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How the Medical Profession Supports Alternative Medicine Michael Edmonds Mar 29

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One of the things we often hear from proponents of alternative medicine is that they like alternative practitioners because of their holistic approach – and some of the bloggers here have previously countered by saying that medical practitioners do the same. For example, I feel that my GP takes a holistic approach to my health – he is happy to discuss a range of issues with me, including diet, exercise, side effects of medications and ways to minimise my need for medication. Over the years, for example, he has helped me manage my asthma and reduce the amount of medication I need.

Recently, however, I was in Australia and had to seek medical attention twice for a relatively minor complaint, and both times I found the attention I received was cold and rushed. Both physicians focused on the symptoms, asked very few holistic questions and didn’t seem much interested when I volunteered additional information which I thought might help. The solution in both cases was a prescription with very little additional advice or suggestions.

With the medical practice I visited I don’t think the problem lies fully with the doctors – the system is set up to encourage doctors to process patients as fast as possible. Signs around the practice explained how doctors were only allowed to deal with one medical condition at a time – if you had more to talk about you needed to extend your session (and pay more). Hardly a good way to facilitate a holistic approach.

The medical practice also required that I pay before seeing the doctor- probably understandable as I was a walk in patient. However, I have since discovered that my partner has to do the same when he visits his regular doctor here in New Zealand. Hardly a way (in my opinion) to establish a good working relationship with your doctor. Also he does not get to see the same doctor each time, something which doesn’t really appeal to me.

While I am sure there are many great holistic thinking doctors in both New Zealand and Australia, I can’t help but think that it is doctors and medical practices like the one  I described above help push people towards alternative practitioners – they may not have treatments that work, but they do make the patient feel listened to and like a whole person – not just a mobile set of symptoms.

 

From the Mouth of Food Babe Michael Edmonds Mar 26

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Food Babe, aka Vani Hari, has developed quite a following on her blog where she provides advice on healthy living. Some of the advice can be quite good, however, it can also include incorrect information often creates unnecessary chemophobia.

A recent article for magazine The Cut provided some good examples of how good advice can be muddled with less than scientific information.

The article starts poorly with Vani explaining that

“For several years, I’ve started my day with warm lemon water and cayenne pepper. Lemon water is very alkaline and can stimulate the liver.”

Lemon water is very alkaline? I don’t think so. Lemons are acidic.

Later she describes her own diet which seems quite sensible – lots of green vegetables, proteins etc. Unfortunately this is accompanied by a requirement that the vegetables are organic due to a fear of the “synthetic pesticides, which can cause cancers and auto-immune disorders.”

She applies the mistaken belief that “An acidic body promotes disease and inflammation.” and consequently she tries “to make my diet mostly alkaline.”

She also plays the fairly standard alternative health card of creating an enemy, explaining that

“There are people who want to keep the chemicals in our food and keep us dependent on chemicals. They’re chemical activists.”

and

 ”I want to know why companies aren’t coming up with chemical inventions that are improving our health. And people can’t argue with that.”

Actually it is fairly easy to argue with that. The pharmaceutical industry has created a wide range of chemical inventions to treat a wide range of conditions including septicaemia, tuberculosis, malaria, HIV and a number of different cancers.

It is such a pity to see good health advice mixed in with misinformation, in a way that is likely to confuse people as well as create some paranoia about different sources of food.

The Evolution of Medicines Michael Edmonds Jan 13

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Next Wednesday evening, the 21st of January at 7 pm, I will be giving a public talk in Christchurch on the “Evolution of Medicines – from Farmer to Pharma”. This will be the first lecture in 2015 for our local Skeptics in the Pub group.

The history and evolution of medicines has always fascinated me. The medicines we use today are the product of centuries of human endeavour to understand and treat disease, and have resulted in significant improvements in both life expectancy and quality of life.

In my talk I will look at how, across time, our understanding of disease and how to treat it with medicines has evolved significantly, from early belief in disease causing demons and bad air, to the four humors, to the science based medicines of the 20th and 21st centuries. I will also look at how some of the erroneous and discarded beliefs about the causes of disease, rather than dying out, are still used to support various “alternative medicine” beliefs.

