Category Archives: 2013

Sunshine could reduce severity of asthma attacks

The activity level of the @_wddty Twitter account is pretty low, considering the volume of bullshit McTaggart and her magazine generate, but today there was a tweet which piqued the interest:

asthma

The content of the News item linked is:

Vitamin D—the ‘sunshine vitamin’—may help reduce the worst affects (sic) of asthma. Sufferers should do more sunbathing or take supplements, say researchers.

Asthmatic s with more severe symptoms tend to have low levels of vitamin D, while those with high levels are able to control their symptoms better. Researchers at King’s College London say the connection between levels of the vitamin and severity of symptoms is “quite striking”.

In laboratory tests with blood samples, the researchers saw that the vitamin was able to lower levels of interleukin-17, a chemical that helps fight off infection. However, in asthmatics the chemical is in constant over-ride, causing the typical symptoms of inflamed, swollen and narrowed airways.

The researchers plan to carry out clinical trials to establish if the vitamin can ease an asthma attack.

(Source: Journal of Allergy and Clinical Immunology, 2013; published online, May 17, 2013).

This should be easy to check, but as usual WDDTY use a non-standard reference format to give the full feel of “referenciness” without inviting tiresome fact-checking.

The Journal of Allergy and Clinical Immunology is free online. The most likely candidate is “Enhanced production of IL-17A in patients with severe asthma is inhibited by 1α,25-dihydroxyvitamin D3 in a glucocorticoid-independent fashion

The conclusion of this paper is:

Patients with severe asthma exhibit increased levels of TH17 cytokines, which are not inhibited by steroids. 1,25(OH)2D3 inhibits TH17 cytokine production in all patients studied, irrespective of their clinical responsiveness to steroids, identifying novel steroid-enhancing properties of vitamin D in asthmatic patients.

So did “researchers” say that “asthma sufferers should do more sunbathing or take a supplement”?

No.

They said that patients with severe asthma tended to have low levels of a vitamin D marker in their blood. At no point in the paper are either sunbathing or supplements mentioned. The paper does not promote therapeutic use of vitamin D, but rather notes that asthma severity may be increased in patients with low levels of vitamin D. It certainly does not suggest that vitamin D might be any kind of replacement for science-based medicine, quite the opposite.

Once again, even when a study finding is broadly ideologically consonant, WDDTY are unable to resist the temptation to put words in the authors’ mouths.

How homeopathy might work

How might homeopathy workThe article has referenciness. Several of these references are familiar. As usual TatMaggot doesn’t give the full reference (wouldn’t want to follow journal practice, after all, or make it too easy to debunk her credulous nonsense)`, and references include that peerless source of cutting edge medical discovery, the Daily Mail.

TL;DR summary

In the end, I’m disappointed. After the debunking of the previous WDDTY advertorial on homeopathy and the Banerjis, this amounts to little more than repeating precisely the same refuted claims because TatMaggot believes she’s right so refutation of Benveniste etc. can be ignored. I was hoping for something new to get my skeptical teeth into, this provides nothing new. Not even a new spin on the tired old conspiracy theories. Medicine sometimes fails, therefore unicorns.

The only genuinely new study since the last go-round is ” The potentized homeopathic drug, Lycopodium clavatum (5C and 15C) has anti-cancer effect on hela cells in vitro” (J Acupunct Meridian Stud. 2013 Aug;6(4):180-7).

 

Bang!

 

This has yet to be replicated (as is the case for most homeopathy basic research) and contains, as usual, no evidence of generalisability, no evidence of potential therapeutic effect, no credible rationale for selection of the “remedy” and no evidence that this will be linked to the “similimum” or any other symptomatic presentation.

It’s all the same old long-debunked rubbish. It’s almost as if there is no credible evidence for homeopathy, just a lot of wishful thinking by believers.

Oh, wait…

Seriously? It is just possible that a homeopath might stumble upon a substance that at clinical doses produces a useful effect. Given the sheer number of substances they use, anything else would be statistically improbable. But there’s no compelling evidence of any persistent effect at homeopathic dilutions, no credible evidence that the diluted and potentised “remedies” have any specific clinical effect, and ridiculous quote mining expeditions like this do nothing other than perpetuate the smokescreen of confabulation used by homeopaths to hide the fact that everything about their beliefs is simply wrong.

The first batch of references seem to be drawn from those cited in the Homeopathy journal’s special issue on the memory of water. We can assume that these are the best of the bunch from that issue.

  • Complement Ther Med. 2007 Jun;15(2):128-38 is “The in vitro evidence for an effect of high homeopathic potencies–a systematic review of the literature” by Witt et. al. Witt is paid by a homeopathy promotion body, the Carstens Foundation. This paper reviews primary research into mechanisms for homeopathy, finding 67 experiments of which 1/3 were replicated (i.e. 2/3 were not replicated, in line with the norm for homeopathy). It notes that the designs were inhomogeneous. Witt claims that “[e]ven experiments with a high methodological standard could demonstrate an effect of high potencies” but notes that “[n]o positive result was stable enough to be reproduced by all investigators. So the take-home from this is that believers can produce a positive result, but can’t replicate it.
  • J Therm Anal Calorim, 2004; 75: 815-36 is “New Physico-Chemical Properties of Extremely Diluted Aqueous Solutions” by V. Elia and M. Nicoli. This was discussed in a Bad Science Journal Club. The significance of this is that Elia claims, according to another paper in homeopathy, to have documented an effect which increases over time – i.e. which apparently violates the second law of thermodynamics. In the nine years since, this has not become anything like mainstream.
  • Homeopathy, 2007; 96: 175–182 is “The defining role of structure (including epitaxy) in the plausibility of homeopathy” by ML Rao, Rustum RoyW, Iris Bell and Claudia Witt (again). BadSciencers fisked this one too, noting that “different” spectra turned out to be the same graph and so on. A letter to the journal, reproduced in a JREF discussion, notes fatal flaws with the data as presented.
  • Physica A, 2003; 323: 67-64 is “Thermoluminescence of ultra-high dilutions of lithium chloride and sodium chloride” by Louise Rey. The Bad Sciencers didn’t have a lot to say about this other than that it’s speculative: it seeks to project condensed matter effects onto liquids. Definitive or conclusive it ain’t.
  • Biochim Biophys Acta, 2003, 1621: 253-60 is “Effects of ultrahigh dilutions of 3,5-dichlorophenol on the luminescence of the bacterium Vibrio fischeri“, by Brack et. al. I can’t find any significant discussion of this other than drive-by citations in laundry lists of references on homeopathy apologist websites.

