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Wheelbarrow of Stupid

Or How Wandering Teacake Wasted His Time Trying To Understand WDDTY’s Sales Figures

Reblogged with permission from Wandering Teacacke, please follow the comments there.

It’s been a while since I’ve written about What Doctors Don’t Tell You, the journal of record for those looking for an alternative to real medical advice. But here I am, pretty much back where I started my blogging career all those 12 long months ago.

Here’s why. Over the past 18 months or so, various individuals, myself included, have contacted various supermarkets and newsagents that stock WDDTY, expressing our concern at the content of this – how can I put it? – festering purulent pile of discarded, discredited and dangerous treatments. Over the years, some stockists have dropped the title, some have dropped it and then reportedly started again, some have just ignored us. But through it all, the editors of WDDTY have screamed about free speech and how the nasty Big Pharma shills want this magazine banned. Continue reading Wheelbarrow of Stupid

Paying the Piper

(Reblogged with permission from Majikthyse. Please go there to comment)

That guardian of all that’s self-righteous about quackery, the magazine and website What Doctors Don’t Tell You, has its ire well stoked this week. The editors reveal that the famous Clinical Trials Service Unit (CTSU) at Oxford University is funded by the pharmaceutical industry. This apparently is the result of tireless investigation by`nutritionist and wholefood campaigner’ Zoë Harcombe. Not you will note a dietician, but a nutritionist, a title that almost anyone seems qualified to hold these days. I can boil an egg, so I’m a nutritionist. “You got an ology?” But enough of flippancy.

I feel duty bound to explain that Ms Harcombe is a writer who mainly sells books on obesity. Her dedication to the truth might be judged by her false claim to the Daily Mail in 2011 that she was studying for a PhD, as reported by my good friend Ben Goldacre. But we all make mistakes. In Ms Harcombe’s case, a further mistake was not realising what the CTSU actually is.

Presumably she has not heard of contract research organisations (CROs). Most of these are commercial companies to whom health care companies contract out a large part of their research, mainly in clinical trials. They have existed for at least 30 years, and some of them are enormous. The usual modus operandi is for the sponsor to engage the CRO to carry out a clinical trial, providing entire or partial functions. So if the contract is `full service’, the CRO will do everything from writing the protocol to writing the final report. The bits in between would include obtaining all the approvals (regulatory, ethics etc), designing the data capture and processing tools, analysing the data, as well as recruiting all the trial sites and investigators and managing the logistics (eg drug and equipment supplies).

However a lot of these contracts are not full service, and in particular data capture and analysis might well not be contracted out at all, or may be delegated to a different contractor. A lot of sponsors run their own data repositories and insist on CROs feeding data into those. Lots of them do their own analysis, and employ armies of statisticians. So what is the CTSU?

It is in fact a CRO, but more so. Rather than rely on what the CTSU claims (“they would say that wouldn’t they?”), let’s look at what the independent Science Media Centre says. The relevant bit is right at the end:

The CTSU conducts, analyses and interprets its clinical trials and other research independently of industry and other funders, with the datasets held by the CTSU rather than by the funders.

Now I’m sure that text came straight from the CTSU, but some credibility is added by its appearance on an independent and respected site. The point though is that the CTSU goes way beyond the probity of a conventional CRO, by erecting a Chinese wall between sponsor and data. The people paying the piper do not call the tune, because they don’t know what the tune is until it’s played at the end of the whole project. Not only that, but the CTSU has a rigorous policy on payments to individuals. Read it and make up your own mind.

What about the funding issue? Look again at the Science Media Centre page. It’s a list of trials, with sponsors and how much they paid. It is baffling as to why anyone should be surprised or indignant about this. The CTSU is a CRO, albeit academically based (and better for that), with a more than usually rigorous policy on independence from financial bias. The CTSU exists to do trials, it has a world-class reputation for that, and companies will pay for that expertise.

WDDTY is full of righteous indignation because Merck & Co, a major statin manufacturer, is also a major funder of the CTSU. Look at the trials Merck has sponsored. Apart from relatively small amounts unrelated to particular trials, Merck provided £63.9 million for statin trials, but £149 million for trials of other drugs unrelated to statins. Yet WDDTY states (my bold):

Over the past 20 years, the two research bodies* have received £268m donations, including £217m from Merck, a major manufacturer of statins.

(*CTSU and its subsidiary The Cholesterol Treatment Trialists Collaboration)

It is a lie to say this funding comprised `donations’ – it was not. It was perfectly normal business and scientific practice, whereby the CTSU was compensated for carrying out research commissioned to it. There is nothing unusual or suspicious about that.

