What Doctors Don't Tell You 2019-04-23T21:14:21+01:00 Follow the money, continued 2019-04-01T21:48:00+01:00 2019-04-01T21:48:00+01:00 The ancient Greek playwright Aeschylus knew a thing or two; one thing he said was that "in war, truth is the first casualty." Usually truth is quickly replaced by propaganda, because winning the war is more important than the citizens knowing what's really happening.

We're seeing a miniseries of this being played out in medicine right now. The war is over the uptake of several drugs and vaccines, the sales of which have been hit by critics who have been pointing out the drugs' inadequacies and dangers.

The starting pistol was fired earlier this year by the World Health Organization, which categorized "vaccine hesitancy"when parents question the safety of the vaccination about to be put into their childas one of the world's top 10 health threats.

These parents are having doubts put in their heads by the 'anti-vaxxers' who use platforms such as Facebook, YouTube and Twitter to spread their 'propaganda,' as the UK's Guardian newspaper recently put it.1 Not pulling its punches, a New York Times editorial weighed in with the view that vaccine naysayers were putting lives at risk.2

Just as 'anti-vaxxers' have legitimate concerns that have not been properly addressed, so too do the scientists and physicians who have argued that statins are unnecessarybecause cholesterol has nothing to do with heart diseaseas well as dangerous.

These 'statin deniers' have been shouted down with the same strident rhetoric being used against the anti-vaxxers. They, too, are endangering lives with their false claims, says Dr Joseph Hill, editor-in-chief of the American Heart Association's journal Circulation. "There is a flood of bad information on the internet and social media that is hurting human beings.

"It's not just an annoyance, this actually puts people in harm's way," he writes in his journal's editorial. "Doctors say too many of their patients shun taking statins because of bad information they picked upoften from politicians, celebrities and others who lack medical expertise."3

Backing up his assertions were the findings of an 'independent' research paper that was jumped on by our sympathetic mainstream media outlets. Around 8,000 deaths a year could be avoided in the UK if only people over 75 would ignore the anti-statin propaganda and instead start popping the pills, according to researchers from the Cholesterol Treatment Triallists Collaboration (CTT).4

The CTT is closely linked to the Oxford Clinical Trials Service Unit (CTSU), which has received nearly $392 million (300 million) in donations from the pharmaceutical industry. The CTT and CTSU share the same research team, and two prominent CTT researchers admit to more than 50 conflicts of interest with drug companies, many of which manufacture statins.

It's hard to criticize a CTT study, because the data on which the results are based is kept under wraps. A similar modus operandi can be found in vaccination studies.

At the time of writing, a UK agency still hasn't published the results of several studies that explored the safety of the HPV (human papillomavirus) vaccinesand that's three years after the studies were finished. And in a review of the MMR vaccine, the US Centers for Disease Control and Prevention (CDC) 'forgot' to include a dataset that demonstrated that black American boys were four times more likely to develop autism after vaccination.5

These errors and omissions are doing little to assuage the concerns of patients and parents. That's why independent voices of reason, such as the Vaccine Confidence Project, have been set up. But the project isn't independent, and it's not weighing up the evidence, good and bad, impartially.

It's created on the premise that vaccines are always good, always safe, and the anti-vaxxers are conspiracy-theory hysterics. Helping it in its endeavors are benefactors such as GlaxoSmithKline, which manufactures more than 40 vaccines that generate $6.8 billion (5.2 billion) in sales every year.

For all of you who just want to get to the truth in this pharmaceutical turf war, ask yourself this one question: who has the most to gain by winning the argument? Is it the anti-vaxxers and statin critics, or is it the drug companies that stand to lose billions of dollars in sales?

By following the money, you can still get to the truth, even in times of war.

Goodbye Dr Google 2019-03-01T14:30:00+00:00 2019-03-01T14:30:00+00:00 What do you do when you first get diagnosed with an illness? Or perhaps when you're put on a new drug? Of courseyou Google it! And why do you Google it when you've just seen your doctor and he or she has given you all the information you're supposed to need? Because perhaps you haven't really understood what was said to you, or, more likely, you want a second opinion.

Long ago, health and medicine sitesand especially alternative onesovertook porn as the main reason people surfed the web, and search terms such as 'alternatives to (insert drug name here)' or 'alternatives to treat (insert disease name here)' have become some of the most commonly used. Welcome to the wonderful world of 'Dr Google.'

But all of this has suddenly changed. Last summer, Google made a significant rewrite to its algorithmswhich apply almost instant weighting criteria to sites to determine where they appear in the search resultsthat focused on health and medical sites. In particular, it has targeted sites that "offer medical or health information that could impact your physical wellbeing."

Overnight, major sites such as Prevention and Dr Axe saw their traffic halve (and our site,, has suffered as well). Their sites, which once may have featured on the first page of Google's search results, were suddenly plunged into the outer darkness of page 52, which only the most indefatigable and obdurate would reach.

Now it is extremely hard to find alternative health information without first wading through page after page of conventional medical sites that toe the party line and which, of course, endorse everything you've already heard from your doctor.

Suddenly, the main reason people are searching Googleto find alternative health advicehas been negated. And why? Because these sites, including ours, can harm "your physical wellbeing." Strange, we always thought we were having the exact opposite effect; well, that's 30 years of publishing well-researched health information down the drain.

As if being demoted to page 52 wasn't enough, the Publicise Groupe, a global communications firm that boasts drug and tobacco companies among its clients, has launched NewsGuard, which will be giving further ratings to sites, and especially those that dare to step outside the mainstream viewpoint.

It's not only Google that's clamping down on alternative medicine. Wikipediathe ill-informed source for the uninterestedhas deleted the page of Dr Malcolm Kendrick, one of our favorite mavericks, who questions the whole cholesterol theory of heart disease.

As is usual with the web, Dr Kendrick's critic is anonymous, and the ultimate arbiter of what you can read on the site, with no recourse or appeal possible. Kendrick isn't alone. Almost any unconventional view is heavily edited, misinterpreted or distorted, and amendments or even corrections of an error are overwritten within minutes.

As Dr Kendrick states in his blog: "To be frank, I am not entirely bothered if I no longer appear on Wikipedia, but I am increasingly annoyed that self-styled anonymous 'experts' can do this sort of thing without making it explicit why they are doing it, what their motives are, and if they have any disclosure of interest."

And there's the rub. What are their motives, and are they being paid to do it? Newspapers were once the 'voice of the people' and would hold industrial conglomerates to account, until they came to their senses with the help of vast advertising revenues from Big Pharma, Big Food and the tobacco industry. The same goes for radio and TV. It's increasingly hard to hear any alternative views on any of these media (and that especially goes for medicine and alternative therapies).

Now it seems the internet, which for years has been a truly democratic platform, is about to go the same way. Newspaper readerships have been in decline for years, partly because people are getting their news from the web but also because they are seeking out a multiverse of opinions and insights instead of the partial fare served up in print. Broadcast media is also fragmenting, with so many optionsand voicesavailable across a stream of channels. There's no longer a dominant voice in mainstream media.

Google's algorithm change could see it going the same way. People will search out information about health alternatives via other platforms, such as Facebook, Twitter and YouTube, just as water seeks out other paths when its usual channels are blocked.

Don't be surprised to read there's been a drop-off in numbers using the search engine as many of us bid a sad goodbye to Dr Google.

The trouble with treating symptoms and not the cause 2019-02-04T15:01:00+00:00 2019-02-04T15:01:00+00:00 Doctors are supposed to inspire confidence. After all, you want someone on the other side of the table who is quietly reassuring and in control. Someone who might say: "Yes, I can see you're close to a complete meltdown, but I can handle this. I've got this one covered."

And in that moment, you think this person can answer any question, from "Why do I have this disease?" to "Will I be all better very soon?" You even suspect there's a ready answer to the more metaphysical questions, such as "Does life have meaning, or are we born only to die on a soulless piece of rock created by chance in an indifferent and cold universe?"

They're all good questionsalthough the last one may be stretching things a little. If you do understand the causes of a disease, you're better placed to treat it and help the patient recover, after all.

Sadly, this is where the mask of reassurance drops. It's estimated that medicine doesn't have a clue about the cause of nearly half of all diseases that doctors encounter day to day.

Wikipedia devotes 80 pages to "ailments of unknown cause," and includes Alzheimer's disease, atherosclerosis (hardening of the arteries), and attention deficit hyperactivity disorder (ADHD) in the listand the keen-eyed of you will notice that's just the A's.

Go down to H and you'll see hypertension, or high blood pressure. In 90 percent of cases, medical students are taught there's no known reason why someone has it. Too much salt? Not really. Stress? No, that doesn't explain it. Drinking? Nope. Smoking, then? Not that, either.

But we can't have doctors telling patients that they don't have a clue why they have some condition. The very fabric of society would be torn asunder. So they hide it with clever terms or some medical gobbledegook.

For high blood pressure, the doctor will probably write on the prescription pad: "Essential hypertension." Reading it, the patient may even feel a tinge of pride. My hypertension isn't one of those unessential types; it's essential, and it probably plays some small part in keeping the country going.

But it's just medical-speak for: "I really don't have a clue why you have high blood pressure, but if I told you that, you'd probably regard me as an idiot and not take the antihypertensive drugs I'm prescribing."

Essential hypertension is just one of the terms the doctor hides behind. Another is 'idiopathic pulmonary fibrosis' to explain the progressive lung disease. The word doing the heavy lifting here is 'idiopathic.' Whenever your doctor mentions it, he's actually saying: "I'm sorry, I haven't a clue." There's also idiopathic granulomatous hepatitis and idiopathic intracranial hypertension, additional examples of this medical shrug of the shoulders.

Then there's 'cryptogenic stroke.' This is medical-speak that's used to describe an ischemic strokeor a blocked artery in the brainwhen the doctor doesn't know why it's happened to you (or anyone else, for that matter).

When you have persistent tingling in your hands or feet, or you suffer occasional tremors, or headaches, or sudden blurred vision, your doctor will probably diagnose 'functional neurological disorder.' It sounds important (you almost feel like you should wear a black tie), but it's just the doctor's way of admitting that they have no idea why you're suffering from these symptoms.

Then there are the 'psychological problems' that doctors call those mysterious issues that don't have a known cause, because there probably isn't one, since it's all in your head, so get a grip.

Depending on the doctor's Paleolithic influences, these can include general tiredness, depression, chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME), irritable bowel syndrome (IBS) and fibromyalgia, or general pain around the body.

Strangely, Gulf War syndrome appears on the list. Surely, all the doctor has to do is ask the patient if he or she fought in the Gulf War, and after getting a positive response, they lean back and say contentedly: "Well, there you are then." But perhaps I'm just being a little naive.

There's even 'medically unexplained physical symptoms,' which sounds like having your cake and eating it. "I'm sorry, you are suffering from 'medically unexplained physical symptoms.'" "Oh no, what's caused that?" the worried patient responds. "You're not paying attention, are you?" responds the doctor.

If you're feeling a little stiffness in your back, you have 'stiff-person syndrome.' Why? Nobody knows. In fact, they don't have a clue.

Collateral medicine 2019-01-01T15:09:00+00:00 2019-01-01T15:09:00+00:00 Collateral damage is one of those weasely words of our times that masks human tragedy and loss in war zones. Clenching a cigar between his teeth, the US general told assembled reporters: "It was a successful mission; we took out the intended target, although there was inadvertent loss of life at a nearby school." It's a militaristic take on the adage that you can't make an omelette without breaking eggs.