So TatMaggot sets out her stall with a series of papers that include weak, irreproducible or uninterpretable results, and which advance in some cases contradictory hypothetical explanations for how homeopathy might work in some classes of substance.

None of these shows any link between “remedy” and symptom or disease, none of them shows any evidence of a clinically useful effect, none of them shows any evidence of a general or universal effect that is unambiguous and specific. This is, in other words, a re-warming of the Homeopathy “memory of water” issue.

Molehill Montagnieering

No paean to the refuted “memory of water” thesis would be complete without reference to Jacques Benveniste and Luc Montagnier.

TatMaggot of course believes Benveniste, it goes without saying, all avid homeopathy believers do. The special pleading is all reproduced: the pejorative characterisation of Randi, the claims that they “changed” the protocol and so on. It really doesn’t mater how sincerely you want to believe in it, the Benveniste experiment is a busted flush. Attempted replications have failed.

Montagnier has a self-published series of experiments that purport to back Benveniste, but these have not been independently validated either and when interviewed by CBC’s Marketplace he acknowledged that his work “cannot be extrapolated to the products used in homeopathy” – and indeed the same is true of Benveniste’s work, had it not been refuted.

Lastly, there is the knotty problem of shelf life. The effects Montagnier claims to have observed, last a few tens of femtoseconds – a fraction of a picosecond. This is entirely incompatible with the claims of an effect that increases over time, or is stable.

Jumping on the Banerji wagon

As with the previous issue of WDDTY claiming homeopathy is “much more than placebo”, the intellectual heart of this thread lies in the Banerji foundation and their extraordinary claim to reverse cancer using homeopathy alone.

Papers cited include the uninterpretable rubbish that is “Cytotoxic effects of ultra-diluted remedies on breast cancer cells” (Int J Oncol. 2010 Feb;36(2):395-403) and the followup “Ruta 6 selectively induces cell death in brain cancer cells but proliferation in normal peripheral blood lymphocytes: A novel treatment for human brain cancer” (Int J Oncol. 2003 Oct;23(4):975-82). The balance of the sources are: a WashPo editorial, the Banerjis’ publication in the best cases series (which explicitly does not establish the validity of the treatment), a Yahoo group, the Banerji website, the “journal of acupuncture and meridian studies“, the only genuinely new source since the last go-round as far as I can tell, (spoiler alert: meridians don’t exist and acupuncture is an elaborate placebo), and the BBC News website. Oh, and the Daily Mail, often cited in the top-tier medical journals for its groundbreaking basic research on the influence of immigration on the British pint or some such.

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

Polio in WDDTY

WDDTY on polio and polio vaccination
According to WDDTY, polio isn’t that dangerous, it’s mainly caused by the oral polio vaccine, the vaccine doesn’t work and it causes other things besides just polio including AIDS, M.E. and autism. Doctors have a safe vaccine but don’t want you to have it because of lobbying from Big Pharma, the prevalence is much lower than governments would have you believe, a baby that’s just been vaccinated should be treated like a biohazard, and polio was dying out anyway before the vaccine was invented.

As an encapsulation of all the things that are wrong with WDDTY, its relentless barrage of polio and polio vaccine disinformation spanning over two decades is a superb study in how to be wrong, and remain wrong in the face of new data.

Cranks and charlatans are accorded equal time with “experts” who aren’t, but whose past employment allows them to be presented as brave whistleblowers. The authority of an anti-vaxer is never questioned. The authority of a scientist defending vaccines is never admitted. Studies showing that vaccination works are presented as evidence that it doesn’t, and that it causes damage. Honesty about the risks of vaccines, openly published, is presented as if it has had to be wrung from the hands of a reluctant establishment.

WDDTY are “viciously, viciously anti-vaccine”. And here we see that this agenda takes precedence over concern for one of the most dreaded of all vaccine-preventable diseases.

Continue reading Polio in WDDTY

Heartburn drugs increase risk of nerve damage, anaemia

heartburn bollocksWhat WDDTY said:

Heartburn drugs increase risk of nerve damage, anaemia

What the source said:

Previous and current gastric acid inhibitor use was significantly associated with the presence of vitamin B12 deficiency. These findings should be considered when balancing the risks and benefits of using these medications.

