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Reblogged posts from other sites

‘WDDTY’ about foot-in-mouth syndrome

(Reblogged with permission from Labcoats Unbuttoned)

I was recently (for a short while) involved in posting on the Facebook page for our favourite magazine, ‘What Doctors Don’t Tell You’. We’ve talked about this rag before, but since then the ‘war’ between the skeptics and the toilet paper has escalated in spectacular style. Rather than try to document this here, it’s probably best to link to the ‘Master List’ drawn up by Josephine Jones on her blog, which is a comprehensive summary of both the dangerous reporting in the magazine along with responses from consumers and retailers regarding the recent attempts to have their ‘homeopathy for cancer’ issue withdrawn from sale in major supermarkets. It’s a fantastic resource, and worth going through.

Now, I WAS engaged in online debate with some of their fans and readers, but this is sadly past tense. Why so? This is because I, alongside several other skeptics, got banned from the page, with our comments deleted leaving embarrassing threads of people who appear to be talking to themselves. From a magazine that cries ‘FREE SPEECH!’ as soon as anyone does something so pesky as I don’t know, ASKING THEM TO BACK UP THEIR CLAIMS WITH EVIDENCE, this is somewhat hypocritical. Apparently we were deleted for (non-existent) ‘personal attacks’, yet a WDDTY supporter who called me a ‘plebeian wage slave’ remains on the page.

One thing that really struck me when talking to people on the page, was the brainwashed, cult-like mindset of some of their ‘followers’. Homeopaths serving up so-called evidence for their claims: that I expected, but what really saddened me was the hero-worship from the general public, who genuinely seem to believe that Lynne McTaggart and her magazine are spearheading a noble crusade against evil Big Pharma. Never mind the dozens of scientists providing concrete evidence to refute their claims-they must all be being paid to do so. It’s classic conspiracy thinking, and very, very similar to what we saw with the Umlingo juice for HIV. Then, as now, the ludicrous claims are so laughably easy to debunk that it is truly exasperating how some people can be so blind. There is genuine ignorance and there is genuine wickedness, and the irony is that while they dismiss their critics as being in the pay of Big Pharma, they publish articles about vitamin C curing all diseases alongside full-page, paid adverts for vitamins. Hypocrisy? Surely not?.

Sometimes Quacks can be somewhat clever. Ben Goldacre devoted an entire book to the clever and subtle tricks that can be used to mislead when it comes to science and in particular healthcare science. Statistics are tricky, and it’s easy enough to manipulate them so that your average untrained (or even trained) eye glosses over the error. What WDDTY do is on a whole other level. It’s so hilariously botched, so pathetically obvious that you almost have to admire their nerve in keeping a straight face as they spout this crap.

Case in point: the most recent post on their Facebook page (and on Lynne McTaggart’s own social media pages):

OUR ESTIMATES OF HARM FROM HPV VACCINE WAS TOO CONSERVATIVE 

We’ve been attacked for reporting that the HPV vaccine has been linked to 68 deaths, but our figures now seem too conservative.

An issue of Morbidity and Mortality Weekly Report (July 26, 2013 / 62(29);591-595), the weekly report prepared by the US government’s Centers for Disease Control and Prevention, says that between June 2006 and March 2013, the US’s Vaccine Adverse Events Reporting System has received approximately 1671 reports to be exact – of ‘serious’ adverse events occurring in girls who’d received the HPV4 vaccine. 

Reports are classified as ‘serious’ if they include one or more of the following, said the CDC: hospitalization , prolongation of an existing hospitalization , permanent disability, life-threatening illness, or death.

This relates to a previous article Labcoats Unbuttoned did on HPV vaccines  and we mostly dealt with the actual vaccine in that post. I’m bringing this up again to illustrate a point about how not only does this magazine cherry pick, mislead and manipulate, they very simply flat-out LIE, and that is the only way of putting it.

They’ve often been criticised for not posting their references, well here they did, and thus the egg met the face. Their ‘source’ is this CDC report. I thought I’d go through what they are claiming and compare it to what is in the report. ‘1671 reports of serious adverse effects’ – true, but neglecting to mention that this is out of 56 MILLION doses given from June 2006 through March 2013. They actually received 21,194 reports of adverse effects, 92.1% of these were classified as non-serious. These can include things like fainting (common in people with a phobia of needles) through to hives, slight fever, localised redness or swelling, etc. These adverse effects are seen across all vaccines. In the ‘serious’ adverse effects, the most common included headaches, fever, weakness, nausea and vomiting. Now, as we addressed previously, serious side effects are an unfortunate part of any vaccination program. They do occur, at rates which are clearly defined (by this exact sort of report on the available data) and there is no ‘cover up’. Actually, 1 serious adverse event in approximately 35,000 doses is in line with or slightly better than what you would expect for most vaccines. No health intervention comes without risk.

What is crucial is that the risk is balanced by the reward, and here WDDTY have been very sneaky indeed. They’ve splashed their ‘evidence’ with a misleading headline and a negative spin, completely neglecting to mention that actually, the report then goes on to discuss that there is no good evidence the vaccine is unsafe, and makes strong, unambiguous recommendations that we need to improve the current vaccination program to ensure better uptake of the HPV vaccine. Far from supporting their agenda, this report directly contradicts them – WDDTY says the vaccine is dangerous while quoting a report that says more people need to have it.

Here is the crucial paragraph in the document which WDDTY seem to have scrolled past:

‘Approximately 79 million persons in the United States are infected with HPV, and approximately 14 million will become newly infected each year. Some HPV types can cause cervical, vaginal, and vulvar cancer among women; penile cancer among men; and anal and some oropharyngeal cancers among both men and women. Other HPV types can cause genital warts among both sexes. Each year in the United States, an estimated 26,200 new cancers attributable to HPV occur: 17,400 among females (of which 10,300 are cervical cancer) and 8,800 among males (of which 6,700 are oropharyngeal cancers).’

