![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 15 to 39 of 54. Go back in thread:
Posted by Klavot on March 26, 2007, at 10:35:32
In reply to Re: correction » Squiggles, posted by Larry Hoover on March 26, 2007, at 8:52:26
> All I hear in your intent to go silent is the sound of a closed mind.
Asking for evidence of safety and efficacy before pursuing a particular treatment modality is not closed minded.
Klavot
Posted by Klavot on March 26, 2007, at 10:48:10
In reply to Re: correction » Squiggles, posted by Larry Hoover on March 26, 2007, at 8:52:26
> I wonder at your pejorative view of alternative medicine, really I do. It harkens back to home remedies and wisdom from the elders.
That doesn't mean it works!
> That's why the lawyers cannot get at it. It belongs to us all, already. You can't patent anything already in the public domain. Doctors can't prevent anyone from employing this knowledge. It is only because that is so that medical science has vilified the practises.
Medical science vilifies alternative medicine because it is unscientific. As and when alternative practitioners provide empirical evidence that their treatments work and are safe, those treatments cease being alternative and become evidence-based and orthodox.
Klavot
Posted by Klavot on March 26, 2007, at 11:06:27
In reply to Re: correction » Squiggles, posted by Larry Hoover on March 26, 2007, at 8:52:26
> With respect to your assertions vis a vis morbidities associated with the two realms, standard and alternative medicines, there is no comparison at all. I know of no deaths attributed to anything but intentional overdose associated with any alternative product, except those cases associated with contaminants arising from the greed of fast-buck operators (e.g. kava kava products with hepatic toxins, the contaminated tryptophan from the early 90's). Contrast the latter with Internet drug sellers, if you want a valid comparison. A woman just died in B.C. from Internet anxiety meds. Mainstream alternative medicine is safer than mainstream medical science, IMHO, and by a great margin. Consider the withdrawal of Serzone due to fulminant liver failure. Yet, that is still listed as a side effect, rather than a toxic effect. Semantics influence the comprehension and interpretation of the event. We allow pharmaceutical drugs to have side effects, yet we assert toxic effects to nutrients. That's bias, plain and simple.
Perhaps there are very few sequelae and mortalities in orthomolecular medicine simply because very few people actually use true megadose quantities of micronutrients. If millions of people had to start taking intravenous Vitamin C at doses of 150 g / day, as some orthomolecular therapists advocate, I suspect things might be different.
I agree that orthodox treatments have more side-effects and carry greater risks than alternative treatments. But this argument does not factor the greater efficacy of orthodox medicine. I believe that given two populations, one of which uses exclusively orthodox medicine and the other using exclusively alternative medicine, the population using orthodox medicine would have a far superior health profile. It is misleading to suggest that alternative medicine is safer than orthodox medicine. It's like saying vitamin C has fewer side-effects than chemotherapy and then trying to demonise chemotherapy for having so many side-effects. Yet it is the cancer patient receiving chemotherapy who has the greater likelihood of survival, rather than the patient opting for Vitamin C supplementation.
Klavot
Posted by Larry Hoover on March 26, 2007, at 11:10:18
In reply to Re: correction, posted by Klavot on March 26, 2007, at 10:35:32
> > All I hear in your intent to go silent is the sound of a closed mind.
>
> Asking for evidence of safety and efficacy before pursuing a particular treatment modality is not closed minded.
>
> KlavotI agree. If there is a pursuit taking place. And if the evidence is considered.
Lar
Posted by Larry Hoover on March 26, 2007, at 11:37:26
In reply to Re: correction, posted by Klavot on March 26, 2007, at 11:06:27
> > With respect to your assertions vis a vis morbidities associated with the two realms, standard and alternative medicines, there is no comparison at all. I know of no deaths attributed to anything but intentional overdose associated with any alternative product, except those cases associated with contaminants arising from the greed of fast-buck operators (e.g. kava kava products with hepatic toxins, the contaminated tryptophan from the early 90's). Contrast the latter with Internet drug sellers, if you want a valid comparison. A woman just died in B.C. from Internet anxiety meds. Mainstream alternative medicine is safer than mainstream medical science, IMHO, and by a great margin. Consider the withdrawal of Serzone due to fulminant liver failure. Yet, that is still listed as a side effect, rather than a toxic effect. Semantics influence the comprehension and interpretation of the event. We allow pharmaceutical drugs to have side effects, yet we assert toxic effects to nutrients. That's bias, plain and simple.
