July 2015 in review: part 2

So far we’ve looked at the cover stories and the first ten pages. Brace yourselves, there’s more to come.

Page 11 is a full-page advert for Cytoplan, who claim that their Wholefood Cherry C contains only pure, powdered acerola cherry because, as they say, “food supplement nutrients in the same form as those in food are always the most optimally effective”.

L-Ascorbic Acid (evil) Natural Vitamin C (not evil)
L-Ascorbic_acid-a L-Ascorbic_acid-g

Spot the difference.

Page 12 retreads the story from April 2015, “Autism is linked to gut problems (so sorry, Andy Wakefield)”, making the entirely spurious claim that any link between autism and the gut would validate Wakefield’s fraudulent work. Sorry, WDDTY, however much you want Andy Wakefield to have been right, he remains a charlatan.

There’s also a repeat of the misleading claim that “86% of children with measles had been vaccinated” (other sources put it closer to 10%, but whatever) based on a source that actually says “substandard vaccination compliance is likely to blame for the recent measles outbreak linked to Disneyland in California“. Easy mathematical exercise for the reader: if 97% of people are vaccinated and 3% are not, and if 14% of those infected are in the unvaxed group, how many times more likely are the unvaxed to catch measles?

We’re also exhorted to “Eat three servings of whole grains a day (even though most Brits don’t)”. Tough luck on the coeliac population I guess, and confusing if you last read WDDTY in a month when wheat was evil. Incidentally, eating a diet with adequate fibre is something doctors very much do tell you.

Page 13 starts with more advice doctors do tell you – “Stay well with a few no-drinking days each week”. In fact, this is taken from the doctors at the World Health Organisation, but from a presentation rather than from peer-reviewed research. It briefly pimps roseroot as a “powerful antidepressant” based on a study of 57 people. It informs us that obesity is not due to inactivity, but to fast food, according to “a leading heart specialist“, an editorial, again not peer-reviewed research. And then:

Singh threatens legal action to stop
homeopathy on the NHS

WDDTY standing up for the canonical quack remedy. Who predicted that? It starts in predictable form:

Simon Singh – the freedom-of-speech champion who has tried for three years to get WDDTY banned from stores across the UK – is now threatening legal action against regional health authorities that offer homeopathy on the National Health Service (NHS).

Lenin may have believed that a lie told often enough becomes the truth, but it actually only becomes a tiresomely repeated lie. Simon has never campaigned for WDDTY to be “banned”, he has merely alerted retailers to the dangerously misleading content and suggested that it is irresponsible to sell it. Your freedom of speech is not infringed when people don’t stock your commercial product.

No article mentioning Simon would be complete without an ad hominem:

Mr Singh has approached the CCGs through his ‘charity’, the Good Thinking Society, which he initially created to sell his own books

If only it were possible to check the actual facts. It turns out the Good Thinking Society was set up to promote maths teaching in schools, though to be fair I can quite see why WDDTY would consider a campaign for more widespread numeracy to be deeply sinister and threatening.

Of course, Simon is not threatening legal action against CCGs across the UK, either:

In February 2015, The Good Thinking Society, working with Bindmans LLP, wrote to Liverpool CCG in order to highlight and challenge the CCG’s decision to approve spending on homeopathic treatments – a decision we believe to be unlawful, and contrary to the best interest of local patients. Since then, we have been challenging spending on homeopathic treatments on the NHS, in Liverpool and around the country.

These are not legal challenges, just challenges. The Liverpool case was specifically a legally-advised request to review a decision that was arguably unlawful, something that the CCG are now doing.

WDDTY’s response is predictably hypocritical: you’re supposed to bully Liverpool CCG into not kowtowing to bully-boys. I’m sure that makes some kind of sense to someone.

On page 14: maple syrup could be the answer to superbugs, we’re told, based on a test of polyphenolic extracts from maple syrup in the lab. It’s a curious thing: the hierarchy of evidence puts lab studies and personal opinion low down, small-scale studies pretty low, and large multi-centre studies at the top; the apparent effect size is pretty much the inverse of this, with striking findings in the petri dish usually translating to a modest proven effect in real populations or (in the vast majority of cases, in fact) nothing clinically useful at all. WDDTY inverts its hierarchy of evidence such that the more striking the finding, the more “reliable” it is.

Lack of sunshine “increases pancreatic risk” (though it may be vitamin D). Just as well sunshine doesn’t cause malignant melanoma, a cancer which is nearly twice as common as pancreatic cancer, having increased in incidence by 20% in the last decade. Oops.

“New ‘Lyme disease’ could be a major health threat”, say WDDTY. Who told us this? A doctor. In Lancet Infectious Diseases (remember The Lancet, the journal that retracted Wakefield’s fraudulent study and published the Shang analysis that arguably catalysed the precipitous decline of homeopathy in the UK?).