That is what this vaccine is trying to protect people from. WDDTY, rather than addressing these statistics, choose instead to stick their fingers in their ears and LALALA, claiming that only 4000 new cases are reported every year. Unsure where they got that figure from – I assume they are capable of reading the paragraph above as well as I can. But I’ve given up on expecting better from them. I’m sad, however, that I’m now banned from the page and can’t call them out on their misguided claims and hypocrisy. One of their supporters, having read the report and as expected, become very confused as to why their claims didn’t match their reference, concluded that it was a ‘CDC’cover up, as it contradicted what WDDTY was saying. If that isn’t worshipping at the altar of a dangerous cult, I’m not sure what is, but for now I’ll sit here and wait, either for Lynne to get back to me on Twitter or for someone to magically produce whatever evidence WDDTY are privy to that the CDC are not. On both counts, I think I might be here for a while.

Legal, decent, honest and truthful

asaIn the UK, advertisements must be legal, decent, honest and truthful. WDDTY’s advertisements have a bit of a problem here.

Fortunately, the Advertising Standards Authority have produced a series of handy guides for advertisers of SCAM, while Jo Brodie has helpfully posted the following useful information:

It [is] the Committee of Advertising Practice who set the guidelines that the Advertising Standards Authority uses in determining if marketing and advertising material are OK, or not. Since a large number of complaints are made about misleading websites promoting alternative or complementary health treatments the section on ‘Therapies’ is now quite extensive, reproduced below.

I like to think of this as a handy list of itemised nonsense. It is not illegal to sell any of these treatments, as far as I’m aware, but it is not fair to make claims for them that cannot be defended.

In each there are two aspects to consider (1) health-condition-specific concerns and (2) treatment-specific evidence.

(1) Health-condition-specific concerns
If an advertiser is making claims about treating really serious health conditions (asthma, cancer, diabetes, depression, high blood pressure etc) but isn’t medically trained themselves or doesn’t have access to a doctor in their clinic then the ASA is more immediately concerned about the customer not having appropriate medical care. The evidence for the actual therapy becomes a secondary concern in this situation. The ASA has also expressed concern if it thinks that customers may be discouraged from seeking appropriate medical care.

(2) Treatment-specific evidence
This covers all the claims that are made for the treatment and the ASA appear to want ‘robust evidence’ – generally the sort of thing that’s published in peer-reviewed journals, ideally a meta-analysis of smaller trials. Evidence from individual small trials is more of a compass bearing than an agreement that you’re in a particular place and not generally seen as robust, it depends on the study of course. Testimonials don’t count.

Full alphabetic index: AdviceOnline index
Searchable index: AdviceOnline database

The relevant T section including all therapies currently listed, I added Testimonials as a bonus.

Thanks, Jo! So now WDDTY’s advertisers will have a quick reference to check what they may and may not claim. And of course this is doubly important now that Trading Standards have become ASA’s legal backstop, making it dramatically easier for ASA to take enforcement action against non-compliant advertisers.

WDDTY and Tesco’s corporate irresponsibility

WDDTY and Tesco’s corporate irresponsibility

Reblogged with permission from Dianthus Medical

I’ve written before about the magazine “What Doctors Don’t Tell You”, but just to refresh your memory, it is a dreadful pile of nonsense, carrying dangerously misleading health advice. It includes such gems as suggesting vitamin C can cure AIDS or that homeopathy can cure cancer. If you want to know more about just how outrageously irresponsible the magazine is, you might want to visit http://wwddtydty.com or look at Josephine Jones’s impressive list of links.

Now, perhaps none of this would matter very much if it were a subscription magazine where alternative medicine cranks could get their monthly fix of drivel and the rest of us didn’t have to worry about it too much. But I think it does matter when respectable high street retailers stock the magazine. That makes it look like a respectable source of health advice, rather than the crazy conspiracy theory nonsense that it is. If someone walking into a respectable retailer saw this magazine in their “health” section, then they might think it is something to be taken seriously. The consequences of that could be tragic. Beyond Positive have written eloquently about the dangers of persons living with HIV being exposed to such dangerous advice.

Sainsburys briefly stocked the magazine, but to their credit, they have since withdrawn it from sale after it was pointed out to them just how dangerous the magazine is. Tesco, however, is another matter. They continue to stock the magazine.

Tesco’s response has been something of an eye opener. They have clearly decided on a position on stocking WDDTY, but do not seem able or willing to explain their position. Their position, as set out in the standard template email that their customer service department has been using to respond to anyone contacting them about WDDTY, reads as follows:

Thank you for your email.

I understand you have concerns over the magazine, What Doctors Don’t Tell You, and I can appreciate your views on the matter.

We are in the position of offering our customers choice rather than appointing ourselves as censors or moral guardians. The publisher of this magazine prints on page 3 a liability statement advising readers to consult a qualified practitioner before undertaking any treatment.

While we cannot comment on the contents of these magazines, your comments have been duly noted and fed back to our Buying Teams.

One thing to note in passing is that their claim not to act as “censors or moral guardians” is obviously not true. Acting as censors and moral guardians is exactly what they did about “lads’ mags” and a rather offensive Halloween costume. I did try asking them why they sometimes act as censors and moral guardians and sometimes don’t on their Facebook page. They initially replied simply to say that they had removed the Halloween costume from sale (which I already knew) and completely failed to answer my question, which does suggest that the people Tesco put in the position of interacting with the public are not exactly completely engaged in their role. When I pointed out that they hadn’t answered my question, they replied again to promise that they’d get back to me, but of course they never did.

Screenshot from 2013-11-22 11:43:47

I also raised my concerns specifically about the magazine on Tesco’s Facebook page, but alas all I got was the same template response that others had got.

Screenshot from 2013-11-22 11:49:17

Sound familiar?