>
> Perhaps there are very few sequelae and mortalities in orthomolecular medicine simply because very few people actually use true megadose quantities of micronutrients.Orthomolecular is not synonymous with megadose. Quite the contrary. First coined by Pauling, it was originally defined as "the right molecule, in the right dose". He later expanded the meaning to "the treatment of disease by the provision of the optimum molecular environment, especially the optimum concentrations of substances normally present in the human body" or as "the preservation of good health and the treatment of disease by varying the concentrations in the human body of substances that are normally present in the body and are required for health."
> If millions of people had to start taking intravenous Vitamin C at doses of 150 g / day, as some orthomolecular therapists advocate, I suspect things might be different.
Considering the proper definition of orthomolecular medicine, this then becomes a straw man argument. Millions of people would not be candidates for such treatment.
> I agree that orthodox treatments have more side-effects and carry greater risks than alternative treatments. But this argument does not factor the greater efficacy of orthodox medicine. I believe that given two populations, one of which uses exclusively orthodox medicine and the other using exclusively alternative medicine, the population using orthodox medicine would have a far superior health profile.
Please permit us to reach different conclusions. Moreover, this dichotomy is really a false dilemma, as orthomolecular medicine does not exclude pharmaceuticals, and conventional medicine does not preclude the precepts of orthomolecular practise.
> It is misleading to suggest that alternative medicine is safer than orthodox medicine. It's like saying vitamin C has fewer side-effects than chemotherapy and then trying to demonise chemotherapy for having so many side-effects. Yet it is the cancer patient receiving chemotherapy who has the greater likelihood of survival, rather than the patient opting for Vitamin C supplementation.
Orthomolecular approaches are best seen as complimentary practises. It needn't be seen as an either/or proposition.
Lar
Posted by Larry Hoover on March 26, 2007, at 11:50:09
In reply to Re: correction, posted by Klavot on March 26, 2007, at 10:48:10
> Medical science vilifies alternative medicine because it is unscientific. As and when alternative practitioners provide empirical evidence that their treatments work and are safe, those treatments cease being alternative and become evidence-based and orthodox.
>
> KlavotIt's not that simple or straight-forward, as I've tried to demonstrate. The graphical representation of the AROI curves was intended to demontrate that there are different rules being applied to nutrients than to other substances. Nutrient intake recommendations are based on symptoms of clinical deficiency, whereas pharmaceutical drugs are judged on symptoms of toxicity. The whole concept of orthomolecular medicine is based on getting into the AROI. Properly applied, toxicity is not relevant. That there are improper (i.e. toxic) applications does not invalidate the AROI concept.
Standard medical wisdom has it that a balanced diet will provide the RDA of all essential nutrients. As I expressed quite clearly, the RDA is itself based on clinical signs of deficiency syndromes, rather than optimal functioning. However, simply ignoring that issue, upon spending many years of effort, I have yet to find evidence that any diet (restricted to reasonable caloric intake) can even meet the nutrient RDAs. I have posted this as a challenge on newsgroups such as sci.med.nutrition, and no one has ever shown that I am wrong. There is no such thing as a balanced diet that meets all known RDAs. It cannot be done even for a single day, let alone providing for a diet with choices of menu items.
One poster developed a spreadsheet of the entire USDA nutrient database, and failed to find even one combination that met the 17 RDAs that were in the database. There are now over 30 nutrients with RDA values.
Lar
Posted by Squiggles on March 26, 2007, at 19:37:13
In reply to Re: neighbourhood, posted by Klavot on March 25, 2007, at 9:08:28
I'll have to read up on it; it's an
extremely complex field, beyond my
scientific background to understand. In cases
of deficiency, disabilities are much
easier to understand. I am sure I am not
the only one who sees this as an experimental
enterprise, and there's the rub. Over and out,
honest; :-)Squiggles
Posted by teejay on March 26, 2007, at 20:54:16
In reply to Re: neighbourhood, posted by Squiggles on March 26, 2007, at 19:37:13
Squiggles,
I gave you the benefit of the doubt when you first posted, but after two lengthy threads I've come to the conclusion that you came to this board purely to stir up a reaction of some kind.
