Respectful Insolence

CAM practitioners versus preventive medicine

If there’s one claim that practitioners of “holistic” medicine frequently make, it’s that “complementary and alternative medicine” (CAM) or “integrative medicine” or whatever the term du jour for the combining of quackery with science-based medicine is these days is allegedly so much better than “conventional” or “allopathic” medicine (or whatever disparaging term “holistic practitioners” prefer) at preventing disease and keeping people healthy. The claim is a load of fetid nonsense, of course, but it sounds convincing on the surface. After all, CAM practitioners have been disturbingly successful at claiming what are science-based modalities (diet and exercise, for example) as somehow being “alternative” or “integrative,” a task they accomplish by adding a dash (or sometimes an enormous dollop) of pseudoscience to them. Such co-opted science-based modalities then serve as the thin edge of the wedge behind which the real quackery follows into medicine.

But are CAMsters really so much better at prevention? As I’ve suggested time and time again, they really are not. For example, they routinely disparage screening tests designed to detect disease before it manifests itself in a more severe form. I realize that for many screening tests, there is a problem with overdiagnosis, and not all tests are as useful as others, but that’s not the sort of criticism based on science that advocates of CAM and integrative medicine make. Rather, what they do tends to be more of a reflexive dismissal of anything resembling screening. We see it when quacks attack mammography, although frequently they attack mammography on the one hand and promote the useless modality of thermography on the other hand. We see it when they attack statins. And we see it when they attack screening for hepatitis C:

The Centers for Disease Control and Prevention recently issued notice that all “baby boomers” – that segment of the population born between 1945 and 1965 – should be tested for Hepatitis C. That would include me. The virus is considered a leading cause of liver cancer, claiming 15,000 lives each year due to related illnesses. The agency suggests that 2 million boomers have the virus and don’t know it. Their recommendation would be for one to come in for testing/screening, and where the virus is found, begin a 48-week round of interferon alpha-2b or Ribavirin treatments.

At $50 to $100 each, the testing process alone could add a $150 million stimulus to the medical industry, but getting 800,000 people on the prescribed Standard of Care, which costs from $50,000 to $150,000, could generate $60 billion in billings (averaged out at $75,000 each), if fully acted upon just once.

Of course, this all amounts to horse hockey, because following the Standard of Care will not restore the natural balance that actually defines, creates, or restores, a state of health. As such, if the Hepatitis condition goes away, you can pretty much count on something else eventually showing up to take its place.

Now, leaving aside the question of scientific merit of screening everyone between 47 and 67 years of age for hepatitis C, notice the pure hostility to the very concept of screening. I know, I know, it’s the Phaelosopher again, a guy who promotes the use of bleach (i.e., MMS) as a miracle treatment for many things and has held a “genome healing” workshop of pure quackery. What would one expect? That he’d be down with a mass screening program of any kind? But the hostility above is very telling. The “Fail”-osopher can’t imagine that the CDC is actually proposing such a screening program at an enormous expense because it has examined the evidence and thinks that detecting previously undetected subclinical hepatitis C in hundreds of thousands of people could save lives. Oh, no. He thinks that the only reason the CDC is proposing these guidelines is because it wants to provide a massive “stimulus” to testing companies and big pharma that provides the drugs designed to prevent subclinical hepatitis C from becoming clinical hepatitis C and frying hundreds of thousands of livers.

Fail-y even goes on to to say:

This story of the Hepatitis C concern comes out at a time when the Obama administration is trying to heighten the appeal of its health care reform law, called Obamacare. This program calls for mandatory enrollment into a health care plan, even suggesting penalties for non-compliance. However, it doesn’t call for mandatory use of methods by healthcare providers, that are known to help restore health. As such, this is a great windfall for the health insurance industry, which still only pays for methods that the policy makers approve. The medical policy makers continue to look askance at anything that isn’t inexpensive, adversarial, destabilizing, or toxifying in its metabolic effect on the body.

In making this story public, the Standard of Care for Hepatitis C is the only option that can be discussed in the mainstream media. As such, the entire population is led to believe that if they have Hepatitis C, irrespective of how they got it, the Medical Autocracy’s solution is the “best” and “most reliable” way to resolve it.

That too is a fiction.

The only “fiction,” of course, is pretty much every word that flows from the keyboard of the Phaelosopher, but let’s take a look at this. What is prevention in medicine? Obviously in general it involves two things: (1) taking actions that optimize health and (2) taking options that prevent disease and treat it while it is still treatable. Determining whether a screening program achieves this goal is a complicated scientific question, but arguably in the passages I’ve cited what we find is far more a reflexive resistance to screening in which it is viewed as a tool of control more than anything else. All of this is of a piece with the false claim that CAM is “personalized.” As I’ve pointed out time and time again, in CAMworld, “personalizing medicine” usually means “making it up as you go along. Quacks like the Phaelosopher are opposed to the very concept of a standard of care, particularly one based on science, because a real standard of care limits what they can do. If there is a standard of care, the can no longer individualize treatments make it up as they go along.

Which brings us full circle. Remember how I discussed how the Phaelospher is a big proponent of using the Miracle Mineral Solution (MMS) to treat what ails you, denying that it is, in fact a form of bleach and claiming that it is some sort of miracle treatment? it looks as though he thinks that MMS would be a great way of preventing subclinical hepatitis C from progressing to harm people’s livers. He mentions WF10, which is based on chlorite and might have some activity against amyotropic lateral sclerosis but for which there is little or no convincing evidence as a treatment for hepatitis C.

We see this time and time again. CAM practitioners try to claim the mantle of promoting prevention, but their claims are not grounded in evidence or science. They will provide you with diet recommendations not based in science claiming that they will reduce your chances of getting cancer to near zero or tell you to take a boatload of supplements to prevent every disease under the sun. All the while, they disparage science-based preventative measures that don’t fit within whatever mystical paradigm they believe in as being products of big pharma designed to enslave you.

It’s a lie, of course. A real primary care doctor practicing science-based medicine is a holistic doctor treating the whole patient. A real primary care doctor practicing science-based medicine is practicing real preventive medicine. A real primary care doctor practicing science-based medicine doesn’t fear and attack the concept of a standard of care.

Comments

  1. #1 dingo199
    January 3, 2013

    Odd how the Failosopher can read the DCD document, establish that additional screening will result in additional treatment, but fail to notice that this strategy will actually prevent 200,000 cases of cirrhosis, 50,000 cases of hepatocellular carcinoma and avert 15,000 liver transplantsd and prevent 120,000 deaths. That’s got to add up to a mighty overall cost benefit, but he just doesn’t get it.

    http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6104a1.htm#Tab2 (Table 3)

    However, regarding Hepatitis C screening, might I be permitted to make a comment that is not “politically correct”? The CDC have done their calculations, and determined that an age cohort of those born between 1945 and 1965 is the “best” group to screen, based on their higher than peer seroprevalence for Hep C. But what their data show is that we should target screening at men if we are to be really objective in our screening cost-benefit calculations, and we should also be limiting screening to black, non hispanic men. I realize such a screening strategy is not possible, but looking at all their numbers entirely dispassionately, and “masking” the relevant risk categories (age, sex, race) that is what an objective, “blinded” analysis of the data would show.

  2. #2 Dangerous Bacon
    January 3, 2013

    “if the Hepatitis condition goes away, you can pretty much count on something else eventually showing up to take its place.”

    By the same token, if your car’s engine starts making worrisome grinding noises, why bother getting it fixed? Some other problem will just crop up.
    I regard this philosophy as being akin to the Laundry Futility Paradigm. Why bother to wash your underwear and socks – they’re just going to get stinky all over again?

  3. #3 Shay
    January 3, 2013

    @Dangerous Bacon

  4. #4 Shay
    in dire need of caffeine
    January 3, 2013

    Oops.

    As I was poised to say, or we can all just start hoping for another Mayan apocolypse. I personally was using that one as an excuse not to clean the basement.

  5. #5 Denice Walter
    January 3, 2013

    Prevention in Woo-topia doesn’t involve standard screenings- which are labelled as dangerous- but does involve blood work, primarily to check vitamin levels and C-reactive protein/ homocysteine. This is just a minor facet of their programmed model of prevention.