Well, I didn’t feel that there was much point pursuing this with Tesco’s customer service team as they were clearly only going to keep parroting the same answer. But I did notice that Tesco claim on their website to have a “Corporate Responsibility” team. So I thought I’d email them and point out the disconnect between selling WDDTY and their corporate responsibility principles, one of which is “Helping and encouraging our colleagues and customers to live healthier lives”. This is what I wrote:

Dear CSR Team

I see that you have a clear policy about helping your customers to make healthy choices. That is admirable, but it seems that one of your purchasing decisions is really not living up to it.

I gather that you sell “What doctors don’t tell you” in your magazine sections. This magazine is dangerous. It consists of much health misinformation (for example, advice to avoid life-saving vaccinations against diseases such as measles or whooping-cough), and if any of your customers were unfortunate enough to believe the articles in it, then their health could be put seriously at risk.

There is a good reason why doctors don’t tell you most of the stuff you read in that magazine, in much the same way that car mechanics don’t tell you to care for your car’s bodywork by regularly driving through salt water.

If you are not familiar with the magazine and would like to read more about just how dangerous it is, there is a useful list of resources here:

https://josephinejones.wordpress.com/2013/03/12/wddty-my-master-list/

I urge you to reconsider your decision to sell the magazine, as it seems to be in clear breach of your CSR policy on helping your customers to live healthy lives.

Kind regards

Adam

PS:

As I’m sure you’re all too aware, CSR policies are often regarded with some cynicism as mere window dressing, not backed up by any meaningful action. This is your chance to prove otherwise!

Tesco’s corporate responsibility team did not respond.

After a decent interval had elapsed, I asked them on their Facebook page when I might expect to get a response. No reply. So a little while later, I asked again. This time, they did reply. They said they couldn’t find my email, and could I forward it to their customer service department. I did so, making it very clear that it was not intended for their customer services department, but for their corporate responsibility department. This was the response I received:

Dear Adam

Thank you for your email.

I understand you have concerns over the magazine, What Doctors Don’t Tell You, and I can appreciate your views on the matter.

We are in the position of offering our customers choice rather than appointing ourselves as censors or moral guardians. The publisher of this magazine prints on page 3 a liability statement advising readers to consult a qualified practitioner before undertaking any treatment.

While we cannot comment on the contents of these magazines, your comments have been duly noted and fed back to our Buying Teams.

Thank you for taking the time to contact us.

Kind regards

Rachel Barnes

Tesco Customer Service

Sound familiar?

There followed much frustrating to-and-fro, both by email and on Facebook, while I asked them if I could have a reply from their corporate responsibility department. Mostly, they simply didn’t understand the question. Eventually, however, we seemed to make progress.

On Facebook, I was told that the corporate responsibility team would not reply to me directly, but would simply send the standard response from customer services that everyone else sent, because they like to ensure that their replies are consistent.

Screenshot from 2013-11-22 12:16:04

On the same day, I received the following email from someone else in their customer services department:

Dear Adam

Thank you for your reply.

I would like to advise that in order for you to contact our Corporate responsibility team you would have to put it in writing to our Head Office in Cheshunt and the address is as follows.

New Tesco House
Delamare Road
Cheshunt
Herts
EN8 9SL

Once again thank you for your reply.

Kind regards

Stephen Horn

Tesco Customer Service

So much for consistent replies.

Well, I did indeed do as Stephen suggested and I wrote an old-fashioned letter on a real piece of paper and put it in the post. That was getting on for 4 weeks ago, and I haven’t had a reply. I don’t honestly expect to get one.

Now, I dare say that Tesco’s corporate responsibility team have other things to worry about. Trying to make sure that not too many of the people who make their clothes in sweatshops in Bangladesh get killed in unsafe working conditions probably keeps them quite busy. They probably also need to spend a certain amount of time figuring out what kind of farm animals are in their ready meals and just how dishonestly to respond when they’re caught selling the wrong kind.

But still, it’s now about 2 months since I first contacted them. Is it really too much to expect a brief reply? Perhaps Tesco don’t see this as a corporate responsibility issue. Well, that’s their prerogative, but I don’t see why someone in their corporate responsibility department couldn’t at least have taken the trouble to spend 5 minutes writing an email to say so. Can we really take Tesco’s commitments to corporate responsibility seriously if their corporate responsibility department so completely fails to engage with members of the public? I do wonder whether their corporate responsibility department even exists. On Twitter, Tesco assured me that it did, but I have yet to see any evidence of that. Certainly never got the promised reply.

Screenshot from 2013-11-22 14:36:06

To my mind, this is absolutely a corporate responsibility issue. By selling WDDTY, Tesco are giving it a stamp of respectability. This is not about “free speech” or whether anyone is trying to “ban” WDDTY, despite some folks’ attempts to paint it that way (those arguments have been dealt with comprehensively by Matthew Lamand Andy Lewis). It’s about whether it’s responsible for retailers such as Tesco to give WDDTY an implicit stamp of approval. Anyone taken in by that false impression of credibility could be harmed, and I don’t think that’s a responsible way for Tesco to act.

 

And Now A Word From Our Sponsors…

And Now A Word From Our Sponsors…
In 1989, Lynne McTaggart promised The Times that WDDTY would take no advertising in order to remain “pure”. A quote from the Times piece is still used today as an endorsement on WDDTY’s home page.

Whether or not WDDTY originally set out to be a factual journal describing alternative treatments, the fact is that its current content makes it part of the SCAM industry’s PR machine, the network of blogs, websites and junk journals that makes the claims the industry cannot legally make, allowing SCAMmers to maintain the fiction of advertising on an “availability only” basis.

Wandering Teacake takes a look at advertising income and specifically analyses how that correlates with advocacy for a particular form of woo. The results show that – like any other magazine in the segment – content may be driven by the availability of advertising revenue as much as by the agenda of the editors. The analysis further undermines WDDTY’s specious claims to independence from vested interests.