I am not going to get into detail about whatever the CTSU’s director Sir Rory Collins said about the discredited papers in the BMJ, which grossly overstated the side effects of statins, or about what he said about his sources of funds. I haven’t reviewed the whole saga in detail, but as the CTSU’s funding is so transparent I can’t see how he could have forgotten about most of it.

Regarding the retraction of papers, the Science Media Centre provides some useful sound bites on its news page. I am not sure whether WDDTY is simply careless and incompetent, or deliberately distorts the truth – I suspect the latter. But whatever the motivation, the editors have got it wrong yet again. They say that an independent panel refused to retract the papers that quoted the incorrect data, which is not true. The truth is that the authors of the erroneous studies agreed that they were wrong. What the panel declined to retract were two other papers that referred to the original ones. As you can see from the comments from various experts, opinions are divided as to whether there was a need to retract the derivative papers, although they are pretty much unanimous that statins are very useful drugs that have saved many lives.

WDDTY has studiously avoided saying anything about the research which shows statins to be better tolerated than previously thought. Instead the editors make invalid connections between unrelated facts, and indulge in selective reporting and distortion. A drug company would be quite rightly castigated for such behaviour, but in 40 years I have never come across one that tried anything as bad as this.


Addendum: This is the full post as it appeared on WDDTY’s website on 21st August 2014.


‘Independent’ statin research group funded by drugs industry

A research unit that influenced wider statin use in the UK was all the time being funded by drug companies, including £217m from Merck, one of the largest producers of the cholesterol-lowering drug.
The Cholesterol Treatment Trialists Collaboration (CTT), based at Oxford University and headed by Sir Rory Collins, has been very influential in shifting UK health policy, which this year started to recommend statin use for all over-60s.
The new guidelines, issued by NICE (National Institute for Health and Care Excellence), followed the publication of ‘independent’ studies from CTT that maintained that statins had few side effects but many major benefits. Sir Rory was also highly critical of studies published in the British Medical Journal that claimed the drugs caused side effects in 22 per cent of users. He demanded that the papers were retracted, which an independent review panel refused to do.
All along, Sir Rory claimed that he and the CTT were independent, and that any funding came from charitable sources such as the British Heart Foundation and Cancer Research UK. Even as recently as last March, Sir Rory repeated in an email to the BMJ that the British Heart Foundation was a major funder, and demanded to know who had funded the critical research he wanted withdrawn.
But these have been minor funders of CTT and its parent body, the Clinical Trial Service Unit (CTSU). Over the past 20 years, the two research bodies have received £268m donations, including £217m from Merck, a major manufacturer of statins.
The true picture came to light only after nutritionist and wholefood campaigner Zoe Harcombe uncovered the original documents that outline the CTSU’s funders.

 

 

Processed food chemical definitely causes cancer, say researchers

Reblogged from Gareth Lewry’s blog, with permission.

Here is a hint, Doctor’s don’t tell you it because it’s crap!!

So I came across the “What Doctors Don’t Tell You” Facebook Page earlier today.  I have known for sometime that this is essentially aimed at people who want an alternative view to the mainstream medicine approach to curing your ails, and cant be bothered to educate themselves any further than this.

On the surface it looks OK, the articles are compelling and full of what they call  “science”. However that is the surface.  When you dig a bit deeper you see that most of the articles and information they are conveying to the public is disingenuous to say the least.

Here is an example of a post on FB:

FB post from 22/7/14

Now, this post is typical of what they are doing, they are sensationalising the story Massively, however there are some half truths in there that make it credible, and therefore lends to being a source of credible information.  However as they have given a source for their article I decided as a good sceptic, it would be irresponsible of me not to back up the information I’m reading by going back to the original source……and here it is: http://www.efsa.europa.eu/en/press/news/140701.htm

http://www.efsa.europa.eu/en/press/news/140701.htm
As you can see the FB post says that Acrylamide definitely causes cancer, but when I look at the actual press release, I’m buggered if I can find the phrase “definitely causes cancer” or anything near it.  Posting this sort of disingenuous misinformation is dangerous, because people who solely read this for their scientific information are already on the wrong path and will end up believing this nonsense.

So as my good deed for the day I thought I would help them out.  Here is my response to them:

response

I hope they understand I’m only trying to help…. by actively discrediting this nonsense before people buy to much into this. However as I am relatively new to this,   I implore you all to to be careful what you read especially about health and science.  I will always post references to articles so at least you will have the source of information, and if I get it wrong (as we all do from time to time) I welcome feedback, as it is a learning experience for me as well.

