Category Archives: 09 Dec 2013

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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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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Misinformation, Stigma and WDDTY – How not to write about TB

How not to write about TB
For WDDTY, the issue is simple: their freedom to state their beliefs is being suppressed by a small group of skeptics just because we hate natural cures and love big pharma.

In this article @NurtureMyBaby explains, more eloquently than I could, why for her it is not about freedom to state an opinion, but about the pernicious effects of agenda-driven falsehoods and misrepresentations, the false hope of unwarranted extrapolation, and the ridiculous notion that adjunct to antibiotics means better than antibiotics, which don’t work anyway.

This is the third article to expose WDDTY’s worrying denialist approach to antibiotics, one of the most successful health interventions we have. Further research is underway to determine if the editors, by all accounts fervent homeopathy believers, are straying into the territory of germ theory denialism so common among that particular band of charlatans.

Now read on…

Continue reading Misinformation, Stigma and WDDTY – How not to write about TB

HIV-AIDS and the deadly denialists at WDDTY

Deadly denialists
We take a trip back in time to vol. 5 no. 4 (July 1994) for a look at the article titled “HIV infection: tested to death”, a veritable cornucopia of denialist dross published around ten years after AIDS was properly identified, seven years after AZT was approved, two years after combination therapies were approved – in other words, at a time when “skepticism” about the HIV-AIDS link had already crossed the line from the normal process of questioning emerging science, and into denialism.

Several well-known AIDS denialists are given a platform in this article, at least one of whom was repeatedly rejected as an expert witness in courts due to having absolutely no professional expertise in the subject.

It’s worth remembering that there is no record of WDDTY ever publishing an apology or correction for this offensive bullshit. In fact, there is reasonable evidence that they still harbour at least vestigial AIDS denialism. Indeed, the response “We covered the ‘does HIV cause AIDS’ controversy years ago, but it’s probably time for an update” is pure denialism: the HIV-AIDS link has not been remotely controversial for decades.

HIV-AIDS and the deadly denialists at WDDTY

Reblogged from Plague of Mice by the author, who has generously granted himself permission to do so

People living with AIDS, 2008
People living with AIDS, 2008

A friend sent me a copy of the latest issue of that collection of outrageous and mercenary lies legally registered under the title of What Doctors Don’t Tell You. It looks like we can expect some especially deadly fuckwittery in the near future. This somewhat transparently fake “letter” (read: an obvious plant) appears in the “Have Your Say” letters page.

Keep up the fight—and now onto AIDS

Dear WDDTY

After reading your excellent November 2013 issue, I felt I must write to you all to congratulate you on your achievements. It’s fabulous that this type of information is available in supermarkets, and essential that such a sphere of influence is maintained. Following your brave articles on assessing true causes of cancer, which often go unreported, as well as treatments which can heal, I was wondering whether you had ever considered similar investigation into what I consider the biggest medical fraud of recent history— that of HIV/AIDS.
A dedicated reader

WDDTY replies: We covered the ‘does HIV cause AIDS’ controversy years ago, but it’s probably time for an update. Thanks for the suggestion. Continue reading HIV-AIDS and the deadly denialists at WDDTY

The Advertising Standards Authority Exposed

The Advertising Standards Authority Exposed
“The ASA is not a government regulator—it’s a media-industry self-regulator—but it behaves as if it were a government regulator” says the callout box in Rob Verkerk’s opinion piece.

Why does the mouthpiece of the Alliance for Natural Health have such a fixation with a group whose mundane job is to check that advertisements are “legal, decent, honest and truthful”?

The answer probably lies in the sheer number of upheld complaints against the SCAM industry in general and WDDTY advertisers in particular.

In this article Verkerk tries a number of well-worn fallacies in order to advance the thesis that it’s perfectly acceptable for the SCAM industry to substitute belief for fact, because natural.

Continue reading The Advertising Standards Authority Exposed

Home birth is “safer option”

WDDTY is, of course, deeply in the grip of the naturalistic fallacy. So it’s not a surprise that it promotes home birth.

In truth, home birth is tolerably safe in the West these days, but research has consistently shown that it is somewhat less safe than hospital birth, albeit with much uncertainty. If you are a first time mother, have a higher risk pregnancy, live more than about half an hour from a hospital, or your area lacks excellent midwifery services with good escalation to secondary care in case of problems, then you are unquestionably better off in hospital. For your second or subsequent pregnancy you should be no worse off at home, provided you live close to a hospital and have a good doctor or a well-trained midwife with good backup services.

The problem in assessing relative risk has always been unpicking the chooser from the choice: mothers with more complicated pregnancies are more likely to opt for a hospital birth, mothers who opt for home birth are normally expecting a routine delivery.

This newborn has apparently correctly identified that his mother's claim that home birth is safer, is a crock.
This newborn has apparently correctly identified that his mother’s claim that home birth is safer, is a crock.

How much Wrong can you pack in a small callout box?