Continue reading And Now A Word From Our Sponsors…

Homeopathy is “more than placebo”

Homeopathy is “more than placebo”
Much more than placebo: homeopathy reverses cancer (March 2012) is one of the articles that first drew large scale skeptical attention to WDDTY. Few skeptics are unaware that homeopathy is nonsense on stilts, and the claim that it can cure cancer is spectacularly inappropriate for a “health magazine”.

In February 2013, WDDTY published a short followup based on a report in BMC Cancer under the heading Homeopathy is “more than placebo”. Does the source support this?

What Doctors Don’t Tell You cites paper that demonstrates there is no such thing as homeopathy

Reblogged from leeturnpenny.com with permission.

Absolutely not just water. Which is why they always illustrate it with... water.
Absolutely not just water. Which is why they always illustrate it with… water.

Back in that supermarket a few days ago, I again found myself driven to taking a thumb through the latest edition of QuackRag What Doctors Don’t Tell You, whose unscrupulously permissive advertising policy is being systematically exposed by The Nightingale Collaboration. Though I didn’t buy the rancid rubbish, I alighted on a small piece entitled ‘Homeopathy is more than placebo’, from which I noted the reference cited as voucher for that statement. From BMC Cancer, no less. I’ll have a look for this, I thought.

Which, thanks to the people’s friend that is Open Access, didn’t take long. The Research article in question is entitled ‘Classical homeopathy in the treatment of cancer patients – a prospective observational study of two independent cohorts’. ‘Classical’? Which means what? Original? Real? Authentic? As opposed to… progressive? Odd qualifier, I frowned, immediately noting also that the title suggests description of a study methodology, but with no conclusory statement regarding the relative efficacy of homeopathy and placebo. So, what’s going on? Is WDDTY mis-appropriating a piece of research? Or is it citing a piece of ropey alternative ‘research’? Or is there, indeed, something to this (which would be at odds with much of the promotional gimmickry to whichWDDTY resorts)? Assumptions can be problematic: time for a print-out and red pen.

The Background provides early warnings, commencing with a justification seemingly based on the popularity of homeopathy, though whether this is justification for its use, or for this study, I’m not certain. There is prevarication somewhat as to whether homeopathy is clinically effective – ‘a matter of heated debate’ – and selective citation of a conveniently limited set of references in order to provide an illusion of ‘balance.’ I don’t know whether or not the authors deliberately obfuscate here, but let’s be clear: there is no debate concerning clinical effectiveness. This is a media-propagated fallacy, a pedlar’s bandwagon jumped on by homeopaths aware that appealing to the ‘controversy’ keeps the ‘debate’ in the media, and hence the matter unresolved in the sympathetic public eye. Homeopathy is not clinically effective, in that it has no effect on organic disease. So, as we’re talking cancer, it does not cause tumours to shrink or disappear. And anybody who flogs its remedies on such basis is an irresponsible charlatan.

The question then, properly put, is not whether homeopathy is clinically effective… but whether it has an ‘effect’ on patients in a clinic – in this case, cancer patients. And this, I think (I hope), is actually the question that the author’s of this study attempted to address. In writing, ‘We wanted to study the clinical effects of classical homeopathy’, surely they mean ‘We wanted to study the effects of classical homeopathy on patients in a clinic’. Indeed, they state that, ‘The effects of homeopathy on quality of life in cancer patients has been studied very rarely’, a statement that this report is indeed of a study of the effects of homeopathy – not on disease – but on ‘quality of life.’ It is not about homeopathic ‘remedies’ and organic disease; it is about psychological/psychotherapeutic well-being. It is thus not (for reasons I will come back to argue later) specifically about homeopathy at all.

I do not/cannot dispute the improved ‘quality of life’ reported by cancer patients receiving some or other ‘alternative’ treatment to complement (prior or ongoing) conventional adjuvant therapy (ie chemotherapeutic drugs, radiotherapy, or other supplemental treatment following surgery). If the patients themselves report such, then who is to argue? They’re hardly going to lie about feeling good when they feel lousy, are they? Attentive care does make people feel better. This has nothing to do with the ‘remedies’ they are administered – not physiologically anyway. Yet the authors seem to be at pains to include attentive care under ‘classical’ homeopathy (explained by Rose Shapiro as the prescribing of a single remedy according to individual presentation or history), with critics being wrong to focus on the implausibility of potentised diluted remedies (ie, shaken water), when this is not classical homeopathy in totality. Such detractors miss the point that ‘classical’ also denotes the ‘individualisation’ that matches a patient to a continually adjusted ‘remedy’ regimen, according to detailed interviews recording the patient’s case symptoms, personality traits, social support (and what colour socks they wear on a Tuesday, or what not), etc. Kind of like a clinical horoscope. Hence, in one fell swoop, the double-blind Randomised Clinical Trial is rendered inapplicable, inappropriate; it is impossible to conduct such a trial of homeopathy proper, as (homeopathically-treated) patients, being different individuals, cannot be randomly combined into a group for objective measure. If a RCT only concentrates on the pilules dispensed for a specific ailment, and those pilules turn out to be no more beneficial than placebo, then that trial is invalidated because it has not taken into account the individualisation of subjects – which, as a RCT, it cannot do. Brilliant! Therein lies the circular logic of the homeopath’s justification for rejection of the assertion that homeopathy is no more effective than placebo.

WDDTY has absolutely never said homeopathy cures cancer.
WDDTY has absolutely never said homeopathy cures cancer.