Clearly nobody comes to the alternative board to question it with such weak arguments as you did, and more importantly without a solid grounding in the subject matter at hand which you clearly lack.
No offence intended and whatever it is you are looking for, I hope you find it and hope it delivers you all the pleasure you desire (apart from stiring it up on here of course).
TJ
Posted by Squiggles on March 26, 2007, at 21:09:32
In reply to Re: neighbourhood, posted by teejay on March 26, 2007, at 20:54:16
One triple chocolate fudge sundae,
with orthomolecular smarties-
hold the whipped cream!:-)Squiggles
Posted by Klavot on March 27, 2007, at 9:03:34
In reply to Re: neighbourhood, posted by teejay on March 26, 2007, at 20:54:16
I belive the following article is interesting in the context of the present discussion:
http://jama.ama-assn.org/cgi/content/abstract/297/8/842
Mortality in Randomized Trials of Antioxidant Supplements for Primary and Secondary Prevention
Systematic Review and Meta-analysisGoran Bjelakovic, MD, DrMedSci; Dimitrinka Nikolova, MA; Lise Lotte Gluud, MD, DrMedSci; Rosa G. Simonetti, MD; Christian Gluud, MD, DrMedSci
JAMA. 2007;297:842-857.Context Antioxidant supplements are used for prevention of several diseases.
Objective To assess the effect of antioxidant supplements on mortality in randomized primary and secondary prevention trials.
Data Sources and Trial Selection We searched electronic databases and bibliographies published by October 2005. All randomized trials involving adults comparing beta carotene, vitamin A, vitamin C (ascorbic acid), vitamin E, and selenium either singly or combined vs placebo or vs no intervention were included in our analysis. Randomization, blinding, and follow-up were considered markers of bias in the included trials. The effect of antioxidant supplements on all-cause mortality was analyzed with random-effects meta-analyses and reported as relative risk (RR) with 95% confidence intervals (CIs). Meta-regression was used to assess the effect of covariates across the trials.
Data Extraction We included 68 randomized trials with 232 606 participants (385 publications).
Data Synthesis When all low- and high-bias risk trials of antioxidant supplements were pooled together there was no significant effect on mortality (RR, 1.02; 95% CI, 0.98-1.06). Multivariate meta-regression analyses showed that low-bias risk trials (RR, 1.16; 95% CI, 1.05-1.29) and selenium (RR, 0.998; 95% CI, 0.997-0.9995) were significantly associated with mortality. In 47 low-bias trials with 180 938 participants, the antioxidant supplements significantly increased mortality (RR, 1.05; 95% CI, 1.02-1.08). In low-bias risk trials, after exclusion of selenium trials, beta carotene (RR, 1.07; 95% CI, 1.02-1.11), vitamin A (RR, 1.16; 95% CI, 1.10-1.24), and vitamin E (RR, 1.04; 95% CI, 1.01-1.07), singly or combined, significantly increased mortality. Vitamin C and selenium had no significant effect on mortality.
Conclusions Treatment with beta carotene, vitamin A, and vitamin E may increase mortality. The potential roles of vitamin C and selenium on mortality need further study.
Author Affiliations: The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Center for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (Drs Bjelakovic, L. L. Gluud, Simonetti, and C. Gluud and Ms Nikolova); Department of Internal Medicine, Gastroenterology and Hepatology, University of Nis, Nis, Serbia (Dr Bjelakovic); and Divisione di Medicina, Ospedale V. Cervello, Palermo, Italy (Dr Simonetti).Klavot
Posted by Meri-Tuuli on March 27, 2007, at 13:40:28
In reply to Re: neighbourhood, posted by Klavot on March 27, 2007, at 9:03:34
I've read that study was flawed in someway (see the text below I've copied and pasted). I personally have no opinion on the matter - I don't have time to check it all out etc etc.
__________________
Today's review of trials on antioxidants in the Journal of the American Medical Association fails the four key tests of 'publication bias'. For the following reasons I suspect it's an attempt to demote vitamin therapy so we keep taking the drugs.The first way to investigate whether an analysis of studies is biased is to read the summary, and see if it correlates with the actual result. The conclusion of this study says 'treatment with beta carotene, vitamin A, and vitamin E may increase mortality' creating the impression these antioxidants are no good. What it fails to say, all of which are clearly shown in the results, is that 'vitamin C given singly, or in combination with other antioxidants, and selenium given singly or in combination with other antioxidant supplements may reduce mortality'. It also fails to say that 'beta-carotene or vitamin A did not show increase in mortality if given in combination with other antioxidants', or that 'vitamin E given singly or combined with 4 other antioxidants did not significantly influence mortality'. If you can have one take home message it is that antioxidants are team players and reduce mortality in combination, and that vitamin C and selenium are more beneficial than beta-carotene or vitamin A.
