic “anti-oxidant kills free radicals” messages we are given, much like “stop the boats”. In fact, too much anti-oxidant can be harmful.

This post is just an excuse to point you to one of my favourite new online information sources, The Conversation. This is an online magazine with contributors from academia and industry, who have the luxury of being able to write in-depth about issues, rather than just give you slogans. And of course, the articles are written by people who know the material, not journalists interpreting others.

In particular, this piece : Health Check: the untrue story of antioxidants vs free radicals gives us another good potted summary of this potentially very complex issue. It is presented in a very clear and accessible way, so give it a try.

Once again, the bottom line: a balanced diet gives you as many anti-oxidants as the body needs, so don’t waste your money, or risk your health by supplementing them with special foods and concoctions.

Glucosamine is a dud – you heard it here first(ish)

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Well, far be it from me to say ‘I told you’, but, I told you so!

Let’s re-wind the clock. Back in the early days of rationalbrain, I put the spotlight on this popular supplement, given my own personal interest in keeping my knees in good order after a lifetime of pounding roads, basketball courts, football grounds, and aths tracks. (My knees are actually quite close to my heart – no, I’m not crouching, nor am I mis-shapen; I’m just quite fond of them).

At the time, this fledgling skeptic concluded that:

Basically, the high quality studies show no improvement over placebo, while the lower quality ones show a 2 point improvement in pain on a scale of 68! Talk about marginal effects. That’s certainly not enough for me to be sucking these things down, even if they are harmless.

Smarties would be cheaper, tastier, and about as effective.

The thing I found most remarkable at the time was that even those who should know better were sucked into the Glucosamine fad: my local GP (who specialises in sports medicine), and, the surgeon who did my knee arthroscopy ops. When I asked the former what the supporting research was, he coyly admitted he didn’t know, and pointed me to the Cochrane Reviews, on which I’ve been relying ever since, and from which the above conclusion came.

There have been other studies which concluded similar things, most of which have been reviewed by Harriet Hall over at the excellent Science Based Medicine blog.

And now, almost 3 years later, there’s a new study to talk about, which also concludes the same thing, but which is also remarkable for another reason.

The study was conducted by the American Academy of Orthopaedic Surgeons (AAOS). I’ll leave the remarkable bit for now. But this was a huge review of the literature for all treatments for osteoarthritis of the knee (which is the ‘wear and tear’ variety that we all suffer in the later years, especially us super-athletes, right?).

They managed to condense the 1200 page report (no, I haven’t read it all), into a handy 13 page summary, which you can read for yourself here.

The work basically rates the various treatments for efficacy. Harriet Hall has summarised the conclusions further as follows, with those items showing strong evidence one way or the other highlighted:

  1. Exercise – strong evidence for effectiveness
  2. Weight loss – moderate evidence for
  3. Acupuncture – strong evidence against
  4. Physical agents (TENS, ultrasound, etc.) – inconclusive
  5. Manual therapy (chiropractic, massage) – inconclusive
  6. Valgus-directing force brace – inconclusive
  7. Lateral wedge insoles – moderate evidence against
  8. Glucosamine and chondroitin – strong evidence against
  9. NSAIDs – strong evidence for
  10. Acetaminophen, opioids, pain patches – inconclusive (this is particularly interesting since acetaminophen is the standard first-choice drug)
  11. Intraarticular corticosteroid injections – inconclusive
  12. Hyaluronic acid injections – strong evidence against (and if injections are ineffective, those oral diet supplements certainly don’t have a chance)
  13. Growth factor injections and/or platelet-rich plasma – inconclusive
  14. Needle lavage – moderate evidence against
  15. Arthroscopy with lavage and debridement – strong evidence against
  16. Partial meniscectomy in osteoarthritis patients with torn meniscus – inconclusive
  17. Valgus-producing proximal tibial osteotomy – limited evidence
  18. Free-floating interpositional device – no evidence; consensus against

There’s a number of really interesting things here.

  • Firstly, the no-brainer: acupuncture is useless. Quelle surprise!
  • Secondly, glucosamine and chondroitin – now it’s strong evidence against (hence my ‘I told you so’)
  • Thirdly, NSAIDS (i.e. non-steroidal anti-inflammatories) like neurofen etc – strong evidence for.
  • Fourthly, exercise is good for you. Who knew? I’ll have more to say on this in a sec.
  • And finally, the shock for me: arthroscopy (the other bit is the trim and vacuum of the bits of cartilage), which I’ve had done a couple of times – seems to be strong evidence against.

While it’s comforting to have my earlier conclusions about glucosamine supported so strongly, I do have to acknowledge that I was/am a great believer in arthroscopy, because of the success I’ve had with it. But I’m prepared to reconsider that belief, not only because of this study, but because of my own more recent experience.