What is necessary, the paper argues, is that because cancer (or other serious chronic disease) patients who seek out homeopathic care have preferences which exclude willingness to participate in a RCT, then any study is obligated to only consider treatments actively chosen by those patients ‘… since free choice is part and parcel of a potentially important therapeutic step.’ This would seem self-fulfilling – the patient will ‘feel’ better, because they have been empowered through choice. Can’t fail, can it? (Though I am very quizzical of the use of the word ‘therapeutic’ in this context.) Control is impossible. Oh, a point to note, if you are not already wondering, is that this homeopathic treatment was offered at homeopathic clinics, along with, or following, conventionalcancer treatment (90% of those opting for homeopathy did so to complement ongoing adjuvant treatment; only 10% went fully alternative, discontinuing conventional treatment). This presents limitations: for direct ‘matched pair’ (homeopathic versus conventional) comparisons, patients of comparable case history, disease progression and prognosis are necessary. And these could only be recruited from palliative stage care groups – that is, patients no longer receiving adjuvant treatment. However, the large differences between patient groups limited formable matched pairs to a number deemed insufficient for meaningful study. Therefore, the results are those of a longitudinal observational study of all consenting cancer patients, without separation of adjuvant and palliative stages.

Messy, isn’t it?

It gets messier. From the (to me) confusing second paragraph of the Discussion, we are informed that the homeopathic versus conventional group comparison is further complicated by the fact that patients receiving homeopathy were more severely affected and, for some reason, delayed commencing their care until four (diagnosis of tumour progress) to seven (initial diagnosis) months after those in the conventional group commenced theirs. This is given as explanation for the homeopathic care group having a higher rate of prior adjuvant (chemotherapy/radiotherapy) treatment. Like the shy questioner in a seminar audience, I feel I’m obtusely missing something obvious here: Why the delays? Why the higher rate of prior adjuvant treatment in the homeopathic group?

Presumably, these, and other, confounding factors were corrected for during the analyses of the data generated from the ‘… patient self-reports, taken at study entry and every 3 months over the course of one year…’– a year in which ‘… a larger proportion of patients under conventional treatment received chemotherapy or radiation…’. Is it unwarranted to question here the validity of those self-reports? Chemotherapy/radiotherapy is often uncomfortable, painful, miserable. It actually makes recipients very ill – and feel it for a while after – and consequently likely (one might not unreasonably predict) to tick low for ‘quality of life’; a score likely (again, predictably) to increase as side-effects fade with time following the treatment. So, if at the commencement of the study more time had elapsed since your last course of chemo/radiotherapy, that lengthening interim will affect how you score yourself. Particularly if you’ve felt empowered by exercising the option of ‘alternative’ care; and further opting, as did a much higher number in this grouping (with a higher rate of prior adjuvant treatment), for no more courses of misery-inducing chemo/radiotherapy. Couple that with lots of personalised attention and follow-up phone consultations, at a time when you perhaps feel vulnerable and alone, then you are bound to experience a sense of improved well-being (however marginal; however influenced by the ethnographical intervention of being asked how you feel – because the ‘presence’ of the attendant, attentive observer affects the ‘behaviour’ response).

Now, this paper was published in a respectable scientific medical journal and so was presumably peer-reviewed by academic types more suitably qualified than I to assess the corrections for confounding factors, the validity of the scoring, and statistical analyses thereon. As I stated above, I don’t dispute that there is a significant improvement in quality of life or mental fatigue (‘chemobrain’?) experienced by those receiving complementary (‘homeopathic’) care; it doesn’t surprise me. Which brings me back to my starting point onWDDTY and its citing of this paper as evidential argument that ‘Homeopathy is more than placebo.’ This now reads as an ambiguous statement, because it is unclear whether or not it refers to the administering of useless shaken water and sugar pilules (and in case you consider this unfair of me, be aware that WDDTY has shameless form on this kind of thing); or whether it is alluding to the other ‘aspect’ of homeopathy, the individualised care, as this study considers – in which case the statement reads as though accepting that the water and pilules are merely placebo; and misses the point that this study does not – because it cannot – evaluate against placebo. One is left to conclude, therefore, that Bryan & Lynne, or whichever lazy lackey to whom they delegated the task, failed to read the paper they refer to. Or deliberately mis-appropriate it. Because by citing it, WDDTY shoots itself in the foot. How so? Because the paper, in its emphasis on ‘classical’, delineating homeopathy into two separate components (‘It is important to notice that we have not studied the effect of homeopathic remedies, but of homeopathic care’) leads to the conclusion that there is no such thing as homeopathy at all. The homeopathic remedies themselves are no more than placebo; the homeopathic care is simply… care. Homeopaths have no monopoly on claiming origination of the provision of good care (palliative or otherwise), which ought to be separated out from homeopathy and its claims to treating the organic basis of disease.

But what if the ‘care’ component includes fermenting the expectation of the dispensation of ‘remedies’? In other words, the remedy and care elements cannot be considered separately. It is worth quoting at length from the final paragraph of the Discussion:

‘It goes without saying that this [care] is an intensive communicative, interactive process that operates via many different pathways, some of which are likely to be psychological and very general in the sense of a meaning response, some of which might be specific to homeopathic therapy and its usage of the remedies. It is also a likely scenario that homeopathic remedies are only active in an unbroken therapeutic context and that, at least for practical therapeutic reasons, the question whether homeopathic remedies are placebo or not, is irrelevant.’

It doesn’t go without saying – it needs to be said. Either the remedies have a biochemical, physiological effect, or they do not. We know they do not… because they contain no active ingredient. If, then, they can only ‘function’ as a ‘psychological device’, the question as to whether or not they are placebo is not irrelevant. It is what they are. I read this excerpt as arguing that ‘homeopathic’ care ‘works’ – in part – due to the anticipationof its remedies; and conversely, that those remedies can only ‘work’ as part of an overall ongoing individualised care process engendering that anticipation, leading inevitably to improved scores on subjective self-reported surveys. (Have I got that right?) Thus (conveniently for the pill-peddling homeopath), it is impossible to extricate and evaluate the discrete remedies relative to placebo in a properly controlled RCT – thereby shielding them from scrutiny. But if homeopaths use such interpretation as bullet-proofing their case that the RCT is inapplicable, then he/she cannot conclude – as WDDTY would have you – that Homeopathy ismore than placebo.