    Nutrition is first and foremost and it ain’t what you find in dieteticians’ research, which is despised. It seems to me that our woo-meisters cannot be basing their ideas upon SB research for the simple reason that they arrive at diametrically opposed conclusions.

    Gary Null promotes a vegan lifestyle that is also gluten-free, organic, mostly raw ( or cooked at low temps), “living foods”, GMO-free, ultra-low fat and low calorie aided and abetted with mega-doses of vitamins/ minerals/ phytonutrients.

    Mike Adams also advises non-GMO, pesticide-free vegetables and fruits but advocates raw milk products, natural ( hormone-free, free range) meat and poultry ( best if you raise your own meats and grow your own crops) ‘and smoothies concocted from his own formulary of Superfoods.
    Mercola advocates a Paleolithic diet ( hunter/ gatherer)- that focuses on natural meats and makes little use for grain products.

    Both sides of the fence claim “data” that supports their position.
    I would really like to see that because the various screeds I read at PRN, NN and Mercola seem rather data-free.

  6. #6 prn
    January 3, 2013

    An ongoing problem with a “standard of care” monopoly is the lack of means to compete by cheap, less toxic, promising treatments without institutional financial support.

    For hepatitis C, there are interesting claims that remain without trial. One effort that comes to mind is Burton Berkson, MD-PhD.

  7. #7 Denice Walter
    January 3, 2013

    OT: but can a pseudo-scientist finally hooking up with a major purveyer of nonsense EVER be truly OT @ RI?

    Today @ AoA ,David Lewis writes about toxins. Working with AJW, being a guest @ PRN, being a ‘whistleblower’…now writing for AoA. What’s next? His own blog?

  8. #8 Eric Lund
    January 3, 2013

    As such, if the Hepatitis condition goes away, you can pretty much count on something else eventually showing up to take its place.

    News flash, Mr. Fail-osopher: Having one medical condition does not make you immune to acquiring another, e.g., opportunistic infections are a medical commonplace. If you do get a second medical condition, then you will have to deal with both conditions, and that’s harder than dealing with one condition alone.

    DB’s car analogy is a good one. If I fix the oil leak in the engine, then the engine may survive to develop some other problem, and it is straightforward for a mechanic with suitable equipment to fix the leak. I might have to leave the car with the mechanic all day, but it will get fixed, and probably for less than the monthly payment on a new car. If I don’t fix the oil leak, the engine will almost certainly develop some other problem, one which could easily involve having the engine rebuilt or replaced (if not the entire car), at considerably more expense and vehicle down time.

  9. #9 lilady
    January 3, 2013

    @ prn: Dr. Berkson has published three times in an alternative journal and he *claims* to have successfully treated hepatitis c and liver cancer with supplements and an opioid antagonist:

    http://www.sciencebasedmedicine.org/index.php/low-dose-naltrexone-bogus-or-cutting-edge-science/

    Berkson has been interviewed by Joe Mercola and Robert Scott Bell and has a line of b.s. about his *expertise*, his association with the CDC, and his miraculous cures…all contained in this *case* study which supposedly was published in Germany:

    http://www.tbyil.com/berkson.htm

  10. #10 William Donlon
    January 3, 2013

    Pet peeve notice: The word is preventive not “preventative”.

  11. #11 Calli Arcale
    January 3, 2013

    “As such, this is a great windfall for the health insurance industry, which still only pays for methods that the policy makers approve. The medical policy makers continue to look askance at anything that isn’t inexpensive, adversarial, destabilizing, or toxifying in its metabolic effect on the body.”

    On what planet does the Failosopher live, where insurance companies are averse to paying less?

    I honestly do not understand this argument, that insurance companies are opposed to treatments on the grounds that they’re too *inexpensive*. Now, objecting to treatment on the grounds that it’s a *waste* of money, like a lot of this guy’s favored treatments, that’s a different matter.

    prn — standard of care isn’t really a monopoly, at least not in the technical, economic sense. It’s more of a regulatory pragmatism. It probably does stifle innovation to some extent, though I think other factors are more significant to the difficulty of bringing new drugs and treatments to the table. (Money, especially. There should be more government grants made available. Leaving it up to industry means only treatments championed by big companies that expect to turn a profit from it are going to get support.) The *benefit* of having a standard of care is that you keep everybody working in a sufficiently consistent manner that it’s possible to hand a patient off to another doctor without dooming them. If there are no standards, and your doctor gets hit by a bus, are you screwed? Will you have to start over completely from scratch with a new doctor, who will treat you completely differently? As with any set of standards, there are both advantages and disadvantages, but generally the advantages outweigh the disadvantages.

  12. #12 Dangerous Bacon
    January 3, 2013

    “I just spent two weeks in bed with acute Hepatitis.”
    “Which one, you lucky dog? They’re both cute, those Hepatitis girls.”

    *vaudeville comedy routine courtesy of J.D. Salinger.

  13. #13 Lawrence
    January 3, 2013

    @Calli – in my experience, insurance companies are extremely risk-averse & do tend towards more predictable ways of doing things (even if it isn’t less expensive) – but if it ultimately is more cost-effective (short term pain for long-term profit) then they are more likely to champion proven treatments.

    However, if a low-cost & effective treatment came along that was at least as effective as current, you bet your ass that the insurance companies would be all over it!

  14. #14 Calli Arcale
    January 3, 2013

    Very much so, Lawrence. One of the dumber things they do (probably) is 100% reimbursement for an annual physical. Annual physicals are of dubious value, and while annual checkups are valuable, the full physical is more than is really needed. It could be made much more efficient, and everybody would be better off. Institutional inertia probably prevents that for now. Plus, there’s a reason they prefer things that are predictable even if they’re a bit more expensive — predictable means they can factor it into their calculations for the year, which means it’s less risky for them and their investors.

    It makes more sense if you think of it like gambling. Insurers are betting you money that you’re not going to get sick or injured. Just like casinos, they like doing anything they can to improve their odds and maximize the payout. They’d rather spend $20 playing blackjack than $15 playing the lottery; the former costs more, but is much more likely to pay off, even though the lottery offers a much bigger jackpot.

  15. #15 herr doktor bimler
    January 3, 2013

    If I understand the Phaelosopher correctly, he is arguing against widespread tests for Hep C because the mainstream treatments are not as good as his personal quackery.
    This does not make sense, until you notice the corollary… his personal treatment for Hep C works best in the absence of widespread reliable tests for whether a customer really has it to start with.

  16. #16 Narad
    January 3, 2013

    Today @ AoA ,David Lewis writes about toxins.

    Um, “At the same time, every large municipality throughout the industrialized world permits chemical wastes to be discharged into sewer systems…”

    Either trivial by construction (nonhazardous waste) or trivially false.

    “… where complex mixtures containing hundreds of thousands of different kinds of fat-soluble heavy metals and toxic organic molecules are concentrated in sewage sludge.”

    Somebody also might want to brush up on this “solubility” concept.

  17. #17 Medical Ironman
    Florida
    January 3, 2013

    I work with DMESupplygroup as a consultant for them. I also do long distance Triathlons. One of my colleagues from both aforementioned circles is a chiropractor, and he tells me that my father should stop taking his cholesterol medication because it is doing brain damage. Something about the brain is healed with cholesterol, and that plaque in the arteries is essentially a bi-product of too much sugar and refined simple carbohydrates. The whole concept is that too many carbs cause inflammation of the cells and as a result numerous toxins are created etc etc etc. Sounds a bit like horse turds.

  18. #18 Krebiozen
    January 3, 2013

    William Donlon

    Pet peeve notice: The word is preventive not “preventative”.

    I don’t wish to be argumentive, but either is acceptable, especially in a relatively informal setting, such as a blog, for example.

  19. #19 Narad
    January 3, 2013

    I don’t wish to be argumentive,but either is acceptable, especially in a relatively informal setting, such as a blog, for example.

    Oh, I’ll be argumentative. Even Fowler accepts the long variant, with the passing note that the shorter is “better.” Both forms are over 300 years old. There is no more basis to claim that the ‘-ative’ form is “incorrect” than there is to pitch a fit over “towards”; it’s purely a stylistic choice.