The next way to investigate whether an analysis is a stitch up is to see if all trials are included, how trials are excluded, and what the trials actually say. Two classic primary prevention studies, where vitamin E is given to healthy people, are those of Stampfer et al, published in the New England Journal of Medicine, the first of which gave 87,200 nurses were given 67mg of vitamin E daily for more than two years. A 40 per cent drop in fatal and non-fatal heart attacks was reported compared to those not taking vitamin E supplements (1). In another study, 39,000 male health professionals were given 67mg of vitamin E for the same length of time and achieved a 39 per cent reduction in heart attacks (2). Guess what? They are not included.
Bjelakovic's analysis goes on to further degrade antioxidants by deciding which trials (usually the positive ones) are high bias, then excluding them, and which trials are low bias (usually the negative ones) and only adding these together. I don't agree with how this is done. For example, it is well known that taking statin drugs, that lower cholesterol and induce CoQ10 deficiency, make vitamin E harmful by turning it into an oxidant. This is an obvious bias but the authors don't even mention this. Once you exclude these trials vitamin E has an overall positive effect.
The next test is to see if the most negative studies were actually negative. These studies can skew results on an overall analysis. One the studies most cited to show increase risk of gastrointestinal cancer is that of Correa et al. So I read the actual paper and contacted the author, Dr Pelayo Correa from the pathology department at the Louisiana State University Health Sciences Centre in New Orleans, and asked about the increased risk he had supposedly found. He was amazed, he said, because his research, far from being negative, had shown clear benefit from taking vitamins.
His study, published in the Journal of the National Cancer Institute, had involved giving people with gastric cancer either beta-carotene, vitamin C or antibiotics to kill off the stomach bacterium Helicobacter pylori. All three interventions produced highly significantly improvements, causing substantial regression of gastric cancer. Correa and his colleagues had concluded: 'dietary supplementation with antioxidant micronutrients may interfere with the precancerous process, mostly by increasing the rate of regression of cancer precursor lesions, and may be an effective strategy to prevent gastric carcinoma'. No evidence of increased mortality there.
In fact, as Correa told us, there was no way the study could show anything about mortality. 'Our study was designed for evaluation of the progress of precancerous lesions,' he said. 'It did not intend, and did not have the power, to study mortality and has no value to examine mortality of cancer.' Without this study the main conclusion, that antioxidants may increase gastrointestinal cancer, becomes completely invalid.
So, I'm afraid this 'meta-analysis' fails all four tests of publication bias. The summary at the front refers to negative results only, not the positive results. Some key positive studies have not been included. Positive studies have become negative studies by jiggling the statistics. Known dynamics that would bias some studies towards a negative effect have been ignored. In conclusion, I will keep doing what I've always been doing, because this study confirms it - and that is to supplement a combination of antioxidants, including selenium and high dose vitamin C, because, as this study says, it seems to make you live longer and reduce your risk of premature death.
Posted by Klavot on March 27, 2007, at 13:52:26
In reply to Re: neighbourhood » Klavot, posted by Meri-Tuuli on March 27, 2007, at 13:40:28
OK OK OK, I give up, you got me.
Posted by Meri-Tuuli on March 27, 2007, at 13:57:16
In reply to Re: neighbourhood, posted by Klavot on March 27, 2007, at 9:03:34
I just want to say some things. My other half is a respected research scientist in his particular field of study. His research area is relatively small - he knows alot of his fellow scientists and has published many papers, including several in Science. I used to work in the scientific journals publishing business too - I had to find reviewers and authors etc.
So. I have come to get to know the academic world somewhat. There are several things I want to point out.