Medicine has been working with collateral damage for years. Doctors call it a side-effect or adverse reaction when they need to explain the unexpected consequences when a drug, for arthritis, say, also happens to cause migraine. Every drug comes with side-effects, and a weighty tome called the Physicians' Desk Reference (PDR) documented every known side-effect and required around 2,000 pages of tiny type to do so.

Even then, it listed only those side-effects that had been recorded in medical trials or from reports sent in by doctors as they started prescribing the drug. A French study once estimated that just one in 20,000 side-effects are ever recorded, usually because of time pressure and the reluctance of the doctor to fill out yet another piece of paperwhich is just as well for the publishers of the PDR and those doctors who have to lift it onto their bookcases.

For many years, the public was not allowed to read the PDR or its UK equivalent. Unlike the military's collateral damage, medicine's is secret and invisible, and we don't want to frighten women, children or anyone, actually. And, anyhow, the neck and arm strains that would result from lifting the PDR would be a further burden on an already overstretched health system.
To illustrate the point, researchers at Brigham and Women's Hospital in Boston did some computer modeling to see how 700 drugs approved by the US Food and Drug Administration (FDA) interacted with different proteins.

Drugs are designed to lock onto a diseased protein targetbut it's always been known that they can interfere with unintended targets and other biological processes, which causes the side-effects and adverse reactions that have been so amply recorded.

But nobody knows the extent to which this happens or what some of the other biological impacts may beespecially those that may not be immediately apparent or witnessed by researchers and doctors.

For instance, they discovered that Tegretol (carbamazepine)a drug designed to treat epilepsy and neuropathic paincan also cause coronary artery disease. Since diabetics may be prescribed carbamazepine, they could be inadvertently increasing their risk of heart disease, which is already high.1

This is a new side-effect that nobody had recorded before, because who could have guessed that an anti-epilepsy drug would cause heart disease? It was only when the researchers looked at the biological processes at play that they could see this was an unintentional, and unsuspected, reaction.

And that's true for most of the 700 drugs tested. Almost all have an effect that nobody had been aware of before. As the lead researcher Joseph Loscalzo put it: "The great majority of drugs are not unique to the single target for which they've been developed."

All the drugs tested had been approved as safe and effectivebut this also explains the many thousands more that work in the laboratory on single-cell tests but fail when they're tested on humans. It's because we are complex beings with a multitude of inter-related biological parts and processes.

And that's why there's no such thing as a safe drug. But it's not all doom and gloom, at least not according to Dr Loscalzothere's an upside too. If a drug can have an unintentional side-effect that increases the risk of a completely different disease, perhaps it could have a positive knock-on effect, too, so a drug for cold sores might happen to cure cancer as well (now, that really is a bonus).

Now Big Pharma has the tools, courtesy of this new modeling, to "facilitate drug repurposing," Dr Loscalzo said. What a boon this would be. No more expensive and laborious testing in the lab, just figure out all the other great ways that the current generation of drugs could be treating different and diverse conditions.

It's rather like a general who, having inadvertently blown up a neighboring school (and killing those inside), points out the great redevelopment opportunity this presents.

The military would never be so crass; medicine just might be.

1 Nat Commun, 2018; 9: 2691

Its true (no, its not) 2018-12-05T15:49:00+00:00 2018-12-05T15:49:00+00:00 This is an urgent appeal on behalf of headline-readers. This troubled group are perpetually confused and bewildered, and some have already ended up in nursing homes, sedated by round-the-clock staff.

These unfortunate people read headlines and take them seriously. As with so many things, it started out with good intentions. They are busy people who are short on time, as most of us are, but they wanted to stay on top of events, including the latest health news.

The best way to do that, they figured, was to focus on the headlines and, if time permitted, perhaps the first paragraph or two. But they soon realized they were getting contradictory information: one day it was safe to drink some alcohol, the next day any amount was dangerous. The same went for different foods and diets, exercise, lifestyle advice, and so on.

Clearly, both pieces of information couldn't be true, and the logical brain of the typical headline-reader was unable to hold a contradiction. Eventually, these people declined into mental illness until they reached the sorry state so many find themselves in today.

Their basic error was in believing the headlines. But they hadn't taken into account two important factors: the journalist who wants more people to read his newspaper or blog, and the academic who needs to make a name for himself.

The most obvious example is the advice being churned out about drinking alcohol. One week, a little drinking is good for you, especially your heart, and the next, even the very whiff of alcohol will make you keel over and die on the spot.

Here's another example. Many of us are on a low-carb dietsuch as Atkinsbecause we've read somewhere that it's healthy and a great way to lose weight, but that's not true anymore, according to recent headlines. In fact, the diet could shorten your life.

The journalists and bloggers jumped on the story because they like nothing better than giving a good kicking to some 'fad' diet, and the researchers got what they wanted, which was publicity, and radio and TV interviews.

It makes a great headline, for surebut it isn't true. The researchers, from Brigham and Women's Hospital in Boston, actually discovered that both a low-carb and a high-carb diet reduced longevity. The ideal was in the middle; those who got around 50 percent of their energy from carbs lived the longest.1

This requires quite a precise calculation, so how did the researchers figure it out? By the least reliable method of them all: a questionnaire. In fact, they relied on two questionnaires, spaced six years apart. As an accompanying editorial made clear, the results should be treated with caution. "So-called group thinking can lead to biases . . . and the use of analytical approaches to produce findings that fit in with current thinking." In other words, the researchers produced the result they wanted to see.

Even the authors admitted as much; the questionnaires revealed a statistical correlation, which doesn't prove anything, they said. It doesn't demonstrate that people eating a low-carb diet will die sooner as a direct result, but that those who ate low-carb tended to die sooner (and the same was true for those eating lots of carbs).

In fact, people eating a low-carb diet who relied more on vegetables for their energy sources were likely to live longer than those eating a high-carb diet.

Yes, the type of carbs you eat makes a differenceeat carbs that are rich in refined sugars, such as white rice or bread, and you'll also reduce your chance of a long and healthy life compared to those who eat vegetables (which also contain carbs, by the way), nuts and whole-grain foods.

So how did the journalists get it so wrong? For one, the researchers issued a press release that highlighted the 'discovery' that a low-carb diet shortens your life, and the journalists, being lazy or not wanting to have the facts spoil a good story, ran with it.

The journalists get a good story, and the researchers get on the map. Sadly, the poor headline-reader is the victim.

So please give generously; it'll make a difference (or won't, according to another study).

1 The Lancet, 2018; 3:e419-28

You could make it up 2018-11-01T11:50:00+00:00 2018-11-01T11:50:00+00:00 Repeat a lie long enough and people start believing it, as Joseph Goebbels, Hitler's propagandist-in-chief, once said. Medicine is full of liessorry, assumptions of dubious provenancethat everyone believes must be true but aren't. We believe them because medicine is a science (discuss), and they wouldn't just make this stuff up (oh no?)
Here are a few, and you probably believe some (if not all) of them yourself, but they've all been plucked out of the air by 'expert committees.'

Eat your five-a-day
This exhorts us to eat five servings of fruit and vegetables every day. In truth, we should be eating more than thatbut where did the idea of five come from? Apparently, it was conjured up in a meeting of fruit and vegetable companies in California in 1991. Strangely, representatives from McDonald's were also there.
It seemed like a good way to sell more produce, but there wasn't a lot of scientific evidence to support the recommendation. At least McDonald's didn't influence the group to include one Big Mac in the healthy eating guidelinesalthough Heinz succeeded.

Miffed that it hadn't been invited to the party, Heinz got into the act a few years later, and since then its tomato ketchup has been included as a legitimate five-a-day option.
And it was confusing what it all meant. Is it three servings of vegetables and two of fruit, or five of each? And what is a serving, anyway? Nobody was sure on that one for years, but in the end everyone has settled on 'a handful.'

When you're obese
You cease to be overweight and become classified as obese when your body mass index (BMI) reaches 30.

But how did this precise line in the sand get drawn? It's hard to track down its origin, but the likeliest suspect is the National Health and Nutritional Examination Study (NHANES), which started tracking the diets of a group of Americans in 1976.

It set the BMI for obesity at 32.3, which got the experts at the World Health Organization thinking that, perhaps, it would be better if it was more of a round figure. So, in 1995, it set the official obesity score at 30. As someone mentioned afterward, the score was "largely arbitrary," which is a science-y way of saying it was made up.

Safe drinking
What's a safe amount to drink? Nobody really knows because no country agrees with another. 'Safe upper limits' in the US are 196 grams (8.4 oz) of pure alcohol a week (that's around 10 pints of beer or eight glasses of wine), while the world's party poopers are, surprisingly, the French, who recommend we should consume just 100 grams (4.3 oz). If you really want to party, go to Japan, which has set its safe limits at 280 grams (12 oz).

But how did these figures come to exist in the first place? It can't be science, because there's no global agreement. A member of the UK's Royal College of Physicians let the cat out of the bag after the group met in 1987 to set the nation's safe limits, when he admitted the figures had been 'plucked out of the air.'

Cholesterol and heart disease
The saturated fats we eat raise our 'bad' LDL cholesterol, and that blocks our arteries and causes heart disease. It's a theory that launched the multibillion-dollar statin drug and low-fat food industries.

The trouble is that it's never been proven, and inconvenient truths keep popping up that are sidelined as a paradox. Like the 'French paradox,' because the French eat large amounts of saturated fats and have lower rates of heart disease (roughly a quarter of that in the UK, for instance), or the 'female paradox,' because women naturally have far higher levels of cholesterol than men and are less likely to get cardiovascular disease.

Or that more than half of people who die from heart disease have normal cholesterol levels, while those with low cholesterol are 64 percent more likely to die prematurely.

So how did it come about? One of the major drivers of the cholesterol hypothesis was medical researcher Ancel Keys, whose famed 'Seven Countries Study' demonstrated a direct cause-and-effect relationship between eating saturated fats and heart disease. However, the association disappeared when you look at an earlier study of his, which included data from 22 countries.

So, keep repeating the same lie long enough... oh, and by the way, Joseph Goebbels never said that. It's just another myth.

Researchers admit they were wrong about full-fat dietary advice 2018-09-26T11:45:00+01:00 2018-09-26T11:45:00+01:00 Hello World, Research HQ here. Hope you're well! (And if you're not, we'll dig and dig and dig until we find out just what's wrong with you!) Anyhow, you remember how we told you that fat in your diet could clog up your arteries and cause heart disease? You know, we've been banging on about it for the past 30 years? Study after study. Frankly, we were exhausted from it.

Because of the sterling efforts of Research HQ, stores are full of low-fat this and fat-free that, and your doctor has been prescribing you a statin to help get rid of all that nasty fat.

Well, don't laugh, but we were wrong! Yup, you can eat high-fat everythingbutter, cheese, milk, you name itand it won't do a thing to your heart. Actually, that's not quite right: it'll in fact reduce your risk of suffering from a stroke. So, it doesn't cause heart disease, it prevents it. Yup, a complete 180-degree turn.

You may not have read about this rather embarrassing error. We hid it behind a cutesy headline so nobody would get what a complete mess we've made of the whole thing. (We worked on the theory that we live in a headline-only-reading society with a five-second attention span, and, thank goodness, we were right!)