The campaign against What Doctors Don’t Tell You Continues

This post appears in a slightly longer format on Plague of Mice)

Pause, if you will, and drop a piteous tear for poor Lynne McTaggart, Saint and Martyr. She feels Put Upon. She considers she is being Bullied. Her Great Life’s Work is under attack from what sounds like a small group of anti-homeopathy terrorists who will stop at nothing to destroy her. There is a Campaign against WDDTY. For the Blessed McTaggart alone knows the Truth and fears not to speak it. This is why the baying hordes of reason…

She’s not fooling anyone, is she? Anyway, this is the rant she just posted on her blog.


A concerted letter-writing campaign by a handful of very vociferous self-styled ‘skeptics’ has managed to convince Tesco that customers are complaining about What Doctors Don’t Tell You, and the store chain has just agreed to withdraw the magazine from the shelves.

These were not legitimate complaints. They were the result of several calls to action by a few sceptical websites to a small band of very devoted and fairly fanatical followers.

This, as you know, is part of an 20-month concerted campaign by Simon Singh, Sense About Science and a variety of rag-tag organizations like the Nightingale Collaboration to ban or crush WDDTY. Singh and co have called Comag, our distributors, multiple times, orchestrated letter writing campaigns to all the store chains that carry the magazine, harassed dozens of our advertisers by reporting them the ASA, sent their foot soldiers to hide our magazines on the shelves of stores and attempted to destroy our Google ranking. One of our websites was even mysteriously hacked into.They don’t engage in open or legitimate dialogue, only innuendo and bully-boy tactics on our social network sites.

Simon Singh is busy these days tweeting his supporters to write Tesco to thank them for not stocking us.

And all this because they don’t want you to have a choice about the information you have about your health care.

They believe that you should only have access to one sort of health information – the information that ridicules alternative medicine of all persuasions and embraces conventional medicine as currently practiced. They believe that they have the right to dictate to you the forms of health care you have access to. They claim to be in favour of free speech in science, but only the information they deem acceptable for you to read.

The skeptics have a loyal following, but there are tens of thousands more who support WDDTY and our work. Tesco will reconsider if they hear from customers who want to buy WDDTY in their stores.

If you buy WDDTY at Tesco, you believe in free speech, and freedom of choice in health care, or you believe that Tesco should continue to stock WDDTY, please write to customer service and tell them exactly why: [email protected]

Well, wasn’t that informative? Let us admire the loaded vocabulary, rife with venomous innuendo, bile dripping from every syllable. Is perchance The Great McTaggart’s revenue stream endangered? My first question is: how did this alleged handful of skeptics manifest in the form of so many people and organisations? Over a year ago, Josephine Jones already had a pretty impressive Master list.

“These were not legitimate complaints” – On the contrary, Lynne, the complaint was that your rag promotes dangerous quackery, while maintaining a resolutely hostile attitude to doctors, vaccines, medical treatment of any kind (including lifesaving treatments for cancer), and this you have proved time and again with every fucking issue. Open one at random, and you’ll find fuckwittery that can kill or cripple. Read any post on this blog, and you’ll see holes poked in your assertions until they look like moth-eaten lace doilies. In any case, it’s not for you to judge whether the complaints were legitimate or not.

“One of our websites was even mysteriously hacked into”‘ – Mysteriously, my arse. The Internet is full of spotty virgins and crooks trying to break into any website they can. So of course McTaggart blames skeptics for her own negligence in not securing her site properly. Simple stuff, I suspect, like not having the login “admin” for the administrator’s account. There are plenty of good security plugins for all the major CMS software, woman. Sodding well use them. We do.

“harassed dozens of our advertisers by reporting them the ASA” – Reporting illegal, indecent, dishonest or untruthful advertising copy isn’t harassment, Lynne. It’s civic duty. If you don’t like your advertisers getting called out for lying, get a better class of advertiser. Although I can see how that would be a problem for you, given the calibre of your rag.

“They don’t engage in open or legitimate dialogue” – The fucking cheek of this duplicitous dipshit! She systematically deletes comments from skeptics, be they on her blog, Facebook or anywhere else she has moderator privileges. It’s so bad that her own followers have actually complained that, since only their side of the dialogue remained, it made them look complete idiots because the exchange no longer made the slightest sense.

“Simon Singh is busy these days tweeting his supporters” – No, he isn’t. In fact, he only mentions WDDTY when you take one of your puerile swipes at him. Amusingly, the last one was to remind you of the existence of AllTrials.net, which you yourself were all for until you realised that skeptics were involved.

“they don’t want you to have a choice about the information you have about your health care” – No, it’s not a matter of choice when a decision is based on false information, manipulation and outright dishonesty. Stop pushing quackery for profit and, er, profit, and start doing some real investigative health journalism, if you want respect and acceptance. Unfortunately, I suspect that neither your medical knowledge nor your journalistic skills are up to the job.