1) One study/published paper does not prove anything - okay it might be true but in general, it takes alot of papers reaching the same conclusions to 'prove' something. Papers can be badly written, with pretty trashy science in them, particulary of the lessor known journals, which can be pretty desperate for material. The so called studies can be made up too - or sort of doctored if you know what I mean. Good journals generally vet this sort of stuff out with good reviewers, but again, reviewers work for free, and often the lessor know journals make do with third rate reviewers, which means that papers get through which shouldn't really make it.
2) Just because an academic researcher is on the faculty of a fancy university doesn't mean he's not a quack. In the field my bf works in, there is a well know prof at Harvard, who is considered a complete Quack by the rest of the scientific community - yet to the layman he isn't.
Conversely, just because a researcher doesn't belong to a uni/whatever, doesn't make him/her any less credible or whatever.
And perhaps people who are considered Quacks now, perhaps some of them just have ideas that aren't accepted by the mainstream? Don't most scientific ideas/theories etc start out as relatively Quack-like? I mean, people laughed when they heard that the Earth revolves around the Sun. People laughed at Darwin, etc etc.
And finally, you probably have to consider the background to which the paper is written - is it funded by Big Pharma? Are the researchers reputable? What other papers have they published?
And so on.Just some thoughts.
Kind regards
Meri
Posted by Meri-Tuuli on March 27, 2007, at 14:04:07
In reply to Re: neighbourhood, posted by Klavot on March 27, 2007, at 9:03:34
I don't know why we can't think of these things as a spectrum - the alternative stuff and the conventional stuff are not so far removed from one another, its just our mindset (and that of the practitioners) is.
I mean, both alternative stuff and conventional stuff should be both practised and should be both intertwined - clearly the altnerative stuff for prevention and general health and the conventional stuff for 'crisis intervention' like a heart attack. But if we can stop the crisis in the first place, by say, eating garlic, being healthy and taking ginkgo, for example, I don't see why this is so hard to comprehend or preach or practise.
Plus I don't see why alternative compounds in plants should be considered so different from conventional drugs -- I think Big Pharma has a big say in this and the subsequent brain washing of Doctors.
I follow the Lar school on this.
Posted by Squiggles on March 27, 2007, at 14:06:59
In reply to Orthomolecular medicine, posted by Klavot on March 27, 2007, at 13:52:26
> OK OK OK, I give up, you got me.
LOL-- i'm sorry to interrupt, but it just
occurred to me that scientific dispute should
not be confused with arm-wrestling.And one more thing -- with one and a half million kids starving in Africa, i think a meal with water, approximating the average nutritional needs, would be scientifically acceptable to them, thank you very much -- you can go to Oxfam.org for that. The orthomolecular research is for the future benefit of mankind - very future.
Squiggles
Posted by teejay on March 28, 2007, at 9:21:09
In reply to Re: Orthomolecular medicine, posted by Squiggles on March 27, 2007, at 14:06:59
You sure do have a lot of 'last words' ;-)
Posted by Larry Hoover on March 28, 2007, at 10:58:36
In reply to Re: neighbourhood, posted by Klavot on March 27, 2007, at 9:03:34
> http://jama.ama-assn.org/cgi/content/abstract/297/8/842
>
> Mortality in Randomized Trials of Antioxidant Supplements for Primary and Secondary Prevention
> Systematic Review and Meta-analysis> Conclusions Treatment with beta carotene, vitamin A, and vitamin E may increase mortality. The potential roles of vitamin C and selenium on mortality need further study.
I found the full-text version.
http://www.jhsph.edu/welchcenter/_pdf/3_6_07.pdf
Where to start? I cannot believe stuff like this gets published. This product is so biased, it does not even support its published conclusions within its own text. Its basic premises are fatally flawed, methodologically. It's junk science.
A priori assumptions for meta-analysis require that the study groups and study methodology are similar. That's the whole point, to create something of the sort of a larger homogenous group than was available through separate and smaller subject pools, subject to similar control of variables, to increase the power of the discriminant measure(s). Here, primary (healthy people) and secondary (those with diagnosed disease/pathology) prevention trials are lumped together without any rationale for doing so. Disease prevention and disease recurrence are different entities, certainly. Also, a prevention trial is disease-specific. They didn't look at disease outcomes, they looked at all-cause mortality. A car accident would count. Using other people's data for purposes not within the bounds of the intent of the original data collection constitutes the derivation of a new hypothesis. It is not a test of the hypothesis, however, as no control of variables is possible. It is purely speculative.