 

 

For anyone local who is interested in coming along I have created an Eventbrite site here which contains all of the details.

The Poisoner’s Handbook on Youtube Michael Edmonds Jan 07

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A couple of weeks ago I came across a TV version of The Poisoner’s Handbook on Sky TV’s History channel. The Poisoner’s Handbook is an excellent book which both Grant and I have previously reviewed (see here and here). It provides a fascinating insight into the development of forensic science in the early 20th century.

I was going to blog about this sooner but unfortunately it hasn’t been repeated (unlike pseudohistoric programmes such as Ancient Aliens which seem to be repeated endlessly – but I digress).

Fortunately, today I discovered that the full programme can be found on Youtube. So for those of you who enjoyed the book, or for those who would prefer to watch it rather than read it, you can watch it below.

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World AIDS Day – Science & Pseudoscience of AIDS Michael Edmonds Nov 30

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In the early 1980s, the emergence of a previously unknown and fatal disease, raised concern amongst medical professions and fear in the general population. Those suffering from this new disease presented with a range of opportunistic infections, including rare forms of pneumonia and cancer – suggesting the cause was a failing immune system.

Thirty years on, we now refer to this disease (or more correctly syndrome) as AIDS (Acquired Immune Deficiency Syndrome) and understand it is caused by HIV (the Human Immunodeficiency Virus).

Much has changed over those thirty years – socially, politically and scientifically. Here, I will focus on the latter describing how fight to combat AIDS and HIV has resulted some of the most brilliant science, and also some of the most appalling pseudoscience.

Fighting a disease requires learning as much as you can about it, in particular being able to isolate the cause. In 1984, this piece of the puzzle was solved by two teams, one in the US and one in France – the cause of this new disease was a retrovirus; named the Lymphadenopathy Associated Virus (LAV) by Luc Montagnier’s team at the Pasteur Institute in France, and HTLV –III by Robert Gallo’s team at the National Cancer Institute, the virus would eventually be known as HIV. On both sides of the Atlantic there were often bitter debates about whose contribution to the discovery of HIV was greatest, which was exacerbated in 2008, when Montagnier, but not Gallo, was awarded the 2008 Nobel prize in physiology and medicine.

The identification of the cause of AIDS, opened the door to a number of research opportunities including the development of a test to detect HIV, drugs to combat HIV and vaccines. One of these was achieved within a year, another required over a decade of research before significant progress was made, and the third has yet to be achieved.

By 1985, a blood test to detect for HIV antibodies was developed and immediately used to screen blood banks. The ability to test patients for HIV also allowed medical professionals to gather more data of the disease, however, without appropriate treatments or a vaccine the death rate from AIDS related conditions continued to climb.

In 1987, the first antiretroviral drug, AZT, was approved by the Federal Drug Administration (FDA) for use in the treatment of HIV infection and AIDS. A fairly blunt weapon in the treatment of HIV and AIDS, many of those given AZT experienced severe side effects, a fact which was later twisted by proponents of pseudoscience to suggest that these treatments actually “caused” AIDS. 1987 also saw the political group ACT UP successfully lobby the FDA to speed up drug approvals.

Over time, modification of AZT dosage lead to improved treatments and in 1990 it was approved for treatment in pediatric AIDS. However, the effects were not great and in 1990 the median time to death after diagnosis of AIDS was one year. It was not until 1995 and the development of the first HIV protease inhibitor, saquinavir, that more effective treatments of HIV began to emerge.

The development of HIV protease inhibitors proved to be a significant turning point in the war of AIDS. By effectively “jamming” the protease enzyme in its’ production of the proteins required for HIV to replicate it slowed the ability of HIV to infect new cells. Saquinavir, was quickly followed by other protease inhibitors and in 1996, nevirapine the first of another family of drugs, the Non Nucleoside Reverse Transcriptase Inhibitors (NNRTI) emerged.  NNRTI’s, like AZT, interfere with the copying (or transcription) of viral genetic material into the host cells DNA, however, unlike AZT their structure is not based on the naturally occurring nucleotides in DNA.