So, here's the headline (hope you like it, we were rather proud of it ourselves): 'New research could banish guilty feeling for consuming dairy products.' Isn't that clever? It doesn't say we were wrong for 30 years, or that low-fat foods and drinks have made the food industry billions of dollars, and statins have made similar amounts for the drug industry, when none of it was necessary, or that our advice could even have increased the rate of stroke. No, it's just that you don't have to feel guilty anymore. That's it!1

We actually imagined two scenarios in the typical family home, one before we issued the press release and one after.

Pre-press release:

Wife: I've just eaten some toast with butter on it. I feel so guilty!

Husband: Guilty? That's the least of it. You will DIE.

Post-press release:

Wife: I've just eaten some toast with butter on it. I feel so guilty!

Husband: Guilty? Don't be, you'll be fine! (Actually, you have reduced your chance of a stroke, but

I sneaked a glimpse beyond the headline. Sorry!)

OK, that's 98 percent of the population taken care of. Now we have to tackle the remaining 2 percent who are still reading (so annoying!) For those tenacious few, we have the summary, and for this we had to be a little more factual: 'Enjoying full-fat milk, yogurt, cheese and butter is unlikely to send people to an early grave, according to new research.'

Still doesn't quite tell the truth, but that's another 1.5 percent of the population dealt with. Now, we're just left with the obstinate 0.5 percent who are still reading (and who probably think a five-hour Wagner opera is a short ditty. What is wrong with these people?)

For these few, who really should get out more, we have to tell the truth (we suppose). And it's more humble pie than full-fat cheese. What we did was recruit around 3,000 people who were at least 65 years old and checked their blood for 22 years to measure three different types of fatty acids found in dairy products. Contrary to current advice, none of these 'bad' fats caused heart disease. In fact, one of them reduced the risk of dying from stroke by 42 percent.2

We described the study as 'robust' (one of our favorite words) and added that "people can make more balanced and informed choices based on scientific fact rather than hearsay." So that would include the hearsay we get from the latest official US Dietary Guidelines, which still recommend eating fat-free or low-fat. Not only is the advice wrong, it's also harmful because many low-fat and fat-free products instead contain added sugars, and of course, it was the sugars all along that cause heart disease.

So, we at Research HQ could say sorry, we suppose, especially as we may have sent millions to an early grave. But, look, we decided instead to just have a bit of fun, and so we did that whacky 'Guilty' headline.

Hard (full-fat) cheese, anyone?



ScienceDaily, 11 July, 2018


Am J Clin Nutr, 2018 Jun 11. doi: 10.1093/ajcn/nqy117

The powerful healing properties of baking soda 2018-09-04T16:58:00+01:00 2018-09-04T16:58:00+01:00 Innovations are often described as being the best thing since sliced breadbut what was the best thing before sliced bread? My money is on an ingredient that helps make the bread in the first place: baking soda (or bicarbonate of soda). It's the rising agent for breads and cakes that also doubles as a potent drain declogger and an efficient scrub to clean the inside of your oven.

But it's not because of its capabilities with ovens and drains that baking soda gets my voteit's because baking soda is one of the very best ways to help improve your health. In fact (hyperbole alert), it could even be the aspirin of alternative health.

It's an antacid that helps ease indigestion and also keeps the blood alkaline. Taken in modest amounts (half a teaspoon diluted in a glass of water), it doesn't have any nasty side-effects, and best of all, it's cheap!

I ordered some from Amazon and just saw the words 'pharmaceutical grade' without noticing the quantity. A day or so later, a bucket of the stuff arrived, which is enough to see me out for the rest of my life and bequeath the balance to my children, who, in turn, should still have enough left over to mention it in their wills. And all that for just $21 (15).

Your local nephrologist (kidney specialist to you and me) already knows about the healing powers of baking sodait's routinely prescribed to kidney patients to help keep their blood alkaline. Their kidneys can't properly balance compounds like acid, potassium and sodium, and so they run a higher risk of developing heart disease and osteoporosis from increased acidity. Baking soda restores the balance.

This got researchers at the Medical College of Georgia thinking: what was it about baking soda that slowed the progress of kidney disease? They actually found out something else of even more significance in the process.

They started out by giving small doses of standard-issue baking soda (available in any store that sells groceries) first to laboratory rats and then to a group of healthy medical students. The baking soda started to change the immune system's inflammatory responseswhich, when out of kilter, can cause arthritis, heart disease and some cancers, and this calming effect was seen in the rats as well as in the human study participants.1

The researchers discovered that baking soda seemed to communicate specifically with the spleen, the fist-sized organ that plays a big part in our immune system by acting as a blood filter. It's also where white blood cells, such as macrophages, are stored.

Drinking a baking soda solution caused the macrophages to stop promoting inflammation, and instead start reducing inflammation, and this improvement started to occur after just two weeks of the students beginning their baking soda regimen.

To be precise, the baking soda communicated with the cells that sit on the surface of the spleen, known as mesothelial cells. These cells line all of our body cavities, and they cover all the major organs to stop them from rubbing together.

Although they haven't attracted the interest of many researchers, a study team discovered around a decade ago that mesothelial cells have tiny 'fingers,' known as microvilli, that are constantly checking the environment around them for potential threats.

The microvilli can warn the organ they're covering that there's an alien invader around and that the immune system needs to launch an inflammatory response.

Of course, inflammation can also be a 'good' thing and part of the healing process. When the microvilli detect danger, macrophages are released. They act like the body's garbage trucksthey sweep up the debris from injured or dead cells and are among the first responders on the scene when an immune response is needed.

But many diseases begin when the inflammatory response is always switched on, almost as if the body's alarm bell is constantly sounding. And this is where baking soda comes in. It's as though it can tell the spleen that "it's most likely a hamburger and not a bacterial infection," said lead researcher Dr Paul O'Connor, to quell any unnecessary immune response.

The day is fast approaching when baking soda is prescribed to anyone with an auto-immune problem, the researchers believe, which includes rheumatoid arthritis, multiple sclerosis , psoriasis, inflammatory bowel disease, pernicious anemia and celiac disease.

Best thing before sliced bread? You betchaand afterwards, too.

Do fewer patients die when the surgeon is away or on strike? 2018-07-31T14:21:00+01:00 2018-07-31T14:21:00+01:00 I can imagine that the typical surgeon, when he was a young boy (or girl, of course), was the sort who would keep fiddling around with things until his exasperated mother exclaimed: "For goodness sake, Bernard (Bernadette), it'll never get better if you keep touching it."

This fiddling around doesn't do anyone any good, least of all the patient. This universal truth struck me recently when I was reading a study that discovered that heart attack patients are more likely to survive if the hospital's leading cardiologists are away at a conference. It's like the urban myth that when doctors go on strike, fewer people die.

Why should this be, when doctorsand heart specialists in particularare life-saving heroes? That's the problem: because they see themselves as that, they like to perform ever trickier and more invasive procedures. But, as lead researcher Anupam Jena from Harvard Medical School points out, "Many medical interventions deliver no mortality benefit." In other words, the patient is more likely to die.1

The junior cardiologist left holding down the fort isn't quite so gung-ho and is prepared to do less, probably very relieved and happy to do less, in fact. The result? The patient survives.

Jena and his colleagues restricted their research to a specific few days when the annual Transcatheter Cardiovascular Therapeutics conference was taking place. The conference attracts the best and brightest cardiologists from around the world, and Jena wanted to know how the patients were faring back at the hospital while these cardiologists were away.

Jena has form. He did something similar a few years back when he checked on the survival rates of heart attack patients when the top cardiologists were attending the annual American Heart Association events from 2002 to 2011. Same resultmore survived.

Not only do the top cardiologists go to the big conferences, they also write most of the academic papersespecially about their breakthroughs, new procedures and so on. So they like to fiddle around, sometimes to the detriment of the patient.

This fiddling around also happens to be behind the great urban myth about fewer patients dying during a doctors' strike. On the face of it, it's true. The myth started in 1983 in Israel when 8,000 of Jerusalem's 11,000 doctors refused to treat hospital patients for three months. There were 83 deaths recorded during the strike, and 89 deaths in each of the three months before and after the strike when the doctors were working.

But a similar pattern had been seen seven years earlier in Los Angeles when half the surgeons reduced their care to emergency cases only for five weeksand the hospital mortality rate dropped by 18 percent.

Researchers from Emory University carried out a review of the impact on mortality rates of five doctors' strikes that happened between 1976 and 2003. In each of the five instances, the mortality rates in hospitals either went down or stayed the samebut none went up, as would be expected. By the end of the strikes, the average mortality rates were lower than anything recorded in the previous five years. The rates were reversed when the doctors went back to work; in Los Angeles, for example, there were 90 more deaths in the first two weeks after surgery resumed.2

In each of the five strikes, doctors still provided emergency cover for life-threatening problems; it was the elective procedures that were canceled. Elective surgery is the scheduled, non-emergency operations that range from anything from a facelift to cataract removal, angioplasty for widening arteries or a hip replacement.

In a fascinating review of elective procedures published back in 1974, two researchers from Cornell University estimated that 20 percent of recommended surgeries were unnecessaryin other words, the patient didn't benefitwhich translated into 2.4 million pointless procedures a year that result in around 12,000 deaths. And remember, this review was carried out at a time when people actually did think twice before having surgery; today, those figures could be conservatively multiplied by a factor of 10. 3

So there you have it: all that fiddling around does nobody any good, just as Bernard's mom told him.

What big picture? 2018-07-17T15:57:00+01:00 2018-07-17T15:57:00+01:00 If you're a doctoror, better yet, a researcher at a pharmaceutical companyyou think you've got human biology nailed. After all, you must know how it all works so that you can develop new drugs and prescribe and treat patients.

And because you've got it all figured out, you can laugh at unscientific alternatives like acupuncture and dismiss them for the quackery they are. Right?

Of course. After all, if you didn't know about the second-largest organ in the human body that explains many bodily processeseven how cancers spreadyou'd have to admit you really didn't know what you're doing.

So guess what? Scientists have just 'discovered' the second-largest organ in the body, which had been missed by everyone these past few centuries. Yes, nobody had spotted it, not scientists or biologists, nor doctors or pharmaceutical researchers. And, by the way, this 'missing' organ also explains how acupuncture works.

The missed organ has been called the interstitium, and it's second in size only to the skin. It sits below the top layer of the skin, and it is also found in tissue layers that line the gut, lungs, blood vessels and muscles.

It is a network of interconnected compartments supported by a mesh of strong and flexible proteins.

It's essential for the healthy functioning of all organs and tissues, and it also plays a vital role in the ebb and flow of most diseases, including cancer. And because its protein bundles generate electrical current, the interstitium provides an explanation for how acupuncture works (and probably a few other holistic alternative therapies, too).

One of its roles is to act as a shock absorber that keeps tissues from tearing as they are squeezed, pumped and pulled by organs, muscles and blood vessels. It is the source of lymph, the vital fluid that allows immune cells to function and control inflammatory processes and, when malfunctioning, contributes to diabetes, heart disease, arthritis and a host of other problems.

This highway of moving fluid could also be the transporter system that allows cancer cells to spread through the body.