Home births are safer. Women who give birth at home suffer far fewer complications who decide to have their baby in In fact, women who opt for hospital delivery are more than twice as likely complications compared with a and nearly two times more likely postbirth haemorrhage—unless it’s the first baby.

Really?

Before we go too far down the line, it must be pointed out: home birth is tolerably safe, and de Jonge’s study is underpowered for robust conclusions. There are many more and larger studies, and NHS Choices provides an excellent overview of one large one specific to England. It’s also important to realise that it is very hard to unpick the effects of chooser and choice. If you live in easy reach of a hospital you might very well opt for a home birth secure in the knowledge that a rapid transfer is possible, whereas if you live in the country you might well opt for a hospital birth, and this would be irrespective of the actual risk when a preference is originally expressed.

In fact, home birth is probably not significantly riskier than hospital birth for uncomplicated pregnancies in areas with good midwifery and referral services and transport links – but only with those caveats. The message that home birth is safer is wrong on two levels: it’s wrong because actually it’s at best no riskier than hospital birth for low risk pregnancies, and it’s wrong because that only applies to low risk pregnancies in a low risk system.

Absent both of these, it is significantly more dangerous, especially for first pregnancies.

Crucially, much of the literature proposing that home birth is safer originates form the same source: Ank de Jonge, a home birth advocate in the Netherlands.

The following is reblogged from Amy Tuteur, MD (The Skeptical OB), who has two posts which are combined here (firstsecond).

Here is Dr. Tuteur’s take on the study under discussion, reblogged with permission:

Surprise! There were home birth deaths in the Dutch study that claimed to show that home birth has lower risks.

Surprised girlOn June 14, I wrote about Ank de Jonge’s latest attempt to show that home birth is safe (No, new Dutch study does NOT show that home birth is safe). As I mentioned at the time, de Jonge continues to slice and dice the Dutch home birth data is an effort to somehow prove that home birth is safe, when the data suggests that it is not.

In the latest paper discussed in that post, Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study,  de Jonge concluded:

Low risk women in primary care at the onset of labour with planned home birth had lower rates of severe acute maternal morbidity, postpartum haemorrhage, and manual removal of placenta than those with planned hospital birth. For parous women these differences were statistically significant…

In other words, there was no difference in severe acute maternal morbidity (SAMM) between home and hospital among nulliparous women and a slightly lower rate of SAMM for parous women at home-birth.

There was just one teensy, weensy problem. de Jonge left out the mortality rates. Severe maternal morbidity is an appropriate measure of safely ONLY when death rate is zero or nearly zero. If the death rate is not zero, that MUST be taken into account in assessing safety. My Letter to the Editor of the BMJ regarding this inexplicable oversight was published the same day. de Jonge and colleagues have finally responded, and what do you know, the maternal mortality was NOT zero.

The reply appears to continue the trend of apparent obfuscation of the results.

The authors claim:

We did not mention maternal deaths in our study, but they were included among the women with severe acute maternal morbidity (SAMM). There were two maternal deaths in the planned home birth group (2 per 100,000) and three in the planned hospital birth group (6 per 100,000). The differences between these rates were not statistically significant (Fisher’s exact test, P=0.367).

They described 1 home birth death due to cerebral hemorrhage possibly secondary to pre-eclampsia. The authors try to blame the doctors who evaluated the woman at 37 weeks, at which time she was felt to fine. A lot can and does happen in the last week of pregnancy. To blame the doctors who saw the woman a week before her collapse and absolve the midwife who cared for her at the time of birth is bizarre.

What about the other home birth death? Funny you should mention that. The authors did not say. They lumped the second home birth death in with the hospital deaths and reported:

The other four women were referred during labour from primary to secondary care because of meconium-stained liquor. One woman suffered from sudden collapse during labour, when she was already in secondary care, and died. Although no definite diagnosis was made at postmortem examination, a cardiac cause appeared to be most likely.

A woman who gave birth spontaneously was discharged after one day. On the fourth day postpartum she was readmitted because of profuse vaginal bleeding and shortness of breath. She had a sudden collapse and died. Postmortem examination showed sinus sagittalis superior thrombosis.

Two women died a few weeks after they gave birth from causes not related to the delivery; one from a severe asthma attack, the other one fell down the stairs, had a skull fracture and died of a subarachnoid haemorrhage.

Since the authors did not specify that either of the woman who died of causes unrelated to delivery was in the home birth group, it seems safe to assume that they were both in the hospital group.

Therefore, as far as I can determine, there were 3 maternal deaths attributable to pregnancy in the entire study, 2 in the home birth group and one in the hospital group, for a death rate of 2/100,000 in each group. The only one that appears to have been potentially preventable was the one that occurred in the home birth group. Therefore, the home birth group had one death that was potentially preventable in the hospital, while the hospital group had none.