I did have a couple of arthroscopy sessions, separated by about 10 years, to get rid of those niggling knee pains. And they worked fine – back to running and basketball within 2-3 weeks. But a few years back, after feeling more knee pains now and then, I concluded I needed another knee ‘tune up’. The only problem was that my doctor disagreed. He didn’t think the wear and tear was bad enough to warrant it, and eventually talked me out of it, suggesting instead that I should do more knee exercises. That didn’t appeal too much – I’d prefer a quick fix to ongoing physio anytime.

However, I embarked on daily leg exercises – mostly straight leg with weights. Lo and behold, it worked.

So, while I was quite convinced that arthroscopy was the bees-knees (sorry, couldn’t resist), it turns out that perhaps there was another way – which is in fact what this study found.

And what was the remarkable thing I mentioned at the top of this post? That the AAOS has found AGAINST one of the biggest money-earners of their entire profession – knee arthroscopy, which at least in Australia is a huge industry. So congrats to the AAOS for being frank and fearless in their research, and letting the facts speak, instead of yielding to self-interest.

It’s also a good example to set for those alternative therapy hypocrites who constantly accuse the medical establishment of being in it for the money.

Elmore – the empire strikes back

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Just as things go quiet on the Elmore front, a new and energetic attack thread appears, but is buried in the comments of a past article.

For those interested in the never-ending saga that is Elmore, take a look at the exchanges in the comments here.

I’m afraid I probably engaged a little too long with one correspondent, but felt obliged to address the scatter-gun mix of put-downs and logical fallacies.

And it turns out that I’m condescending. Who knew?

Read the comments, and see what you think, you insignificant peons.

Swisse vs. Reality

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Back in July I had a crack at Swisse – one of the biggest marketers of questionable supplements and alternative therapies currently going around. I got a really interesting comment from correspondent Pam, and felt it was worth putting the comment up in lights, rather than having it languish in a comment thread. She had this to say about the subject:

After a PET scan showed multiple ordinary-nothing-to-worry-about cysts on my liver (as part of a work up to diagnose breast cancer bone mets) I decided to take Swisse Liver Detox tablets to help support my liver function. I don’t drink alcohol and have a good well balanced diet. The only reason I decided to try them was because an osteopath friend of mine suggested finding something with milk thistle in it – so stupid me I did! Within a fortnight of taking them my entire body is itching terribly (to the point that I am now cover in little sores) and when I had my blood test this week the oncologist phoned me to tell me my liver function was badly ABNORMAL when previously it had been perfectly normal!! Needless to say I stopped taking the tablets three days ago but I am still itching terribly. This is an allergy to the tablets and they have caused my poor liver to now not function properly! I have to have another blood test in a fortnight to reassess its function now! Not happy! There is nothing on the Swisse website for Liver Detox warning about this sort of reaction.

Pam’s story is a timely warning  that these ‘feel good’ treatments don’t guarantee that you’ll actually feel good. Or even better. They really don’t guarantee anything. In Pam’s case I wouldn’t be surprised if she had some legal recourse for what she has suffered.  So don’t believe the hype, or even the anecdotes  (see my Elmore threads for good examples of those), and ensure you check with your doctor (of Real Medicine) about whether the supplement will help or hinder. At least this way if something goes wrong, it will be quicker to diagnose.

And for those cynics out there, who want to yell at me: “hypocrite, you’re just citing an anecdote yourself” – good work! Your critical thinking skills are coming along. Yes, it’s an anecdote, and yes, Pam could work for an opposition supplement company. Or Pam could be part of the Big Pharma conspiracy aiming to kill the ‘real treatments because they’re so effective’. But the difference is that it’s an example of what could happen, not a guarantee of what will happen. It’s  a warning, not encouragement. Buyer or user beware.

And how is Pam doing now? Her most recent update is:

My second blood test after stopping the Liver Detox tablets showed a marked improvement although it was still not back to the normal level it showed pre-self medicating!! Never again!!

Good luck with it Pam. To really get that liver humming, I recommend 1 litre of Elmore Oil daily. I drank some, and my liver is just dandy.

More juvenile nonsense from the anti-vaccination crowd

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Just to underline how irrational and desperate the anti-vaccination lobby is, here’s a simple graph presented by one of their star speakers (Dr. Julian Whitaker) at a recent debate, as reported in great detail by Orac. The debate was part of ‘FreedomFest‘, which presumably means ‘freedom from reality’, judging by the topics under discussion.

This graph was presented in an attempt to show how the rate of autism was increasing as a result of the intrusion of big pharma in pushing vaccinations onto our children.

