Had dodgy advice from a nutritional therapist? We have!

by , Senior Food Researcher Consumer Rights 16 January 2012
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Have you ever visited a nutritional therapist? In this month’s Which? magazine we investigated the profession and found some worrying practices, such as therapists advising against going to your GP.

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One therapist advised our researcher, who was posing as a cancer sufferer, against having conventional treatment (a lumpectomy and radiotherapy), saying that she should try for three to six months to rid herself of the cancer through diet (by cutting out sugar).

Nutritional therapy can be big business; therapists charge up to £80 for a consultation and often prescribe expensive supplements on top. So we wanted to investigate whether it was worth the money.

How our investigation worked

We asked five undercover researchers to each visit three therapists. Each researcher was provided with a scenario.

One researcher (in her early 30s) had been trying to conceive unsuccessfully for over a year. Two (in their 50s) had been suffering from severe tiredness for the past three months. And two women (in their 40s) had recently been diagnosed with DCIS (Ductal Carcinoma in Situ), the most common type of non-invasive breast cancer.

A panel of experts (a dietitian, a GP and a Professor of Pharmacology) then assessed recordings of the visits and any other information the therapists provided to the researchers, including prescriptions for supplements.

Are nutritional therapists worth the money?

Our expert panel concluded that visiting a nutritional therapist wasn’t worth the money – and in some cases could have actually endangered the health of the researcher. Six of the fifteen consultations were rated as ‘dangerous fails’.

This could have been down to a number of reasons:

  • The advice given by the therapist could have potentially harmed the researcher.
  • Therapists were diagnosing conditions without relevant testing (even though their Code of Practice says they shouldn’t diagnose).
  • Researchers were advised not to visit their GPs about the problem, recommending unproven testing such as hair mineral analysis, and the case above, advising against cancer treatment.

Of the remaining visits, eight were rated as ‘fails’ and only one was graded as a ‘borderline pass’. Our experts were disappointed by the advice given by therapists and concerned at their poor knowledge of the body and how it works.

The experts were also worried by some therapists using non-evidence-based testing to diagnose symptoms. These tests included iridology (studying the patterns, colour and other characteristics of the iris), hair mineral analysis and a researcher being given several liquids to hold in his mouth before being told he had a chromium deficiency.

Are the recommendations right?

Twelve of the therapists prescribed supplements to the researchers, costing up to £70 a month. Researchers were told not to buy them from Boots or other high street chemists as they weren’t ‘pure enough’ and you were effectively ‘flushing your money down the loo’. Instead, they were asked to buy them from the retailers recommended by the therapist.

Of course, there is benefit in following healthy dietary advice, but most of what was provided by the nutritional therapists is freely available on websites such as the NHS site.

Plus, most of the therapists in our investigation recommended quite restrictive diets that excluded several foods (predominantly dairy and wheat) and taking expensive supplements.

If you do have a medical condition that you are concerned about, your first port of call should be your GP. If necessary they can then refer you to a dietitian. We have contacted the British Association of Applied Nutrition and Nutritional Therapy (BANT) with our findings and concerns.

People who have visited nutritional therapists emailed us to say that they found the diets recommended to them difficult to maintain over a long time and eventually gave up.

Have you visited a nutritional therapist? What was your experience like – do any of these findings ring true or did you have a more positive experience?

1951 comments

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Katie

I’m disappointed Wavechange – its not a competition between NT and conventional medicine – both could work together and prescription drugs would not be needed as much but they would still be needed surgery and high tech modern diagnosis and surgery definitely would ve needed

 
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wavechange

Agreed Katie, but with conventional medicine so well established, I believe that NTs need to work on gaining more respect from those working in conventional medicine. That means divorcing NT from what is regarded as quackery (whether it is quackery or seems to be on the basis of current knowledge).

As I have said many times, one of my main concerns is recommendation of supplements without evidence that they are needed. I accept that this is not as bad as a GP handing out unnecessary drugs or continuing treatment long after it is necessary, but it is bad practice. Perhaps NTs could push for more routine testing to identify nutritional deficiencies. Perhaps NTs could push for the RDA for vitamin D to be raised on the basis of recent studies.