The source additionally shows that:

  • 12% of people with Vitamin B12 deficiency are taking PPIs (i.e. most are not)
  • 7.3% of people without Vitamin B12 deficiency are taking PPIs
  • 4.2% of people with vitamin B12 deficiency are taking H2RAs
  • 3.2% of people without vitamin B12 deficiency are taking H2RAs

Here’s how WDDTY interpreted this:

Heartburn and acid reflux medications are causing B12 deficiency, which can lead to nerve damage, anaemia and dementia. The medications, known as PPIs (protein pump inhibitors), increase the risk of vitamin deficiency by 65 per cent in those who take them longer than two years, say researchers at the Kaiser Permanente research division. Similar risks have been seen in those who take higher-strength drugs but for shorter periods. PPIs are among the most common pharmaceuticals; in the US alone, around 157 million prescriptions for the drugs are written every year. The researchers discovered the B12 deficiency risk when they analysed the records of 25,956 people with the deficiency and compared them to 184,199 people with normal levels of B12. Twelve per cent of those with a deficiency had been taken a PPI for at least two years compared to 7 per cent in the healthy group. (Source: JAMA, 2013; 310: 2435-42)

Sadly space did not permit the following quotes from the investigators:

These findings do not recommend against acid suppression for persons with clear indications for treatment, but clinicians should exercise appropriate vigilance when prescribing these medications and use the lowest possible effective dose.

At a minimum, the use of these medications identifies a population at higher risk of B12 deficiency, independent of additional risk factors. (emphasis added)

Here are some of the problems with WDDTY’s slant:

  • The study only covers courses of 2 years or more. The absence of the words “long-term” from the WDDTY headline is scaremongering.
  • The study does not show a link between PPIs and H2RAs and dementia, anaemia or nerve damage. This is a potential secondary effect of Vitamin B12 deficiency. The implied direct link is scaremongering.
  • The study results clearly show that if all PPI and H2RA mediated B12 deficiency stopped overnight, the overall effect on B12 deficiency levels would be barely noticeable.
  • As an observational study, no causal link is established (though it is entirely plausible and quite likely to be at least contributory).

So, WDDTY’s hysterical anti-medicine agenda leads it to turn “long-term use of certain classes of drugs for acid reflux may increase your risk of vitamin B12 deficiency” to “HEARTBURN MEDICINE CAUSES DEMENTIA“.

Now put yourself in the position of someone who has short-term acid reflux, perhaps as a result of pregnancy. Would the difference between these two statements be significant to you? You can see how an Ob-Gyn news journal covers the story here.

Who’s most at risk of dementia? Perhaps the following might have been considered relevant, taken from Ob Gyn News:

The association between vitamin B12 deficiency and the use of acid inhibitors was strongest among patients younger than 30 years of age and diminished with increasing age.

And why don’t doctors tell you this? Oh wait, they did. One of the researchers was part-sponsored by “big pharma”, even though the findings are clearly not to big pharma’s advantage.

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Leaky gut syndrome

Leaky gut syndrome
Leaky gut syndrome is a condition invented by nutritionists and sold by sciencey-sounding nonsense.

As we shall see, the diagnosis of “leaky gut syndrome” is a convenient catch-all to offer an illusion of knowledge to patients suffering from medically obscure symptoms. This is particularly pernicious, since in many cases such conditions have a psychosomatic component: the illusion of diagnosis is almost its own cure.

A competent and ethical health publication would urge caution around unproven diagnoses that make claims which should be verifiable from pathology, but aren’t.

WDDTY of course supports the nutritionist industry agenda.

Leaky gut syndrome

Leaky Gut Syndrome
‘Leaky gut syndrome’ is a proposed condition some health practitioners claim is the cause of a wide range of long-term conditions, including chronic fatigue syndrome and multiple sclerosis.

Proponents of ‘leaky gut syndrome’ claim that many symptoms and diseases are caused by the immune system reacting to germs, toxins or other large molecules that have been absorbed into the bloodstream via a porous (‘leaky’) bowel.

There is little evidence to support this theory, and no evidence that so-called ‘treatments’ for ‘leaky gut syndrome’, such as nutritional supplements and a gluten-free diet, have any beneficial effect for most of the conditions they are claimed to help.

While it is true that certain factors can make the bowel more permeable, this probably does not lead to anything more than temporary mild inflammation of an area of the bowel.

NHS Choices

The world of alternative medicine has a certain fondness for inventing conditions in order to be able to sell a “cure” that medicine cannot offer. morgellonsW and chronic Lyme diseaseW are two of the better known. Another, particularly beloved of nutritionists, is leaky gut syndromeW.

Often there is an overlap with reality: in morgellons the condition is delusional parasitosisW, patients preferring the alternative because they repudiate the psychological cause; in chronic Lyme there is a genuine condition (post-Lyme syndrome) though many self-diagnosed sufferers show no evidence of borrelia burgdorferi, the cause of Lyme disease.

Other genuine disorders such as infectious mononucleosisW (also known as glandular fever) have lasting effects similar to chronic fatigue syndromeW (CFS).

In the case of “leaky gut syndrome” there is some substance to the idea that the gut wall can become more permeable in those suffering from inflammatory bowel diseaseW but the crossover between this and the alternative diagnosis of “leaky gut” happens early. However, the idea of a leaky gut syndrome, particularly as the cause of autism, CFS and even multiple sclerosisW, is entirely speculative and not supported by credible evidence.

Nutritionists typically pin the blame for “leaky gut” on whichever idée fixe they happen to hold: gluten is a frequent target, milk and candida overgrowth are also fingered.

leaky gut As an example, the website leakygutcure.com uses the illustration at right. This shows: top left, a normal gut wall; top right, villous atrophy, a diagnostic sign of coeliac diseaseW, and bottom, vague references to food and unspecified “toxins”.