    If one is going to indulge a prescriptivist tendency, it’s wise not to do it in an unfounded manner.

  20. #20 Denice Walter
    January 3, 2013

    @ Medical Ironman:

    I am sickeningly familiar with alt med’s ideas about sugar.
    Here are examples of the bad science at their most cloying-
    Sugar, Sweet Suicide prn.fm/2012/12/4 gary-null-sugar

    So bad it will make your teeth hurt.

  21. #21 Denice Walter
    January 3, 2013

    @ Narad:

    I’m expecting that Lewis’ next article @ AoA will be about starting a petition to ban people who make sense.

  22. #22 Narad
    January 3, 2013

    I’m expecting that Lewis’ next article @ AoA will be about starting a petition to ban people who make sense.

    I do try to spare myself and stay away, but I managed to catch this self-iimmolation by half-gainer into a vat of molten irony yesterday:

    People like Frith are not dumb but they assume we are. They expect us to buy into whatever red herring explanation they put put out for the autism increase. That way they can cover up the truth that the autism epidemic is really driven by population control and eugenics.

  23. #23 herr doktor bimler
    January 3, 2013

    People like Frith are not dumb but they assume we are.

    This is better for the self-esteem than “People like Frith [Uta or Chris?] don’t give two tugs of a dead dingo’s dick about our intelligence”.

  24. #24 prn
    LL
    January 3, 2013

    Berkson claims good success treating hep C patients with things like selenium containing supplements, lipoic acid, and silymarin for under $2000 per year. Online discount sources might be more like $100-$200 per year for those three as generic oral supplements.

    Yes, there’s a Berkson interview with RI’s ever popular, Joe Mercola. Also “Dr. Berkson tailors his treatments for each individual…”

    Berkson is a scientist turned clinician, still a results oriented scientist, working outside the box. Often keeping people out of the box, 6 ft deep.

  25. #25 Kelly M Bray
    January 3, 2013

    This is off topic but interesting. Hospital employees fired for refusing flu shots. Hahahaha.

    http://www.huffingtonpost.com/2013/01/03/goshen-hospital-employees-fired-flu-shot_n_2404328.html

  26. #26 Kelly M Bray
    January 3, 2013

    @ Pprn. Berkson can claim anything he wants. What can he prove?

  27. #27 Alain
    January 3, 2013

    offtopic: New blog post (again!)

    http://www.securivm.ca/2013/01/reflexion.html

    Alain

  28. #28 prn
    January 3, 2013

    The good doctor can “prove it” to severely ill patients that already flunked “standard medicine”. Dramatic recoveries from severe, objective disease are still evidence.

    In the future, individual cases may become better defined pieces of evidence as multiparameter measurements soar and accumulate, somewhat akin to computing power advances.

    In the meantime, gate keeping will continue by affected institutions as patient patients wait decades for someone to do the trials (ahem, heh).

  29. #29 Narad
    January 3, 2013

    This is off topic but interesting. Hospital employees fired for refusing flu shots.

    Good G-d, one was an oncology nurse. “Personal faith walk” yourself out the door, toots.

    The one at the beginning of the WSBT piece is perhaps even dumber: “I just feel like it’s a toxin I don’t want in my body. There are side effects with it.” Instant religious-exemption fail. (Also: hospice nurse.)

  30. #30 Krubozumo Nyankoye
    January 3, 2013

    To Narad’s last comment and a previous post lamenting the sad state of awareness about the medical and other pseudo-scientific scams that pervade modern civilization.

    Population is a big part of the problem. There are simply too many people living on this small planet to be sustainable. That would lead logically to some kind of argument over some kind of eugenics, who has the “right” to reproduce?

    For over 1000 years humanity lanquished in squalid superstition and subservience to fantastic dogma. Then Galileo broke the mold and showed that reason could perform actual miracles instead of just claim them. For the past three centuries or so we have managed to keep that fire burning and have made such astonishing progress that even the well grounded material realists have a bit of a choke of awe. Can anyone here imagine a human population exceeding 7 billion without antibiotics?

    But even as we reach new thresholds of amazing insights, the old school flim-flam artists are at it again hammer and tongs literally forging fetid bullshit as science.

    We appear to be on the cusp of a new dark age. It is a little ironic that carbon turns out – though it is the key element in our own existence, to be the bain of our future. It further turns out that even with our so-called advanced technology, we are a long way from having the accumen and knowledge base upon which we might be able to mitigate the deleterious effects of our profligacy. Climate science is no less opaque, obdurate and resistant to elucidation than is cancer research. Nature is obscure but not malicious.

    Instead of harnessing our 7 billion minds to delve into the deep problems that confront us, we employ them to make trinkets, or to shovel the excrement of cattle doomed to produce milk for our endless font of new humans, hungry,
    ignorant and afraid. Knowledge is not hereditary.

    I’ll not use the analogy of the pendulum because it is too regular. We have no idea what extremes our current folly might ultimately entail.

    Underlying all of this is the concept of “growth” which seems to be more sacrosanct than the virgin birth or son of god or god hypothesis itself. It goes to the definition of profit. This I think is the ultmate perversion of science that we live with, the thing far more demonic than various hucksters getting rich off fools. Science tells us in no uncertain terms that we cannot win in the end. Our only viable choice is to play the game out for as long as we possibly can.

    Our nearby star, which provides all of the energy which supports life on earth, will die in about 4 billion years or so. In 300 years we humans have gotten pretty smart about some things. But generally we behave like wildebeasts stampeded by a pride of lions.

    The only thing that will make any difference is to change our culture away from superstition and toward knowledge.

    After 63 cycloids around our star I am not a little perturbed that in my short lifetime reason has been caricatured into a form of greed.

    From the rain forest, happy new cycloid to all.

  31. #31 lilady
    January 3, 2013

    @ Kelly & Narad: I’ve already posted twice about those G-ddamn nurses, at The Poxes blog…

    http://thepoxesblog.blogspot.com/2013/01/eight-nurses-with-one-neuron-between.html

    And here, where our Chris is having some “fun” with some of the anti-vaccine comments…

    http://skeweddistribution.com/2013/01/02/8-hospital-employees-terminated-for-refusing-flu-shot/

  32. #32 Chris
    Neither here nor there...
    January 4, 2013

    Thank you, lilady.

  33. #33 Kelly M Bray
    January 4, 2013

    I could use some support here. There is a Dr. Max Chartrand that is an audiologist posing as an MD. Total quack.

    http://www.huffingtonpost.com/social/KellyMBray/goshen-hospital-employees-fired-flu-shot_n_2404328_218912783.html

  34. #34 lilady
    January 4, 2013

    @ prn: “The good doctor can “prove it” to severely ill patients that already flunked “standard medicine”. Dramatic recoveries from severe, objective disease are still evidence.”

    Evidence by testimonial. How quaint.

    “In the future, individual cases may become better defined pieces of evidence as multiparameter measurements soar and accumulate, somewhat akin to computing power advances.”

    How about some case studies, published in first tier, peer reviewed medical journals?

    “In the meantime, gate keeping will continue by affected institutions as patient patients wait decades for someone to do the trials (ahem, heh).”

    Why doesn’t Berkson do the trials?

  35. #35 Kelly M Bray
    January 4, 2013

    Beat me to it Lilady. Exactly what I thought. The great power of anecdote.

  36. #36 lilady
    January 4, 2013

    Kelly…I’ve already posted several times at the Ho-Po…targeting the audiologist. :-)

  37. #37 novalox
    January 4, 2013

    @lilady

    Looking at the comments at the Elkhart website, some of the posters truly don;t have an idea about what the heck they are talking about.

    A lot of Godwin’s, a bunch of “woe is me” type comments, the usual “personal rights” and discrimination spiel, slippery slope arguments, and even a citation to natural news.

  38. #38 Narad
    January 4, 2013

    There is a Dr. Max Chartrand that is an audiologist posing as an MD. Total quack.

    Oh, yeah, I always confuse that guy with “Citizen Jimserac” (“Dr.” James Pannozzi).