Take a look at it. If you’ve done high-school maths (early high school at that), you’ll see how absurd it is, especially as it was presented by someone with a Dr. in their name.

For a start, take a look at the data at 2012. There is nothing in the data for preceding years which would suggest the succeeding years growing at the exponential rate shown. This is sheer fabrication.

The graph also tells us that by around 2030-40, ALL children born will be autistic.

In fact, but the time 100% of girls are being born autistic, about 110% of boys will be born autistic. That’s some achievement, even for big pharma!

The general population curve just doesn’t make sense. Presumable, it’s just the sum of male and female births, but the curve doesn’t seem to work that way. Maybe he’s included some other lifeforms in the general population, but it’s hard to say.

Anyway, simple story, but just another example of the tactics employed by this crowd. Like so many denialists, it’s the FUD tactic – sowing fear, uncertainty and doubt, instead of presenting real facts.

 

Say NO to neck twisting treatments

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I’ve previously had a crack at chiropractic manipulation (here and here for example), and recent research published in the British Medical Journal does nothing to change my mind.

I admit not having read the whole article, since I’m not a member, but rather I’m going on a recent article by Dr. Steve Novella, who wrote an analysis here for the James Randi Educational Foundation.

The article in the BMJ has the conclusion neatly encapsulated in the title: “Should we abandon cervical spine manipulation for mechanical neck pain? Yes”.

Steve looks at the issue from a risk point of view, noting that all therapies can carry some risk, and the ultimately it’s a risk vs benefit analysis that must be done. He has in past written a long analysis of the issue himself here. While chiropractors have been doing the high-velocity neck manipulations for many years now, there is now emerging evidence that neck manipulation carries a risk of stroke and death from trauma to the neck arteries.

The article points out that practitioners of neck manipulation have been generally denied or minimised the possibility of harm. It is of course true that other therapies, like vaccination, also have a small risk asssociated with them – but the risk is accepted by society because of the benefits. The difference with neck manipulation is that it is now clear there is no real benefit to offset the small risk. This has been established by systematic reviews over a long period now. As with many ‘alternative therapies’, all we have are the enthusiastic claims of the practitioners, most of whom never demand evidence. They would also almost never see one of these catastrophic injuries, and therefore wrongly assess the risk. It’s the old ‘my grandfather smoked all his life and he lived to be 100‘ syndrome. Our experience is a very bad way to assess a proposition. Admittedly, the risk is quite small in absolute terms. However when viewed in a cost-benefit light, the risk is too high. As Steve puts it:

In absolute terms this is a low risk, and we certainly accept higher chances of adverse outcomes in many mainstream treatments. But we need to also consider that, while the chance may be low, the risk we are talking about is stroke or death – a very serious adverse outcome. Further, this may occur in young and otherwise healthy individuals. In that context, the risk is relative high for a medical intervention.

So, not only is there no evidence for this therapy to offset the high risk (high risk in the sense of low probability but high impact), there is no reasonable theory or method of action to support such neck manipulation. Chiropractors will tell you about so-called subluxations, which cause all manner of internal bodily illnesses. However, these continue to be imaginary. While vertabrae of the spine do often impinge on nerves to cause serious issues, the chiropractors’ claims regarding the range of illnesses caused by subluxations are fanciful. Just think about it logically for a minute: if minor (adjustable) spinal mis-alignment can cause liver problems (for example), then anyone who experiences paraplegia or quadroplegia should suffer massive organ failure, right? But they don’t. They live on in varying levels of immobility, despite suffering the mother of all subluxations. Bogus therapy – there’s no other way to put it.

So, anytime someone offers to give your head a quick whip around to relieve that headache, or stress, or digestive illness, or sore ankle, or emotional problem, JUST SAY NO.

Autism – How to really help your child

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This is a subject about which I try to be very careful, since it is hugely emotionally charged for the parents involved.

I have in past put my foot in it when discussing the issue with a friend, one of whose children is autistic. To my surprise, he was firmly of the view that vaccination was the culprit, and that Andrew Wakefield was misunderstood. Of course, no matter how much skepti-babble I threw at him, his view was firmly entrenched. At that time I realised the difference between an academic view of the world, and one in which you were so invested emotionally, and backed off  to the point of apologising for challenging his views.

I have blogged in past about the antivax crowd and their exploits, but have not really looked at the autism side of things in any great detail, other than as a vehicle for debunking miracle cures and other nonsense (search on ‘autism’ here on rationalbrain for a selection of these).

Unfortunately, the nonsense keeps coming, so in this article I think it’s timely to contrast it with an approach which seems to promise some real progress in treating the effects of autism.