It's been discovered by pathologist Neil Theise at New York University's School of Medicine (Nobel Prize, anyone?), who analyzed tissue samples from a dozen cancer surgeries on the pancreas and bile duct. As with most important discoveries, he didn't do it on his own. A couple of years back, two endoscopists from the Beth Israel Medical Center noticed something odd when they were examining a patient's bile duct looking for cancer spread. They saw a series of interconnected cavities at the tissue level that wasn't explained by current knowledge of human anatomyso they showed them to Theise.

So how come everyone has missed it? It's all down to the way biologists review tissue samples, Theise explains. Essentially, the interstitium is in the spaces between the known organs (hence its name), and biologists have focused on fixed tissue on microscope slides, believing it gave "the most accurate view of biological reality." Except, of course, it missed the big picture.1

Before putting a tissue sample under the microscope, biologists prepare the sample with chemicals in a process known as 'fixing,' slice it thinly, and dye it. The trouble is, this process drains away any fluidand, in doing so, drains away the interstitium.

And there's also the human element. If you don't think it's there, you just don't see it.

For his own analysis, Theise used a different technology, called (deep breath) probe-based confocal laser endomicroscopy, or pCLE, which doesn't use any of the techniques of standard microscopic analysis.

The significance of his discovery isn't lost on Theise. It has "the potential to drive dramatic advances in medicine, including the possibility that the direct sampling of interstitial fluid may become a powerful diagnostic tool."

That, and understanding how many chronic diseases develop, and why holistic medicineand especially acupuncturecan be so effective. And, of course, how the body works.

A slice or two of humble pie before we all crawl back to the drawing board, everyone?

1 Scientific Reports, 2018; 8: 4947

A maverick's passing 2018-04-23T15:30:00+01:00 2018-04-23T15:30:00+01:00 We need our nay-sayers if medicine is ever to improve

The death of a maverick is always worth a moment's reflection. They often put their own personal ambitions and career on the back burner as they strive for something that's more important, such as changing the system they're a part of.

One such maverick was Professor Alan Maynard, whose recent death brought back memories of another member of the awkward squad, Dr Bob Mendelsohn, who was one of the inspirations for What Doctors Don't Tell You.

Both had cast a critical eye over medicine and found their profession wanting. Their insights and suggestions were met with a spectrum of responses that ranged from indifference and dismissiveness to ridicule. Mendelsohn expected nothing lessafter all, he had likened medicine to a religion, and a dogmatic one at that, which requires the absolute obedience of its high priests.

Maynard believed something similar. "It is curious," he once wrote, "that the debates about the design of healthcare systems worldwide are dominated by assertions and almost religious beliefs to the exclusion of construction of hypotheses and their testing by careful collection of data."

All of which is academic-speak for saying something like: Look, you're throwing tons of money at medicine (with annual spending on healthcare topping $3 trillion in the US alone) when you haven't properly tested it to make sure it's working, or even doing any good.

He suggested that medicine adopt the model created with the 1854 Lunacy Act in the UK, which checked to see just how many patients the doctors were actually helping to get better (as opposed to those who were being killed by the treatment).

Surprisingly, such a simple and obvious measure was never implemented, and Maynard suspected this was because of a powerful triumvirate whose fortress could never be breached: the clinicians who didn't want their effectiveness measured; politicians who took a fashionably romantic view of the existing healthcare system (and didn't want to lose votes); and a pharmaceutical industry that was making a mint (and who strenuously lobbied the politicians to ensure they continued cashing in).

He estimated that nearly half of all medical treatments had absolutely no evidence of working (and even the conservative British Medical Association has accepted that around one-third of drugs and treatments are unproven). His contribution to the celebrations for the 50th anniversary of the UK's National Health Service was the observation that "successive governments clearly did not wish to be confused by facts. ... We know relatively little about the figures concerning patients' treatments, and so doctors fly by the seat of their pants and the scientific basis for their choices is really quite poor." Talk about a party pooper.

Maynard, who was based at the University of York, wasn't very complimentary about our much-loved family doctors either. In fact, he described them as "a marauding bunch of shopkeepers who wish to preserve the inefficient provision of care." Ouch.

Bob Mendelsohn wasn't a great one for taking prisoners either. The title of one of his books, How to Raise a Healthy Child in Spite of Your Doctor, pretty much sums up his position. Although he died nearly 30 years ago, he was already seeing the first signs of a society that was becoming over-medicalized.

He believed that most drugs and treatments were unnecessary because diseases tend to self-correct, especially when supported by a healthy diet and a loving family. But perhaps most controversially, he was opposed to the growing litany of vaccinations that toddlers were supposed to have. And this from one of America's leading pediatricianssee if you can spot any today who would dare to question the party line like this.

He even went on national television to tell American parents that they probably didn't need to get their babies immunized (as good hygiene, diet and sanitation make most childhood diseases relatively benign). Horrified industry observers made sure that a medical heretic (as Mendelsohn liked to describe himself) would never again be given free rein on a major TV show, and, of course, it hasn't happened since.

Bob's one legacy, in an age before the internet and social media, was to get the publishers of the Physicians' Desk Reference (PDR) to make this reference book available to the public. The PDR lists every side-effect and adverse reaction to all drugsbut it was distributed only to doctors.

So you see, we need our mavericks and nay-sayers. They are our change agents, whose courage helps make the world a better place. RIP, Alan and Bob.

Calories aren't all created equal 2018-03-27T11:59:00+01:00 2018-03-27T11:59:00+01:00 You wouldn't ask your doctor about nutrition any more than you'd interrogate a nomadic tribesman of the Sahara about the intricacies of snow. The typical doctor's dietary knowledge is primitive, but then, he's only been taught about it in medical school for an average of 10 or so hours over his five years of training.

Most doctors cling to the extraordinary idea, first proposed in 1878 by the German nutritionist Max Rubner, that 'a calorie is a calorie.' Interestingly, it was resurrected in the 1950s by the sugar industry when their products came under public scrutiny for a brief while (before it was successfully deflected to saturated fats in animal products, which became the artery-clogging bad guy until, well, pretty much today).

The 'calorie is a calorie' camp believes it's all to do with quantity, and not quality: all calories are equal. Follow that path to its logical conclusion, and you'll pass through a black hole in deepest space and out into a strange parallel universe where Wonderland suddenly makes sense. In this distorted world, there's no direct-line correlation between what we eat and our overall healthjust as long as we're eating enough of anything. Someone who eats 500 calories of Cocoa Krispies every day, for instance, will be as healthy as someone else who munches through a similar quantity of broccoli.

While the 'calorie is a calorie' mantra is the dominant idea in medicine, nations will continue to throw enormous sums at treating the sick (at the most recent count, that's over $3 trillion in the US every year). According to the prevailing wisdom, the sums keep rising every year primarily because people are living longer. But that's simplistic: the real problem is that people are living badly.

That's borne out by a recent survey of grocery shopping habits in 19 European nations. Researchers at the University of Sao Paulo in Brazil estimated how much the average household in each country spent on 'ultra-processed' foodsindustrially made products like salty snacks, sugary cereals, instant meals and soda. They found that for every four percent increase in the availability of ultra-processed food, there was a one percent increase in the prevalence of obesity.1

Britain's shopping cart was the least healthy, with ultra-processed foods making up over 50 percent of daily grocery purchases; Germany had the dubious distinction of coming in second, at 46 percent, while these foods made up the smallest part of the diet in Portugal (10 percent) and Italy (13 percent).

Unlike doctors, researcher Carlos Monteiro said he had "deep concerns" about the impact that processed food has on our health and obesity. "Take breakfast cereals like Froot Loops. They are 50 percent sugar, but there is no fruit. Ultra-processed foods are essentially new creations of the food industry with very low-cost ingredients in a very attractive product," he said. Not only are they attractively presented, they are also highly addictive, of course.

The quality-not-quantity school of thought (and one that is diametrically opposed to the 'a calorie-is-a-calorie' theory) has been explored by Valter Longo, a professor at the University of Southern California. He believes we can live to 110 years old, and that's something that is within our grasp todayif we eat healthily. Not only is the quality of the food we eat vital, we should be eating less, and go on a day-long fast at least four times a year when we consume fewer than 800 calories (that's one in the eye for the calorie-is-a-calorie camp).

Eating well (and less) can also reverse a range of chronic conditions, says Longo, including multiple sclerosis and even some cancersand he's carried out 15 clinical trials to prove it.

And he practices what he preaches, by restricting his sugar intake, eating low to moderate amounts of starches from pasta, bread and rice, and plenty of carbohydrates from legumes and vegetables; protein comes from nuts and salmon rather than from other animal fats.

It's not difficult to follow. "I love food. I'm never hungry, my friends can't believe how much I eatbut people don't understand food. I eat much more food than others, but much less calories," he told The Times.2

But then, he knows that it's about quality, not quantity.



Public Health Nutr, 2018; 21: 18-26


The Times, January 27, 2018

Getting the vax facts wrong 2018-02-28T15:43:00+00:00 2018-02-28T15:43:00+00:00 The media is pulled by the forces of simplification and sensationalism, says American sociologist Robert McChesney. I'd add a third 'S' to the list: suppression. All three are amply exercised when it comes to reporting on vaccinations, a touchy subject that has had journalists tying themselves up in knots for decades.

Simplification and sensationalism were the hallmarks of the coverage of gastroenterologist Andrew Wakefield and his discovery that the triple MMR (measles-mumps-rubella) vaccine was causing inflammation in the guts of a small group of children, and which, he postulated, could presage autism.

Vaccination rates started to fall, and so researchers had to undo the damage done by Wakefield's press coverage by 'proving' that he was wrong, and that the MMR didn't cause autism. Of course, he never exactly said it did, but that's simplification and sensationalism for you.

Cowed after being caught committing the first two 'S's, the media went into suppression mode, and now can't write a bad word about vaccinations, even when it's in the public interest that they do so.

Medical journalist Rob Wipond has noted the phenomenon with the reporting of a worrying reaction to the flu vaccine.1

Researchers from the Centers for Disease Control and Prevention (CDC) had discovered that women vaccinated against the pandemic pH1N1 flu strain in 2009, and who were vaccinated again a year later, were nearly eight times more likely to suffer a miscarriage within 28 days of receiving the second vaccination.2

Pretty damning stuff, not that you'd realize it from the media coverage that followed. The health website, STAT, announced the study with the headline that the risk of miscarriage 'may' increase after a flu shotwhen the study seemed pretty definitive, Wipond points outwhile the Associated Press, which feeds many news outlets, announced that the study "prompts call to examine flu vaccine and miscarriage," when this had been the purpose of the study in the first place.

The Washington Post displayed the greatest vacillation in the face of bad news with a double headline. It first declared that researchers "find hint of a link" between the flu shot and miscarriagealthough a 7.7-times increased risk might be considered slightly more than a hintbut even this mealy-mouthed heading proved too much for the Post's sub-editors, who quickly changed it to: "What to know about a study of flu vaccine and miscarriage."3

Wipond discovered the CDC had set the news response by briefing journalists from the three news organizations beforehand in a private meeting. They met lead author James Donahue, who told the British Medical Journal: "We wanted to make sure that they got a full story on this and carried the right messagesthe messages that we think
are important."

Duly briefed by the expert, none of the journalists even mentioned the 7.7-times increased risk in their reports, and suggested that "no knowledgeable person could reasonably interpret the study as a serious cause for concern." They all pointed out several times throughout their pieces that experts consider the vaccine to be safe, and that pregnant women should still go ahead and get the shot.