The study is underpowered to determine whether there is a statistically significant difference in the death rate between the two groups, but the fact that even one woman in the home birth group died of a potentially preventable cause means that there is no basis for concluding that home birth is as safer or safer than hospital birth among the women in this study.

Simply put, the death rate was not zero and until the difference (if any) between maternal deaths at home and in the hospital is determined, we cannot draw any conclusions about the safety of home birth for Dutch mothers.

A more appropriate conclusions for the study would be:

Low risk women in primary care at the onset of labor with planned home birth had lower rates of severe acute maternal morbidity, but this difference was statistically significant only for parous women. However, there was a potentially preventable death in the home birth group, while there were no potentially preventable deaths in the hospital group. The study is underpowered to detect a difference in maternal mortality between home and hospital, therefore, no conclusion can be drawn about the safety of home birth.

Yes, fewer women in the home birth group experienced severe acute maternal morbidity, but that’s nothing to crow about if one of them died and might have been saved in the hospital.

What Doctors Don't Tell You
Why don’t doctors tell you that home birth is safer?

Because it’s not true.

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People do die after vaccination

WDDTY is not, says Lynne McTaggart, anti-vaccination. It’s just a bizarre coincidence that every single mention of vaccines anywhere in any issue of WDDTY turns out to be negative, often exaggerated, and routinely accompanied by egregious fearmongering.

Here a paper showing that mortality rates are lower post vaccination than pre vaccination, and that the causes of death are the same, ruling out any definite effect form vaccines themselves, is spun to pretend that doctors have finally admitted vaccines can kill.

Even by WDDTY’s standards, this is unusually dishonest.

People die after vacinationApparently doctors at CDC have finally admitted that vaccines kill:

People have died after a ‘safe’ routine vaccination, American regulators have admitted for the first time. Over a three-year period, more than 15,000 people died within 60 days of being vaccinated in the US.

Presenting this as a fact finally wrung out of reluctant regulators in denial is really quite funny.

Data from the Vaccine Adverse Event Reporting SystemW (VAERS) is far from secret. In fact, you (yes, even you) can freely search the database online.

The risk is small—it’s only around 0.13 per cent—but it does exist, say researchers from America’s Centers for Disease Control and PreventionW (CDC)

It is small. 8,474 people have died after vaccination since the VAERS database was established, billions of vaccinations have been administered. But this is not new information.

Surprisingly, the research was intended to allay people’s fears about vaccines. But, say the CDC researchers, not all deaths following vaccination were caused by the vaccine itself, and there is still no absolute proof that vaccines can cause death.

Wow. So the CDC set out to allay fears, found disturbing data indicating death, and grew a pair and published it?

Not as such, no. As above, the fact that people sometimes die after vaccination is well-known. Some people have even died because of vaccination (e.g. the Cutter IncidentW). But, as VAERS makes absolutely clear at every stage, there is no causal link implied or expressed. These are events that follow, in time, a vaccination. That does not mean the vaccination caused the event. In some cases it’s plausible (mild fever), in others not so much (drowning).

I begin to suspect that WDDTY may have misrepresented the source. Again. So let’s check the reference: Mortality rates and cause-of-death patterns in a vaccinated population. McCarthy NL, Weintraub E, Vellozzi C, Duffy J, Gee J, Donahue JG, Jackson ML, Lee GM, Glanz J, Baxter R, Lugg MM, Naleway A, Omer SB, Nakasato C, Vazquez-Benitez G, DeStefano F, Am J Prev Med. 2013 Jul;45(1):91-7 – this is a CDC publication so full text should be available free, please let us know if you find a link to the full text.

BACKGROUND: Determining the baseline mortality rate in a vaccinated population is necessary to be able to identify any unusual increases in deaths following vaccine administration. Background rates are particularly useful during mass immunization campaigns and in the evaluation of new vaccines.

PURPOSE: Provide background mortality rates and describe causes of death following vaccination in the Vaccine Safety Datalink (VSD).

METHODS: Analyses were conducted in 2012. Mortality rates were calculated at 0-1 day, 0-7 days, 0-30 days, and 0-60 days following vaccination for deaths occurring between January 1, 2005, and December 31, 2008. Analyses were stratified by age and gender. Causes of death were examined, and findings were compared to National Center for Health Statistics (NCHS) data.

RESULTS: Among 13,033,274 vaccinated people, 15,455 deaths occurred between 0 and 60 days following vaccination. The mortality rate within 60 days of a vaccination visit was 442.5 deaths per 100,000 person-years. Rates were highest in the group aged ≥85 years, and increased from the 0-1-day to the 0-60-day interval following vaccination. Eleven of the 15 leading causes of death in the VSD and NCHS overlap in both systems, and the top four causes of death were the same in both systems.

CONCLUSIONS: VSD mortality rates demonstrate a healthy vaccinee effect, with rates lowest in the days immediately following vaccination, most apparent in the older age groups. The VSD mortality rate is lower than that in the general U.S. population, and the causes of death are similar.

Wait, what?