“They claim to be in favour of free speech in science, but only the information they deem acceptable for you to read” – Apart from this being a barefaced lie, McTaggart has delusions of adequacy if she thinks what she spouts in her blog, her rag, her books, etc are anything even remotely related to science.

“there are tens of thousands more who support WDDTY” – ORLY? I see only 14K ‘Likes’ on Facebook, the WDDTY Twitter account has a pathetic 703 followers, while McTaggart’s own account has all of 17.7K. This sounds like the police estimates vs organiser estimates for protest marches, doesn’t it? Even so, it stinks of wide exaggeration on your part.

Now here’s the absolute biscuit, the coup de grâce in hypocritical bullshittery: “If you buy WDDTY at Tesco, you believe in free speech…”.

Remember, McTaggart herself doesn’t believe in free speech, as she mercilessly extirpates the slightest criticism of her monthly bowel-dump of rancid WTF wherever she can, going as far as to threaten legal action in an attempt to scare Simon Singh into silence (the BCA must have been piddling themselves with laughter). Secondly, Lynne, the concept of free speech is not as you would have us believe: that you are allowed to say whatever you like, to whomever you like, without fear of contradiction, and hang the consequences.

No, Ms McTaggart, freedom of speech means freedom of opinion, with the necessary corollary that others have the right to criticise that opinion. But you don’t have that protection, and rightly so, because WDDTY isn’t being sold as opinion, it’s being sold as solidly-researched advice. Your poisonous little rag doesn’t benefit from freedom of speech because of the many and monstrous errors of fact that it contains. Of course, you could always claim “SCIENCE!”, but I strongly advise you not to. You see, an important part of science is the critical analysis and testing of other scientists’ claims, so you’re back to square one.

You have no case, Ms. McTaggart. None at all. You’re a hypocrite and liar, and that is my considered opinion based on the evidence before me.

Read also:

What Whole Foods Markets Doesn’t Tell You

(Reprinted with permission from Science-Based Medicine: What Whole Foods Markets Doesn’t Tell You  by Jann Bellamy. Please go there to read the rest of the post and comment on it)

Whole Foods Market
Whole Foods Market (Photo credit: Wikipedia)

Whole Foods Market is a relentlessly hip American supermarket chain which prides itself on organic fruits and vegetables, gluten-free just-about-everything, and high-end touches like wine bars and exotic take out items (roasted yucca, anyone?). The health products aisle is stocked with Bach Flower and homeopathic remedies. For example, in-house brand Flu Ease: “an established homeopathic formula that should be taken at the first sign of flu for temporary relief of symptoms including fever chills and body aches.”

Selling Flu Ease and like products certainly exhibits a lack of appreciation for scientific evidence, not to mention basic science. But I recently saw a product in the checkout line that was so filled with over-the-top quackery and so shocking in its disregard for the public’s health that I haven’t been back to Whole Foods since. And I won’t be going back.

The product? A glossy, slickly-produced magazine with the conspiracy-minded title What Doctors Don’t Tell You. The April 2014 issue promises, in banner-headline font size, a “New Light on Cancer.” It features the well-known symbol of fighting breast cancer, a loop of pink ribbon, but with a tear in the middle of the loop. We’ll look into this “new light” in a bit.

WDDTY is a British export. The magazine launched there a couple of years ago as a companion to the website of the same name, which has been around since 1989. Both are the creation of Lynne McTaggart and Bryan Hubbard. She claimed, in 2012, that the magazine has a circulation of 40,000. I am not sure when it made its American debut, but this is the first I’ve seen of it.

McTaggert and Hubbard are no strangers to pseudoscience. I’ll let the UK blog Tessera introduce them.

Who are McTaggart and Hubbard? She has form as an anti-vaccination campaigner. In one of her books, The Intention Experiment, she says that the universe is connected by a vast quantum energy field and can be influenced by thought. He recommends vitamin C as a treatment for cancer and they complain about the Cancer Act which prevents them promoting their ‘cures’. So I think we know what we’re dealing with.

Yes, we certainly do…. Rest the rest (there’s quite a lot, all cracking stuff) HERE. It’s worth it.

The Intention “Experiment”

Reblogged from ChapmanCentral with permission.

In science, an experiment is something you do to test whether something works or not, or to make a measurement to quantify something. In pseudoscience, an experiment is something you do to demonstrate your delusional beliefs to a credulous world. Which sort is Lynne McTaggart’s “Intention Experiment”? (As if you had to ask). It works like this:

  1. Someone registers a medical issue, such as a sore shoulder.
  2. People care.
  3. The person is asked if they feel better as a result.