In other words, Donahue told them there was no cause for concern, and the journalists duly complied.

Donahue was right in one regard: large-scale, mass-population reviewsknown as epidemiological studiescan't absolutely prove that one thing causes another, because there are so many variables at play, such as age and lifestyle choices. By the same measure, the same studies can't prove that vaccinations definitively prevent diseasebecause, again, factors such as hygiene, nutrition and sanitation could have just as important an impactbut it's surprising how rarely this is pointed out.

Other experts, such as Chris Del Mar, a professor of public health at Bond University in Australia and editor for the independent Cochrane group, believed the journalists did a terrible disservice to the public. The vaccine isn't even effective, he said, and while there is a risk of miscarriage if a woman develops flu while she's pregnant, the chances of that happening are slight compared to the risk of miscarriage posed by getting vaccinated.

While sensationalism and simplification are not desirable, especially when it comes to medical news, suppression isn't much better.

Blame the Russians 2018-01-25T17:54:00+00:00 2018-01-25T17:54:00+00:00 The vaccine debate has taken a sinister turn. Any bad news you read about the MMR (measles-mumps-rubella) and flu vaccines on social media sites has been placed there by Russian cyber units, plotting to destabilize the West, according to a British tabloid newspaper.

First they orchestrated Brexit, then they helped get Trump into the White House, and now those Kremlin hackers are targeting vaccines. The Daily Mirror reports that "Russian cyber units are spreading false information about flu and measles jabs, experts claim."1

The Mirror reports that "health chiefs have had emergency meetings over the spread of 'fake news' over vaccination campaigns," but unfortunately not a single expert the newspaper interviewed could back up the extraordinary claim with any evidence, and a closer read reveals nobody except the reporter actually made the claim in the first place.

It isn't entirely clear why the Russian hackers would seek to raise doubts about the safety of vaccinations, when government agencies do such a good job of it without any outside help, but the timing could have something to do with a sudden outbreak of measles in several of the UK's northern cities.

The outbreaks happened just months after a major health agency had applauded the UK for having 'eliminated' measles.

Last September, the European Regional Verification Commission announced that not a single case of measles had been reported in the UK for 36 months, an official measure of whether a contagious disease has been eradicated.

Taking the plaudits, the Head of the Immunisation, Hepatitis and Blood Safety Department at Public Health England, Dr Mary Ramsay, said: "National vaccine coverage of the first MMR dose in five-year-olds has hit the World Health Organization (WHO) 95 percent target." This is the magic number for achieving herd immunity.

The new cases have happened among children and adults who haven't been vaccinated, say health officials, and so it seems that a revision of the definition of herd immunity is in order. In fact, the outbreaks have happened in areas that have a mere 94 percent coverage. This alarming one percent failing is down to parents being scared off from having their children vaccinated after reading "false information on the internet," says the newspaper.

It all goes back to the MMR bogeyman Andrew Wakefield who, 23 years ago, feared that the triple vaccine could be causing autism. His discovery sparked a torrent of 'fake news' from the anti-vaccine crowd, according to the pro-vaccine groups, and now, to cap it all, along come the Russians.

This very magazine is considered to be among the anti-vaccine group (aka vaccine deniers). Over the years we've published articles that have revealed adverse reactions to many vaccines, the ineffectiveness of others, such as the flu shot, and generally pointed out that health agencies have been stingy about doling out all the evidence about the safety of the shots. As a result, parents haven't been able to give their informed consentsimply because they haven't been properly informedeven though it is a legal and moral requirement.

However, for those of you who are worried, we'd like to make the following statements:
We're not a Russian bot, nor do we have any connection with Russian hackers, cyber groups, trolls or even good balalaika players.
We are not, nor have we ever been, a member of the Communist Party.
We're not looking to overthrow Western civilization.

Instead, our concerns are always with the parentsnot with government agencies, who seek to achieve herd immunity, or with doctors who are paid a bonus for every child they vaccinate. Because parents deserve to know all the facts before consenting to have their child have a vast array of vaccinations, we look to serious and verified research, often conducted at some of the world's leading centers, such as Harvard, Oxford and Yale.

The problem with the Daily Mirror story is that it stifles all debate. Any negative story about vaccinations must have been placed there by Russian agentsbecause there is nothing bad to say about vaccines. They don't have any adverse reactions (which is odd because the Vaccine Injury Compensation Program has paid out $3.6 billion in compensation for damages since its formation in 1988), and they work (also odd, because even proponents of vaccines say that average effectiveness is around 86 percent, which is why vaccinated people still get measles, mumps and the rest). But they could all be Russians, of course.

It's all a Wonderland 2017-12-21T14:07:00+00:00 2017-12-21T14:07:00+00:00 Curiouser and curiouser, as Alice might have said if she'd seen some of the research papers that have been passing across the WDDTY desks in recent weeks. They're curious because they provide more evidence of the humbling fact that we have so much still to learn about how the body works and how (or why) disease develops.

And because we don't really have a clue, it's hardly surprising that conventional medicine and its tools of trade get it right less than half the time. On average, a drug benefits the patient in some way around 40 per cent of the time, while the British Medical Association has demonstrated that just one-third of drugs and therapies are effective. And by effectiveness, they mean it provides some benefit, such as a lessening of pain, but doesn't necessarily cure anything.

The first paper we looked at is about the microbiome. The microbiome is all the rage these days; it describes the micro-universe of bacteria that exist in our gut. Medicine has been dragged kicking and screaming to the realization that the microbiome influences the course of a vast array of diseases, from cancers to diabetes and even depression. Get the balance wrong between 'good' and 'bad' bacteria, and you raise the possibility
of disease.

But as medicine is still slowly wrapping its corporate head around this revelationnot that it's being taught in medical schools, or anything radical like thatthis new paper has just revealed that breast cancer can also be caused by bacterial imbalances. So far, on messageexcept that the microbiome isn't in the gut at all: it's a mini-microbiome present in the breast tissue itself.1

The implications are dizzying, and make medicine want to sit down in a darkened room, gently sipping a comforting cup of hot chocolate. For one, it could mean that there are mini-microbiomes scattered all over the body. For another, it completely changes the way that breast cancer could be treatednot with chemotherapy or surgery, but with prebiotics and probiotics that restore the bacterial imbalance within the breast's own mini-microbiome.

The second paper came from one of our favourite maverick doctors (we collect
them), Dr Malcolm Kendrick. Dr Kendrick is a family doctor who has become convinced that cholesterol, and especially 'bad' LDL cholesterol, has nothing to do with heart disease.

He has been derided by conventional medicine, which, at the same time, is slowly tip-toeing around to his point of view as it quietly drops the idea that fats have anything to with cardiovascular diseaseinstead, it's always been sugars, stupid.

Having won that little skirmish, Dr Kendrick has raised the bar a little higher by questioning the long-held convention that a heart attack, or myocardial infarction (MI) in medical-speak, happens when a coronary artery becomes blocked.

There's plenty of evidence to show that it doesn't always happen like this; in fact, the blood clot can form after a heart attack, as researchers like Carlos Monteiro have shown, and sometimes a blood clot never does appear.

One paper discovered that "a substantial minority of MI patients" don't have any obstruction in their arteriesand yet still had a heart attack.2 And to make it all curiouser and curiouser, other research has discovered that in some cases where an artery has become blocked, a heart attack happens days, or sometimes weeks, later.

There have even been cases where the artery has become completely blocked, and the patient never suffers a heart attack.3

Finally, there are heart attacks that aren't heart attacks at all: they are instances of Takutsubo cardiomyopathy, more commonly described as 'broken heart syndrome'. It has all the usual tell-tale signs of a heart attack, but it's caused by extreme stress and not a blocked artery.

So that's just how curious you are: you don't just have a gut microbiome, you have mini-microbiomes; bacterial imbalances in the mini-microbiome can cause cancer; a blood clot that is supposed to cause a heart attack can appear after one happens, and some people have a heart attack when there's never a blood clot at all. Still others never have a heart attack even when their arteries are completely blocked.

As Alice almost said, go figure.

Fake real news 2017-11-21T11:13:00+00:00 2017-11-21T11:13:00+00:00 In more innocent times, there was news, pure and simple. We believed most of what we were told in newspapers and on TV. Now, in the Days of Trump, we also have fake news: blatant untruths like 'Hillary Clinton uses a body double' or 'Donald's tan is natural.'

But there's a gray area between these binary possibilities: fake real news. It's fake, because some group deliberately created it, usually for a commercial reason, and yet it becomes news because it enters the zeitgeist, and eventually it's seen as an accepted fact (even though it isn't).

Fake news, on the other hand, seems to have a half-life of days before it gets found out, and plenty of people never believe it to begin with.

Over the years, there have been numerous examples of fake real news. From the world of health and medicine there's been 'smoking is good for you' (yes, really, a classic from the 1930s and 40s), 'sugar won't harm your health' (we believed that one for 30 years), and 'cholesterol causes heart disease' (oh, you still believe that one?).

Fake real news has another name when it comes to stories specifically about healthcare and pharmaceuticals, processed foods and drinks: it's healthwashing, a play on 'whitewashing,' which is defined as 'a co-ordinated attempt to hide unpleasant facts.'

Healthwashing's cover was finally blown in 2015 when a New York Times writer discovered that Coca-Cola had spent billions of dollars funding scientists and organizations to create a public 'groupthink' that fat is responsible for the obesity epidemic, and not the sugar that its products are full of. And it worked. The food industry fell for it, and produced an enormous range of low-fat products, and the pharmaceutical industry created statins to lower cholesterol. And we all drank Coke to celebrate (and got fat).

An Australian university professor, Rob Moodie, has examined healthwashing, and has come up with some of its tactics; you may recognize a few of them.

Attack science: Use terms such as 'junk science' and 'bad science.' Withhold data that may damage your product. Fund your own research that gets the answer you're looking for. Fund 'sympathetic' researchers.

Attack scientists: Create doubt by attacking the integrity of a scientist who may have discovered some inconvenient truths about your products or industry. Sue, or threaten to sue, scientists. Infiltrate science groups.

Create arm's length organizations: Create front groups. Sponsor conferences and workshops. Distribute your message through pamphlets and booklets, and actively through social media.

Manufacture false debate: Create the impression there's a controversy. Demand balance, especially from journalists. Divert attention from harmful products. Focus on corporate social responsibility, and set up foundations. Focus on other issues as the problem, such as physical activity instead of diet, for example.

Frame issues in creative ways: Insist the problem is complex, and it would be premature to suggest remedies. Insist that parents, and not governments, should influence the behavior of their children. Use colorful imagery, and words like 'speculative,' 'oversimplified,' 'premature,' and 'unbalanced.' Diminish the severity of the problem.

Fund industry disinformation campaigns: Run disinformation campaigns, and co-opt celebrities and sympathetic 'expert' witnesses to represent your case.

Influence the political agenda: Donate to political parties. Invest heavily in paid lobbyists. Target former politicians or their advisers to become sympathizers to your cause.

These tactics work wonderfully, and Coca-Cola used most of them. In the early 1970s, when scientists were trying to figure out just why cardiovascular disease was reaching epidemic proportions, the corporation wanted to strangle at birth any suspicions that sugar might be the culprit.