This study is designed to assess baseline mortality, for comparison with mortality in the vaccinated population in the period post-vaccine.  The conclusion is – and I think I might make this a fraction more prominent:

The VSD mortality rate is lower than that  in the general U.S. population, and the causes of death are similar

Yes, you read that right. The conclusion is that the mortality rate is lower in the VSD population, and this is presented as evidence of CDC reluctantly admitting that vaccines kill.

Their study looked at all deaths that happened within 60 days of a vaccination and covered the period from
January 2005 to December 2008, during which time more than 13 million people were vaccinated.

Most of the 15,455 deaths were among older people, presumably after a flu shot, and the causes of death among the vaccinated matched the four leading causes of death recorded among the general population.

Aside from the elderly, other vulnerable groups include pregnant women and those with chronic health problems, so doctors perhaps need to think carefully before vaccinating these people, say the researchers

This is blatant editorialising. Actually, no, seeing the comments from fragmeister below, it’s simple fabrication. The paper says no such thing!

What the study shows is that people were less likely to die following vaccination, indicating (as it says) a healthy vaccinee effect, and that the causes of death were the same, so the vaccines were unlikely to be responsible.

In fact, we can be even more confident here. According to CDC, analysis of all deaths reported to VAERS between 1990 and 1992, which investigated each death and determined the root cause, found only one (of over 800) that was even plausibly caused by the vaccine.

There’s another thing the VAERS database shows: for each new vaccine it’s notable that the rates of reported adverse events decline over time, irrespective of uptake.

VAERS reports for Gardasil
VAERS reports for Gardasil

As the chart at right shows, adverse event reports for Gardasil have declined steeply over time. This is normal and expected. The medical community becomes more comfortable with an intervention over time; the first time someone feels nauseous the day after a vaccine you may well report it, but when you’ve seen a thousand patients tolerate the vaccine well you’ll not bother because you know the person has salmonella and you’re confident that the vaccine didn’t cause it.

So adverse events are initially over-reported and latterly probably under-reported, with the degree of under-reporting increasing with the triviality of the symptom. Few to no deaths will be missed, many mild transient cases of light-headedness may be.

What Doctors Don't Tell You
Why don’t doctors tell you that vaccines kill?

Because it would be grossly misleading.

CT scans increase children’s cancer risk

CT scansCT scans increase children’s cancer risk 

Children who are given powerful CT (computed tomography) scan—which delivers high doses of radiation—are more likely to develop cancer. CT […] CT radiation increases the risk by 24 per cent, and the risk rises by an additional 16 per cent each time the child has a scan, researchers found.

Although the researchers say the risk is small, their discovery does emphasize that CT imaging should be done more sparingly and only in cases where it is absolutely necessary. BMJ, 2013; 346: f2360

CT scans – X-ray computed tomographyW, technically – are scans that combine numerous X-ray images to form a three-dimensional picture of the soft tissues, slice by slice. They are an important diagnostic tool and can identify potentially life-threatening conditions such as subdural haematomaW. The primary use of CT scans is head CT, usually following head trauma. In adults this is quite low risk but in children the brain is still growing, so the risk is higher (and this has been known for a long time).

The term “CT radiation” is classic framing, of the type WDDTY routinely engage in. CT involves X-rays, X-rays are radiation, this is not a secret, but “CT radiation” invokes the radiation bogeyman for additional fearmongering effect.

The fact that X-rays involve ionising radiation and hence a risk of cancer, is well-known and forms part of the informed consent process for the procedure.

With X-rays generally and CT scans in particular there is a balance to be struck between risk and benefit. The BMJ article puts some figures on that.

It also uses relative risk. The BMJ paper is based on Australian data but finds similar results to the US and British data in the Lancet last year (see below).

It also makes this interesting point:

Our study shows that CT scans during childhood and adolescence are followed by an increase in cancer incidence for all cancers combined and for many individual types of cancer. We cannot, however, necessarily assume that all the excess cancers seen during the current period of follow-up were caused by CT scans, because scanning decisions are based on medical indications and are not allocated at random. Thus, we cannot rule out the possibility of reverse causation, whereby symptoms of precancerous conditions (including genetic conditions) or early symptoms of the cancer itself might themselves prompt a CT scan. Such reverse causation is most likely to be present for brain cancers following a brain CT, where low-grade cancers could lead to symptoms prompting investigation several years before the eventual diagnosis of cancer.

This is good data and worth knowing, but not really a novel finding. A paper in The Lancet in 2012 states:

During follow-up, 74 of 178,604 patients were diagnosed with leukaemia and 135 of 176,587 patients were diagnosed with brain tumours. We noted a positive association between radiation dose from CT scans and leukaemia […]

Because these cancers are relatively rare, the cumulative absolute risks are small: in the 10 years after the first scan for patients younger than 10 years, one excess case of leukaemia and one excess case of brain tumour per 10,000 head CT scans is estimated to occur.