My view is that NTs should focus on assisting the government to have a massive campaign to tackle obesity and get more of us eating a diet that contains much less processed food. I detest TV celebrities but their endorsement could achieve a lot, and if a campaign catches the public imagination we could set an example for other countries. Would it not be good if the US follows the UK, if only for once?

Like it or not, the Which? report has discovered a problem that deserves to be investigated thoroughly. Rather than criticising the study for 101 reasons it would be better to look for ways of ensuring that any future investigation will have a much more positive outcome.

 
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wavechange

This is an interesting and thought provoking article. It would be interested to hear the views of dieticians, since they are being portrayed as the bad guys.

 
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wavechange

Oops. This is supposed to be a reply to the recent message from ExR&D containing a link to the Alliance for Natural Health website.

 
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chrisb

Alan,
I am aware of Florence Nightingales abilities and achievements but just quoted on her innovations and how this was met with Medical opposition.

I am in agreement with you in that the public needs to be protected from dubious health modalities and the dubious claims they make, and where you have mentioned Homeopathy as an example. I have mentioned in a previous post that I am not a fan of this, and some other alternative therapies as well.

It is true that science is about changing views by providing robust evidence, but what I strongly object to is when that evidence is ignored by Mainstream and discounted by them when the efficacy of a particular therapeutic modality is supported by strong scientific evidence: I am referring here to Functional Medicine and Nutritional Medicine (which both have a strong scientific base) but are not accepted by Mainstream for reasons unknown.

Speaking of HIV/AIDS
Homeopathy may not be the answer to the solution to the HIV epidemic in Africa, and where Antiretroviral drugs have also not been the acclaimed protocol that many would have us have been led to believe and as portrayed by Janine Roberts: her book Fear of the Invisible (Impact Investigative Media Productions, 2009).
Roberts revealed that the medical authorities wanted to hide the adverse side effects of antiretrovirals. She ironically states: ´It is supposed to take HIV up to 10 years to destroy the immune system.´ The antiretroviral drugs (however) can do the job much faster, implying the very thing that is supposed to treat aids is actually causing aids!

The medical industry has made all the adverse effects of antiretrovirals into a new sickness or syndrome and call this IRS – The Immune Reconstitution Syndrome. Roberts describes two reports: a study from S.A. Shelburne, et al. Medicine 81:231-27, 2002, details all the symptoms of IRS, and the CDC HIV/AIDS Surveillance Report, year and edition, 1997, detailing all the AIDS symptoms

It turns out that the twelve items mentioned in these separate list for IRS and AIDS are 100% identical: Kaposi Sarcoma, MAC, TB, Cryptococcus, Fungal Pneumonia (PCP), Cytomegalovirus, Histoplasmosis, Herpes, Leukoencephalopathy, Leprosy, Meningitis and Lymphoma . A grave warning Roberts gives to those people who may test falsely positive on a HIV-test. Be aware, being healthy and taking antiretrovirals you may be getting aids from these medicines!
http://www.shout-africa.com/health-lifestyle/origin-and-cure-for-aids-antiretrovirals-good-or-bad-science-continued-part-6/

………………………….so if we are going to challenge health modalities that are misleading and fallacious or even ineffective/harmful, then that also means we should address ALL of those health modalities into the one equation and not just alternatives.

I agree with you in that we should challenge the claims made to the public by practitioners of Alternative Therapies, but not to the exclusion of Mainstream Medicine which should also fall into this very same category. This should be about balance rather than the victimization of Alternatives exclusively.

Do Alternative therapies kill? Do you have any reliable figures to support that accusation?

 
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Alan Henness

chrisb said:

“I agree with you in that we should challenge the claims made to the public by practitioners of Alternative Therapies, but not to the exclusion of Mainstream Medicine which should also fall into this very same category. This should be about balance rather than the victimization of Alternatives exclusively.”

As I said, I have expertise and abilities that allow me to effectively challenge questionable AltMed claims made to the public. I do not have sufficient expertise to effectively challenge Big Pharma claims and will have to leave that to others to do (and as I also said, I would support those who do).