  39. #39 prn
    LL
    January 4, 2013

    “Evidence by testimonial. How quaint.”
    How obtuse. For primary parties, like severe ill patients with poor prognoses, evidence by direct measurement and observation of a therapeutic trial can be pretty dramatic, hard to miss or misinterpret. For third parties, it is testimonial if it is an unmeasured and undocumented or unpublished result. The surprising, dramatic individual result IS recognized as a legitimate, lesser level of evidence in Evidence Based Medicine, even if often unused.

    case studies, published in first tier, peer reviewed medical journals?
    outside of NIH, CDC, NCI or pharma sponsors, you’ve got to be kidding right? Berkson already did that with slam dunk material on lipoic acid and mushroom poisoning within the NIH system and essentially got nowhere.

  40. #40 Krebiozen
    January 4, 2013

    prn,

    The surprising, dramatic individual result IS recognized as a legitimate, lesser level of evidence in Evidence Based Medicine, even if often unused.

    In that case, what do you make of this “surprising, dramatic individual result “? He had normal liver function and started taking ALA but he developed hepatitis. He stopped taking the ALA and the hepatitis resolved. He resumed the ALA and the hepatitis returned, and it resolved again when he stopped taking it.

    Alpha-lipoic acid, also known as thioctic acid, improves metabolic glucose control and peripheral neuropathies associated with diabetes mellitus. Its administration appears to be safe and, as far as we know, there are no reports of liver toxicity associated with its use. Our patient developed acute cholestatic hepatitis after beginning treatment with thioctic acid. Use of the Roussel Uclaf causality assessment scale indicated that the association between thioctic acid treatment and our patient’s drug-induced liver injury was highly probable; use of the Maria and Victorino scale indicated that the association was probable.

  41. #41 LW
    January 4, 2013

    @prn:

    In the future, individual cases may become better defined pieces of evidence as multiparameter measurements soar and accumulate, somewhat akin to computing power advances.

    How will we know what those multiparameter measurements mean for clinical results, if there have never been any properly conducted tests of their effects?

  42. #42 al kimeea
    www.quackademiology.com
    January 4, 2013

    prn – milkthistle? Sure.

    The good doc has all kinds of accurate records, charting the various levels of blood markers for liver function/damage and the virus count with accompanying biopsy/USound results?

    Publish those.

    Happy New Year everybody

  43. #43 Antaeus Feldspar
    January 4, 2013

    For third parties, it is testimonial if it is an unmeasured and undocumented or unpublished result.

    For the very good reason that unmeasured/undocumented/unpublished results are often said to be something far different from what measured, documented and published results later prove them to be. You’re not a babe in the woods, prn, you know that measuring and documenting became the key practice of science precisely because unmeasured and undocumented results proved to be so error-riddled.

    Sure, we’d all love to see “promising” approaches pan out and become treatments superior in every metric to the current standard of care. But not everything lives up to its “promise.”

  44. #44 Shay
    January 4, 2013

    I’ve toyed with the idea of going back to school after I retire and getting my doctorate in military history (don’t laugh. There are programs available, and I already have a title for my thesis).

    Then I could call myself “Doctor” and people would have to believe everything I say.

    Oy.

    Narad , I’m with you on the “personal faith walk” yourself out the door on this one.

  45. #45 lilady
    January 4, 2013

    One other comment about Dr. Berkson..after I checked out his website.

    He doesn’t take any insurances…cash upfront.

    He states that the IVs he provides are not covered by insurance.

    He *prescribes* the supplements and the patient buys the supplements from him.

    He states that his practice is “office-based” and he has no hospital affiliations.

    Which other alternative medicine MD does this remind you of?

  46. #46 prn
    replies
    January 4, 2013

    Calli Arcal: …doctor gets hit by a bus, are you screwed? Will you have to start over completely from scratch with a new doctor, who will treat you completely differently?
    screwed? not nearly as badly as the unfortunate doctor! Many of the biolgically/chemically based alternative treatments used by licensed MDs, DOs, NDs appear to be alternative systems with a lot of overlap or commonality with nutrients and off label generics that are increasingly common or a broad awareness.

    From a patient perspective, the issues include having extra choices available (very important when dealing with usually fatal illness and no remotely adequate standard options) and freedom from outside interference.

    Kerbiozen: Short answer, I don’t know. Without seeing the whole paper, I have over half a dozen speculations.

    LW: Existing literature already gives many clinical answers and avenues of investigation for measurable parameters. Future papers increase the value of personal and historical data.

    Antaeus Feldspar: Many inexpensive, useful treatments don’t fare so well in less competent or adversarial hands without paid marketing support to bird dog error and malice. Competitive, adversarial advertising appears to take many forms in the medical industry.

    LL: Which other alternative medicine MD does this remind you of?
    I think your list is common for MDs with alternative treatments due to practical reasons including discriminatory and adversarial behaviors of insurers, medical competitors, and their confederates.

  47. #47 Lawrence
    January 4, 2013

    @lilady – do I hear somebody talking about Dr. B again?

    Again, I can’t recommend:

    http://theotherburzynskipatientgroup.wordpress.com/

    Nearly enough – should be required reading for anyone even considering looking at Dr. B.

  48. #48 lilady
    January 4, 2013

    prn: I hoped to provide you with hints about another MD who practices *uncoventional* medicine (Stanislaw Burzynski), who doesn’t take insurance, who sells his own manufactured medicine…along with other chemotherapeutic drugs at his own pharmacy at jacked-up prices, whose IV treatments are not covered by insurance and whose practice is “office based” (no hospital affiliation).

    “I think your list is common for MDs with alternative treatments due to practical reasons including discriminatory and adversarial behaviors of insurers, medical competitors, and their confederates.”

    Again, with the *Big Pharma*, *Big Medical Insurance* and the *International Doctors’ Conspiracy*, eh.

    Here’s an article recent published in the Annals of Internal Medicine about treatment for Hepatitis C infection, analyzing 86 published articles about the various anti-viral treatments available to achieve SVRs (Sustained Virologic Response) in patients who were infected with the virus. There are 86 journal articles cited in this article and none of them were written by Berkson.

    http://www.uspreventiveservicestaskforce.org/uspstf12/hepc/hepctrtart.htm

    Why doesn’t Berkson submit case studies to any of these 86 publications/journals…describing his *treatment* and the resulting SVRs he has achieved?

    Evidence by testimonial. How quaint.

  49. #49 prn
    LL
    January 4, 2013

    It’s hard to have a productive discussion with someone who won’t distinguish between commonality of situational constraints (insurance billing, legal constraints, etc) and stark differences of sui generis personality traits (unconstrained ambition and ego) and track record. Guilt by strained, distant association, perhaps the Ber – Bur sound part too?

    Your link only covers the expensive, nasty MSM stuff. What happens to patients who strike out on ribivarin and pegylated interferon? Berkson’s approach is totally independent via a hepatoprotective model.

    Here’s Berkson’s three case paper on triple antioxidant therapy for HCV.
    Here is MSM research citing Berkson’s paper on triple antioxidant therapy for HCV, trying to extend the antioxidant model.

    There are a bunch of recent papers citing reactive oxygen species for HCV caused damage.

    Same old, same old. Follow the money, f— the patients. Who says pharma or FDA-NIH are running a charity for free or publicly paid trials?

  50. #50 Krebiozen
    January 5, 2013

    Who says pharma or FDA-NIH are running a charity for free or publicly paid trials?

    NCCAM has handed out $1.3 billion in awards and grants for research into CAM since 2000. Perhaps Berkson should apply for a grant.

  51. #51 al kimeea
    www.quackademiology.com
    January 5, 2013

    of Berkson’s three cases, only one even mentions the viral load and that person still has Hep-C as the viral load appears not to be <100/ml.

    All are about monkeying with ALT & AST – which will change by having a regular meal.

    Not very impressive, if that is the best of Berkson.

    She is free of the signs and symptoms of a serious
    chronic hepatitis C infection.

    Patient one, feeling better but, still with the virus. So, not actually better.

    Mrs. P. P. was put on our balanced health and lifestyle program, and within 7 months regained her health. Figures 3 to 5 trace the favorable changes in her ALT levels, viral load and platelet levels.

    Patient 2, the only mention of a viral load – and they still have it.
    Again, feeling better, not actually better.