I am not aware of any credible pathological findings of undigested food in the blood, as this suggests, nor is any such objective test proposed for “leaky gut”. Instead the diagnosis is one of – well, guesswork: usually exclusion diets, but with the nutritionist’s favourite bête noire always in the mix, and (it seems) always found to be the One True Cause.

Comparison with coeliac is illustrative. Coeliac is an autoimmune disorder where the immune system attacks the gut wall where the proteins in gluten are absorbed. Diagnosis is by blood tests for tissue transglutaminase (tTG) antibodies, possibly confirmed by duodenal biopsy, which typically shows exactly the features seen at top right in the picture: blunting of the villi, enlargement of the crypts and invasion of the crypts by lymphocytes (white blood cells).

Chinese herbs contain dangerous pesticides

Chinese herbs contain dangerous pesticides

WDDTY, December 2013

Chinese herbs contain dangerous pesticidesThis is a story that tells us more in what it doesn’t say than in what it does say.

There has been concern for some time over contamination of Chinese herbs. There’s published evidence of microbial and heavy metal contamination, and this goes back a long way. There are reports of solanaceous alkaloids, too.

WDDTY has been strangely silent on this. They tell you about heavy metals in high fructose corn syrup, tap water, processed food, toiletries, cosmetics, fillings, deodorant and bread, but a keyword search of the back issues finds no mention of their presence in Chinese herbs.

We’re still trying to find WDDTY’s coverage of the fact that many herbs on open sale contain little or none of the advertised product. Up to now, though, it’s fairly clear that WDDTY has been toeing the party line on contamination of Chinese herbs.

What’s changed? Well, the trade body are now “fed up” with the string of problems emanating from China. Heavy metal poisoning is one thing, undermining the trade in herbs is quite another. So WDDTY speaks out.

If you’re regularly taking Chinese herbs, you might want to check that they’ve been grown organically. Many herbs used in traditional Chinese medicine contain a cocktail of pesticides, including several that are considered ‘extremely hazardous’, a Greenpeace analysis has revealed.

The Greenpeace scientists found that 32 of the 36 herbs imported from China that they tested contained three or more pesticides, and samples of honeysuckle had up to 26 toxic chemicals. Seventeen samples contained pesticides classified as “highly or extremely hazardous” by the World Health Organization.

What about the heavy metals and microbial contaminants? Oh, wait, they are natural.

What Doctors Don't Tell You
Why don’t doctors tell you that Chinese herbs may be contaminated?

They have been telling you for at least 15 years, it’s WDDTY that was keeping it quiet. 

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WDDTY invents advice from researchers on antidepressant use in pregnancy and Autism

Two major drug groups could cause autism
Autism is a fertile hunting ground for quacks and cranks. Pseudoscience is rampant. It’s hugely draining for parents, there is precious little anyone can do about it, and the causes are unknown. It’s notorious as the foundation of Andrew Wakefield’s fraudulent MMR studies, and quack treatments such as chelation therapy and bleach drinking cross the line into child abuse. Parents are driven to horrific and desperate lengths, often by the very cranks who claim to support them.

The SCAM community (naturally) tries to pin the blame on the bogeyman du jour: vaccines, of course, antibiotics, mercury, fluoride in the water, electrosensitivity – and here, antidepressants.

There are three truly evil aspects of this story. First, it screams about a threefold increase in risk, when actually it goes from 0.6% to 1.3% . Second, it screams cause when the study referenced explicitly repudiates this, as well it should – a case control study has no way of telling if, for example, there is a genetic cause which is a cofactor in both maternal depression and autism. Third, and worst by far, it lays a burden of guilt at the feet of the mothers, without any good evidence to back this.

There’s no doubt that the less medication a pregnant mother uses, the better. On the other hand the dramatic effects of depression are well documented. There is always  a balance of risk and benefit in any effective treatment (whatever the peddlers of natural woo tell you to the contrary).  WDDTY cynically exploit and exaggerate the risks, and ignore the benefits, in order to serve their own agenda – a case this eloquent blog post makes very clearly.

 

Reblogged from NurtureMyBaby with permission

“What Doctors Don’t Tell You” is a magazine that apparently, for the princely sum of £3.95 “aims to meet the demand of those seeking information about alternatives to conventional medicine.”

In my opinion this should actually read misinformation. And as GP, Margaret McCartney, put it “The only ethical way I can see of selling it is if it is kept behind the counter in a plastic bag, with a label saying the contents are dangerous.”

Yet supermarkets continue to stock it (apart from Waitrose), despite many people making them aware of issues with its content.

If you’ve not heard of this magazine before there are many, many blog posts about the misinformation presented in this magazine. On cancer and chemotherapy. HIV/AIDSHomeopathyThe HPV vaccineMMR.

There’s a master list of posts over on Josephine Jones’s blog too, as well as a whole blog dedicated solely to highlighting the issues with this magazine.

autism-antidepressantsIn this post I want to talk specifically about the article titled “Two major drug groups could cause autism” found on page 17 of the November edition that states:

“Women who take certain prescription drugs while pregnant are increasing the chances of Autism in their child”

The drugs that the magazine “reports” on are antidepressants and Epilim. I wanted to take a closer look at the claims made about antidepressants. I tend to get my knickers in a twist about flippant pill shaming so any hint of that and my interest is piqued.

I checked the reference that the magazine points you to and I don’t think it backs up what is written.

The magazine tells you:

“All antidepressants, including the newer generation of SSRIs, triple the chances of the unborn child developing autism”

There’s a few issues with this statement in my eyes.