There was already a move toward fats being to blame, thanks to the fake research of Ancel Keyes, but there was one problem: an English professor, John Yudkin, was certain that sugar was the real problem, and had even written a book, Pure, White and Deadly, to make his point.

Poor Yudkin never stood a chance. His research was discredited, 'alternative' research was carried out that proved him wrong, he was locked out of his facilities at his university, his talks were mysteriously canceled at the last minute, and he became a laughingstock of the scientific community. Yudkin retired a broken, and very disillusioned, man.

Of course, he was right, and he is championed by brave scientists of today such as Robert Lustig, a professor of pediatric endocrinology at the University of California, San Francisco. "Everything this man [Yudkin] said in 1972 was the God's honest truth," Lustig has told journalists.

Of course it was, but it was up against fake real news, and there's only one winner in a fight like that.

Chinese delivery 2017-10-25T15:32:00+01:00 2017-10-25T15:32:00+01:00 The Economist magazine has recently been voted the world's most trusted news source, but even such a highly rated title can get it badly wrong when it reports on alternative medicine. In an editorial, it has accused the Chinese government of state-sponsored 'quackery'for supporting the country's own ancient healing system, traditional Chinese medicine (TCM).

It's quackery because it's unproven, the magazine thunders, and yet the Chinese government is set to promote the use of TCM remedies globally, while upping its investment in an already extensive domestic network of TCM clinics and hospitals.

China's leader Xi Jinping champions TCM and sanctioned a government white paper last year that noted the therapy's "positive impact on the progress of human civilization."

But that's nonsense, says The Economist's editorial: TCM is based on a universal energy field called qi, it uses the fungus from dead caterpillars to boost the libido, and the horns of the rhino to treat arthritis. The editorial dismisses most TCM therapieswhich include acupuncture and herbal medicineas "at best placebo and at worst a harmful distraction from the task of curing people, or downright dangerous."1

A day or so after reading the magazine, I came across new research from the University of British Columbia that has discovered that a TCM compound helps prevent bone loss and could be employed as a successful treatment for osteoporosis.

The compound, derived from red sage, works in the same way as some osteoporosis drugs, by blocking an enzyme called cathepsin K (CatK) that breaks down collagen in bones. But unlike the drugs under development, the TCM remedy doesn't have any side-effects. "All clinical trials [of CatK blocking drugs] to date have failed due to side-effects ranging from stroke, skin fibrosis and cardiovascular issues," said lead researcher Dieter Bromme.2

For years, Western researchers have demonstrated many benefits of TCM therapies. Acupuncture, which acts on the mysterious concept of qi energy flowing through our bodies, is routinely used as a painkiller, and its effectiveness has been vindicated by a multitude of studies, far beyond any placebo effect.

The world's largest randomized controlled trial of the use of acupuncture in hospital emergency units has discovered that it's
as effective for pain relief as standard drug regimens.

The method was tested on 528 patients who went to an emergency unit in one of four hospitals in Melbourne, Australia, over two years for the treatment of acute low back pain, migraine or ankle sprain.3

It's a real alternative to standard painkilling drugs, such as opioids, to which a patient can all too easily become addicted, says lead researcher Marc Cohen, from the RMIT School of Health and Biomedical Sciences.

TCM can even kill cancer cells. The TCM preparation compound kushen injection (CKI) is already used routinely in China, often as an adjunct to chemotherapy, to treat a range of tumors, and now oncologists in the West are starting to show an interest. Researchers from the University of Adelaide recently found that CKI could kill breast cancer cells in laboratory tests and shed light on the genetic pathways that it acts on.4

If TCM is effectiveand way beyond placeboas studies have shown, why isn't it being more widely adopted in the West? Skepticism, as displayed by The Economist, persists, often because it's all just so exotic and different, and rooted in traditions and a lexicon that are thousands of years old.

Even if we can prove it works, we really don't understand why, and falling back on mysterious energy forces doesn't convince the Western scientific mind.

Trying to bridge the divide, two Chinese academics have explained that TCM is founded on spirituality, religion and philosophy, which makes it magical and mysterious to Western medicine, which has evolved from observing biological processes.

TCM's underlying premise is that the mind and body are inseparable: to be in good health, a person must have good spirit and pay attention to cultivating their spirit. "Good health and longevity are what we pursue. More and more people are concerned about ways to prevent disease and strengthen their bodies, which is the emphasis of TCM," say Lin Shi and Chenguang Zhang.5

TCM is about prevention and balance. It's a lesson that the West could take to heart: instead of pouring countless billions of dollars, pounds and euros into treating the sick, without ever really understanding why people get ill in the first place, an understanding of the whole person could be a useful new avenue for Western medicine to follow.



The Economist, September 1, 2017


J Bone Miner Res, 2017; doi: 10.1002/jbmr.3227


Med J Aust, 2017;206:494-9


Oncotarget, 2016;7(40):66003-19


Pastoral Psychol, 2012;61:959-74

Reasonable doubt 2017-09-26T11:01:00+01:00 2017-09-26T11:01:00+01:00 Proof of vaccine damage is now down to common sense.

Courts of law deal in probabilities. If the defendant pleads innocence, a jury must assess all the evidence and come to a verdict that is "beyond reasonable doubt." This means that the juror may still have some doubts, but the evidence is strong enough to support a verdict.

Parents whose child suffers a serious reaction after a vaccination haven't been granted the same privilege. They have had to jump through a much higher legal hoop, that of "beyond a shadow of a doubt."

Most legal experts agree that this is almost an impossibility, and this is especially so for establishing cause-and-effect in matters of health. The first place to look is the medical evidence. If no research can be found to support the defendant's claim, the claim is invariably immediately dismissed. If there is some evidence, the claim will still probably fail because it cannot be established beyond a shadow of a doubt that the vaccine was to blame on that particular occasion.

Instead, it could have been some other factor at play, or, at best, the child had a genetic propensity, and the vaccine merely accelerated the process.

Not surprisingly, very few cases of vaccine damage are accepted, and compensation payments from governmentswhich take on a vaccine manufacturer's liabilityare rare. A result for the government, and confidence is maintained in a national vaccine program, perhaps, but the parents may be left with a child who has suffered permanent damage, and for whom there is no financial support.

Accepting the unreasonableness of establishing vaccine damage, the European Court of Justicewhich has ultimate jurisdiction over the 28 member states of the European Union (EU)has lowered the legal requirement to that of "beyond reasonable doubt."

It is now sufficient in a European court for the evidence to satisfy four criteria, and the first of these is that there is "specific and consistent evidence" around the time of the vaccination. In other words, it is reasonable to assume that the vaccine is responsible if, for instance, a perfectly healthy child starts rocking his head or loses the ability to speak within days of being vaccinated.

The second relates to the child's state of health, and is linked to the first proof: up to being vaccinated, the child has always enjoyed good health, and has suffered none of the symptoms before.

The third is also related to the first and second proofs: there is no family history of
the child's sudden post-vaccination health problem.

Although all the tests are grounded in common sense, the fourth is perhaps the most common-sensical of them all: are the symptoms common in children soon after they have been vaccinated? Collectively, a court could therefore reasonably assume that "the administering of the vaccine is the most plausible explanation" for a child's poor health, provided the evidence is "sufficiently serious, specific and consistent." Interestingly, the ruling doesn't look for scientific evidence, which has upset the pro-vaccine lobby.

It came about when the court was asked to make an ultimate ruling on the case of a French man, known only as J.W., who developed multiple sclerosis (MS) a year after he had the hepatitis B vaccine in 1998. He sued the manufacturer, Sanofi Pasteur, in 2006, and his case eventually reached the French court of appeal, which ruled that there was no evidence that linked the vaccine to MS, and so dismissed it. Although J.W. died in 2011, the French Court of Cassation took his case to the European Court of Justice.

The court wasn't ruling on J.W.'s case specificallyand it may well be that it would have failed the fourth test, as it's not common for someone to develop MS after the hepatitis B vaccinebut was setting general markers for courts to follow going forwards.

To establish that a vaccine may do individual harm, it's enough to produce reasonable, and not absolute, proof. It's what we require of someone facing a criminal charge, and it should be enough for parents who had their child vaccinated, and who believed the vaccine was safe.

Quiet as mice 2017-08-29T19:13:00+01:00 2017-08-29T19:13:00+01:00 I'm not a mouse; nor, I suspect, are you (unless you're a highly intelligent one who reads our magazine when you're not eating cheese or whizzing around on one of those running wheelsfun, aren't they?)

If you don't have a very serious identity crisis, this is not earth-shattering news, although it could be if you're a drug company. Mice are usually on the front line when drug companies begin testing the safety and effectiveness of a new drug. If the mice give it the paw's up, the drug will be given to healthy young medical students who aren't anything like the frail and elderly people who'll actually be the targets of the drug.

But researchers from King's College London and Lund University in Sweden have just pointed out something obvious: mice aren't people. Drugs that do well in animal tests may not fare quite so successfully when they're given to humans.

They've discovered that two types of laboratory mice that have been used for more than a century in medical trials aren't very much like us after all. This astonishing insight came to them when they looked for receptors in mouse and human cells that produce insulin.1

Humans don't have anywhere near as many insulin-producing receptors as the mice do, and so drugs that are designed to stimulate or repress insulin production could have different effects in mice and humans. A diabetes drug that seems to be successful in tests on mice could have no effector even a harmful effectin people.

This would explain the problems drug researchers have always experienced when they've tried to replicate results from animal studies in tests on human cell lines. "This is well known, and a source of great frustration for researchers and the pharmaceutical industry," says Albert Salehi from Lund University. "Is it then right to continue to develop drugs based on research conducted on mice, when these drugs cannot be used on humans?"

Good question, and he's not the first to raise it. Researchers at the London School of Hygiene took a look at six animal trials and discovered that none of the 'successes' could be replicated in tests on humans. One trial of a corticosteroid drug for head injuries helped the problem, at least according to the animal study, but was of no benefit at all when humans tried it, while a heart drug that was extremely effective in animal studies actually made things worse in humans.2

Human drug trials can sometimes go very wrong after a new drug has passed safety tests on animals. In 2016, six men suffered severe brain injuries, and one subsequently died, after they took a painkiller that was 'safe.' It had been tested on mice, rats, dogs and monkeys, and in doses that were 400 times greater than those given to the human volunteers.

Ten years earlier, a drug trial was stopped abruptly when six men were treated in intensive care with heart, liver and kidney failure after they had been given a drug to treat rheumatoid arthritis, which had proven safe in monkeys at doses that were
500 times higher.

Drug companies say these reactions are very rare, but then they would. In fact, they're under no obligation to reveal the results of early-stage trials, but one study discovered 11 serious adverse drug reactions in 394 trials.3 A Freedom of Information request discovered that, between 2010 and 2014 in the UK, 7,187 people suffered serious reactions and 761 died while participating in a drug trial.

In the US, a drug trial was stopped suddenly when five of the 15 participants suddenly died, and even a late-stage trial was abandoned in 2016 when several participants died while taking a drug for blood cancer, although the actual number of fatalities has never been revealed.

None of this is new. Back in 1984, three professors opined: "The methods of assessing toxicity in animals are largely empirical and unvalidated... it is necessary to know whether the tests as in fact conducted have sufficient predictive value to be justifiable, or whether they are a colossal waste of resources to no good purpose."4

The good professors miss the most important point of all: animal tests are cruel and cause unnecessary suffering, because mice and people really are different.