So the scans increase a tiny risk to a slightly less tiny risk. Whereas acute subdural haematoma is always a medical emergency requiring prompt surgical intervention to avoid coma or permanent brain damage.

This research was funded by the US National cancer Institute and the UK Department of Health – so not only is the medical establishment not suppressing this information, they are primarily responsible for ensuring that it’s available.

It’s a matter of clinical judgement and informed consent.

What WDDTY don’t tell you is the alternatives. Dowsing, perhaps?

What Doctors Don't Tell You
Why don’t doctors tell you that CT scans involve radiation and a risk of cancer?

They do. It’s right there on the consent form.

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Wakefield was right! Or not

Autism-bacteriaAndrew Wakefield is a figure who polarises opinion.

To quacks, cranks, and especially antivaccinationists, he is a Brave Maverick Doctor who blew the whistle on the vaccine industry and found the One True Cause of autism.

To the reality-based community he is an unethical quack, struck off for dishonesty and conducting invasive experiments on vulnerable children without proper consent or ethical oversight, reviled for publishing fraudulent research without declaring massive conflicts of interest, and demonised as a significant cause of a resurgence in measles leading to permanent harm and even death.

You might be able to guess which camp we fall into.

Antivaccinationists desperately want Wakefield to be right, even though he wasn’t. So any study showing any kind of link between intestinal disorders and autism is portrayed as vindication, regardless of the actual facts.

In this short piece WDDTY seek to vindicate Wakefield by reference to a study, Reduced Incidence of Prevotella and Other Fermenters in Intestinal Microflora of Autistic Children, Kang et. al., PLoS ONE, 2013; 8: e68322.

“We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described” – Wakefield et. al, 1998

The first thing to note is that the PLoS ONE article does not cite Wakefield’s work. Some will think this is because Wakefield is a pariah, others will know that his work has been retracted so won’t be cited, but the real reason is that the finding has absolutely nothing to do with Wakefield’s hypothesis.

Say it quietly, but the first part of maligned doctor Andrew Wakefield’s theory about the MMR (measles–mumps–rubella) vaccine and autism has been proved right: autistic children do have low levels of three critical bacteria in their gut.

No! Not even close. Wakefield’s claim was that autism is caused by “autistic enterocolitis” triggered by the MMR vaccine. You don’t have to take my word for it, the full text is available on The Lancet website (free registration required). No part of Wakefield’s paper is in any way supported by the new work!

Doctors know that autistic children usually have a range of gut problems, so researchers at Arizona State University decided to find out if it was more than a coincidence. They analyzed the gut flora of 20 autistic children aged between three and 16 years and compared them with samples from 20 typical non-autistic children. The autistic children had fewer types of gut bacteria in general and were also low in three critical varieties: Prevotella, Coprococcus and members of the Veillonellaceae family. Of these, Prevotella species are the most important as they play a vital role in gut interaction.

This is entirely unrelated to Wakefield’s claims, which in any case were admitted in the paper (though not by implication in his grossly irresponsible press statement) not to be provably causal:

“We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers.”

The triggers were identified as MMR in eight cases and measles infection in one. And the claims were quite specific:

Onset of behavioural symptoms was associated, by the parents, with measles, mumps, and rubella vaccination in eight of the 12 children, with measles infection in one child, and otitis media in another. All 12 children had intestinal abnormalities, ranging from lymphoid nodular hyperplasia to aphthoid ulceration. Histology showed patchy chronic inflammation in the colon in 11 children and reactive ileal lymphoid hyperplasia in seven, but no granulomas. Behavioural disorders included autism (nine), disintegrative psychosis (one), and possible postviral or vaccinal encephalitis (two). There were no focal neurological abnormalities and MRI and EEG tests were normal. Abnormal laboratory results were significantly raised urinary methylmalonic acid compared with agematched controls (p=0·003), low haemoglobin in four children, and a low serum IgA in four children.

The research was funded by a payment of £55,000 to the Royal Free Hospital by a firm of lawyers engaged in preparing a suit against the manufacturers of the MMR vaccine. It subsequently emerged that a further £400,000 had been paid to Wakefield himself. The lawyers also recruited some of the children in the study. None of this was declared in the published output.

It has also subsequently emerged that the PCR tests that Wakefield claimed identified measles virus in the gut of autistic children, was the result of contamination.

So Wakefield’s thesis was:

  • Autism is caused by enterocolitis
  • This enterocolitis is triggered by the measles virus

Both of these claims are wrong. And the PLoS ONE study does not in any way challenge that. In fact even Wakefield’s own original paper does not support it, it contains the following statement:

“We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described”

The PLoS ONE paper does not find evidence of measles virus in the gut, or of a form of enterocolitis. It doesn’t use the term enterocolitis. the signature features claimed by Wakefield et. al include lymphoid nodular hyperplasia and aphthoid ulceration. Neither of these is mentioned in the PLoS ONE paper. The PLoS ONE paper mentions PrevotellaCoprococcus, and unclassified Veillonellaceae. Wakefield et. al. make no mention of these, its only mention of bacteria is screening for evidence of campylobacter, salmonella, shigella and yersinia – in other words specifically ruling out bacteria as a cause of the purported enterocolitis. No mention is made of the level or makeup of gut flora.