    Within 2 weeks she began to feel much better and recovered quickly. Her blood sugar fell into the normal range and the pain in her liver and spleen ended. She became energized and was able to do her normal work as a housewife. She returned to college the next semester earning a 3.8 grade point average.

    The best for last, this patient was scheduled for a transplant!! Funny. No mention of how damaged the liver was, because if you are requiring a new liva due to hep-c cirrhosis damage, ain’t nuthin bringing it back to life but a new liva.

    Same old, same old. Follow the money, f— the patients. Who says pharma or FDA-NIH are running a charity for free or publicly paid trials?

    Yes, this is a tiresome excuse for poor evidence.

  52. #52 Antaeus Feldspar
    January 5, 2013

    Many of the biolgically/chemically based alternative treatments used by licensed MDs, DOs, NDs appear to be alternative systems with a lot of overlap or commonality with nutrients and off label generics that are increasingly common or a broad awareness.

    I’d like to respond with “[citation needed]” but for that sentence, “[translation needed]” is the higher priority.

  53. #53 lilady
    January 5, 2013

    I’m not going to even attempt to reply to prn. It is abundantly clear that prn has not read the link I provided up thread and is still shilling for alternative treatment for hepatitis C.

    Symptomatic patients who are treated with anti-viral and achieve SVR (Sustained Viral Response)…no detectable virus, have a low rate of relapse. (less that 1 %).

    http://cid.oxfordjournals.org/content/52/7/889.full

    Sustained Virologic Response to Antiviral Therapy for Chronic Hepatitis C Virus Infection: A Cure and So Much More

    “…In chronic HCV infection, therapy-induced SVR is a clinically meaningful end point (Table 4). SVR is a durable marker of viral eradication, because evidence for extrahepatic residual viremia is limited, and multiple reports demonstrate that late relapse is rarely observed; SVR is tantamount to cure. Besides posttherapy improvement in hepatic histologic damage, it is likely that SVR-achieving patients have a diminution in HCV-related insulin resistance and in diabetes development and, relative to therapy nonresponders, have a striking reduction in liver-related complications and mortality.

    With the anticipated approval of DAAs to be used in concert with interferon-based therapy, it is reassuring that SVR rates achieved with triple therapy (eg, HCV protease inhibitor plus pegylated interferon with ribavirin) will be superior to those with current standard of care and SVR may be equally durable.

    In conclusion, SVR should no longer be considered to be a surrogate end point, but a clinically meaningful end point of successful therapy for hepatitis C infection; SVR represents a cure and so much more.”

  54. #54 Ken
    January 5, 2013

    @lilady: Which other alternative medicine MD does this remind you of?

    I was going to say Clark Stanley, the “Rattlesnake King”, but Burzynski’s a good match too. So many to choose from, sadly.

  55. #55 lilady
    January 5, 2013

    Good one, Ken. Clark Stanley, the original snake oil salesman..

    http://en.wikipedia.org/wiki/Clark_Stanley

  56. #56 Kelly M Bray
    January 5, 2013

    Just for fun. *Dr.* Tenpenney has shut down all of her Facebook pages and Twitter accounts. Something has hit the fan….oh……too…….bad……..

  57. #57 prn
    January 5, 2013

    LL’s ad hominem, speculative and conclusory statements misstate my points, as seems common with her.

    prn… is still shilling for alternative treatment for hepatitis C
    Burkson’s paper lists three cases of iatrogenic HCV where at least two had failed standard care and the third was being evaluated for liver transplant. The “alternative treatment” being discussed regards liver tranplant vs one simple, cheap oral segment of Berkson’s current alternative protocols. I did not even mention the subject of Berkson’s treatment as primary treatment over standard care for chemo naive patients.

    LL’s antiviral HCV paper is clear that there are still *a lot* of HCV treatment failures:

    Across all antiviral regimens, absolute treatment response rates are lower in older patients; black patients; and patients with higher baseline viral load, genotype 1 infection, or more advanced fibrosis.

    So Berkson’s rationale and rather large niche in the HCV failed treatments population appears to remain to be satisfactorily addressed by standard care, at least from failed patients’ perspective.
    ———————————-
    al kimeea: Your assertion simply ignores Berkson’s results, to avert catastrophic liver failure in patients that failed or were too late for [then] standard treatments for HCV.

    Berkson’s paper focuses on a simple, cheap oral treatment that appears to be hepatoprotective and it does not even mention several other treatments to help clear HCV, nor his other measures to restore liver function. One proposed therapeutic aspect of his triple antioxidant treatment is that HCV is less toxic due to reduced HCV spawned oxidative damage while taking the triple antioxidant treatment rather than viral load elimination.

    In his practice, he appears to use other steps to promote HCV viral clearance and liver repair, but that is beyond the scope of his 1999 paper.

  58. #58 Kelly M Bray
    January 5, 2013

    “but that is beyond the scope of his 1999 paper.”

    This is 2013.

  59. #59 lilady
    January 5, 2013

    The “points” prn attempted to make are duly noted and have been refuted by me and other posters….as are her rants against “mainstream medicine”, medical insurance companies, scientists, researchers and physicians….

    “Follow the money F__ the patients”.

    I can only conclude that prn is shilling for this doctor.

    Where are the case studies published by Berkson…instead of the anecdotal “testimonials”?

  60. #60 Krebiozen
    January 5, 2013

    It looks as if prn has bought into the idea that various effective CAM treatments are being suppressed by Big Pharma. I read so many complaints about how expensive it is to carry out clinical trials (ignoring NIH and other grants), and how drug companies can’t patent natural substances (not true) so they don’t bother investigating them etc. etc., but I find it hard to believe this is true. If you look through the NCCAM trial results and that $1.3 billion they have spent on research over the past 12 years, they haven’t found anything very useful, certainly nothing to justify the expense. When you consider that the budget of the Office of Cancer Complementary and Alternative Medicine (OCCAM) is similar, and has been similarly unsuccessful, you have to wonder. Presumably these organizations have sought out the most promising of CAM treatments to investigate, but have come up with nothing. Either there is an enormous conspiracy, or scientists and doctors are unbelievably dumb, or those modalities of CAM that are effective became medicine decades ago and NCCAM and OCCAM are wasting time and money.

    I noticed this paper among the NCCAM results.

    Trial results indicate that treatment with either higher-than-usual silymarin doses or placebo in patients with treatment resistant hepatitis C does not change indicators of hepatitis C disease activity.

    If only they had given them alpha lipoic acid as well.

  61. #61 S
    January 5, 2013

    many complaints about how expensive it is to carry out clinical trials (ignoring NIH and other grants), and how drug companies can’t patent natural substances (not true) so they don’t bother investigating them etc. etc.,

    This is utter nonsense. Those are common ploys that sCAM advocates use to mislead naive and gullible people. They then let those gullible people run around repeating the myths until they and everyone around them believe them to be true.

    Natural substances can and have been used in pharmaceuticals, and as the main active ingredient. A product marketed as a supplement is not required to be regulated or even evidenced to be effective in treating anything at all. It’s all in the marketing program. A supplement sold with a skilled marketing plan has the potential to earn the company much more money than if they sold the same exact product as a pharmaceutical. Any pharmaceutical CEO or legal/financial expert should be able to attest to that. At a minimum, pharmaceutical products must evidence that they are effective in treating something, supplements have no such criteria.

    Patients should be angry that they are being manipulated like ignorant little puppets by these sCAM artists.

  62. #62 al kimeea
    www.quackademiology.com
    January 5, 2013

    assertion my ass, I accurately described the data Berkson presented

    One proposed therapeutic aspect of his triple antioxidant treatment is that HCV is less toxic due to reduced HCV spawned oxidative damage while taking the triple antioxidant treatment rather than viral load elimination.

    this would indicate buying Berkson’s treatment forever, a la insulin

    this is 2013, things for Hep-c in the real world have progressed – 50% or better with conventional peg-interferon+ribavirin for those with type 1 hep-c and 80% for those with type 2 or 3

    it would interesting to see what the followup is on these three women – so much for only screening certain men – since they still have the virus which could easily flare up again as it does for those with type 1 whose standard treatment shows success – as in canna find the wee beasties at all, ZERO – until the breakthrough at 12 months.