Sci Rep, 2017; 7: 46600


BMJ, 2007; 334: 197-200


BMJ, 2015; 350: h3271


Laurence DR et al. Safety Testing of New Drugs: Laboratory Predictions and Clinical Performance. London, Academic Press, 1984

Don't trust me (I'm Big Pharma) 2017-07-21T12:15:00+01:00 2017-07-21T12:15:00+01:00 When you start something, are you prepared to see it through to the bitter end? Whatever the outcome or consequences? Without fear or favour?

These are questions that a group of brave souls will need to answer if they're going to achieve their ambition to clean up medicine. The group, mostly made up of doctors and researchers, wants to put evidencerather than money or other inducementsat centre stage when determining best practices or choosing the most effective drugs for treatment.

Experts from Oxford University's Centre for Evidence-Based Medicine have teamed up with the editorial panel from The British Medical Journal to produce a manifesto that lays out nine steps to make medicine ethical, patient-focused and, yes, scientific.

This bold proposal wants to bring patients into the decision-making process (patients deciding their own treatment?whatever next) as well as put health professionals and policy makers in the driving seat of medicine. Presumably, that means the drug companies are pushed into the back seat, like a troublesome in-law on a long car journey.

It's a bold and brave move that, if successful, should turn medicine on its head. Not that the drug companies can complain: they've been fleecing taxpayers and health insurers for years with their products that are often supported by only the dodgiest research.

And that seems to be the spur driving the ambition of the group's manifesto. Research studies are poorly designed and executed, says Prof Carl Heneghan, editor of the journal Evidence-Based Medicine, and then the results are withheld (if unfavourable) or released only piecemeal. It's a problem that's getting worse, he claims, and this has compromised medicine's ability to provide affordable, effective, high-value care to patients.

Together, these failings "contribute to escalating costs of treatment, medical excess . . . and avoidable harm".1

They've certainly caught the mood among doctors. More than 80 per cent of them don't trust medical research, a recent survey has discoveredwhich is pretty worrying, as that's what they're supposed to base their clinical decisions on.2

In a poll of more than a thousand doctors across the UK, 82 per cent said they doubted the results of any clinical trials into drugs funded by the manufacturer. And as the drug company is almost always the sole funder of research into its own products, most doctors are doubting the outcomes and conclusions of their own science.

The public is nearly as sceptical: around two-thirds of the 2,000 people questioned also doubted the reliability of clinical research. Instead, they took their health advice from family and friends.

Let's take pause and recap here for a moment: the multibillion-dollar drugs industry is being driven by doctors who don't believe the science that tells them the drug is safe or effective, or both, but who are nonetheless prescribing them to people who also don't believe in the science behind whatever it is they're taking.

Meantime, the UK taxpayer is throwing around 112 billion a year at the National Health Service while, in the US, many billions of dollars more are being coughed up by health insurers for a medical system that nobody believes in and which everyone knows is crooked. As such, it's a scandal and a confidence trick being perpetrated on the publicor it would be if patients didn't seem to have their eyes open.

So what is sustaining the system? Essentially, no one can imagine an alternative, so everyone puts up with a mediocre or inadequate service that can, on occasion, work. This is especially true of surgeryand of emergency treatment in particularbut even this is questionable. Professor Andy Carr, an orthopaedic surgeon working for Oxford University Hospitals, has suggested that many surgical procedures are unnecessary and that any improvement the patient experiences is actually down to the placebo effect.3

Because of ethical concerns, very few surgical procedures have ever been tested against a placebo, where the surgeon does nothing. But when a procedure has been tested against non-treatment or a placeboas has happened with knee surgery for arthritis, spinal cement injections for vertebral fracwtures and gastric balloon proceduresthere's scarcely been any difference in outcome.

So, hats off to the evidence-based crowd. But will they see it through to the bitter end and its inevitableand medicine-transformingconclusions?



BMJ, 2017; 357: j2973



Thinking makes it so 2017-06-26T21:52:00+01:00 2017-06-26T21:52:00+01:00 Here's a very radical thought: suppose it's all placebo. Does the thought that a remedy will work actually make it workwhether you've been given a prescription drug, a placebo or dummy drug, or a homeopathic pill?

The idea that the mind can make us feel better when we're given any kind of pill isn't new to medicine. It's the basis of the double-blind placebo-controlled trial, where a group of participants is given either an active drug or a 'dummy' placebo drug, and no onenot even the researchersknows which they've been given. The drug is deemed a success if its positive effects outperform those of the placebo, even if by just a few per cent.

But with fraud now so rife in medical researchit's been reckoned that around 70 per cent of studies have been 'massaged' to get a positive result for the drug company, which has invariably funded the whole projectwas there really ever any difference between the drug and its dummy version?

It's not just that we feel bettera relaxing piece of music or a hot bath might achieve something similarbut people given a placebo report that physical symptoms, even long-standing ones, have disappeared. Linda Buonanno, of Methuen, Massachusetts, said her chronic symptoms of irritable bowel syndrome (IBS), which she described as worse than labour pains, reversed after she took a placebo pill for just four days. The intense cramps, bloating, diarrhoea and pain, which she had endured for 15 years, suddenly went away and have never returned.

Here's the most extraordinary part of Buonanno's story: she knew she was being given a placebo. She was taking part in a study run by Ted Kaptchuk, at Harvard Medical School, who has been studying the placebo effect for years. For this study in 2010, he wanted to push the envelope and run an 'open-label' placebo trial, where half the 80 IBS sufferers, including Buonanno, were told they were being given a placebo, while the others were given no treatment at all.

Even though they knew they were taking a sugar pill, Buonanno and her fellow sufferers reported "significant" improvements in their symptoms, including a fivefold reduction in pain, as determined by an independent IBS measure.1

Kaptchuk repeated the experiment six years later when he treated 83 chronic low back pain sufferers with open-label placebos, although this time, half of them carried on with their usual treatment, such as pain-killing medications and massage. Again, the placebo delivered the best results, with pain and disability reduced 1.5 timesand similar results were found when the two groups switched treatments.2

Looking beyond Kaptchuk's work, Jeremy Howick of Oxford University led a team that looked at 24 reports and found five trials, involving 260 participants, which had used open-label placebos for a range of health problems, including IBS, depression, allergic rhinitis (hay fever), back pain and ADHD. Overall, the approach had "positive clinical effects compared to no treatment," Howick concluded. In other words, the placebos worked.3

But how can a dummy pill cause physical changesespecially when the patient knows it's a fake? One theory is that patients are subconsciously boosting their levels of endorphins and neurotransmitters when given a placebo by a trusted doctor who may, in the past, have helped them to positively recover. Another suggestion is that the patient's expectations of the placebo working may be raised by the knowledge that it helped others who've had the same health problem.

But neither theory explains why conventional treatments have failedas those same conditions are in place when a real drug is prescribedwhereas the placebo succeeded.

Kaptchuk thinks the answer may be found in a new theory known as 'embodied cognition'. This suggests that the brain isn't the centre of everything, but that our body, and the experiences it has had, influence cognition itself. But, again, this doesn't entirely explain why conventional treatments have failed.

So, going back to our radical idea at the beginning, suppose everything is a placebo (or nothing is, whichever you prefer). On its own, the therapy per se is not the essential point; instead, it's just one component of a complex mix that may include trust in a doctor, belief in the therapy, the current mental state of the patient, support from family and friends, and so on. Only when
all of these aspects are positive does healing become possible.

Just a thought, I knowbut then, a thought may be all you need.


1) PLoS One, 2010; 5: e15591

2) Pain, 2016; 157: 2766-72

3) J Evid Based Med, 2017; doi: 10.1111/jebm.12251

First mad, then destroyed 2017-05-24T13:35:00+01:00 2017-05-24T13:35:00+01:00 Those whom the gods wish to destroy, they first make mad.

Medicine's governing bodiesthose who determine the truth about disease, its causes and proper treatments at any given timeclearly took a leaf from Euripides's book when it came to dealing with malcontents, nay-sayers and iconoclastsor, in other words, people who disagree.

The history of medicine is littered with visionary folk who were right, told they were wrong, then driven mad in the process before their careers and reputations were destroyed. When they were safely out of the way (as in dead, retired or banished), someone from the 'right' side of the fence would pop up, say exactly the same thing and be applauded for his wonderful insight.

You don't have to look too far back in time to find an example. Step forward John Yudkin, the nutritionist physiologist who set up the nutrition department at the University of London. Back in the 1970s, Yudkin was banging on about how sugar was the real cause of heart disease. But by then, saturated fats had been fingered as the culprit, based on the theory expounded by Ancel Keys and 'proven' by what has since been revealed to be some pretty dodgy science.

No matterit launched the multibillion-dollar statin drug industry and the even more lucrative low-fat food and diet-drink industry. With that sort of money at stake, Yudkin was about as welcome as a mime act on a radio show.

So, taking lesson one from the Euripides Guidebook for Sorting Out Malcontents, the process of making Yudkin go mad began. The British Sugar Bureau started the ball rolling with a press release that dismissed him as "emotional", while the chorus was bolstered by the World Sugar Research Organisation, which described his theory as "science fiction".

Yudkin fought back and sued the organizations. They quickly retracted their slanderous remarks with this apology: "Professor Yudkin recognizes that we do not agree with his views and accepts that we are entitled to express our disagreement." So, having been slandered, it now read as though he was the narrow-minded bigot who couldn't stand being contradicted.

Then stage two of the Madness Process kicked in. Yudkin found himself suddenly, and inexplicably, uninvited to conferences, and even the ones he had organized were mysteriously cancelled. Papers he submitted were left out of publications, and his own college refused to let him use the research facilities he had created once he had retired.

As he once wrote: "Can you wonder that one sometimes becomes quite despondent about whether it is worthwhile trying to do scientific research in matters of health? The results may be of great importance in helping people to avoid disease, but you then find they are being misled by propaganda designed to support commercial interests in a way you thought only existed in bad B films."

He died in 1995, a forgotten and discredited scientist.

Move the clock forward to today and guess what? Sugar is becoming recognized as the real cause of heart disease. Poor Yudkin: driven mad, then destroyed.

Wouldn't happen today? Just ask Prof Tim Noakes or Dr Gary Fettke. Noakes is the scientist at the University of Cape Town who, over the years, has become an advocate of the high-fat/low-carb diet. A couple of years back, he found himself in front of the Health Professions Council of South Africa for sending a Tweet to a breastfeeding mother about giving her baby high-fat breast milk, then weaning it onto high-fat foods.

It wasn't clear what the charge against him was, as it wasn't apparent what rules, if any, he'd breached. Not surprisingly, he was eventually acquitted, but the country's Nutrition Society, which had started the whole rigmarole, remained unrepentant. In a statement, it said: "We are glad that the hearing has been finalized after almost three years, unless there is an appeal. The judgement, however, has absolutely no bearing on the current or future status of nutrition or the dietary guidelines in South Africa."

So, having been left hanging for three years, Noakes could still face a new hearing, and he is still wrong, say his persecutors, and always will be. About what? Having a different point of view, it seems.