It does not claim to find a causal relationship, in fact it states that:

[T]he direction of causality among interconnected pathophysiological factors (e.g., autistic symptoms, diet patterns, GI symptoms, and gut microbiome profile) is still unclear

It does not identify a distinct “autistic enterocolitis”, but a “relatively low level” of gut flora, specifically a reduction in diversity.

It concludes:

In summary, we demonstrated that autism is closely associated with a distinct gut microflora that can be characterized by reduced richness and diversity as well as by altered composition and structure of microbial community. Most notably, we also discovered that the genera PrevotellaCoprococcus, and unclassified Veillonellaceae were significantly reduced in autistic children. Unexpectedly, these microbial changes were more closely linked to the presence of autistic symptoms rather than to the severity of GI symptoms and specific diet/supplement regimens. Despite limited information on the direction of causality among autism, diet, GI problems, and microbiome profiles, the findings from this study are stepping-stones for better understanding of the crosstalk between gut microbiota and autism, which may provide potential targets for diagnosis or treatment of neurological as well as GI symptoms in autistic children.

To infer from this that Wakefield is in any way vindicated, is to engage in wishful thinking of the most fanciful kind. The two are related only in as much as they both involve the gut – and given the drivers for Wakefield’s work this is almost certainly pure coincidence.

What Doctors Don't Tell You
Why don’t doctors tell you that new research vindicates Andrew Wakefield?

Because it doesn’t.

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WDDTY on UTIs and antibiotics

Women with UTIs get better in a week without drugs
Sometimes WDDTY so grossly misrepresents its sources that a rebuttal takes very much longer than the original content. This is one of those times.

A subset (70%) of a subset (55%) of a subset (37%) of a subset (137) of  a subset (176) of a small (205) eligible pool of people asked to consider delaying antibiotics, got better anyway. In other words, the uncomplicated UTIs that doctors told them might get better on their own, sometimes did.

This is spun by WDDTY as brave maverick women who refused antibiotics generally getting better anyway. But they didn’t refuse, they were asked to defer treatment to see if the condition resolved spontaneously, as it sometimes does.

WDDTY’s agenda-driven style is expertly dissected below by Nurture My Baby.

“What Doctors Don’t Tell You” magazine on UTIs and antibiotics

Reblogged with permission from nurturemybaby (@nurturemybaby)

UITsIf you want some background about this magazine that promotes quack nonsense and potentially puts lives at risk, I’ll just refer you here and also to Josephine Jones’s master list which contains all manner of relevant blog posts including ones that debunk the articles in this magazine.

I did write a letter to the supermarkets stocking it too, so that might be of interest if you want to further understand some of the issues, or if you want to write your own letter you can find the relevant email addresses there.

Anyway, I’d like to talk about a specific article from the magazine in this blog post.

Here’s a headline from the December 2013 edition:

WOMEN WITH UTIS GET BETTER IN A WEEK WITHOUT DRUGS

This got my attention, having suffered from this particular affliction myself repeatedly over the years.

Actually, 7 days after giving birth to my son I was admitted to hospital for three days and nights and put on several IV antibiotics for what started as a UTI. Only later did I realise I had “Sus Seps” scrawled over my notes. That means suspected sepsis. Sepsis. That’s quite serious.

Anyway I digress.

Let’s see what happens next.

What follows is FOUR sentences which try to report on this this paper.

The research was clearly so trivial and straightforward and easy to summarise that it required a mere four sentences to explain:

Women with urinary tract infections (UTIs) such as cystitis who refused antibiotics have found that the problem cleared up on its own within seven days.

Up to 70 per cent of women with uncomplicated UTIs found themselves clear of the problem without taking the drugs, a new study from the University of Amsterdam has found. In the study, women with the problem were asked if they would postpone taking antibiotics. One-third of the participants agreed, and nearly three-quarters of those women were better or had improved symptoms within a week, the researchers reported.

I don’t really think research is ever so clear-cut that you can say anything useful about it with so few words. You need context.

Even the last sentence which tries to explain some of this context and show a bit more clearly where the figure of “nearly three-quarters” comes from is wrong, but we’ll get to that later.

I think we need to start with why this research was carried out in the first place. WDDTY don’t think this is important, but I do.

You might think from WDDTY’s article that the research was done to find out what proportion of women with UTIs that don’t take antibiotics are likely to get better. (I think that’s what WDDTY want you to believe.)

