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What Doctors Don’t Tell You is wrong about autism

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

Reblogged with permission from penumbrage.com

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

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

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

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

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

The Autism Explosion

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

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

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

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

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

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

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

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

It’s All In The Gut

WDDTY argues that

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

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

Statement 1 (Key Statement)

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

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

Statement 4

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

Statement 5

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

Statement 11

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

Statement 12

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

Statement 18

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

Statement 19

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

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

Antibiotics and Processed Food

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

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

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

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

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

Gluten and Casein

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

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

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

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

Meanwhile back in the UK

WDDTY turns to:

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

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

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

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

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

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

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

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

Pick a card, any card …

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

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

The Bits on the Side

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

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

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

Aspirin to greater accuracy

Sorry about the bad pun.

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

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

The John Diamond Challenge

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

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

Doctors misdiagnose depression 86 per cent of the time

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

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

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

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

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

Continue reading Doctors misdiagnose depression 86 per cent of the time

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.)

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

The paranoid delusions of Lynne McTaggart

Reblogged from Guy Chapman’s Blahg.

Andrew Neil sums up conspiracy theories as expounded by Alex Jones
Andrew Neil sums up conspiracy theories as expounded by Alex Jones

It’s not news that SCAM believers are also into conspiracy theories. Global epicentre of bullshit The Whale is only the most notorious example of the crank magnetism that draws believers in the unverifiable and implausible together.

Naturally this provides a fertile source of mirth. For example, Lynne McTaggart stated as fact that I am @_JosephineJones, an idea so self-evidently ludicrous that I had no reservations over replying: “Yes, Lynne, you’ve got me: like electrons, there is only one skeptic in the universe, I get about a lot”.

McTaggart believed it! And when @JoBrodie pointed out it was a blindingly obvious piss-take, Tat Maggot deleted Jo’s comment because free speech is so important.

Today, another one:

loon mctagnutYes, according to Loon McTagnut not only am I Josephine Jones, I am also @southwarkbelle. And a Dark Lord of Google (I love this, I am so shit at SEO that I will substitute her reality for mine on this, any time!).

Better still: apparently there are “canaries in [my] midst”, which raises the rather amusing possibility that Lynne is not just making this shit up out of thin air, but being actively and very expertly trolled. Whoever it is, keep it up!

Obviously there’s a serious side. McTaggart seriously believes that there is a sinister conspiracy to discredit her, using such underhand techniques as demonstrating her history of AIDS denialism. The bastards.

Actually of course we suck badly at conspiracy. Rule no. 1 for a successful conspiracy: don’t do it using open social media platforms like Twitter and Facebook.

And collaboration is not conspiracy. Of course we collaborate and share and talk and joke, we have a lot of interests in common, especially debunking quackery and bigging up SCIENCE, because it rocks.

Get a group of skeptics together you’d almost certainly find we’re all fans of Ben Goldacre and the Infinite Monkey Cage. You’ll also find that we’re very different. The youngest are teenagers, the oldest are retired. There are gay men, young mums, single people, secular Muslims, atheists, even Christians. Most of us have a scientific education, that’s the root of the common ground.

batshitAnd it’s why the cranks will eventually lose. Nothing about SCAM is new, really: the cognitive errors are old, the appeals to fallacious reasons are old, the conspiracy theories are old. Nothing about modern SCAM is in any way qualitatively different from the 19th century snake oil salesman or the bible-belt creationist.

And if you look at the lesson of history, increasing societal education tends to correlate with decreasing belief in gods. The New Age will wane as the religions of old waned. And the public will again move away from belief in nonsense. At least I hope so.

I just hope it doesn’t take a modern-day equivalent of the 1950s polio epidemics to cause people to wake up and smell the bat guano as sold by every woo-monger in Britain.

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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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.

WDDTY, Guy Hudson and Electrosmog: Editorial or misleading advertorial?

Editorial or Advertising?

Reblogged with permission from Slipp Digby 

Apparently Guy Hudson's customers spend so much on his crank products that entire families to share one bed.
Apparently Guy Hudson’s customers spend so much on his crank products that entire families have to share one bed.

The latest edition of What Doctors Don’t Tell You (December 2013) contains an article from self-styled ‘Electrosmog Doctor’ (and dowser) Guy Hudson. I say article, but perhaps that is open to question, since amongst the general (and free to implement) recommendations, he suggests some very specific and potentially costly measures that readers should take, and which he is rather familiar with.

Top of the 10 point plan for reducing electrosmog in the bedroom is this

1. Sleep earthed and reduce dirty electricity.  To start with, when I’m surveying I give absolute priority to creating a beneficial environment for each persons sleeping environment

and how does Guy suggest doing this? Continue reading WDDTY, Guy Hudson and Electrosmog: Editorial or misleading advertorial?