Now having a range of drugs with which to treat HIV, doctors experimented with varying combinations and HAART (Highly Active Anti-Retroviral Therapy) became the standard treatment whereby patients were treated with several drugs simultaneously. As these treatments were perfected into the 21st century, deaths from AIDS began to decrease, and life expectancy of those with HIV began to lengthen.

The benefits of having multiple drugs to treat HIV are two-fold. Different types of drugs target different pathways that the virus uses to reproduce in the body. The more pathways that can be disrupted the less chance the virus has to reproduce. Also, HIV has the ability to mutate allowing it to become resistant to a specific drug – should this occur, the ability to switch to a new combination of drugs means that HIV replication can still be suppressed.

The effectiveness of the drugs developed in the 1990s lead to somewhat of a reduction in interest by drug companies to develop new drugs to treat HIV moving into the 21st century, however, some notable achievements included the development of fusion and integrase inhibitors. The first fusion inhibitor, Enfuvirtide, was approved by the FDA in 2003 and works by blocking the ability of HIV to fuse with cells and infect them. Raltegravir, the first integrase inhibitor was approved for use in 2007, and works by blocking the enzyme which integrates viral material into the host cells DNA. Incorporation of these drugs into the armamentarium available to today’s medical professional has further improved the outcome for those infected with HIV, with life expectancies expanding beyond several decades.

Although modern treatments of HIV have extended life expectancy and can reduce viral load to undetectable levels, this should not be accompanied by complacency. HIV still requires careful management – any break from the daily drug regimen can allow the virus the opportunity to develop resistance. Even after 30 years there is no cure, just careful management HIV’s replication. The old adage that prevention is better than cure an appropriate one.

 

AIDS related Pseudoscience

Like many other areas of science, HIV research has attracted its’ fair share of pseudoscientific beliefs. One of the most prominent are claims that AIDS is not caused by HIV. One of the key proponents of this argument is Peter Duesberg whose book “Inventing the AIDS Virus” claims that HIV is not the causative agent. Instead, his claims tend to be based on the suggestion that it is a “lifestyle” disease caused by a range of factors such as drug use (including anti-retrovirals), poor nutrition and poor sanitation. Such claims have been widely dispelled by the scientific community as they do not match the evidence. Indeed my impression of Duesberg’s book is that it has a moralistic rather than scientific undertone.

Based on the claims of Dueberg and other opponents of retroviral therapies, President Mbeki of South Africa delayed the use of these therapies in South Africa, in favour of traditional “remedies” no doubt resulting in hundreds of thousands of unnecessary infections and deaths.

Over the past 30 years homeopaths have also made regular claims that they hold the answer to curing AIDS, however, no evidence has been presented. Similarly claims that HIV can be treated or cured through nutrition have never been proven. And where such alternative treatments are used to replace conventional treatments, the typical consequences are a much shorter lifespan.

Conspiracy “theories” occasionally arise around the origin of HIV, including the suggestion that it was engineered to kill off one section of the population, for example African Americans or homosexuals. Given the nascent state of the sciences that would have been required to do this in the 1980s’ such ideas would be almost laughable if they weren’t so disturbing.

Homeopathy takes another hit Michael Edmonds Nov 11

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On Friday 31st of October Dr Siouxsie Wiles from Sciblogs very own Infectious Thoughts blog gave an excellent interview of Breakfast TV explaining why homeopathy isn’t an appropriate treatment for ebola (or anything else).

Now Vicki Hyde from NZSkeptics has presented a thorough explanation of why homeopathy is not a valid medical treatment on CTV, including a demonstration of how homeopathy dilutions “work”.

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This is great because I think the best way to discourage people from using homeopathic remedies is to explain to them what it is.