    There are new options coming online via real medicine as we pixilate.

    One way to reduce oxidative damage is to stop breathing.

  63. #63 S
    January 5, 2013

    I can only conclude that prn is shilling for this doctor.

    Speaking of shilling for doctors, lilady. Journalists seem to do this as well. In fact, one is alleging a witch hunt on one of your favorite groups of sCAM artists right now. She even has nominated herself for a Pulitzer Prize and has solicited the patients to vote for her! Voting ends later this month.

    Interesting that the Pulitzer committee is out of Columbia, home to Dr. Oz and those other sCAM artists’ idol. Columbia is rapidly becoming a wasteland of ‘medical unethicals’.

  64. #64 al kimeea
    January 5, 2013

    HCV protease inhibitor – new options such as this mentioned by lilady

    how long before the transplants were required? weeks? decades? not in paper. Berkson keeps excellent records.

  65. #65 Krebiozen
    January 5, 2013

    S,

    Patients should be angry that they are being manipulated like ignorant little puppets by these sCAM artists.

    Indeed. One thing that amuses me about this is that vitamin manufacturers and ‘Big Pharma’ are often the same companies. The biggest supplement manufacturer in the world is, I believe, DSM which is a huge multinational chemical company that also produces pharmaceuticals and makes an annual profit of over $1 billion. Poor little supplement sellers who can’t afford clinical trials? I don’t think so.

  66. #66 S
    January 5, 2013

    DSM which is a huge multinational chemical company that also produces pharmaceuticals and makes an annual profit of over $1 billion.

    Now that’s just throwing salt on a wound, Krebiozen.

    Poor little supplement sellers who can’t afford clinical trials?

    The product can launch faster if they sell it as a supplement and just advertise that their clinical trials will be starting soon. Other sCAM artists advertise having done trials, when they have not. These are the kinds of details that the average patient needs to understand. Education is the best prevention against being sCAMmed.

  67. #67 al kimeea
    www.quackademiology.com
    January 5, 2013

    no one has to promote liver repair of cirrhosis, it is quite capable by itself – to a point

    you really have no idea what u r yapping about, do you prn?

  68. #68 Marg
    January 6, 2013

    @prn
    You can’t win. It’s a waste of time to try to convince anyone here of anything outside the narrow confines of what they know to be true.

  69. #69 Alain
    January 6, 2013

    Dear Marg,

    You and prn appear to be living in an alternate reality where testimonial are the primary source of evidence. In the case of scientists, they use a method to eliminate bias, which are common in testimonial but hey, if testimonial satisfy you, it’s not the case with us.

    Are you aware that it’s one of the job of scientists to find holes in studies. Reviewers help correct holes in studies and there is more correction or replication of published studies so the end result is a very solid body of knowledge.

    Do you find alternative health provider finding holes in testimonial? that never happened so far. All I see is promotion over promotion which is not the way you build a solid foundation (in fact, it’s pretty brittle).

    This is why you can’t win here (neither prn) :). You want to win, demolish a testimonial and try to find holes in a study from the NCCAM.

    Captain Obvious.

  70. #70 Militant Agnostic
    In a house where we obey the laws of thermodynamics.
    January 6, 2013

    Marg – can you explain where Begston got the energy equivalent to burning over a hundred tonnes of anthracite coal for his hand waving cloud busting? I showed my work – holding my breath well waiting for you to show yours would be a good way to avoid oxidative damage according to Al Kimeea.

  71. #71 novalox
    January 6, 2013

    @marg

    Still scamming innocents of their money, fraud?

    And honey, you serve a useful purpose, as easy target practice.

  72. #72 Chemmomo
    Reality Biased
    January 6, 2013

    Marg

    You can’t win

    Perhaps if you spent less time tossing out insults and posting links that regurgitate themselves, and more time thinking about what kind of information those of us who understand scientific method might find convincing, you could get more folks here to take you more seriously.

    The path to changing our minds has been spelled out to you, repeatedly. It’s not our fault you are unable to follow it.

  73. #73 herr doktor bimler
    January 6, 2013

    The path to changing our minds has been spelled out to you, repeatedly

    Beer works for me.

  74. #74 Narad
    January 6, 2013

    You can’t win. It’s a waste of time to try to convince anyone here of anything outside the narrow confines of what they know to be true.

    Note: (2) Essential nature of ontologically plural minds. (1) Notion of “time” as an expendable good, despite the assertion that “energy healing” is not bound by any sort of spacetime relationships. (3) Pathetic come-on attempt.

  75. #75 Chemmomo
    January 6, 2013

    herr doktor bimler

    Beer works for me.

    Cheers!

  76. #76 Narad
    January 6, 2013

    Nearly forgot… I have been meaning to note that Marg’s (and Judith’s) version of paranormal healing is a cheapened variety of this well-established tradition. The diagnostic talent has been tossed overboard (ready falsifiabily being irksome, one might suppose); there is just an amorphous “healing” blob.

  77. #77 Narad
    January 6, 2013

    ^ “falsifiability”

  78. #78 sheepmilker
    Wondering if I should shovel the drive—again
    January 6, 2013

    Sigh. The local newspaper has an ad for a new (to me) energy healing technique-—”Access The Bars”*. Apparently there are 32 pressure points on the head which when touched unblock your energy flow, or whatever. A mere $200.

    The outfit which offers courses and franchises looks ver well set up. Lots of levels of certification and expensive courses. Lots of science sounding stuff too “Molecular De-Manifestation & De-molecular Manifestation” !

    The local course is above the gourmet coffee shop, I wonder if there will be an extra buzz in the coffee on that day?

    *Not nearly as much fun as it sounds I bet.

  79. #79 al kimeea
    www.quackademiology.com
    January 6, 2013
  80. #80 Mephistopheles O'Brien
    January 6, 2013

    @Marg,

    It’d be a lot easier to convince people here about novel concepts, theories, and treatments if you’d provide a reasonable argument backed by strong evidence.

    Saying that someone can cure cancer in mice he managed to accidentally treat with his mind (while trying hard not to), and saying that he learned to do this first by learning to manipulate the clouds, is pretty much a non-starter unless you’ve got really, really good evidence for both claims.

  81. #81 Militant Agnostic
    In a house where we obey the laws of thermodynamics.
    January 6, 2013

    @sheepmilker

    Sigh. The local newspaper has an ad for a new (to me) energy healing technique-—”Access The Bars”*

    Are you sure they weren’t selling fake ID?

    The outfit which offers courses and franchises looks very well set up. Lots of levels of certification and expensive courses.

    Looks like they have improved upon the Reiki business model. The latter tends to have all the disadvantages of an MLM without the the advantages (for those at the top only).

  82. #82 Militant Agnostic
    Regretting the absence of preview
    January 6, 2013

    The second last paragraph should have been a blockquote of sheepmilker.

  83. #83 Denice Walter
    January 6, 2013

    @ Mephistopheles O’Brien:

    Re: Marg

    Now IIRC, hasn’t she been around, on-and-off,** since *August* ( on the thread the finally expired).
    Is it persistence/ perseverance or perseveration? In her case, I doubt there would be any operative difference between them.

    ** possibly making prior appearances.

  84. #84 Denice Walter
    January 6, 2013

    THAT finally expired

    ( as well it should have)

  85. #85 Militant Agnostic
    In a house where we obey the laws of thermodynamics.
    January 6, 2013

    Marg in case you don’t understand what Mephistopheles O’Brien is getting at – extraordinary claims require extraordinary evidence. I believe I clearly demonstrated via step by step calculations involving elementary school (in fact probably 3d grade) math why Bengston’s cload busting was an extraordinary claim. I take your lack of a response to my calculations as assent that this an extraordinary claim for which you provided what could at best be called ordinary evidence and could more reasonably be considered weak or dubious evidence.

    While I am not an expert in cancer or mice, thermodynamics and to a lesser degree micrometeorology are within my domain of expertise.

  86. #86 Mephistopheles O'Brien
    January 6, 2013

    @Militant Agnostic – in all fairness, rather than evaporating the clouds he might have meant he dispersed the water droplets in them or compressed them. This would have the appearance of dissolving a cloud. I haven’t worked out the difference in energy required for that technique, but have heard that large fans can be used for that purpose with fog.