Can you see where the problem is? It would be relatively trivial to test wishful thinking (or “intention” as McTaggart rather pretentiously brands it). The group of people with medical problems registers up front, they are randomly assigned to wishful thinking or not, both wishful thinking and non wishful thinking groups are given identical-looking output in terms of messages of support, and at the end feedback is gathered, then finally we match responses to group membership and see if the wishful thinking group fares differently. McTaggart’s wishful thinking is identical to intercessory prayer, which has been tested in this way. Guess what? It doesn’t work. Just like homeopathy and other inert interventions, the more carefully you control for confounders and bias, the less likely you are to find an effect. McTaggart shows no sign of having the intellectual honesty necessary to do a test like this. In promoting “The New Science” she is, in fact, promoting the same old pseudoscience. But don’t forget to click-through and buy the book, because otherwise you can’t possibly expect to understand the subtlety of it all.1 —- 1Statement may contain sarcasm.

What Doctors Don’t Tell You is wrong about autism

A splendid fisking by Mike Stanton (@Convivir) of WDDTY’s latest nonsensical piece on autism, the quack target du jour for pretty much every jour since Andy Wakefield’s fraudfest. Numerous other hot buttons of the SCAM community are also present.

Reblogged with permission from penumbrage.com

What Doctors Don’t Tell You (WDDTY) is a magazine that claims it is “helping you make better health choices.” But it has drawn criticism from those like Andy Lewis who wrote on the Quackometer blog,

this magazine is the latest offering from Lynne McTaggart who produces the What Doctors Don’t Tell You website. It is one of the most consistently misleading health sites in the UK, reveling in misinformation that routinely undermine readers’ confidence in their doctor and to scare them into accepting questionable alternatives, such as vitamin pills. The website and magazine advertise many problematic health products that could harm people if used in place of real medicine.

I have just bought a copy from my local supermarket. It is a glossy magazine with lots of adverts and articles promoting diets, vitamins, supplements, creams and  lotions, super foods, exercise regimes and holistic therapies. There are even alternative remedies for pets. It is not always clear where editorial content ends and advertising begins. The pet therapies are a case in point. Paul Boland contributes a two page spread on veterinary acupuncture. Turn over and there is a full-page advert for Natural Health Vet, a company selling products “developed, used and recommended by …” Yes, you guessed it, Paul Boland. Advertorial, anybody?

The headline story is called, “Reversing osteoporosis. You can rebuild your bones.” It tells us that osteoporosis is “a lifestyle disorder” that is reversible by following a diet, supplement and exercise plan. We are told that Linus Pauling was right. Cancer is curable with high dose Vitamin C. But you have to inject it, not ingest it. An osteopath writes an article claiming you can cure whiplash with osteopathy. Lifestyle changes can reduce your risk of dementia by 60%.

Like most people who pick up magazines in supermarkets I am not a doctor and have no way of evaluating these claims. I have no argument with healthy eating and regular exercise. But I am suspicious of claims that doctors and drug companies are in it together to spread misleading information and promote the use of profitable but unnecessary medications. However this issue does contain an article on autism, which is why I bought it.  And I do know enough about autism to critically read that article. And if WDDTY is wrong about my area of expertise why should I believe them about anything else?

The Autism Explosion

This month (April 2014) the print edition of WDDTY features an article entitled “Autism: it’s all in the gut,” which begins with a familiar claim.

There’s one startling fact about autism that marks it out from all the other chronic diseases of modern times – the explosion of cases over the past 30 years.  Back in 1985, just six children out of every  10,000 were diagnosed with autism; today one in every 88 children has the condition, and some reckon it affects one in 50 children.

I have four problems with this statement, apart from the fact that it is wrong.

  1. If you are going to compare statistics do not make your readers do the math. Make the comparison obvious. 1 in 88 equates to 112 in 10000 which makes for easier comparison with 6 in 10000.
  2. Source your statistics. There are a number of references at the end of this article. But none are given for the epidemiological data. Hence the reader cannot check its accuracy.
  3. Use real statistics. WDDTY is a UK publication and the key data points for autism epidemiology in the UK are 4.5 in 10000 (Lotter 1966); 21.2 in 10000 (Wing and Gould 1979); 116 in 10000 (Baird et al 2006). All these studies are referenced on the National Autistic Society website. None of them are mentioned by WDDTY.
  4. Make sure you are comparing like with like. Wing and Gould found similar results to Lotter when they used his criteria. But a broader definition of autism produced their higher figure. Baird used different criteria again (ICD-10) and found 38.9 in 10,000 for childhood autism, and 77.2 in 10,000 for other autism spectrum disorders. WDDTY use headline figures for all autistic spectrum disorders and pretend they are referring to the narrow definition of childhood autism used by most researchers for 40 years after Kanner’s original description of autism in 1943.

There may or may not have been an actual increase in autism over the last 30 years. But there are alternative explanations for the increase in numbers.