A cartoon scientist in the Einstein style informs us about “Vitamin E, the vital nutrient to avoid Alzheimer’s”. You could be forgiven for thinking that a study on zebrafish finding lipid peroxidation in fish fed a vitamin E deficient diet had little to do with “the ultimate brain food” (and advice to BUY SUPPLEMENTS! BUY! BUY! BUY!). But who knows. If the effect does pan out, that could be a great reason to take statins.  Sorry, that’s statin DRUGS!!!!!one one 111 eleventy.

Page 15 exhorts us to “Reverse prostate problems by treating gum disease” (source: dentists). Well, not reverse, so much as improve somewhat. If you have chronic periodontitis. It also pimps co-enzyme Q10, which “reduces deaths in heart-failure patients” in an industry-funded study on 420 patients. In WDDTY, extravagant claims for drugs are fine as long as they are branded “natural”. Not sure how happy Pharma Nord will be that WDDTY used a picture of a competitor’s product to illustrate this.

A perennial favourite feature, Drug News, tells us that paracetamol makes us emotional zombies, based on a study of a whopping 82 participants; half of adults are taking aspirin when they shouldn’t, according to a survey that has apparently not been independently validated; digoxin apparently increases risk of cardiac death by an enormous margin – a finding by doctors doing the kind of science that shows alternative medicine to be bogus, a finding that may be true, and if so, doctors will doubtless tell us as they always do.

And finally for this page: “What happens when you stop taking drugs when you have a serious medical condition? Not a lot, it seems“. This is precisely the kind of lethally dangerous hyperbole for which WDDTY is justly infamous. The study refers to multiple sclerosis, a disease for which medicine can currently do very little.  Specifically, it’s stabilised MS, and as WDDTY acknowledge, “Almost nothing is known of the progression of stabilized MS”. So, based on this study for a condition about which virtually nothing is known, WDDTY generalise to: stop taking the drugs for your serious condition, you’ll probably be fine. What could possibly go wrong?

Page 16 is a full-page, full-colour advert for WDDTY. So is page 17. If I was paying for this mag I would be rather offended by now – around a quarter done and there’s actually no substantive new content.

Pages 18 to 20 cover the Academy of Royal Medical Colleges’ recommendation against overtreatment. This is actually an interesting story: there is an initiative to bring the “choosing wisely” initiative over from the USA. I’m not sure how happy WDDTY would be with recommendations such as “Don’t use homeopathic medications, non-vitamin dietary supplements or herbal supplements as treatments for disease or preventive health measures.” Unsurprisingly, WDDTY proposes instead that psychiatric DRUGS should be at the top of the list. And rest assured: overtreatment is only a problem when doctors do it. There will be no reduction in WDDTY’s exhortations to endlessly self-medicate with vitamins and supplements, or to adopt quack overdiagnoses of non-existent diseases.

Long-term “fans” of WDDTY will be hugely amused to see the list of questionable medical tests. PSA; routine mammograms (because of false positives, which are apparently not a problem at all if they are made by a thermography huckster); cervical smears, which of course would be much less necessary of HPV vaccination rates were high enough; routine dental X-rays, but no mention of chiropractors sing full-spine X-rays to diagnose non-existent subluxations; routine prenatal ultrasound, for which WDDTY seems to have an irrational hatred; peripheral bone densitometry; biopsy… wait, what? Avoid biopsy? Because, what, if a cell is cancerous you’d rather not know?

This list is made up of exactly two classes of things: genuinely questionable tests, as described in Margaret McCartney’s The Patient Paradox, a source WDDTY “inexplicably” fails to cite despite its obvious relevance, and pure batshit craziness. Why for the love of God would anybody avoid, on principle, blood pressure monitoring, as WDDTY advise?

And in a box: “Way back in 1990, in the second issue of our fledgling journal What Doctors Don’t Tell You, we started a campaign urging patients to ask their doctors 10 questions before accepting any treatment”

  1. Is drug therapy really needed for this problem?
  2. What will happen if I don’t take the drug?
  3. What sorts of drugs or substances (including non-prescription drugs, food and alcohol) should I avoid when taking this drug?
  4. With what other drugs does this drug have dangerous reactions?
  5. What are the known side-effects of this drug, as reported in MIMS or the electronic Medicines Compendium (eMC; both now online)?
  6. What are the latest reports in the medical literature about this drug’s side-effects?
  7. Can I discontinue any other drugs I am currently taking?
  8. What is the drug supposed to do for me?
  9. How and under what conditions should I stop taking this drug if I notice certain side-effects?
  10. If I don’t wish to take this drug, what other possible therapies can I consider?

Any halfway decent doctor will tell you all this unprompted; that’s not the problem in most cases. There’s a huge problem with antibiotic resistance because people won’t listen when their doctor tells them antibiotics don’t work for viral infections like the common cold, for example.

Now, try asking yourself these ten questions about virtually any of the treatments pimped by WDDTY. Or the conditions, if you add question 0, “is there any evidence this condition actually exists”.

But of course that would be off-message. Mustn’t upset Weleda, manufacturer of homeopathic and anthroposophic barmpottery, whose full-page, full-colour advert fills page 21.

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