    Of course, I’ve not seen compelling evidence that the human mind can create a mighty wind, outside of politicians – and they use lungs for that purpose.

  87. #87 Mephistopheles O'Brien
    January 6, 2013

    @Deniece Walter,

    Not being a psychiatrist, I am hesitant to speculate on another’s motivation, especially without a consultation. However, based on my observations of her (assuming Marg is a her) messages over the months would indicate that her purpose has changed. Originally she intended to convince people of the wonders that she believes she has personally observed, or at least had heard about from others. The messages then went farther afield, attempting to show that (in the words of the Firesign Theatre) “Everything You Know Is Wrong!”. Some time ago she stopped that and retreated to the occasional support of posters who disagrees with what she sees as the general consensus.

    I would personally prefer if she would pass the various critiques of the items she’s brought us to people who would provide a considered response or perform better tests. Nothing but good could come from that.

  88. #88 Kelly M Bray
    January 6, 2013

    What is the deal about Cancer Treatment Centers of America? My ears perked when they talked about *ancillary support* and listed Naturopathy. Hmmmm. Is it sCAM?

  89. #89 Chemmomo
    Different Computer in Land Without Preview
    January 6, 2013

    Denice,
    Marg arrived here, along with Judith, back in June on the Reiki vs Dogs being Dogs post.:
    http://scienceblogs.com/insolence/2012/06/05/reiki-versus-dogs-just-being-dogs/comment-167704
    (it’s supposed to link to what I think is her first citation of Bengstron on June 12, but I am not it will work)

    Remembering when things occurred is a side effect of seasonal employment.

  90. #90 Chemmomo
    Sorry!
    January 6, 2013

    Above link definitely does not work.

  91. #91 Narad
    January 6, 2013

    Above link definitely does not work.

    Needs more octothorpe.

  92. #92 prn
    K
    January 7, 2013

    DSM which is a huge multinational chemical company that also produces pharmaceuticals and makes an annual profit of over $1 billion.
    It is the net margins of the individual product that determine the economic viability of any technical marketing support like trials. I suspect that Americans are usually buying the cheap stuff sourced from China and India, not DSM. At perhaps 30 cents per day for Berkson’s formulas via mail order suppliers, that’s not a lot of revenue to support testing like the ca $300 per day “triple therapy” including an HCV protease inhibitor.

    Presumably these organizations have sought out the most promising of CAM treatments to investigate…
    not from what I see

  93. #93 prn
    K again
    January 7, 2013

    Trial results indicate that treatment with either higher-than-usual silymarin doses or placebo in patients with treatment resistant hepatitis C does not change indicators of hepatitis C disease activity.

    If only they had given them alpha lipoic acid as well.

    Selenium, lipoic, silymarin *plus* some of the support nutrients should be considered the minimum treatment unit. This is one of the problems with single component testing instead of multicomponent synergists (critical components) in subtherapeutic amounts for inadequate durations.

    You can have silver bullets in virgin brass cartridges with super premium powder, but no primer, no bang.

  94. #94 JGC
    January 7, 2013

    I’m curious-you’ve indicated that you believe that although NCCAM has spent over $1 billion over the past decade investigating CAM treatments they’ve somehow failed to look at the most promising ones.

    A question leaps to mind: how exactly can one distinguish the most promising CAM treatments from all other CAM treatments, when they all share the same lack of any clinical evidence of efficacy?

  95. #95 Krebiozen
    January 7, 2013

    prn,
    It is very easy for people, including clinicians, to fool themselves into thinking that a treatment they try is effective, especially with an illness with a variable course (or one that is self-limiting). These are the diseases for which we often see woomeisters claiming they have an effective treatment; whether they have deceived themselves or are cynically exploiting sufferers it is hard to say. Hepatitis C is one of several illnesses with a variable course that lends itself to this kind of deception. Here’s what the WHO have to say about hepatitis C:

    The course of acute hepatitis C is variable, although elevations in serum ALT levels, often in a fluctuating pattern, are its most characteristic feature. Normalization of ALT levels might occur and suggests full recovery, but this is frequently followed by ALT elevations that indicate progression to chronic disease. [...] HCV-associated cirrhosis leads to liver failure and death in about 20%-25% of cirrhotic cases.

    It seems clear that Berkson’s case study patients might have seen the same course of their disease without any treatment. Without a well-designed clinical trial it is impossible to say whether Berkson’s results are due to the treatment he uses or not.

  96. #96 Denice Walter
    January 7, 2013

    One way in which people might fool themselves is by assuming that the action they took that immediately preceded a desired result or event CAUSED it.

    Someone’s blood sugar might be generally elevated so he or she might try an herb or supplement supposedly “known” to lower blood sugar- if the blood sugar is then lower, the person might assume that the herb/ supplement caused the desired change. A purchase and a testimonial might immediately follow that ‘discovery’. In reality, one or several OTHER factors might have caused the change in blood sugar: the person will never know which one or combination really caused the change
    .
    People who have had surgery for cancer and later followed up with alt med protocols might attribute later good results to alt med not the surgery.

    A psychologist fed pigeons on a random schedule: he found that the pigeons repeated the actions that they were engaged in immediately prior to the feeding – which had NO connection whatsoever to the feeding. Thus, one pigeon might turn in circles superstitiously to invoke additional feedings – which only occur intermittenly- while another moves its head up and down. Intermittent reinforcement takes much longer to extinguish. These pigeon superstitions might continue for a long time- not all pigeons are birds.

    Self-observation is riddled with other traps besides this: real research involves objective observers and manoeuvres to dis-entangle the many confounders that occur in complex systems like human physiology.

  97. #97 Krebiozen
    January 7, 2013

    Denice,
    In this regard I always remember the commenter here who insisted he had found that homeopathy was effective in treating his gout. He would try remedy after remedy until his gout subsided, but the next time he had an exacerbation, that remedy wouldn’t work, and he would have to try different remedies again. It seemed clear to most of us that his gout was following its normal course of exacerbations and remissions, but he was attributing the remissions to homeopathy. As I recall he required surgery on one of his toe as a result of permanent damage that could have been prevented by conventional treatment.

  98. #98 Mephistopheles O'Brien
    January 7, 2013

    To put the same phenomenon (post hoc ergo propter hoc reasoning) into a different context, is the following sufficient proof?
    - I got in a fight with Mrs. Smith, the one with the big wart.
    - She gave me a nasty look and muttered something I couldn’t understand.
    - Later that day, I fell off a ladder and fractured my coccyx.
    - Mrs. Smith must have caused my bad luck.

  99. #99 herr doktor bimler
    January 7, 2013

    Selenium, lipoic, silymarin *plus* some of the support nutrients should be considered the minimum treatment unit.

    I have nothing against multi-drug regimes, but it was my impression that normally each of the constituent drugs has some measurable therapeutic effect on its own. Otherwise it’s not going to occur to anyone that they will combine to overwhelm the targeted virus or whatever.

    Is that the case here? Does silymarin have *any* effect in isolation? If not, I am going to wonder how the promoter of some treatment combination came up with it… whether by pulling it out of the ether, or following the Weil philosophy of “Some plant combines these chemicals so they are clearly destined for human benefit”.

  100. #100 Krebiozen
    January 7, 2013

    M.O’B.,

    - Mrs. Smith must have caused my bad luck.

    I think that if Mrs. Smith habitually glares at everyone and mutters to herself, and you are extremely clumsy, that is a closer analogy to someone using a CAM remedy for a variable condition – the one event will inevitably and repeatedly follow the other, which can result in someone being absolutely convinced there is a causative relationship. The same applies to Berkson giving his cocktail of supplements to hepatitis C sufferers. Of course it is possible that his cocktail is effective, but I do wonder why there hasn’t been a clinical trial, how many failures he has, and what long term follow-up of his patients shows.

    HDB,
    Milk thistle has a long traditional use in liver complaints that goes back at least as far as Pliny the Elder. It also repels snakes, allegedly. Research results in animals and humans are equivocal.

  101. #101 al kimeea
    www.quackademiology.com
    January 7, 2013

    Well, if I hadn’t missed the “reiki vs. dogs” thread for some unfathomable reason, I wouldn’t have ever bothered with JudithMarg seeing as almost everything they ignored/misunderstood from me had already been well covered by many of you.