  1. If you go out and look for autism in the general population you will find more cases than if you sit in your office waiting for patients to arrive. Studies that screen whole populations and directly assess individuals identified in that screening process produce higher figures than studies that interrogate patient databases.
  2. If you change the criteria for autism you can engineer dramatic increases as demonstrated by Wing and Gould in their Camberwell study. Using Lotter’s strict criteria they found 4.9 in 10000 which compares well to Lotter’s finding of 4.5 in 10000. But  by including all children identified with the now familiar triad of impairments, regardless of whether or not they met Lotter’s criteria, they found a four-fold increase. This is easy to understand if you compare the criteria. Lotter required “a profound lack of affective contact.”  The triad refers instead to impairments in ability.
  3. The success of  advocacy groups in raising awareness has led to better estimates of the numbers. Autism statistics were just not collected thirty years ago and are still not in many countries. Without numbers there is no impetus to create services. But once services exist they drive the numbers up. California’s autism statistics were used to fuel claims for an autism epidemic until it was pointed out that the massive unevenness in rates within California coincided with the availability of services in affluent areas (high rates) and the lack of services in poorer areas (low rates). Those states in the USA with a reputation for providing good autism services have higher rates than the national average. In the UK 40 years ago autistic children were denied access to education. Now a diagnosis is a passport to special educational provision, albeit of variable quality,

All of which gives me cause to question that sentence at the beginning of the WDDTY article.

There’s one startling fact about autism that marks it out from all the other chronic diseases of modern times – the explosion of cases over the past 30 years.

It’s All In The Gut

WDDTY argues that

New research is narrowing the focus to the gut. Many autistic children have a host of gastrointestinal (GI) problems that carry on into adulthood, and some of the worst symptoms seem to improve if the diet is changed, often to exclude gluten.

The GI narrative has a long history and very little definitive evidence to support it. In 2010 a Consensus Report by 28 doctors and researchers published in Pediatrics, the Official Journal of the American Association of Pediatrics, concluded that most studies suffered methodological limitations. Small sample sizes, lack of a control group, failure to apply standardized definitions of GI disorders and of severity of autistic symptoms were commonly cited. The consensus was that GI symptoms were probably more prevalent in people with ASD but we did not know for certain and could not say why. Among the 23 consensus statements the following are most pertinent to our present discussion.

Statement 1 (Key Statement)

Individuals with ASDs who present with gastrointestinal symptoms warrant a thorough evaluation, as would be undertaken for individuals without ASDs who have the same symptoms or signs. Evidence-based algorithms for the assessment of abdominal pain, constipation, chronic diarrhea, and gastroesophageal reflux disease (GERD) should be developed.

This is the key statement. Too often GI symptoms in autistic patients are misinterpreted as behavioural manifestations of autism and treated accordingly. This is most likely to happen in young children and others who are unable to verbally describe their symptoms. The symptoms continue unabated and may worsen. Caregivers then turn to practitioners of alt-med, like the purveyors of WDDTY, who persuade them that these GI symptoms are not the result of autism but its cause. And of course they have the explanation and the cure. But other consensus statements from the AAP undermine this simplistic perspective.

Statement 4

The existence of a gastrointestinal disturbance specific to persons with ASDs (eg, “autistic enterocolitis”) has not been established.

Statement 5

The evidence for abnormal gastrointestinal permeability in individuals with ASDs is limited. Prospective studies should be performed to determine the role of abnormal permeability in neuropsychiatric manifestations of ASDs.

Statement 11

Anecdotal reports have suggested that there may be a subgroup of individuals with ASDs who respond to dietary intervention. Additional data are needed before pediatricians and other professionals can recommend specific dietary modifications.

Statement 12

Available research data do not support the use of a casein-free diet, a gluten-free diet, or combined gluten-free, casein-free (GFCF) diet as a primary treatment for individuals with ASDs.

Statement 18

The role of immune responses in the pathogenesis of gastrointestinal disorders in individuals with ASDs warrants additional investigation.

Statement 19

The role of gut microflora in the pathogenesis of gastrointestinal disorders in individuals with ASDs is not well understood.

This is serious work. There were seven working parties reviewing the expert literature in their fields: child psychiatry, developmental paediatrics, epidemiology, medical genetics, immunology, nursing, paediatric allergy, paediatric gastroenterology, paediatric pain, paediatric neurology, paediatric nutrition, and psychology.

Antibiotics and Processed Food

Yet WDDTY chose to ignore them completely. Instead they make this claim for a study of 20 autistic children entitled “Reduced Incidence of Prevotella and Other Fermenters in Intestinal Microflora of Autistic Children.”

The findings suggest that an overuse of antibiotics and  the typical Western diet of processed foods could be significant factors in autism.