In the case of Gary Fettke, a surgeon in Australia, he has been "banned from giving nutritional advice to his patients or the public for the rest of his medical career". Fettke is another high-fat/low-carb advocate who happened to recommend the diet to a patient who had type 2 diabetes. Although the patient saw his diabetes reverse, Fettke hadn't followed the standard dietary protocols, which attest that diabetes can't be cured by diet (even when it is). By now, some of you may be quietly whispering the name of Andy Wakefield under your breath, but I couldn't possibly comment.

Prove it! 2017-05-03T18:14:00+01:00 2017-05-03T18:14:00+01:00 Complementary and alternative medicine (CAM) groups could soon lose their tax-advantageous charitable status in the UK unless they can demonstrate that the therapies they represent benefit the public.

It's the test for every group that's a charity. For some, like Oxfam and Christian Aid, it's easy to demonstrate that their work benefits the public, and you might think the same would apply to alternative therapy groups as well.

But the Charity Commission has been faced with a legal challenge, engineered by the self-appointed scourge of all things alternative, Simon Singh (whose own groups, the Good Thinking Society and Sense About Science, both enjoy charity status).

That means the burden of proof becomes tougher. Anecdotal accounts of how a therapy has helped someone simply won't do, nor will a properly conducted trial if it's been published in a second-division medical journal.

What the Charity Commission is looking for are 'robust' (that loathsome word du jour) trials that have been published in prestigious medical journals, and it mentions The Lancet and British Medical Journal by way of examples.

The commission's approach is safe, but nave. Surprisingly few medical trials are robust, even when they're published in leading journals, as two new reports have made clear. One was prepared by Dr Tim Errington, an immunologist at the University of Virginia, who has become so concerned about fraud and spin in scienceand medical studies in particularthat he's created The Reproducibility Project, so named because the ability to reproduce somebody else's results is one of the cornerstones of science.

He took a look at five medical trialsincluding one for a cancer treatmentthat had been published in medical journals so prestigious they would make even the Charity Commission swoon. He spent two years going over their methods, their analyses and their conclusions, and was able to fully reproduce the results of only two of them. Two others were 'inconclusive', and the fifth was impossible to replicate.1

"It's worrying because replication is supposed to be a hallmark of scientific integrity," said Dr Errington.

Similar worries are being raised in the UK. Retraction Watch has been set up to monitor fraud in medical research, and its findings are alarming: in the past five years, there have been at least 300 allegations of fabrication, inaccuracy and plagiarism reported at 23 of the 24 research-led universities the group investigated.2

Medical breakthroughsthe kind beloved by national mediaare the most common type of fraud, and there has been a 10-fold increase in these over the past decade, says Retraction Watch. Worse, industry watchers reckon only a tiny fraction of fraudulent research is ever exposed.

Why does it happen? There are commercial pressures from drug companies that pay for research and expect to see their new drug pass with flying colours, and there are pressures from universities and research centres that are dependent on grants and funding, and wish to be seen as the reliable 'go-to' place to deliver the results everyone wants.

The prestigious journals are keen to publish this kind of research too. If they can be the publisher of major, and exciting, research, their publication will rise even higher in the consciousness of the medical community.

Finally, there's the human factor. The researcher needs to make his mark and put his name to that breakthrough piece of research that changes the landscape of medicine.

As Dame Ottoline Leyser, director of the Sainsbury Laboratory at Cambridge University, summarizes the problem: "It's about a culture that promotes impact over substance, flashy findings over the dull, confirmatory work that most of science is about. Everyone has to take a share of the blame. The way the system is set up encourages less-than-optimal outcomes."

The controversy has even reached the doors of the Houses of Parliament. The science and technology committee at the House of Commons has launched an inquiry into scientific integrity. "Where research has been found to be fraudulent at a later point, it has a big impact on the public," said committee chairman Stephen Metcalfe.

It does more than that, of course. It means treatments can be recommended and drugs prescribed that aren't effective and may even be dangerous; it means that doctors and patients can be duped by commercial interests dressed up as science.

The nuances of these arguments are no doubt lost on the Charity Commission, and probably elude Mr Singh as well, who will continue to use the heavy cosh of science to beat the world into a shape that satisfies only him.



eLife, 2017; 6: e23383


The spaces between facts 2017-03-31T12:25:00+01:00 2017-03-31T12:25:00+01:00 William Halsted is revered among surgeons. He died in 1922, and yet is still considered one of the most influential surgeons ever, with many of his innovationssuch as the use of rubber gloves and a surgical procedure on the digestive tractstill in use in operating theatres today.

He also developed the radical mastectomy procedure after some women he operated on for breast cancer relapsed when the cancer spread to other parts of the body. Halsted was convinced that the operation wasn't 'clean' and had left behind some of the tumour, so he began to remove the breast, lymph nodes and chest wall muscles to ensure no trace of the cancer was left behind.

Radical mastectomy quickly established itself as the standard operation for breast cancer even though it was never tested, and surgeons were happy to go along with Halsted's strange ideas about 'unclean' surgery. Even when surgeons like Sir Geoffrey Keynes questioned the approach in the 1940s, they were shouted down and ignored.

In 1980around 80 years after Halsted introduced the procedurethe first-ever randomized trial was carried out and tested against conservative, breast-saving surgery. But it was hard to find surgeons prepared to try out this latter alternative, so convinced were they that radical mastectomy was the only ethical and effective response to breast cancer.

Eventually the researchers found enough recruits to test the more conservative approachand, to their amazement, they discovered that the death rate among women who had a radical mastectomy was the same as those who had the conservative surgery.

As no one could believe the results, the researchers took another look in the 1990s and then again in 2000. Eventually, everyone had to agree that radical mastectomy had been a false direction. Sadly, by then, more than 500,000 women had undergone the unnecessary surgery in the US alone.

Halsted had got it seriously wrong. It wasn't that some of the cancer had been left behind after surgery: long before the women had gone under the knife, their cancer had already spread and that's why they suffered a relapse.

The story of Halsted has now been told by leading oncologist Siddhartha Mukherjee in a TED talk and subsequent book, The Laws of Medicine (Simon & Schuster, 2015). It's an example of how doctors work with incomplete knowledge and sometimes fail. It's the space between the facts, as he describes it.

These spaces, rich with quantum uncertainty, can make a 'typical' case of cardiovascular disease suddenly veer into unknown terrain, or a drug that's been effective in thousands kill the next patient, or convince an eminent surgeon of 'unclean' surgery.

Far from being a science, medicine is "a lawless, uncertain world. I wondered if the compulsive naming of parts, diseases, and chemical reactions was a mechanism invented by doctors to defend themselves against a largely unknowable sphere of knowledge," said Mukherjee.

As if trying to put a Band-Aid across the chasms created by a massive earthquake, Mukherjee has come up with 'three laws' to help guide him through medicine's otherwise lawless landscape.

His first law reminds us that strong intuition is much more powerful than a weak test. No test is perfect and all will throw up their share of false positivesseeing a disease that's not actually thereand false negativeswhere it fails to see a disease that really is there. So how can you know the result is true? Without prior knowledge, you can't, but a fair slice of common sense and a little bit of information about the person being screened can reduce the odds.

The second law states that 'normals' teach us rules, while 'outliers' teach us laws. Most diseases and treatments follow a similar patternthese are the normalbut it's the unusual and unexpected that teaches doctors something new. Outliers are also known as 'anecdotal', a term that sends a shiver down the spines of most researchers, because the anecdotal is the exception to the rulebut it shouldn't be ignored.

The third law, inspired by Halsted and his unclean surgery, tells us that, for every perfect medical experiment, there is a perfect human bias.

All of this suggests that, despite the progress that's been made, Voltaire's caustic view of medicine still holds true three hundred years on: Doctors are men who prescribe medicines of which they know little, to cure disease of which they know less, in human beings of whom they know nothing.

Sugar and spite 2017-02-23T18:12:00+00:00 2017-02-23T18:12:00+00:00 It's a belief that still underpins our most popular weight-loss programmes and, if truth be told, somewhere deep down you probably believe it too. It's this: the more you eat, the more weight you'll put on.

It seems logical enough, but it's not entirely true. The idea of the equality of calories was started by the sugar industry in the late 1950s, and has been endorsed and promoted by supposedly independent researchers and our health guardians ever since. The National Institutes of Health in the US states that obesity is the result of "an energy imbalance"you're eating more than you're burning offand the UK's National Health Service tells us that "obesity is generally caused by consuming more caloriesparticularly those in fatty and sugary foodsthan you burn off through physical activity. The excess energy is stored by the body as fat".

But calories aren't equal, of course, and it's more to do with what you eat than the quantity, as perhaps we're all slowly starting to realize.

The self-evident 'truth' of the equality of calories had inauspicious beginnings. It saw the light of day in a newspaper advertisement the sugar industry paid for to counteract the publicity shots of President Dwight D. Eisenhower following doctor's orders and using saccharin to sweeten his coffee.

The advert explained that there was no such thing as fattening food. Instead, "all foods supply calories and there is no difference between the calories that come from sugar or steak or grapefruit or ice cream." A calorie is a calorie is a calorie, and the source doesn't matter.

The trouble was, there was barely any evidence to support the claim. So the sugar industry paid to get some, as some papers uncovered last year have revealed.1

They paid the equivalent today of $50,000 to three Harvard scientists to 'prove' that sugar wasn't the problem, but saturated fatsmainly from meatwere.

The seminal paper was published in the prestigious The New England Journal of Medicine in 1967, which helped launch the low-fats industry. The report also threw off the scent any researcher who might have been suspecting that sugar also had something to do with weight gain.

And these weren't just the shenanigans of a dim past: in 2016, scientists announced that diet drinksmanufactured by the sugar industrywere about the same for losing weight as plain water. However, it was later revealed that the lead researcher was sponsored by Sugar Nutrition, which itself is funded by the sugar industry, and six of the 11 researchers who helped him had some association with the sugar industry too, with sugar manufacturers directly employing two of them.2

All the while, real science was going on, but it wasn't sexy and it wasn't supporting the sugar industry. As health researcher Gary Taubes explains in his new book, The Case Against Sugar (Knopf, 2016), endocrinologythe study of hormones and hormone-related diseasesand biochemistry were making extraordinary discoveries.

Even as early as the 1960s, scientists knew that we metabolize different carbohydrates, like glucose and fructose, differently. It may be subtle, but over the years, these differences add up, and consuming the 'wrong' sugars long term has created the obesity epidemic we're seeing today.

Taubes is a fierce critic of sugar, believing it to be more deadly than tobacco. "The disorders for which it is the prime suspectobesity and type 2 diabetesin turn elevate our risk of virtually every major chronic disease, from heart disease to cancer and Alzheimer's," he writes.3

But he doesn't just blame the sugar industry. Like a mother hen protecting its chicks, the sugar industry has been defending its commercial interests and those of its stakeholders and shareholders.

Not so the scientists-for-hire, who were happy to say exactly what their paymasters wanted them to say. The Harvard researchers were recruited by the sugar industry, which also paid them and told them the results they were expecting.

Like schoolboys eager to please, the researchers sent their paymaster early drafts of what they intended to write. "Let me assure you this is quite what we had in mind, and we look forward to its appearance in print," wrote back their funders.

It's hard to believe how these scientists, and the many others who followed them, could believe they were practising objective, without-fear-or-favour science.

No, they took the money and duped generations of trusting people who, influenced by their 'discoveries', accepted that a calorie is a calorie is a calorie.