Absolute risk versus relative risk

“Triples the chances” Crikey. Sounds dramatic doesn’t it. Well first off the “triples” figure is not backed up by the results in the paper. We can look at that in a bit more detail later.

But a big issue I have with this is that WDDTY have done that thing, where, in order to make a story sound a bit more exciting, a bit more headline grabbing, they have reported solely on the relative risk.

This seems to happen quite a lot in the media in general, it’s certainly not unique to WDDTY. It’s frequent enough that Cancer Research UK have gone to the trouble of writing a pretty good explanation of the meanings of relative and absolute risks here.

The relative risk tells us:

“how much more, or less, likely the disease is in one group, compared to another.”

When it is reported that the risk is tripled, this could mean that the risk is 20% in one group and 60% in another. Or it could mean the risk is 0.1% in one group and 0.3% in another. The figures I’ve given in these examples are known as “absolute risks”

As there is a big difference between a 60% risk and a 0.3% risk, you can see that to solely report on the relative risk with no mention of the actual figures involved ie. the underlying absolute risks does not give the full picture. From looking at the WDDTY article we have no idea what the absolute risks are, nor is the writer clear about the two groups being compared.

I’m no expert, but looking at the actual paper, I tried to work out where this “triple the chances” came from. I’m not entirely sure.

In very (and probably, over-) simple terms, the research took a load of people with autism (cases) and then took a load of people who matched the autism group in terms of sex and age, but did not suffer from autism. This second group is known as the control group. Then they looked at information on the parents of the people in both groups and looked at how many suffered from depression and how many mothers took antidepressants during the pregnancy, including the type of antidepressant.

Then they did lots of clever number crunching. It’s impossible within the scope of this blog post to go into the details of the statistical analysis that was performed. But a key conclusion that they reached is that:

“Any antidepressant use during pregnancy in mothers of cases was 1.3% compared with 0.6% of controls equating to an almost twofold increase in risk of autism spectrum disorder”

So it seems that the figures for the absolute risks in these two groups are rather low and ultimately, when they did all their odds ratio calculations, it showed almost double the risk, not triple. I think reporting on the figures shown above, alongside the relative risk, would have given WDDTY’s article a bit of a different feel.

(It is all a bit tricky, and my understanding of the numbers and the way the study was done means that the above percentages do not relate directly to risks in women that do take antidepressants versus those that don’t – so it is a bit unfair to simply say that they should have quoted these numbers as absolute risks – but I think some context is needed other than just saying “triples” – this all goes to show the really big problems with just taking numbers out of context in the manner that WDDTY have done. I’m sorry if my attempt to clarify the numbers has made matters worse. Perhaps I should delete all of this section and just say – “I think you’ll find it’s a bit more complicated than that”)

That’s not to say that relative risks are unimportant, indeed they are of great importance in decision-making – comparing risk/benefit of one exposure/treatment vs another, but the absolute risks do put them in context, and I feel that context is important.

Sadly, context is frequently missing in WDDTY. (Another example of missing context can be seen in an article on UTIs and antibiotics, where in failing to tell us the actual purpose of the research they cite, WDDTY try and take a figure from the paper and extrapolate it to the general population, thus having us believe that 70% of women can get better from uncomplicated UTIs without antibiotics, when the figure is actually estimated to be 25 – 50%)

To be fair to WDDTY, (I don’t know why I keep bothering to do that) I think I can see where they got the “triples” figure from. I think (from looking at table 4 in the paper) it is from looking at a link between depressed women taking antidepressants and autism in offspring, rather than a link between taking antidepressants and autism in offspring. (Antidepressants can be prescribed for things other than depression, such as neuropathic pain.)

I think this serves to highlight the importance of my earlier question of what two groups are we comparing when we talk about a tripled risk, and it also highlights the general importance of context.

Causality

The paper this article is based on is very cautious about saying that antidepressant use directly causes autism. It says:

“it is not possible to conclude whether the association between antidepressant use and autism spectrum disorder reflects severe depression during pregnancy or is a direct effect of the drug.”

And

“Caution is required before making causal assumptions or clinical decisions based on observational studies”

I don’t think this is reflected in what we see in WDDTY. I think the two statements I’ve already quoted from the magazine infer that autism is caused by the drugs. Here they are again:

“Women who take certain prescription drugs while pregnant are increasing the chances of Autism in their child”

“All antidepressants, including the newer generation of SSRIs, triple the chances of the unborn child developing autism”

Notice that in that first sentence, it’s not even the drugs that WDDTY wants to blame, it’s the women themselves that are increasing the chances by taking the drugs.

No consideration at all that it might be the severity of the depression that could result in an increased risk of Autism and that perhaps treatment might reduce the risk (the researchers even explicitly say this later, as we’ll see, so I’m not sure what WDDTY’s excuse is for failing to mention this.)

Certainly no consideration for the fact that it is not the individual fault of any women that she might end up in a position where taking antidepressants is necessary. Just a straight up blame game, yep, take these drugs and YOU, pregnant lady, are increasing the risk of damaging your unborn child. I can’t put into words how much I’m annoyed by the way WDDTY frames this sentence.

I’m not the only one who sees a problem with how happy WDDTY seem to be to blame pregnant women.SouthwarkBelle has also written about the way WDDTY misrepresent this research.

Perspective

Further reading of the paper offers further perspective on the figures:

“From a public health perspective, if antidepressant use had a causal relation with autism spectrum disorders, it would explain less than 1% of cases”

The actual figure, given elsewhere in the paper is 0.6%. So looking at it this way, not only is “triples” inaccurate, it also appears to be a little alarmist. What would you do if you were a responsible health journalist, would you report on an invented tripled risk or would you report on the 0.6% of cases that would result if antidepressant use did cause autism?