But the study specifically excluded children who had received antibiotics in the previous month on the grounds that antibiotic usage would have confounded their results. Moreover the study is clear that its autistic subjects do not follow a typical western diet. Five of the twenty were on a gluten-free, casein-free diet at the time of the study compared to one in the neurotypical control group (n=20). 13 were taking additional supplements compared to 5 in the control group. Taken overall the autistic group consumed more probiotics and more sea food than the control group. Nearly all the parents of the autistic reported problems with the amount their child ate and their child’s restricted diet. This data was not available for the control group. From this it is reasonable to assume that their atypical diet was more likely to contribute to their atypical microflora than the “typical western diet of processed foods” consumed by the typically western control group.

While the autistic group did have significantly higher GI symptoms than the control group there was no relation between the severity of GI symptoms and the severity of their autism. All of which gives me cause to question the statement that

The findings suggest that an overuse of antibiotics and  the typical Western diet of processed foods could be significant factors in autism.

Gluten and Casein

WDDTY believes another study supports their suggestion that antibiotics and processed food are significant factors in autism. In fact it does nothing of the kind. It does not mention antibiotics and did not collect data on or control for variation in diet. It included four children on a gluten-free diet “Because the effect of gluten-free diet on antibody levels in autism is not known.”

It tested autistic children for antibodies in their blood associated with celiac disease and compared them with normal controls. Despite higher levels of antibodies to gluten in the autistic group none of them had celiac disease. There are problems with this study. All 37 autistic subjects were recruited in the USA. But 62 out of 74 members of the control group were recruited in Sweden. Why? And there was no data on the GI disorders in the controls despite extensive but incomplete data on the autistic group. I agree with Laurent Mottron who commented on the study.

These data are uninterpretable in their relation to autism without a non-autistic comparison group matched in gastro-intestinal problems, (using the same instrument of course).

But WDDTY did not cite these studies to prove a point. They are included because they bear some relation to the subject and seem to show that WDDTY have done their research. WDDTY rely on their readers not following up on references and reading the actual studies. I very much doubt whether the author read them either.

Meanwhile back in the UK

WDDTY turns to:

researchers at the Autism Research Unit at the University of Sunderland, now working as ESPA Research.

This was an offshoot of the university that now operates under the auspices of ESPA since its driving force, Paul Shattock, has retired from his position in the Pharmacy department at the university. I know Paul Shattock. He has an autistic son and set up ESPA to provide educational services for autistic people in the Sunderland area. For this and other services to autism he received a well-merited OBE. For a while I was sympathetic to his opioid excess theory of autism causation, often referred to as the Leaky Gut Theory of Autism. But other researchers have tried and failed to replicate his findings.

The theory has been around for a lot longer than the fifteen years cited by WDDTY. I bought a copy of the pamphlet, “Autism as a Metabolic Disorder” from Paul Shattock in 2002 when I was in Sunderland to see if ESPA could provide a suitable placement for my son. Mine is the second edition (May 2001) and even then it stated that the Autism Research Unit had been testing samples for fifteen years. But the theory is older than that. According to the pamphlet

This model is based upon acceptance of the opioid excess theory of autism as initially expounded by Panksepp (1979) and extended by Reichelt (1981)  and ourselves (Shattock 1991).

When I first entered the online autism world of newsgroups and email listservs back in 1997 the leaky gut theory was very popular with parents. It went like this.

  1. Some children have difficulty digesting the proteins gluten (found in grains like wheat and barley) and casein (found in dairy products).
  2. This leads to an excess of peptides in the gut.
  3. If the gut wall is damaged these peptides will leak into the bloodstream and cross the blood brain barrier.
  4. Once inside the brain they either imitate the activity of opioid peptides occurring naturally in the brain or bind to the enzymes that normally break down these naturally occurring opioid peptides.
  5. The result is the same: excess opioid activity in the brain.
  6. This explains the “autistic” behaviour of sufferers. They are like drug addicts who swing between being “high” on the peptides or doing “cold turkey” when they need more peptides. This may also explain some of the cravings for dairy and grain based products in autistic children.
  7. Remove gluten and casein from the diet and the symptoms will diminish.
  8. But they may get worse initially when the “cold turkey” phase kicks in.

This hypothesis was attractive to parents because it seemed to fit their experience; children with food fads or a history of being picky eaters, who appeared to suffer from disruptions to normal perceptual, cognitive, emotional and social development with resultant mood swings and behavioural difficulties. But the hypothesis proved rather too flexible.