From the details of the study given in the piece it seems an odd way to go about trying to figure out this number. (Which I think WDDTY want us to believe is 70 or 75%)

That’s because this is not the purpose of the research at all. The purpose was to find out how many women would delay antibiotic treatment if asked by their GP. (Yes they did also look at how many women who agreed to not take antibiotics managed stay off them and get better – but the context is important. I think the study design means that whatever numbers they got for this are not applicable to a wider population) Why would the researchers be interested in numbers of women willing to delay antibiotics? Well it seems to me that they are basing this interest on the fact that antibiotic resistance is a bad thing and as previous research (from placebo arms of randomised trials) has shown that 25 – 50% of women would spontaneously get better without treatment, it seems it might be worth looking at.

Yes that’s right, the figure that WDDTY wants us to believe is 70% (based on a study designed to give information about something different) is actually, according to previous research quoted in the very same paper, 25 – 50%.

So now we better understand the purpose of the research lets take a more thorough look at the article.

Clearly the headline is massively sensationalist and misleading. It’s even misleading when you just compare it to WDDTY’s fabulous four sentences without looking at the research paper.

It’s rather a generalisation, and I don’t find it terribly….honest, or helpful, or meaningful. Look, it’s just stupid, OK?

It would appear from this headline that this “finding” would apply universally. Silly me then for letting those daft doctors prod me with those nasty sharp things and shove antibiotics into my blood stream!

Of course, from reading the paper, apart from bit where it is not the intention of the study to give any indication of how many women generally would get better without antibiotics, it’s obvious that someone in my situation would not have participated in this study. Perhaps it’s a given that this research would not apply to someone who looked like they had a serious infection, I don’t know, perhaps I should forgive WDDTY for failing to provide this particular bit of context terribly well in their headline, or in their next sentence, which continues the generalisation. Here’s that sentence again:

Women with urinary tract infections (UTIs) such as cystitis who refused antibiotics have found that the problem cleared up on its own within seven days.

Interesting use of the word “refused”.

This is not really what happened.

To reiterate some details about how the study was carried out:

Eligible participants (ie. over 12 and visiting GP with painful and/or frequent micturition and who did not meet any of the following exclusion criteria: pregnancy, lactation, signs of pyelonephritis, having used antibiotics or having undergone a urological procedure in the past two weeks, known anatomical or functional abnormalities of the urogenital tract, and being immunocompromised (with the exception of diabetes mellitus).) were ASKED BY THEIR GP if they would consider DELAYING ANTIBIOTICS FOR AS LONG AS POSSIBLE.

This is not the same as refused. Come on WDDTY, if you’ve only got four sentences you should use them wisely. At least try to accurately provide information on how the study was carried out. A bit much to ask when you ignore the purpose of the study in the first place, I suppose.

I guess “refused” just sounds cooler or something. After all it does fit in with the agenda of this rag, doesn’t it? Quick! Run away from your doctor and find some vitamin C/magic water pills/quack remedy pick of the day! You might say that putting it in this way fits in with a certain message that WDDTY want to give out. You might. Certainly I think you would say it’s not very accurate.

All this context is important, (ie. who took part, how the study was performed, the purpose of the study(!)) I think, when you are trying to interpret research, trying to help the reader “make better health choices” as they splash on the front of their glossy cover. WDDTY consistently defend themselves by saying that they just report the research that allows their readers to make an informed decision. It’s arguable that this is not possible to do in four sentences in the first place, but nothing that we have read here so far has indicated that they are capable of, or even genuinely interested in doing this.

Next up (I repeat):

Up to 70 per cent of women with uncomplicated UTIs found themselves clear of the problem without taking the drugs, a new study from the University of Amsterdam has found. In the study, women with the problem were asked if they would postpone taking antibiotics. One-third of the participants agreed, and nearly three-quarters of those women were better or had improved symptoms within a week, the researchers reported.

Oh right, so here we do find out that refused was a stupid word to use. Are they deliberately trying to make their writings confusing and hard to understand? I don’t know.

And they’ve also let us in somewhat (only somewhat, mind, as we’ll see when we look at the figures – and we’ve still not been told the purpose of the study) on how misleading their own headline and opening sentence is by clarifying that it’s uncomplicated UTIs we are talking about, and by giving us some numbers rather than suggesting this applies to everyone (even if the numbers are questionable). A whole magazine dedicated to helping people make health decisions and they go down the route of sensationalist, meaningless headlines and almost contradict themselves within the space of two sentences. (And did I mention they don’t even tell us the purpose of the research ;) )

Bah.

Anyway.

Let’s look at the numbers

This 70 per cent lark. Bearing in mind that this figure is what was observed as part of a study that aimed to look at something else and they are presenting it as the main finding and purpose of the research I think this figure is misleading. What I’m trying to say is that is was never the intention of the researchers, I don’t think, to take this 70%, and apply it to the general population. The paper already quotes a figure of 25-50% as being something that might be applicable in a more general sense.

I think it all makes more sense if we look at just how this figure is reached, so let’s go through some of the numbers from the study, as I see them, and then we can compare them to what WDDTY have told us:

Across 20 GP practices 205 women were eligible to take part.