The latest nonsense is administering bleach to kids, based on the theory that autism is caused by gut bacteria. Yes, the new Miracle Mineral Solution is actually 28% sodium chlorite. Bleach. Orac has a detailed discussion of it here. Children are now being tortured with this stuff as we speak, aided and abetted by the usual suspects.

Needless to say, MMS is just another quack cure, with no basis in science and absolutely no trials to assess safety or long term benefits. Just more anecdotes from quacks, preying on desperate parents.

And the irony is stunning: after whining about the ‘toxicity’ of vaccines for so many years, the anti-pharma crowd is now embracing one of the most toxic substances as its miracle cure. If ever a ‘WTF’ is appropriate, it is now, right?

So what’s the alternative for parents seeking to address autism? Firstly, a bit of lay advice: it’s not your fault. You did not cause it by making bad decisions. But there is something you can do about it. Try ABA. According to wikipedia:

Applied behavior analysis (ABA) is a science that involves using modern behavioural learning theory to modify behaviors. Behavior analysts reject the use of hypothetical constructs and focus on the observable relationship of behavior to the environment. By functionally assessing the relationship between a targeted behavior and the environment, the methods of ABA can be used to change that behavior. Research in applied behavior analysis ranges from behavioral intervention methods to basic research which investigates the rules by which humans adapt and maintain behavior.

Why do I recommend this treatment? One of my correspondents, rationalfollower, is trained in neuroscience and is a practitioner of ABA. Rationalfollower has had fantastic success recently in assisting a 3 y.o. child. I know what you’re thinking (because I’m rationalbrain): but all you have is an anecdote – right? Well, yes. But the stunning and objective improvements achieved for this young patient are worth raising,  if only to encourage others to try this approach, rather than subject their children to poisoning via MMS, colloidal silver, or other crazy torture. Here’s the story of ‘J’, in rationalfollower’s own words:

I am currently working as an ABA therapist with a 3 year old high-functioning autistic child, J. We have been working on the pre-requisites to future learning- we call this ‘learning to learn’. Since I started introducing ABA to J a few months ago, I have seen an amazing progression.

When I first met him, J would refuse to walk anywhere: his mother had to carry him, or else he would scream bloody murder. This was the case anytime they had to go anywhere.

When I first attended kindergarten with J, I was shocked to see how much time he spent wandering around, completely unengaged. He was not motivated to do anything and didn’t seem to know what he was supposed to be doing (no wonder he hated kinder – how confusing it must have been!).

There was virtually no engagement with any of the other children. J would refuse to sit with the other children at mat time, instead he’d be running around while teachers frantically tried to control him.

I began by introducing a cool walking program. After only a few months practicing and reinforcement, J will now jump out of the car and walk into kinder or the psychologist’s offices by himself.

Through focusing on engagement and attention, J (after walking into kinder on his own) will now run straight to the play-doh table, or straight to the pasting, and sit down to play… appropriately. As the weeks go on he spends a little longer engaged in each activity.

I also introduced a mat time/good sitting program, involving role playing at home. J will now sits cross legged, facing the teacher, looking at the book the teacher is reading for a few minutes at time. If he is ever going to be able to comprehend the book being read to him, he first needs to be able to sit quietly, attend to the book, and listen to the words.

Another step forward is that J is now required to tell me when he has finished with an activity rather then just getting up and leaving. J has to use his words for communicating as I no longer tolerate grunts and tantrums. Instead of throwing a tantrum, J is encouraged to say “I don’t like it” or “Help please”.

A week or so ago, another key aspect of the work,  the Communication Temptation program, paid off, as I saw a little girl approach J and hand him a shape. J looked straight at this little girl, and clearly said “Thank-you”. This was a completely appropriate social interaction between J and another child.

This is a work in progress. ABA does not cure autism, but it is a way of helping that child to be the best they can, and to prepare them as best as possible for life. ABA works on reinforcement principles, and seeks to replace self stimulatory behaviours with more productive/socially appropriate ways to meet that same function. It is important to remember that any one behaviour can have many different functions or purposes, so it is important to do a ‘functional behaviour assessment’ before trying to introduce replacement behaviours.

This is certainly an uplifting story, and I have been privy to regular updates on J’s progress. Reports of the mother’s tears of joy at simply seeing J walk into kindergarten are heartwarming, and real tangible evidence that this child is becoming better prepared to learn and participate in all that lies before him.

And to be clear, this has happened over the course of a few months this year, with rationalfollower spending only 1 hour per day, 5 days a week with J.

For those of you seeking answers on what caused your child’s condition, or who/what is to blame, ABA cannot help. On the other hand, if you are seeking to try to improve their (and your) quality of life, it may be the way to go.

Look it up, and talk to a trained practitioner. Save the bleach for those stubborn stains.