(I think ideally, you might write more than 3 paragraphs, so that you can go into a little more depth and provide context)

Also of relevance is this:

“All associations were higher in cases of autism without intellectual disability, there being no evidence of an increased risk of autism with intellectual disability.”

Once again if WDDTY looked closely at the study and were careful to point out this detail….well it paints the research in a different light doesn’t it? An association between anti-depressants and autism was found but only with autism without an intellectual disability. Less alarmist, for sure, not really WDDTY’s style.

“Seek out non-drug therapies, say researchers”

Now we move onto what I find to be the worst part of the article. Here is the full sentence I’m talking about:

“So women who suffer from depression during pregnancy should seek out non-drug therapies, say researchers from the University of Bristol”

Gosh. If I was pregnant and had decided to take or stay on antidepressants, I think I’d already be quite concerned by the article so far. But that is quite a recommendation from the researchers isn’t it? Quite firm advice. The researchers must be certain about the clinical implications of their research.

Apart from of course, they are not, as we’ve already seen from the quote about clinical decisions requiring caution.

Here’s what else they say:

“….the results of the present study as well as the US study present a major dilemma in relation to clinical advice to pregnant women with depression. If antidepressants increase the risk of autism spectrum disorder, it would be reasonable to warn women about this possibility. However, if the association actually reflects the risk of autism spectrum disorder related to the non-genetic effects of severe depression during pregnancy, treatment may reduce the risk. Informed decisions would also need to consider weighing the wider risks of untreated depression with the other adverse outcomes related to antidepressant use. With the current evidence, if the potential risk of autism were a consideration in the decision-making process, it may be reasonable to think about, wherever appropriate, non-drug approaches such as psychological treatments. However, their timely availability to pregnant women will need to be enhanced.”

It’s just not the same as what was written in this magazine is it? I have to wonder how the folk at WDDTY translate “a major dilemma in relation to clinical advice to pregnant women” into what I read as a quite firm statement telling pregnant women suffering from depression to “seek out non drug therapies” I recognise that there is mention of non-drug approaches by the research, but saying “it may be reasonable to think about, wherever appropriate” is very different from saying “should” I really think that once again WDDTY has taken a study and misrepresented it. Either that or the researchers spoke to WDDTY and made additional comments on the research aside from what is published.

Only that is not the case either.

I had email correspondence with Dr Dheeraj Rai, the lead author of the BMJ paper who said,

“It would be unwise to suggest that clinical decisions be based solely on our one study. As we mention in our paper, it is not yet clear whether the associations that were observed between antidepressant use during pregnancy and offspring autism were causal, or related to the risk associated with the underlying depression. Although future research will help answer this question, it is understandable that the possibility of potential harm creates concern. However, decisions regarding treatment require a large number of considerations including type and severity of symptoms, risks to mother and baby, and potential benefits. Doctors or other relevant healthcare practitioners can discuss these with concerned women in relation to their personal circumstances and help them to make informed decisions.”

I know it can’t be easy to simplify such a study into a small accessible, informative snippet, (and I wonder how wise it is to attempt it at all) but I’m just not impressed with the job done here. I hate to think that a pregnant woman struggling to make decisions around antidepressants in pregnancy might read this at take it at face value. And I also hate to think of the Mum who has a child with Autism and took antidepressants during pregnancy, who reads this and ends up feeling to blame.

I also think, that in ignoring the complexities surrounding making decisions around antidepressant use in pregnancy, WDDTY trivialise depression. Their flippant suggestion of seeking out non drug therapies shows no understanding of the condition and the effect it can have on a person. By making such a suggestion, I would argue that WDDTY contribute to the stigma surrounding mental health and potentially their writing could affect more than just the person that chooses to read it. Elsewhere they have done a similar thing with TB patients, ie contribute to stigma, by promoting fear of and discrimination towards people that they would have you believe are suffering from a disease that is incurable (Note: TB is curable).

For responsible advice on anti – depressants and pregnancy read here.

What can be done?

This magazine is damaging. If people trust this magazine with its impressive sounding references without realising the extent to which it misleads, then they will make decisions about health based on wrong information and possibly form attitudes towards patient groups that result in discrimination.

The way they write about cancer and quack cures does nothing but sell false hope. (Read that blog post if you get a chance – it sums up my views on this magazine very well)

Having it available in Smiths and supermarkets with its glossy cover gives it a certain air of respectability it does not deserve. The thought of anyone I care about being seriously ill and picking up this magazine for advice scares me. I wouldn’t want them to use it to educate themselves about depression either, being that it’s something that I personally suffer from.

Myself and many others, would love to raise awareness of the bad reporting in this magazine and get this magazine out of high street stores, and have been making their views known to the relevant companies.

Waitrose have already listened to peoples’ views and have decided to stop stocking it. But the likes of WH Smiths, Tesco, Asda and Sainsbury’s are less responsive. (Sainsbury’s did say they were going to stop selling it, however they appear to have backtracked)

Putting more pressure on these big chains could make a huge difference.

If Tesco and Asda can withdraw their mental health patient costumes because they recognise that selling them reinforces stigma and causes damage to those living with mental illness, then when the damage that this magazine could cause is brought to their attention they ought to act accordingly. If you agree, and fancy letting your views known then here are some email addresses:

[email protected]

[email protected]

Sainsbury’s can be emailed here

[email protected]

The more people who are aware of the misleading information in this magazine the better. So if you agree that this magazine is problematic please spread the word in whatever ways you can. Twitter it(#wddty), Facebook it, blog it, tell your neighbour, if you find a copy speak to the manager of the store or have a word with the pharmacist. Whatever small things you can do. Whatever you think is appropriate.