Homeopathy not the solution for Ebola (or anything else) Michael Edmonds Oct 30

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A petition calling for the World Health Organisation (WHO) to “test and distribute homeopathy as quickly as possible to contain the (Ebola) outbreaks” is unlikely to gain much traction, given that the WHO, in August 2009, made statements indicating that homeopathy was not an effective treatment for diseases such as tuberculosis, malaria, diarrhoea or HIV infection.

Unfortunately, Green MP Steffan Browning does not seem to have been aware of this when he signed an on-line petition, asking the WHO to consider treating Ebola with homeopathy. Since this revelation the Green party has distanced themselves these comments with Greens co-leader Russell Norman stating that ”There are many New Zealanders who use homeopathy but I think even they would say it’s not the right thing to use for Ebola. It’s not something we support and it’s not Green Party Policy.” Mr Browning has also back pedalled his position suggesting it was “unwise” to sign the petition. However, it is noticeable that both Mr Browning and Dr Norman have been very careful in how they have worded their response so as not to offend those who believe in homeopathy.

The petition demonstrates a naivety about medicine and homeopathy with the petitioners requesting

We call on those within WHO in positions of authority and influence to:

1. Look at homeopathy’s record in the treatment and prevention of serious epidemic disease

2. Engage with qualified representatives from the homeopathic profession to formally identify the best-indicated remedies

3. Test those remedies to determine which are best for the treatment and prevention of Ebola

4. Obtain supplies of those remedies from waiting and concerned homeopathic pharmacies

5. Bring the outbreaks under control by distributing these remedies as quickly as possible throughout the affected areas.

Finally, please end the suffering of those in the Ebola crisis by using the tried and proven homeopathic option.

 

Repeated studies of homeopathy have already demonstrated that when it is tested properly it has no noticeable effect beyond the placebo effect, and when it is used instead of effective medicines it can put people’s lives at risk. Many of those who accept homeopathy may also be doing so under the misapprehension that it is a herbal medicine. It is not.

Homeopathy is based on a series of nonsensical suppositions. First, that a disease can be treated by using a substances that causes the same symptoms. Second, that by diluting this substance to the extent that none of the existing material remains, it creates a cure, and the more you dilute it the more effective it is as a treatment. Third, that between dilutions the striking (succussing) of the container in a certain way somehow transfers curative properties to the water.

Homeopathy arose 200 years ago, when medicine was still developing and was steeped in myth rather than science. At a time when doctors prescribed toxic concoctions such as mercury and arsenic salts and regularly bled patients, a magical bottle of water may have indeed been your best option for survival. However, modern medicine has now advanced to treat many diseases, diseases which homeopathy has not managed to treat in spite of having 200 years to do so.  To now suggest that homeopathy is an appropriate way to combat Ebola is naive and dangerous.

Pain, Pus & Poison – a fascinating series covering the development of modern medicine Michael Edmonds Oct 28

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I’ve always been fascinated by the evolution of modern medicine, particularly the development of modern pharmaceuticals, so I was looking forward to catching “Pain, Pus & Poison – The Search For Modern Medicine” on Sky TV, however, managed to miss the first episode. Luckily I discovered the episodes are also available on Youtube

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The first episode covers the development of some of the drugs that have changed history – from ether and nitrous oxide for pain free surgery, aspirin for treating pain and fever, to some of the less spectacular developments such as heroin and chloral hydrate (the active ingredient of a Mickey Finn).

The first episode was an fascinating mix of science, history, and self experimentation, as producer, Michael Mosley demonstrated the effects of drugs including nitrous oxide and sodium pentothal (definitely don’t try this at home).

I look forward to watch the next few episodes.

Gluten Free & Pseudoscience Michael Edmonds Aug 10

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There is little doubt that some people have an intolerance to gluten and that a gluten free diet is an appropriate way to address this. However, the gluten free diet is also associated with pseudoscience in terms of what it can achieve and how it is diagnosed.