    Thick as bricks and invisible to mirrors.

    real research involves objective observers and manoeuvres to dis-entangle the many confounders that occur in complex systems like human physiology.

    Human physiology is so complex that science is dumbfounded by the healing abilities of abject fraudsters like The Waverly Sisters and unable to provide any insight as their hand jive negates all accumulated knowledge.

    And we’re the arrogant ones.

  102. #102 al kimeea
    www.quackademiology.com
    January 7, 2013

    Large doses of vitamin C do really nothing more than create pricey pee

    IIRC

  103. #103 herr doktor bimler
    January 7, 2013

    Milk thistle has a long traditional use in liver complaints

    I saw that the Cochrane Collaboration report on silymarin for Hep C was not favourable:
    http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003620.pub3/abstract
    OTOH there have been reports of good effects saving people’s livers after Amanita poisoning.

    I was wondering about prn’s argument that tests of silymarin on its own are not appropriate here. What is the rationale for this particular combination of antioxidants?
    I ask out of curiosity rather than criticism, not having any knowledge or reason to challenge prn.

  104. #104 Krebiozen
    January 7, 2013

    I have a few musings on biochemical musings on alpha lipoic acid and antioxidants in general, which might be appropriate to post here. Alpha lipoic acid with acetyl l-carnitine was the “elixir of youth” that Reader’s Digest claimed would “end aging” (PDF) a few years ago, some may remember. Ten years on, there still isn’t any compelling evidence that this cocktail of antioxidants is effective in preventing aging and the idea of large amounts of antioxidants taken as supplements or even in the diet sadly hasn’t lived up to the hopes many of us had for it a few decades ago.

    I used to have an interest in vitamin C, and its potential as an antioxidant that might prevent or even treat disease. Most other animals make their own vitamin C out of glucose, and excrete large amounts in their urine, so the “expensive urine” line isn’t necessarily accurate, as vitamin C is metabolically expensive for animals. Some have described the inability of haplorrhini primates to synthesize ascorbate as a inborn error of metabolism i.e. L-gulonolactone oxidase deficiency. At some point one of our ancestors must have found itself in an evolutionary bottleneck where there was a survival advantage in conserving glucose rather than converting it to ascorbate, and those without the enzyme survived. However, we have had 63 million years to adapt to this enzyme deficiency and we are now metabolically adept at conserving reduced ascorbate and in using small amounts of ascorbate very efficiently.

    Humans also appear to have adapted to use urate instead of ascorbate as an endogenous antioxidant, and it circulates in the blood in concentrations far higher than even the most ardent Pauling fan could hope to achieve with ascorbate. This suggests that the effect of ingested antioxidants is swamped by that of urate. Urate is basically the product of breaking down DNA in the diet – all fruits, vegetables, meat and fish contain lots of DNA, obviously. It always puzzled me why humans (and other higher primates) don’t break down the relatively insoluble urate into the very soluble allantoin, as other mammals and birds do. The consequence of this is gout and kidney stones, but presumably the advantages of urate as an antioxidant outweigh this.

  105. #105 al kimeea
    www.quackademiology.com
    January 7, 2013

    The rationale may be that all these things are claimed to be good for many things that ail you – despite the lack of solid evidence – therefore in combo, they will be even more effective

  106. #106 sailor
    January 7, 2013

    “everyone born between 1945 and 1965″. Seems overkill to me. This includes a lot of people who lived through the hippie years. Probably make more sense to to take test according to obvious risk factors (sharing needles, having many sexual partners, etc etc.

  107. #107 Narad
    January 7, 2013

    Large doses of vitamin C do really nothing more than create pricey pee

    Try telling that to your bowels.

  108. #108 Denice Walter
    January 7, 2013

    @ Narad:

    I was about to comment with the very same thought.
    (However many alt med folk want to be ultra thin so I guess they don’t mind excess poo)

    @ Kreb:

    One of the idiots I survey insists that the fact that humans have lost the capacity to synthesise vitamin C “explains” why humans are SO much more unhealthy than other small-to-medium size mammals who seem to enjoy sparkling, vibrant, cancer-free health** ( unless of course, we start feeding the litttle carnivores factory-produced cat food etc, like some people I know)

    **sarcasm

  109. #109 al kimeea
    January 8, 2013

    did not know that, or don’t remember that aspect as it was some time ago

  110. #110 JGC
    January 8, 2013

    I think it’s less that conserving C conferred a survival advantage than losing the ability to synthesize vitamin C when there are abundant dietary sources available is a neutral change. (The Genetics of Vitamin C Loss in Vertebrates, Drouin et al, Curr Genomics. 2011 August; 12(5): 371–378.)

  111. #111 Krebiozen
    January 8, 2013

    JGC,

    I think it’s less that conserving C conferred a survival advantage than losing the ability to synthesize vitamin C when there are abundant dietary sources available is a neutral change.

    Thanks, I hadn’t seen that article before. I was actually suggesting that conserving glucose may have offered an evolutionary advantage, though presumably if our little furry ancestors had sufficient ascorbate in their diet they would have had sufficient carbohydrate as well . It just seems odd to me that a neutral mutation would take over a species completely. Why didn’t our ancestors that could synthesize ascorbate survive?

  112. #112 JGC
    January 8, 2013

    It doesn’t look like the mutation took over the species completely, as members of the primate suborder Prosimii possess active GULO enzyme and can synthesize their own vitamin C.

    Us members of the suborder Anthopoidea may just have lucked out when picking our ‘parents’ .

  113. #113 Krebiozen
    January 8, 2013

    JGC,

    It doesn’t look like the mutation took over the species completely, as members of the primate suborder Prosimii possess active GULO enzyme and can synthesize their own vitamin C.

    I still don’t see how all members of a suborder can end up possessing a mutation if it is neutral.

  114. #114 prn
    January 9, 2013

    HrDrBimler
    but it was my impression that normally each of the constituent drugs has some measurable therapeutic effect on its own.
    That might be better described as additivity for situations where several components are fractional or incremental in nature. In synergism, combination of critical components may have had zero or very low improvements, for the individual component or pair, very hard to see in situ or even in a lab experiment. As the multiple mechanisms, molecular targets, or delivery of several components are brought together, more reliable or dramatic improvement can result.

    I saw that the Cochrane Collaboration report on silymarin for Hep C was
    not favourable

    Actually the mean results were favorable (median 1). I don’t have access to Cochrane to see the individual trials used as far as differences of disease, dosage, schedule, or other heterogeneities etc. This could happen for a number of reasons where a treatment works well for an indentifiable group for stage, severity, dosage or variant, human or viral. Conventional commentators refer to the poor absorption of silymarin and the low doses tested compared to tolerable higher intakes possible (I think I’ve seen a paper with over 10 grams of silymarin for cancer vs 200-500 mg per day usually trialed or even 900+ mg for Berkson’s basic oral protocol for HCV).

    I found this review interesting, presumably it overlaps the Cochrane study an shows the heterogeneity and subtherapeutic aspects of many “acceptable” trials ( Berkson has been suggesting his dose regime for ca 20 years)

    This recent paper, Hepatitis C Virus and Natural Compounds: a New Antiviral Approach? appears to show conventional medicine inching up to the idea of multiple agents including natural ones.

  115. #115 prn
    Location: my comment awaiting moderation
    January 9, 2013

    had problem with algebraic signs, “less than” and “greater than” signs, should read “Actually the mean results were favorable (median under 1)”, the but did not reach statistical significance (upper end of range greater than 1)

  116. #117 Krebiozen
    January 9, 2013

    prn,
    WordPress sees < and > as starting and ending HTML tags, so you have to use &lt; and &gt; instead. This is a pain when copying and pasting.

  117. #118 JGC
    January 9, 2013

    One possible explanation for GULO minus becoming fixed in the population would be if it were physically linked (present on the same chromosome as) an allele that did confer increased fitness. In that case selection for the beneficial allele would effect selection for GULO minus.

  118. #119 JGC
    January 9, 2013

    Or we could have something as simple as a founder’s effect (the reason Manx cats don’t have tails).