As always, please let me know if anything is unclear or you feel I have made any mistakes.

See also

Use of Selective Serotonin Reuptake Inhibitors during Pregnancy and Risk of Autism, Anders Hviid, Dr.Med.Sci., Mads Melbye, M.D., Dr.Med.Sci., and Björn Pasternak, M.D., Ph.D. N Engl J Med 2013; 369:2406-2415:

CONCLUSIONS: We did not detect a significant association between maternal use of SSRIs during pregnancy and autism spectrum disorder in the offspring. On the basis of the upper boundary of the confidence interval, our study could not rule out a relative risk up to 1.61, and therefore the association warrants further study. (Funded by the Danish Health and Medicines Authority.)

The right vibes: music therapy

The right vibes
An article from vol. 24 no. 5 (August 2013) gives a staggeringly credulous overview of the inflated claims made for music therapy by those who allow their imagination to run riot.

The article itself is a game of two halves, Bryan. It starts out by establishing, at tedious length, the entirely uncontroversial fact that music can make people happier and take their mind off pain, and then switches to all manner of speculative hyperbole drawn primarily from the self-published opinions of those who are (over)selling patented music interventions.

When you read that “new research shows that music offers a powerful therapy after stroke, heart disease—and even cancer”, are you likely to understand that the effect in cancer is that playing music makes patients feel a bit less miserable? Because that is about the limit of it. It’s a soft “quality of life” outcome: even the often shockingly poor sources cited don’t make the claim that music has any material effect on the progression of cancer.

The article has many good examples of wishful thinking, some obvious cases of confirmation bias, a hilarious reference to the bonkers “morphic resonance” conjectures of Rupert Sheldrake, and several examples of using valid results to support wildly speculative arguments.

Continue reading The right vibes: music therapy

Emotional Freedom Techniques: More advertorial

2013-05 vol 24 no 2 May 2013_31Emotional Freedom techniquesW (EFT) are a form of counselling intervention that draws on various forms of nonsense including acupuncture meridianWs, neuro-linguistic programmingW and energy medicineW.

Unsurprisingly, evidence for any effect beyond what would be expected from talk therapy, is elusive. And equally unsurprisingly, given that it’s pseudoscience, WDDTY seems happy to give practitioners a platform for advertisements masquerading as content.

The first mention I can trace is in vol. 19 no. 4 (July 2008) where this letter is printed:

Hypnotherapy for de-stressing
Re May’s cover story, ‘Stress: the pain of going it alone’ (WDDTY vol 19 no 2), what I found disappointing was the omission of hypnotherapy in a list that covered many approaches and modalities, some of which are far less well-established and tested.

As a hypnopsychotherapist (who uses biofeedback, cognitive behavioural therapy, neurolinguistic programming, Emotional Freedom Technique, integrative breathing therapy and music, along with Gestalt, various accelerated learning techniques and other approaches, tailored to the needs of each client), and as a researcher and author, this strikes me as a major omission and detracts from an otherwise very useful article by not acknowledging the value of hypnosis as one of the fastest and most effective ways to trigger the relaxation response and reduce or eliminate altogether all the symptoms of the stress response.

I was also surprised that there was no mention of Emotional Freedom Technique and Thought Field Therapy, some of the fastest-growing self-help tools using energy-medicine approaches.

I realize that no single article can be completely comprehensive, but the fact that hypnotherapy, in particular, was omitted is baffling—especially as it is so widely available and easily learned for self-help.

Hypnotherapy incorporates many of the techniques mentioned in the article, including breathing and visualization, and has been used as a stress-reduction tool for as long as we’ve been referring to ‘stress’—and long before that.—Dr Leila Edwards, via e-mail

First, Edwards does make a fair point in that hypnotherapyW is a valid therapy for stress. Perhaps WDDTY excluded it because it is widely used and taught to patients by doctors, but they also included cognitive behavioural therapy (CBT) which is also entirely mainstream, as are exercise and yoga, which are freely mixed with such nonsense as “HeartTouch”.

However, the inclusion of “energy medicineW” and its derivatives marks this out as being quackery, and EFT is indeed just that.

Next up was a testimonial from an advert from the pretentiously titled trade association the General Naturopathic Council Ltd. in vol 23 no. 8 (November 2012):

  • Patient – 35-year-old single mother with a 3-year-old autistic son; previously in a violent relationship.
  • Symptoms – mental and physical exhaustion, anxiety, depression and panic attacks. Prescribed antidepressants (an SSRI); although they have helped a little with her state of mind, the exhaustion is unrelenting, she feels her life is out of control and is finding it difficult to cope with her son’s needs.
  • The case history taking, along with an iris analysis, suggested adrenal exhaustion. It was noted at the consultation that the patient was hyper-ventilating.
  • Protocol – the patient’s diet had been carbohydrate-heavy. The long-term lack of protein could have been influencing the brain’s neurotransmitter production, resulting in a lack of serotonin to produce a feeling of calm and well-being. Dietary recommendations were to incorporate more protein and essential fats.
  • A constitutional homeopathic remedy was prescribed. Ashwagandha, an Ayurvedic herbal remedy, was prescribed for adrenal support. The patient was taught Emotional Freedom Technique to help with her previous traumatic experiences. Light exercise was encouraged, along with breathing exercises.
  • Outcome – the patient’s energy levels and well-being steadily improved and within 2 months she informed her GP that she didn’t need to take the anti-depressants.
  • A naturopathic assessment takes into account the web-like interconnection of the body’s organs and systems. A Naturopath will aim to identify the root causes, rather than treating individual symptoms.