Another disturbing methodological flaw is the a priori exclusion of all studies in which no subject died. As the analysis was (supposedly) to find correlations between antioxidant supplementation and mortality, excluding 747 trials with no mortality, and analyzing only 68 trials with mortality seems illogical, at best. But apart from a single paragraph in the preamble, I didn't see it mentioned in the discussion. Maybe I missed it.
Another a priori discriminant (with subsequent effects on the statistics), a completely arbitrary separation of trials into two groups which they call low-risk and high-risk, is without any realistic relevance. Does it really matter if subjects took vitamin E or whatever in a double-blind trial environment (as one of the four criteria for risk was applied)? No, it doesn't. So long as some people took it and some people didn't, whether they died or not can't be attributed to placebo effect. All this arbitrary distinction does is provide you with yet another form of data exclusion, which permits derivation of new statistics. If you divide a heterogenous group without significant variation enough times, you will find statistical significance, eventually. This is called data mining, pejoratively, amongst scientists.
Consider yet another a priori decision, with subsequent profound effect on mortality stats....the lumping together of chronic vs. acute exposure. For example, one study in which bed-ridden geriatric patients were given a single injection of 200,000 IU vitamin A is lumped together with data from long-term oral supplementation of healthy people with 2,000 IU/day. Remember, meta-analysis requires similarity of subject pools and methodology, yet the obtained statistical relative risk for vitamin A, by dose, was 1.000006. That was found to be significant, but with the underlying assumptions (or ignorance, as you might alternatively conclude), does that have any relevance to others? Does it warrant inclusion in the abstract?
Now, within the obtained statistics, there is a hierarchy of groups. There is the statistic derived from all data. That would be the main outcome of the study. There are then statistics for the individual antioxidants, but with all data included. Then analyses within those groups for factors influencing the outcomes. And only at the end, was the high-risk/low-risk data exclusion criterion applied. Way down the relevance/validity tree. Here are the study outcomes, in order of validity (notwithstanding the methodological flaws):
"The pooled effect of all supplements vs placebo or no intervention in all randomized trials was not significant (RR, 1.02; 95% CI, 0.98-1.06)."
No harm done. Where is that in the abstract?
Next in line, the individual antioxidants, with dose alone amongst lone variables that led to significant statistics....
"Univariate meta-regression analyses revealed significant influences of dose of beta carotene (RR, 1.004; 95% CI, 1.001-1.007; P = .012), dose of vitamin A (RR, 1.000006; 95% CI, 1.000002-1.000009; P = .003), dose of selenium (RR, 0.998; 95% CI, 0.997-0.999; P = .002), and bias-risk (RR, 1.16; 95% CI, 1.05-1.29; P = .004) on mortality. None of the other covariates (dose of vitamin C; dose of vitamin E; single or combined antioxidant regimen; duration of supplementation; and primary or secondary prevention) were significantly associated with mortality."
So, beta carotene (a single form of provitamin A)/Vitamin A have statistical mortality risk, of 0.4% and .0006%, respectively, *by dose*. Selenium significantly reduced mortality. Do you see that in the abstract? No, it "needs further study". And vitamin E has yet to be implicated. Please also note the other variables which did not obtain significance when regressed alone (i.e. by univariate analysis).
Next, you have the multivariate analyses, which attempt to tease out the variables which significantly influence the collective statistic, from those that don't seem to make a difference one way or the other. We're getting into data mining territory, here. This is where you typically obtain rationale for conducting future hypothesis-testing. We're already beyond the true scope of meta-analysis available from this diverse data-set, but lets see what they find, anyway.
"In multivariate meta-regression analysis including all covariates, dose of selenium was associated with significantly lower mortality (RR 0.998; 95% CI, 0.997-0.999, P=0.005) and low-bias risk trials with significantly higher mortality, (RR, 1.16; 1.05-1.29; P=.005). None of the other covariates was significantly associated with mortality."
Let's start at the last sentence. The mortality risk of beta-carotene and vitamin A do not survive data-mining, no matter how they slice it. No evidence against vitamins C or E, by any measure. Selenium still looks golden, except when the arbitrary data exclusion of "bias risk" is applied. Look at the expansion of the 95% confidence interval following this data exclusion. Heterogeneity has gone way up (larger CI), so the subject pool was drastically reduced, or they were dissimilar in some way.