[I contacted the paper’s corresponding author to ask ‘whether you consider that the title of this magazine piece is used appropriately; ie do you concur with it as a statement, and to the reference to your paper in a magazine endorsing homeopathy?’ I have had no response. However, as there is an online comment facility, I will, again like the shy questioner in a seminar audience wary of asking a silly question, post a link to this piece there.]

Actually, this realisation, that any beneficial effect wrought by homeopathy is a consequence of the care and not the remedies, is nothing new. Although the recent not dissimilar findings published in another peer-reviewed scientific/clinical journal were apparently deemed insufficiently relevant, one might wonder why emphasis of this point in the accompanying editorial by Edzard Ernst isn’t cited. Ernst argues that a deficient empathetic care element in mainstream medicine could do well to adopt the therapeutic care boasted by homeopaths. But also that we must be honest with patients about the relative effectiveness of that therapy and any medicines administered. And in disregard of (the anticipation of) the claims made of homeopathic remedies – homeopathic care becomes simply… care.

Is it not through its invention and administering of implausible counterfeit remedies that homeopathy has created its own care industry and perpetuated the myth of its validity? Because orthodox medicine is (relatively) ‘bad’ at this (because it doesn’t have the time), the homeopathy alternative seizes the niche opportunity to present itself as the ‘good.’ We know that the ‘remedies’ themselves are useless, and that any effect is merely suggestive. If homeopaths could come clean on this, reject their nonsense shaken water and sugar pills (and forget the reaching pseudoscience), and concentrate on what does have an effect – the care – then we might envisage a fuller integration of a caring clinical sub-branch (re-trained nursing and counselling?), of benefit to all patients, and reclaim doing good from deluded do-gooders.

But the remedies are clung to staunchly; and hypocritically: when observation fits, numbers are irrelevant; when observation doesn’t fit, numbers are insufficient. Because without them, homeopathy is nothing. (Indeed, is not the term ‘homeopathy’ itself coined from its remedial irrationality?) Homeopaths (have to) believe the water and pills work; like other belief systems, homeopathy relies on something miraculous (and also appeals to the ‘spiritual’). But without the promise of these remedies entwined with the attention, the individualising component is revealed for what it is – care – and the homeopath is rendered redundant.

I posit (unoriginally) that those opting for homeopathy (providers and recipients) do so in the belief that it (will) make(s) them feel better, and so will be inclined to respond to questions as to their quality of life and (‘spiritual’) well-being in a more positive manner. Understandably, then, like other strongly held beliefs, homeopathy does not cope well with rational criticism. As John Diamond empathised, accepting and admitting that it is all useless, invalid knowledge would be impossibly difficult; the implication that it was all an unfounded waste of time taken as personal insult. And so, it must respond: presenting itself as ‘good’ through retaliatory propaganda painting impersonal-uncaring-vested interest-toxic-big pharma-mainstream-conventional-orthodox-medicine as the oppressing devil. Confirmation bias for the homeopathy zealot; page-filling material for publications like WDDTY.

Editorial note: Andy Lewis (@LeCanardNoir) has also covered this paper in detail and come to similar conclusions. The only kind of zombie that definitely exists is the zombie argument…

What Doctors Don't Tell You
Why don’t doctors tell you that homeopathy can reverse cancer?

Because it can’t.

Sick as a dog – another worthless advert in WDDTY

Reblogged with permission from westernsloth.wordpress.com, thanks to Dr. Matthew Lam (@DrMatthewL).

2013-11-apocapsSo I was just casually scanning over the most recent (November) issue of WDDTY – yes that issue with the atrocious homeopathy and cancer article – when my eyes glanced over an advert for:

‘Apocaps –The world’s first all-natural apoptogen formula’

Now I have to admit, when I see the prefix ‘apop’, I automatically think of apoptosis, the process of programmed cell death that plays such a vital role in many aspects of an organism’s development.  On closer inspection it’s clear that the product in question is selling something about apoptosis – something that got my interest having previously spent time in the lab researching that very mechanism.  So let’s see what kind of bullshit the team at ‘Functional Nutriments’ have concocted for this ‘world’s first’.

The product itself appears to be a pill made up of ‘natural’ chemicals for kick-starting apoptosis in dogs.  Now I don’t know about dogs, but as a human I would not be convinced by someone wanting to kick off apoptosis in my cells by feeding me a pill.  Sounds like a quick way to end up in the hospital.

The special ‘apoptosis formula’ (I have to keep putting these things in quotations because I just don’t understand what they mean) is a powerful nutraceutical supplement designed by Dr Demian Dressler.  A quick Google search on Dressler reveals that he once thought of himself as a conventional veterinarian but know considers himself a full spectrum veterinarian, combining the best of conventional medicine with nutraceuticals, supplements, diet and body-mind medicine.  He is co-founder of Functional Nutriments and the inventor of Apopcaps.

But what are Apopcaps? The advert doesn’t really give you any information as to what the product is or does – a common theme amongst adverts of quackery.  I had to log on to their wonderful website to find out more information.  I always find the ‘About’ section of these websites the best for finding bullshit.  Here’s what they have to say about Apopcaps:

‘Apocaps was created as dog lovers began asking for a simpler, easier way to give apoptogens to their dogs.’

Really?! What the fuck are apoptogens? I’ve never used the word before and a quick Google search reveals that apoptogen is only ever used in conjunction with Apocaps.  So without knowing what they are how does one know that they need a simpler and easier way to give them to their dogs?

‘The challenge was to find a combination of the most important – luteolin, apigenin, silymarin and curcumin and other key ingredients – in a formula that is absorbed by the body.’

Ahh..so here are four alleged apoptogens.  Two flavonoids (luteolin and apigenin), milk thistle extract (silymarin) and a curcuminoid (curcumin).  I know from experience that luteolin and apigenin have been shown to induce apoptosis in the lab.  But so have many other things.  So how much evidence is there that these chemicals could induce apoptosis in dogs?  I’ll answer that in due course, for now let’s continue with the spiel.