Oh dear. I wonder what the quacks offered for the autistic child? I hope it wasn’t chelation therapy or CEASE or any of the other legion of child abuses to which these loons subject autistic children in the mistaken belief that they have the faintest clue what they are doing.

A naturopath should not really be treating this patient. She should have been referred to a competent psychologist to help with the stress and diagnose whether the history of abuse had caused post-traumatic stress disorderW. Fortunately homeopathy and EFT “worked”, so this was unlikely to be the case, but that is blind luck. SSRIs are problematic and the doctor probably would have had her off them pretty soon anyway.

The last bullet is just hilarious. A naturopath cannot do these things because a naturopath is not, in the main, medically trained or qualified. Attempts to understand what naturopaths and other quacks mean by these vaguely referenced interconnections between systems is likely to leave you needing a drink, and with a strong desire to punch walls.

So we move to the advertorial itself, spread over pages 74-82. It is a promotion of EFT under its other name, Tapping (or Tapping Therapy).

Tap yourself to good health: Emotional Freedom Technique (EFT) has been called the all-purpose solution to emotional problems, but it can also be used to heal your body and overcome stress. Here’s how.

Yes, it’s another One True Cure. The article begins by describing the “journey of discovery” of Callahan, the inventor of EFT. Stripped of the overtones of credulous awe, the anecdote is pretty straightforward: Callahan had a patient, engaged in a theatre of mystery and the patient improved. The null hypothesis was never considered, because who would not want to be the “discoverer” of a new and powerful cure for illness? The gravy train was filled with coal and steamed out of the station, leaving reality standing on the platform.

Three sources are cited:

Human Brain Mapping Volume 30, Issue 4, pages 1196–1206, April 2009 The salient characteristics of the central effects of acupuncture needling: Limbic-paralimbic-neocortical network modulation, Fang et. al. is used as a source for the claim that “Research at Harvard Medical School over the past decade has shown that stimulation of selected meridian acupoints decreases activity in the amygdala, hippocampus (another part of the limbic system) and other parts of the brain associated with fear, findings that have been captured on functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) brain scans”. This is disingenuous: the study is in respect of acupuncture, not pressure or tapping, and as the authors state: “Although certain differences could be observed between real and sham points, the hemodynamic response (BOLD signal changes) and psychophysical response (sensory experience) to acupuncture were generally similar for all four points.” In other words, the study provides only weak and indirect support for the idea that the acupoints have any actual relevance and some evidence that in fact they don’t (which is the scientific consensus view based not least on the fact that they have no associated physiology).

J Nerv Ment Dis. 2012 Oct;200(10):891-6. The effect of emotional freedom techniques on stress biochemistry: a randomized controlled trial. Church D, Yount G, Brooks AJ. This is a study in a low impact factor journal written by authors from the research arm of “Soul medicine Institute”, which now calls itself the National Institute for Integrative Healthcare (NIIH), absolutely not in any way trying to sound like the National Institutes for Health (NIH). This body is dedicated to promoting energy medicine and energy psychology – in other words EFT. The study uses a control which is less theatrical, so is not a valid comparator. We don’t have the full study, the abstract does not make it clear whether the comparisons are with no treatment (NT) or standard psychotherapy groups.

Rev Gen Psychol, 2012; 16: 364–80 Feinstein, D. (2012). Acupoint stimulation in treating psychological disorders: evidence of efficacy. Feinstein is on the faculty of the “Energy Medicine University“, an unaccredited for-profit “university” that teaches all manner of bullshit. The paper does not establish the validity of acupuncture points, unsurprisingly (that would have scored the author a Nobel prize), and fails to discount the null hypothesis.

The article is of course entirely uncritical. Its author is Nick Ortner, an “international expert” on EFT – in other words, a vendor. WDDTY’s usual approach is in evidence: alternative claims are never challenged, the obvious conflicts of interest are never a problem. Only “big pharma” and the rest of the evidence-based world is subject to conflicts of interest, it seems.

And what does the real world have to say?

An article in the Skeptical Inquirer argued that there is no plausible mechanism to explain how the specifics of EFT could add to its effectiveness, and they have been described as unfalsifiable and therefore pseudoscientific.[4] Evidence has not been found for the existence of meridians or other concepts involved in traditional Chinese medicine.[5]

A Delphi poll of an expert panel of psychologists rated EFT on a scale describing how discredited EFT has been in the field of psychology. On average, this panel found EFT had a score of 3.8 on a scale from 1.0 to 5.0, with 3.0 meaning “possibly discredited” and a 4.0 meaning “probably discredited.”[6] A book examining pseudoscientific practices in psychology characterized EFT as one of a number of “fringe psychotherapeutic practices,”[7] and a psychiatry handbook states EFT has “all the hallmarks of pseudoscience.”[8]

EFT, along with its predecessor, Thought Field Therapy, has been dismissed with warnings to avoid their use by publications such as the The Skeptic’s Dictionary[9] and Quackwatch.[10]

How disappointing: once again the lone genius turns out simply to have been wrong.

What Doctors Don't Tell You
Why don’t doctors tell you that tapping your acupressure points can cure your ills?

Because there’s no good evidence these points exist, let alone that the therapy works.