When bias risk itself was examined, we find significant effects.
"In trials with low-bias risk mortality was significantly increased in the supplemented group (RR, 1.05; 95% CI, 1.02-1.08)", whereas in high-bias trials, "...mortality was significantly decreased in the supplemented group (RR, 0.91; 95% CI, 0.83-1.00)."
What does this mean? One possible variable (of four; they never say which one(s) were applied) is 'absence of blindedness'. Is it inconceivable that people who take a supplement knowing it is good for their health might have a state of mind that is different from someone who is being given a supplement that may be a placebo? I still contend that this data exclusion criterion is arbitrary, and in any case, it has not yet had any influence on the obtained statistics, save that one adverse finding for selenium trials.
The researchers continue to massage the data, however, and obtain some further statistics. Now they consider only whether a supp was used alone or in combination, but not dose.
When we examine the stats, we find that beta-carotene used alone is bad: RR 1.06 (CI = 1.01-1.11), but when combined with other antioxidants, it's okay: RR 1.01 (CI = 0.94-1.08). Only when you further exclude data, i.e. combinations which include selenium, *and* they apply the arbitrary risk criterion, is there any significant risk found in combinatory analyses: RR 1.07 (CI = 1.02-1.11). We already knew you shouldn't take beta-carotene alone. Why were such studies even conducted? Anyway....
When we look at vitamin A, there is no significant risk of using it alone or in combination. That is the main finding. Only when data are excluded, do you see any significant risk. Again, it is when the risk bias is applied, *and* selenium combinations are excluded. Why don't they say that?
I've still yet to see anything about vitamin E being bad. Oh, wait. Vitamin E, alone, in combination, in arbitrarily low or high dose, had no effect on mortality. However, when data are excluded, specifically when the risk criterion *and* selenium combinations are excluded, we see a significant finding of increased mortality. Are you starting to see a pattern here?
Vitamin C? They couldn't find anything. Even when they excluded any data they could. So why does it "need further study"?
Selenium? When used alone and/or in combination, it significantly reduced mortality: RR 0.91 (CI 0.84-0.99), and survived the risk criterion. And they conclude further study is required?
Here, once again, is the published conclusion in the abstract:
"Treatment with beta carotene, vitamin A, and vitamin E may increase mortality. The potential roles of vitamin C and selenium on mortality need further study."
In fact, their own evidence shows that selenium reduces mortality, and is an essential component of any antioxidant supplementation regime. Beta-carotene should never be taken alone, but in a combination of antioxidants, it is safe to use. That would be a valid abstract conclusion.
The interdependence of antioxidants is worthy of an entirely separate discussion. For example, vitamin C is required to regenerate oxidized vitamin E. And I've totally ignored the fact that d-alpha-tocopherol (synthetic) is *not* a surrogate for natural vitamin E. d-alpha-tocopherol displaces d-gamma-tocopherol (one of eight structural variations of vitamin E), but fails to accept electrons in the chain reaction in which d-gamma protects membranes from oxidation. It is thus toxic, if absorbed in this synthetic unnatural form, without simultaneous increases in gamma-tocopherol. We haven't even considered beta- and delta-tocopherols, or the tocotrienols (eight more, which some include with tocopherols under the term vitamin E).
Nothing was said here about the absence of cofactors, which explain *why* beta-carotene is toxic if taken alone. It is reductionist science in the extreme, reductio ad adsurdum, to isolate a nutrient and manipulate that sole variable.
Nutrients act like instruments in an orchestra. You can't give cellos to the violinists and expect them to play their role, nor silence all but the percussionists, and expect to hear the melody. What are they thinking? Moreover, what do these experiments collectively demonstrate? That is the real question. If all experiments are methodologically suspect, then GIGO is the only conclusion. We got garbage out, here, without even considering if it was garbage going in.
Lar
Posted by Larry Hoover on March 28, 2007, at 11:02:18
In reply to Re: neighbourhood, posted by Squiggles on March 26, 2007, at 19:37:13
> I'll have to read up on it; it's an
> extremely complex field, beyond my
> scientific background to understand.Then why do you have so much to say?
Lar
Posted by Larry Hoover on March 28, 2007, at 11:05:36
In reply to Re: neighbourhood » Klavot, posted by Meri-Tuuli on March 27, 2007, at 13:40:28
> So, I'm afraid this 'meta-analysis' fails all four tests of publication bias.
