Tag Archives: inflammation

WDDTY on depression

depression
Until coffee was discovered, people committed suicide all the time. Sometimes twice a day.

WDDTY makes some predictably reckless claims about depression, a serious condition which, if neglected, can destroy (both metaphorically and literally) the life of the sufferer and those around him or her. Needless to say, they conflate “feeling a bit low” with clinical depression, because money. The NHS has information on the symptoms of clinical depression here, with a simple test anyone can do. There is advice on what to do and telephone numbers to call if the situation is urgent. Certainly modern medicine does not yet have a perfect answer to the problem of depression, which presents in a number of forms and may well have a number of causes; nevertheless, this imperfect response is infinitely preferable to the completely and dangerously wrong fuckwittery to be found on the WDDTY website.

For example:

The great depression deception (WDDTY, Vol 23.3, June 2012)
Chronic depression has been described as the disease of modern times. It afflicts 121 million people worldwide (1), which equates to around one in 10 adults, while one out of every 13 Europeans is currently (2) taking an SSRI (selective serotonin reuptake inhibitor) antidepressant such as Prozac to counter it.

Tragically, they are all being poorly served by medicine, which is working with an unproven, and flawed, theory of the causes of depression, and with drugs that are doing more harm than good (3).
Instead, a new theory is developing that suggests that depression is the byproduct of the body’s natural inflammatory response to infection (4). If true, an anti-inflammatory would be a better drug therapy than an SSRI (5), and this is supported by the evidence (6), which has found that the SSRI drugs are ineffective in around two-thirds of depressed people (7) (Am J Geriatr Psychiatry, 2011; 19: 839–50).(8)

  1. Wrong. The WHO says over 350 million and simple arithmetic says neither that nor WDDTY‘s figure equates to 10% of 7 billion.
  2. Untrue. The report WDDTY is presumably referring to says, according to Science Daily: “One in thirteen of adult European citizens — and 10% of middle-aged Europeans — took an antidepressant in the previous twelve months“.
  3. A blatant lie. The increase in antidepressant prescription over recent years correlates with a decrease in the suicide rate. While a direct link has not, as far as I know, been shown, it is certainly not evidence of the drugs “doing more harm than good”.
  4. Again, this is misleading. It suggests a single cause for depression. The study I found (dated 3 Sept, 2012, and published in Archives of General Psychiatry) looked at patients with moderately hard-to-treat depression who also suffered from chronic inflammatory diseases, because there is a known correlation between hard-to-treat depression and chronic inflammation.
  5. Again, this erroneously assumes a single cause for depression, and on the basis of a single study to boot. It’s like saying all cancers can be treated by the same drug, or that if we find a treatment for cystic fibrosis it will also work for other genetic disorders, such as dwarfism and Down’s.
  6. Which, you will note, is not forthcoming. Unsupported assertion.
  7. I can find no other instance of this assertion, which I can only conclude has been internally (i.e. rectally) sourced by the anonymous author. Or again, it may be based on a single study on a specific population, and WDDTY has once more massaged the language to make it apply to the general case.
  8. This is the best part of all. I looked up the article at Am J Geriatr Psychiatry, 2011; 19: 839–50. It is not the study the author is referring to. Or, if it is, he/she has been spectacularly dishonest in presenting it. The reference is, in full: The American Journal of Geriatric Psychiatry Volume 19, Issue 10 , Pages 839-850, October 2011 “Complementary Use of Tai Chi Chih Augments Escitalopram Treatment of Geriatric Depression: A Randomized Controlled Trial”

Geriatric depression. In people who have doubtless suffered chronic inflammation for a long time, on top of all the other problems of ageing, and who are taking an anti-depressant. All the abstract confirms is what we suspected all along: a little gentle exercise and socialising does you good, especially as you get older, frailer, and more likely to find yourself isolated.

There’s more to that WDDTY article, much more: all of it similarly debatable, disingenuous or downright dishonest. It all boils down to the usual “self-diagnosis and supplements” mantra you expect from the anti-health extremists. Here’s a second example from another piece, this time online:

Coffee helps ward of depression and suicidal thoughts (30 July 2013)

Caffeine in coffee acts as a mild antidepressant that could even be enough to stop someone committing suicide.
Drinking two or more cups of coffee day reduces the risk of suicide by around 45 per cent, say researchers at the Harvard School of Public Health. They think that caffeine boosts mood hormones in the brain, and stops us feeling depressed. But the benefits seem to stop at around three cups, or 400 mg of caffeine a day, they say.

The published research is here. Notice the title: “Coffee, caffeine, and risk of completed suicide” – completed suicide is not the same thing as suicidal thoughts, or even suicide attempts. It’s a pretty crude measure, really. Notice that WDDTY uses affirmative verbs – “helps”, “acts” – while the researchers themselves carefully employ the conditional – “may”, “appears” and so on. And a “lowered risk of depression” is not the same thing as “stops depression”, otherwise no coffee drinkers anywhere would ever be depressed.

There are other examples of WDDTY’s reckless, misleading and irresponsible reporting on depression, mostly involving the old warhorse of nutrition. Depression is due to bad diet, to lack of various B-vitamins, to hypothyroidism… Well, the last one isn’t entirely false: untreated hypothyroidism can result in depression, but the assertion that “diagnosing hypothyroidism isn’t easy” is a downright lie. It’s very easy; all you need is a blood test. The test is a bit of a pain, admittedly, but only for the patient who’s forgotten to bring music or a podcast to listen to. The biology side of it is pretty simple.

My third and final example of WDDTY’s deadly fuckwittery on the subject is this headline from their webshite. Just the headline, as it’s quite evil enough:

Alternatives to drugs for depression

I find ripping the balls out of WDDTY’s vicious, mercenary falsehoods a briefly stimulating alternative to getting roaring drunk and playing Pink Floyd’s The Wall at neighbour-baiting volume, but it hasn’t cured my depression. Nor will taking extra doses of vitamins that I already get a full daily dose of in my normal diet. Drinking more coffee not only doesn’t cheer me up, it proactively treats any incipient constipation for the next 48 hours, so stuff that. No, all things considered, I’ll keep taking the pills, thank you very much, and make sure I always have someone to get in touch with when things get on top of me.

Also posted at Plague of Mice

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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