The initial theory suggested that children who were prone to infections would have their gut damaged by antibiotics which destroyed the good bacteria in the gut and let the bad bacteria take over.  Yeast and other fungal agents were also suggested as potential villains. So you had to repair and restore the gut to good health while removing the gluten and casein from the diet. Vaccines, particularly MMR, were also implicated based on parental reports. The measles virus from the vaccine was supposed to invade the gut and damage it. So was the damage bacterial, fungal or viral? The picture was further confused by arguments that it was the measles virus that invaded the central nervous system and led to  the autistic symptoms by causing encephalitis. Then came attempts to synthesize all this with a hypothesis from the USA that the mercury content in some vaccines was to blame. Either it induced mercury poisoning in vulnerable children which was mistakenly diagnosed as autism or it acted to make the gut more susceptible to damage from the MMR vaccine.

Pick a card, any card …

Real science, when faced with conflicting and sometimes contradictory theories, tries to control for all the variables and test each one in turn. What is the evidence for leaky gut in autistic subjects? Is leaky gut caused by bacterial, fungal or viral factors? Can we detect excess opioid activity in the brains of autistic people? Given that autistic people are supposed to suffer the double whammy of leaky gut and gluten/casein intolerance what is the evidence for a “single whammy” (either leaky gut or gluten/casein intolerance) in the non-autistic population?

WDDTY does not ask these questions. It does not ask any questions. Instead we are asked to accept that all the theories of causation promoted by the alt-med community are equally valid. There is no conflict between them. Choose a theory, any theory. You pays your money (in most cases a lot of money) and you takes your choice. Any number of therapies may help: vitamin D therapy; gluten and casein free diet; supplements; sensory enrichment (which just snuck in with no mention in the main article of the genuine sensory difficulties in autism); chelation therapy – the  removal of toxic heavy metals like mercury that are alleged to be there in excessive quantities in autistic children.

The Bits on the Side

The article includes two sidebars. One is a puff piece for a book in defence of Andrew Wakefield and the role of vaccines in autism by a quacktitioner called Graham Ewing of Montague Healthcare, a one man operation that he runs from his family home in a village near Nottingham, who promotes his own “virtual scanning” technology as a cure-all for most things. If your credulity is already stretched prepare for it to be snapped by Dr Weinberg and his NeuroModulation Technique™ which has reversed autism, cured arthritis, Crohn’s disease, IBS and other inflammatory disorders. Moreover the person being treated does not have to present for the treatment. The therapist can test functioning by muscle-testing their own arm and transmit their therapy by the power of thought. As WDDTY states in its intro to this sidebar

People of a logical, dogmatic or sceptical disposition, please look away now.

Yes. please do. And on this evidence I suggest that we continue to look away and dogmatically insist on evidence based science to guide our health choices rather than the “good old-fashioned medicated goo” on offer from WDDTY.

Aspirin to greater accuracy

Sorry about the bad pun.

Hot on the heels of the John Diamond Challenge, in which WDDTY is busted for peddling nonsense about aspirin, @jdc325 published an article demolishing a related comment also about aspirin.

It’s reproduced below with permission. Continue reading Aspirin to greater accuracy

The John Diamond Challenge

excellent-frogWe’ve already discussed the “apology deficit” at WDDTY, but we have been well and truly outdone by the following exceptional article by David Hills (@WanderinTeacake). The absolute best bit is that skeptic legend John DiamondW has, in a very real sense, reached out from beyond the grave and poked Lynne McTaggart with the pointy stick of reason.  We will absolutely rename our “Corrections and Clarifications” page in his honour.

Enjoy this post, reblogged from WanderingTeacake, because it’s eleven different kinds of awesome. Continue reading The John Diamond Challenge

Doctors misdiagnose depression 86 per cent of the time

Doctors misdiagnose depression 86 per cent of the time
An accurate title for this story would have been: “86% of over-65s in the U.S. who say they recall a doctor or other medical professional saying they had “depression” in the past year don’t remember enough symptoms in the past year to meet the DSM criteria for MDE“.

Instead, WDDTY magazine went with the scaremongering headline: Doctors misdiagnose depression 86 per cent of the time

That’s a wildly inaccurate account of the research. But the magazine went a step further, and converted that claim into direct advice for its readers. Here’s the first paragraph of the WDDTY piece:

Has your doctor diagnosed you as clinically depressed and prescribed an antidepressant? If you’re a senior citizen, you should get a second opinion — because there’s a very good chance you’re not depressed at all.

That’s both an irresponsible, and an inaccurate, piece of journalism. The research is silent on the rates of 12-month, or current, antidepressant usage for this (or indeed any) sub-group of study participants, so WDDTY has absolutely no basis for its claim that if you are over 65 and have been prescribed antidepressants “there’s a very good chance you’re not depressed at all”. WDDTY gives direct advice to an already vulnerable population, on the basis of misreporting somewhat nebulous research.

Continue reading Doctors misdiagnose depression 86 per cent of the time