‘Because luteolin, apigenin, curcumin and silymarin are all natural substances, the body’s digestive and elimination systems could potentially use up or eliminate these apoptogens before they reach the bloodstream. We didn’t want that to happen.’

This statement hints at a complete misunderstanding of mammalian physiology.  I eat a lot of natural substances every day, if I spent all that energy digesting food only to shit and piss the best bits out, I’d be very unhappy.  Nutrient absorption in the gut is very effective.  It’s evolved that way over thousands of years so we can spend energy doing other things like riding bikes or blogging about stupid pseudoscience.

‘The patent-pending proprietary “Trojan Horse” formula used to create Apocaps “tricks” the body into circulating the apoptogens throughout the bloodstream.’

This sounds exciting but my sceptic radar detects bullshit.  I couldn’t find a shred of evidence for their ‘Trojan Horse’ formula or how it would work.

After looking at the entire website for Apocaps, I still could not find one statement that actually said what the product was for or for what conditions it should be given.  I mean: do you go into Dr Dressler’s clinic with your dog and he says:

“Yes, it looks like your dog has low levels of natural apoptosis; let’s boost this back up with Apocaps.  Don’t worry the active ingredients easily get into your dog’s circulation where they can have an effect on the whole body”.

Even if Apocaps worked, how would increasing apoptosis across your dog’s body help with anything?! It sounds like the least targeted form of chemotherapy ever made.  So back to my earlier question – is there any evidence that the four key ingredients have any effect on apoptosis in dogs?

The answer is no:

  • PubMed search for ‘Luteolin’ AND ‘dog’ – 8 papers, none on apoptosis
  • PubMed search for ‘Apigenin’ AND ‘dog’ – 11 papers, none on apoptosis
  • PubMed search for ‘silymarin’ AND ‘dog’ – 39 papers, none on apoptosis
  • PubMed search for ‘curcumin’ and ‘dog’ – 23 papers, none on apoptosis
What Doctors Don't Tell You
Why don’t doctors tell you that luteolin, apigenin, silymarin and curcumin restore apoptosis and stop cancer?

Because there’s no evidence it’s true

Oncologist: Lynne McTaggart’s use of chemotherapy figures “quite misleading to patients”

Reblogged with permission from slippdigby.wordpress.com

oncology-coverLynne McTaggart recently published another blog post titled ‘Medical McCarthyism‘ defending the content of What Doctors Don’t Tell You. In the post she attacks Cancer Research UK:-

According to Cancer Research UK, just over half of cancer patients survive beyond five years. This is the very attractive figure now being bandied about to convince us all that we’re winning the war on cancer.”

If you look at Cancer Research UK webpage you will find survival statistics and yes, the predicted overall five-year survival figures for those diagnosed with cancer in 2007 is 46% of men and 56% of women.

Despite these figures, Lynne goes on to quote some figures which she believes supports her case that conventional treatments are actually failing:-

“Actually, as WDDTY has reported, after cherrypicking the very best clinical trials showing positive results, Australia’s leading oncologists found that chemotherapy’s contribution to five-year survival was only 2.3 per cent in Australia and 2.1 per cent in the US (Ann Oncol, 2013; doi: 10: 1093/annonc/mds636).”

These claims were featured in What Doctors Don’t Tell You Volume 23 no 11.

Now ignoring the fact that chemotherapy is only one of a range of conventional treatments, this is quite a broad, unqualified statement which would give a lay person the impression that chemotherapy is very ineffective against ‘cancer’ full stop.

Cancer is however a complex range of diseases which respond differently to chemotherapy, so I was very curious where Lynne got these figures from – it turns out the reference quoted is a paper titled Bias in reporting of end points of efficacy and toxicity in randomized, clinical trials for women with breast cancer.

Now, I am not an expert on cancer and I couldn’t get access to the full paper, but just from the abstract it seems pretty clear to me that the paper cannot possibly support a broad statement about the overall efficacy, or failure of chemotherapy. I suspected that the paper Lynne meant to refer to was The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies which is deconstructed brilliantly by David Gorski here.

So I asked Lynne if this reference was a mistake on her blog. I got no response, which is worrying as the veracity of these claims and the evidence to support them – even in a blog post – is important. Lynne has also recently defended herself by claimed that she simply reports the finding of research without bias to allow people to make up their own mind.

I thought the best way to clear this up would be to contact the lead author of the original paper Lynne cited and ask him whether the quote above regarding his paper was accurate. He was kind enough to email me and his response I reproduce below, without further comment:

I think the statement is probably accurate but quite misleading to patients. Across all cancers, I suspect the contribution of chemotherapy to long-term survival  is quite low, given the prevalence of disease in the elderly and those never treated because of comorbidity, and the prevalence of minimally responsive common tumours (pancreas, lung, colon etc) where there will be little impact on 5yr survival.

However adjuvant chemo for breast and other cancers can have a substantial effect to improve long-term survival and there are many less common types (testis, lymphoma, leukemia, childhood cancers) where the effects are large.

It would be a tragedy if a young or middle-aged  woman with breast cancer or a man with metastatic testis cancer refused chemo because they believed there was only a 2% increase in long term survival.

With kind regards,

Ian Tannock

Ian F. Tannock MD, PhD, DSc
Professor of Medical Oncology,
Princess Margaret Hospital and University of Toronto

Why don’t doctors tell you that the success rate of chemotherapy is 2.3%?

Because it’s not true.

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What Doctors Don’t Tell You & Sainsburys

Reblogged with permission from nucella.wordpress.com

By @MrMWarren

Since the print edition of What Doctors Don’t Tell You appeared in September 2012 it has attracted a lot of attention from the skeptic community, bloggers, social media, and more recently mainstream media including the Guardian and The Times.

The magazine, whose masthead proclaims, ‘Helping you make better health choices’, promises to ‘uncover the hard-to-get facts about health and the causes of illness.’