Even more reason to dismiss this propaganda out of hand.
Thanks,
Lar
Posted by Larry Hoover on March 28, 2007, at 11:13:45
In reply to A word about Quacks etc, posted by Meri-Tuuli on March 27, 2007, at 13:57:16
> I just want to say some things.
And good things they were.
I've done substantial lit reviews, professionally, and I'd have to say I'm astounded by what gets published. Or how often the abstract is unsupported by the experimental outcomes.
Thanks for your input.
Lar
Posted by Larry Hoover on March 28, 2007, at 11:19:51
In reply to Re: neighbourhood, posted by Meri-Tuuli on March 27, 2007, at 14:04:07
> I mean, both alternative stuff and conventional stuff should be both practised and should be both intertwined - clearly the altnerative stuff for prevention and general health and the conventional stuff for 'crisis intervention' like a heart attack.
Indeed. Who says orthomolecular approaches were to replace anything?
> I follow the Lar school on this.
<grin>
Lar
Posted by Squiggles on March 28, 2007, at 12:21:41
In reply to Re: neighbourhood » Squiggles, posted by Larry Hoover on March 28, 2007, at 11:02:18
It is not I who have so much to say
but you who have so little. Look, I'm a
simple person. Show me the proof that
orthomolecular medicine is superiour
to what we presently practice for affective
disorders (or cancer), and I will say that
you have made a scientific breakthrough in
mental health.Squiggles
Posted by Klavot on March 28, 2007, at 13:01:12
In reply to Re: neighbourhood, posted by Meri-Tuuli on March 27, 2007, at 14:04:07
> I mean, both alternative stuff and conventional stuff should be both practised and should be both intertwined - clearly the altnerative stuff for prevention and general health and the conventional stuff for 'crisis intervention' like a heart attack.
Forget for a moment the issue of orthomolecular medicine. I do not agree with implementing alternative treatments simply for the sake of using alternative treatments. What does "alternative" mean? I would understand "alternative" to be the complement of "conventional", which is to say "evidence-based". Conventional medicine is not static; alternative treatments may become conventional as and when there is evidence to support their safety and efficacy. Likewise conventional treatments may be relegated to the status of "alternative" as and when they are found to be bogus. It is wrong to encourage the use of treatments which have no evidence to back up their safety or efficacy.
Some alternative treatments, for example homeopathy, simply do not work. The principles which underlie homeopathy violate some of the basic laws of chemistry and physics.
If a treatment works beyond placebo, then it should be possible to demonstrate that fact. Most alternative treatments are alternative simply because their practitioners are consistently unable to demonstrate efficacy.
Klavot
Posted by Larry Hoover on March 28, 2007, at 13:14:56
In reply to Re: neighbourhood, posted by Squiggles on March 28, 2007, at 12:21:41
> It is not I who have so much to say
> but you who have so little.Eh? I don't believe I've ever heard anyone say that about me, before this.
> Look, I'm a
> simple person.I'll take your word for it.
> Show me the proof that
> orthomolecular medicine is superiour
> to what we presently practice for affective
> disorders (or cancer)....I've got nothing to say about something I didn't say.
Lar
Posted by Meri-Tuuli on March 28, 2007, at 16:32:42
In reply to Alternative treatments, posted by Klavot on March 28, 2007, at 13:01:12
Well I meant more straightforward 'alternative' practices, like eating garlic to help heart health, taking exercise, or taking ginkgo or fish oils or eating lots of fruits and vegetables, taking vitamin supplements and yes, taking herbs.
Just because something hasn't been documented by the research literature doesn't mean it doesn't have a helpful effect. For instance, lypocene in tomatoes protects against prostate cancer - so if you're worried about that, eat more tomatoes - but this effect was only discovered relatively recently. But tomatoes have been helping people for centuries.....okay tomatoes are hardly an 'alternative' treatment, you see what I'm saying.
I'm not sure where I stand on homopathy. I think in some instances it might be useful - a friend of mine was helped a great deal by homopathy with a skin complaint - but I took some pills for warts and they didn't do a thing! It took a trip to Iceland and bathing in these hydrothermal springs to kill off a nasty wart on my thumb. Anyway I'm rambling!
Kind regards
Meri
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