Interestingly, 1 surgery thought that it was a wholly bad idea to ask patients presenting with a UTI if they would consider forgoing antibiotics (Obviously WDDTY aren’t going to tell you that though!). So 25 patients from that practice ended up not taking part. A further 4 were not included because their records were missing.

This leaves us with 176 women.

Of these 176, the actual number of patients who ended up being asked by the GP to consider delaying treatment was 137.

Of all the 137 patients asked to delay treatment, 51 (37%) agreed to it.

(At least WDDTY got something right. Well 37% is not quite the same as one-third, but I’ll let them off.)

So what happened to the 51 people who agreed to delay treatment (out of the 137 that were asked)?

Well, it was made clear to the participants that if they wanted to start on antibiotics at any point then they should and so at the 7 day follow-up it was observed that 15 of the 51 decided that yes, antibiotics were a jolly good idea after all. 8 did not report on antibiotic use.

So out of the 51 patients that agreed to delay treatment we know that 28 of them (55%) had stayed off antibiotics at the 7 day follow-up.

And so what happened to those 28?

Well 20 of them reported that they felt better or were cured. There we go. This is where the 70% (or 71.4%) comes from.

So when WDDTY say:

“Up to 70 per cent of women with uncomplicated UTIs found themselves clear of the problem without taking the drugs”

I put it to you that they are once again misrepresenting the research they cite.

I think the context that they have failed to provide is a huge problem.

It is 70% of 55% of 37% of 137 people asked to consider not taking antibiotics (out of 176 included participants out of 205 of eligible participants).

I do think all of this is quite relevant. Also, I don’t know why they say “up to 70%” but never mind.

Looking at how we got to these 28 women who did not take antibiotics, I think it’s fair to say that this 70% figure is in no way going to apply in a wider more general sense, to all women suffering from uncomplicated UTIs (Of course! Because this is not the purpose of the study!) It’s up to you whether you think WDDTY are trying to infer this from their article, but I think they do, as I’ve said.

Of course there is lots of other stuff in the paper that you are never going to capture if you condense it into four sentences. Data from the women was collected pertaining to the severity of their symptoms, whether they’d had a UTI before, whether they thought they were currently suffering from a UTI etc. and a urine sample was checked for blood, nitrites and leukocytes (all of which indicate infection) and was sent of to a lab to see if any bacteria were present. It is interesting to look at this data and look at the differences between those the GP asked to delay and those that the GP didn’t; those who agreed to forgo antibiotics and those that didn’t; and those that managed the 7 days without antibiotics and those that decided to take them even after agreeing to delay as long as possible.

I don’t really want to go into all these details right here, as I think the main point is that none of this has been mentioned at all, (nor have the limitations of the study) but I do find it interesting for example, that women who had haematuria and leukocyturia on urinalyis were less likely to be willing to delay antibiotic treatment when asked. Also of note, is that when the results of the culture came back it turned out to be positive for 51% (26/51) of the delaying women and for 67% (58/86) of the non-delaying women. This is especially interesting in light of the fact WDDTY is trying to make out these 28 women (not that they tell you there’s only 28 of them) who ended up delaying treatment are somehow representative of the wider population.

Whether you agree with me or not that WDDTY are trying to take this study and infer that 70% of women in the general population can get better from a UTI without antibiotics, it’s definitely fair to say that there is no mention of any of the above. There’s definitely a lot of context missing.

But what can you do when all you’ve got is four sentences.

Well you could at least try to get the last one right. I repeat:

One-third of the participants agreed [to forgo antibiotics], and nearly three-quarters of those women were better or had improved symptoms within a week, the researchers reported.

Do you see what they did there? In trying to give at least some context to this figure of “up to 70%” (or as they now call it “nearly three-quarters”) they have chosen to completely ignore the fact that not all participants who said that they would delay treatment did in fact stay off antibiotics. The 70% figure comes from looking at how many of the remaining 55% of participants, that did actually stay off antibiotics, (ie. 28) got better. Not by looking at how many of the one-third of participants that agreed to not take antibiotics (ie. 51), got better, which is what WDDTY would have you believe.

If you want to look at the amount of people who got better expressed as a percentage of the participants that agreed to forgo antibiotics then it would be 20 out of 51, by my reckoning. Which is 39%. Which is not nearly 75%. So I think that sentence is plain wrong. Never mind lacking in context and likely inferring things that shouldn’t be inferred, just wrong.

Overall not a great 4 sentences. At best the article is meaningless, out of context nonsense. At worst it’s misleading and inaccurate.

Have I been unfair? Please let me know if I have, or if there are any inaccuracies, or if there is anything that I could write more clearly. I’m not an expert at this. I haven’t quite got through my Big Pharma Shill training yet.

What Doctors Don't Tell You
Why don’t doctors tell you that UTIs sometimes get better on their own without antibiotics?
They do.