Take, for example, the recent news that tennis player, Novak Djokovic, has embraced a gluten free diet on the advice of his nutritionist. According to a recent article by Dr Joe Schwarcz, Djokovic was diagnosed as follows:

Djokovic’s “nutritionist” asked him to stretch out his right arm while placing his left hand on his stomach. He then pushed down on the tennis champion’s right arm and told him to resist the pressure, which he was able to do. Next, Djokovic was asked to hold a slice of bread against his stomach with his left hand while the nutritionist again tried to push down on his outstretched right arm. This time, he was able to push it down easily. The demonstration, Djokovic was told, showed that he was sensitive to gluten, which is why he had suffered so many mid-match collapses in his career.

Some readers will be aware of this “applied kinesiology” approach where the apparent “weakness” is the result of adjusting the angle of the pressure applied by the practitioner, not by the presence of a slice a bread. Hardly an appropriate method for diagnosing any disease or disorder.

 

 

Taking an Experimental Approach to Weight Loss Michael Edmonds Aug 03

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I need to lose some weight.

The was the conclusion I came to on a Friday night just over a week ago when my bathroom scales told me I weighed 92.2 kg, which according to a BMI calculation for my height and weight puts me into the “overweight” category. Not the best place for someone who has a family history of heart disease and who is already exhibiting early signs of osteoarthritis.

Of course, I have known this for a while – prior to the Christchurch quakes I weighed around 85 kg, however, when the quakes stuck and took out my gym (and most of the others around Christchurch) for 6 months my weight increased, helped along with the comfort food consumed during this time. Even though I still go to the gym 3-4 times a week, I’ve never lost the weight I gained.  I’ve been meaning to do something about it for a while now, but on Friday a convergence of several factors helped me resolve to explore how to lose some weight.

One of these factors was watching a documentary by Michael Mosley called Eat Fast and Live Longer. In the documentary Dr Mosley explored the use of fasting to improve health and encourage weight loss. Various approaches to fasting were explored but by the end of the documentary Dr Mosley had settled on a 5:2 approach to dieting, whereby calorie intake was restricted to 600* calories a day for two days of a week, while one eats normally for the other 5 days. A book has now been produced based on this documentary outlining this dietary approach.

* that is 600 calories for men, 500 calories for women

So on Saturday, I decided to try to see what this fasting approach would be like. Porridge with half a banana and skim milk  for breakfast consumed 150 calories. Finding myself hungry by lunch a sandwich with soup took out 300 of my remaining allowance of calories. By evening I was hungry for more than the remaining 150 calories so had a reasonably healthy chicken and vegetable dinner of 386 calories.

So fasting wasn’t as easy as I thought, however, I had achieved a day of relatively low calorific intake. If I could sustain this surely I would lose weight? I decided to turn this into an experiment – if I continued on a restricted calorie diet would I lose weight? The short answer is yes.

In order to track my food intake, I decided to use an iPad app called MyFitnessPal which allows you to calculate your calorie intake using a database containing information on the nutritional content of a wide range of foods. Since last Saturday morning my calorific intake (measured in kJ) has been as follows:

 


calories

The orange line is the number of kJ which the MyFitnessPal determined that I should be able to get moderate sustained weight loss with. The blue points indicate my calorific intake for each day (in kJ) with large increase on the 2nd of August due to a “cheat day” where I ate what I felt like, including some chocolate brownie ice cream. Some well known diets recommend a cheat day once a week as a treat. As well as relaxing for a day I was interested in seeing what effect it had on my weight.

weight

Over the week I have had a significant weight loss. However, most interesting to me is what happened at the beginning when I went from a day (Friday) of poor eating choices to a restricted calorie diet. The drop in weight was quite substantial. Also, the morning after my “cheat day” my weight jumped by almost 1 kg. It is an interesting effect which I’m curious to explore further.

In conclusion, it would appear a restricted calorie diet is working for me. It will be interesting to explore further how varying my calorie intake affects the weight loss, and whether my body might attempt to adapt to this. I’ll let you know how it is going next week. In the meantime I off to have a mandarin and a glass of water :-)

 

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