In practice, this means promoting all manner of quackery and woo. This has been exposed by a large number of bloggers so I won’t spend time covering the issues here. Anyone who is interested should visit Josephine Jones blog where they will find and an extensive and ever-growing list of links to relevant sources.

Many bloggers take the view that retailers should consider whether or not they should continue stocking and selling the magazine. Please note, this is not a campaign for a ban on the magazine. It is a call for retailers to consider whether or not selling WDDTY is in the best interests of the retailer and their customers.

My position is clear. WDDTY contains articles and advertisements which are inaccurate and misleading which put the ill-informed and vulnerable at risk. Retailers who sell the magazine are doing their customers a disservice. I was pleased when I saw this series of tweets on Twitter.

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I do my shopping at Sainsburys. When WDDTY was first published I looked through the magazine section at my local store but couldn’t find a copy. I assumed they didn’t stock it. When I visited the store yesterday (Nov 5th 2013, 9.15 am) I was surprised to see this:

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When I got home I posted the picture on Twitter. I made no comment, no complaint, no demands. The response was immediate.

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I visited the store later in the day.

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True to their word, Sainsburys had removed WDDTY from the shelves.

WDDTY and their supporters will complain about censorship, denial of free speech and so on. This is nonsense. Mike Ward, posting on the WDDTY Facebook page (until he’s banned and his posts deleted) sums it up nicely:

No one is suppressing anything. If you wish to read or write nonsense about any subject under the sun, feel free, The (cyber) world is your oyster. Once, however, you start selling products or magazines and advertising them, you have to meet certain ethical and legal standards. Preying on vulnerable people with serious medical conditions like cancer, offering them false hope, and dissuading them from seeking evidence-based medical interventions does, I submit, not meet such standards.

Why don’t doctors tell you that Sainsbury’s sell WDDTY?

Because it’s not true!

BEYOND POSITIVE — OPINION: What Doctors Don’t Tell You – Dangerous Hypocrisy

Reblogged with permission from Beyond Positive, an online magazine for people living with HIV in the UK

Last week I was made aware of  a particularly disturbing publication. What Doctors Don’t Tell You (WDDTY) is a magazine available for sale in UK shops that peddles dangerous “natural alternatives” to “big pharma” – and they’re taking their dangerous nonsense to the next step.

AIDScoverOriginally starting as a website, and now in print form, WDDTY centres around a number of conspiracy theories all of which, they claim, result in your doctors withholding cheap and natural solutions to health problems from you – the patient.

One of their most frequently repeated (and saying something many times doesn’t make it true) claims is that our doctors are so far in bed with “big pharma” (drug companies) that they withhold these easy cures from us in order to line their own pockets. That’s quite simply, and objectively, nonsense. If the NHS could cure a patient by prescribing a banana and herb tea instead of spending hundreds, sometimes tens of thousands, on medication they would do so.

Far be it from WDDTY to miss out on a trick though. Their poorly written, badly researched and often dangerous articles are frequently accompanied by an advert for a ludicrously expensive vitamin supplement or miracle cream. So, WDDTY are annoyed that doctors are keeping us in the dark to make money from/for “big pharma”, but it’s OK to spout pseudo-science in order to push some hideously over priced potions? Hypocrisy thy name art WDDTY.

Many of their articles focus on low impact conditions such as acne or hay fever but earlier this year they published a piece entitled ‘Mega-cure for the incurables – Vitamin C fights it all from AIDS to measles’. The article claims that massive doses of Vitamin C can slow or even cure HIV, this is all based on decade old “research” that has been dis-proven time and time again in the subsequent years.

HIV is a complex retrovirus, for which there is no known cure. Billions upon billions of pounds, dollars and euros have been spent over the last thirty years in the attempt to both manage and cure HIV. If there was a cure already we’d know about it, and the pharmaceutical companies would be busy selling a vaccine to every person on the planet.

vitcNow, I get hundreds of emails each day – many of which are peddling some magic cure to HIV (the best one I had was rubbing beetroot on your feet). These people are out there, that’s a fact. But there’s a difference between a badly written email or blog claiming that someone cured their own HIV with pumpkin seeds, and a magazine using dis-proven science to push their own dangerous ideas.

The old adage “don’t believe everything that you read” seems appropriate here – the thing is many people do. By printing this dangerous nonsense in a glossy magazine and selling it through reputable high street stores they automatically gain a certain amount of credibility. I mean if an “expert” has written it and a magazine has printed it then it must be true – no?

Starting HIV treatment can be a big deal for lots of people. Your medication has to be taken at the same time every day – for the rest of your life. It can come with side-effects, and serves as a daily reminder that you’re living with HIV. So it’s far from surprising that some people wish to delay starting treatment for as long as possible.

These people, these vulnerable and worried people, are exactly the people who’ll come to harm from the nonsense peddled in WDDTY. Scared of HIV medication? Worry not, a glass of orange juice will cure that pesky HIV for you. Left unchecked and untreated over time a HIV infection will destroy your immune system and lead to death – that’s a fact. Thanks to modern medication we can live a full healthy life, but a tangerine isn’t a cure.

I’m asking, pleading if I have to, with the stores that stock WDDTY (including Tesco, Sainsburys, Waitrose and WHSmith) that they remove this dangerous publication from their shelves.

Store buyers and management: If you have a bad batch of burgers you withdraw them from sale to prevent your customers from e-coli. If you have a defective toy you recall it to stop children choking. You wouldn’t sell a magazine that promoted eating disorders or suicide. So I’m asking you to remove ‘What Doctors Don’t Tell You’ from your magazine selection before someone with HIV, Cancer or Diabetes follows these poisonous recommendations and dies as a result. By selling the magazine in your stores you are both legitimising WDDTY’s message and opening yourself up to potential law suits. Do the right thing here and withdraw WDDTY from sale, today.

(Read and comment on the original article, published 30 Sept. 2013, here)