Of course, Big Pharma are prohibited by law from advertising Prescription Only Medicines to the public (despite the alleged power they have over Government), so the public are not subjected to the same barrage of misinformation as are from purveyors of AltMed.

Perhaps trying to sort out Big Pharma is something you’d like to take up?

“Do Alternative therapies kill? Do you have any reliable figures to support that accusation?”

AltMed practitioners are notoriously poor at recording adverse effects and delays to proper treatment and there is no parallel system to the MHRA’s Yellow Card scheme. However, it is clear that many AltMed therapies are not ‘natural’, side-effect free and safe, despite loud proclamations to the contrary.

 
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chrisb

Hello wavechange,
In your reply to Katie, I would just like to add that if the findings of the panel are indeed correct, then NT’s do need to work on gaining more respect from those in conventional medicine, but I fail to see how this can be accomplished, when Functional Medicine (from which Nutritional Therapy originates) is not accepted by them, despite strong scientific supporting evidence in favor of it.

The problem with the recommendation of supplements, is that they can be seen as “competition” with pharmaceuticals in their efficacy in disease states, rather than just addressing their need in deficiencies.
Nutrition is not just about deficiencies, but as a treatment modality in higher than normal doses with few if any side-effects and which are so commonplace with pharmaceuticals. This I feel is the real bone of contention, despite proof to the contrary.

And I agree with you that………………
“Perhaps NTs could push for the RDA for vitamin D to be raised on the basis of recent studies”. but that could also apply to other nutrients in achieving an optimal status rather than an RDI which merely acts as a minimum in preventing malnourishment.

Also…………..
“My view is that NTs should focus on assisting the government to have a massive campaign to tackle obesity, and get more of us eating a diet that contains much less processed food. I detest TV celebrities but their endorsement could achieve a lot, and if a campaign catches the public imagination we could set an example for other countries. Would it not be good if the US follows the UK, if only for once?”

Absolutely…………….
If you recall Jamie Oliver has been instrumental in improving the nutritional status in school dinners.

I also agree with your last paragraph……………………………..

“Like it or not, the Which? report has discovered a problem that deserves to be investigated thoroughly. Rather than criticizing the study for 101 reasons it would be better to look for ways of ensuring that any future investigation will have a much more positive outcome”.

 
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wavechange

Jamie Oliver’s input was what I was thinking of when I suggested a TV campaign. I was quite appalled to discover what rubbish is fed to school kids (I don’t have any kids, having decided not to contribute to overpopulation, otherwise I might have been better informed.) I hope that what Jamie reported was some of the most extreme examples, which is what helps make ‘good’ TV programmes.

I don’t see that supplements and drugs need to be in competition and am very keen on prevention rather than treatment of disease, and that is where I see the role of NTs – working in association with GPs, consultants and hospital doctors. Rather than the NHS spending money on giving me an annual asthma check which has not revealed any change in the last 15 years, I would rather have the money spent on more comprehensive tests, including ones for common vitamin and mineral deficiencies.

Perhaps it is time for nutritionists and NTs to find common ground. The short article provided by ExR&D makes interesting reading.

Anyway, that’s it for today. I’ve got a lot to do.

 
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Katie

Wavechange – when you are back – do you not think though that if you tipped the contents of the capsule out onto your food that would make it a food too? – the japanese use seaweed – do you not think it is difficult to define what a supplement is? . Also As a chemist do you not think there is a difference between a mulitvit formula containing synthetic vitamins and a capsule containing a natural substance of something like seaweed or ginger or even turmeric? I dont think we should look at all supplements as though they are the same.
Your point about testing on NHS all common deficiencies ( essential fatty acids, vitamin D, iron it would include zinc and magnesium) it will never happen too expensive!!!!! That is why there is demand for NTs.

 
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wavechange

Perhaps I could define a supplement as something that I don’t need. I have a few aspirin, paracetamol and ibuprofen tablets and maybe a few indigestion pills, but I would not think of taking these unless there was a good reason. I have a prescription nasal spray but use this only when I have a problem. Would you advise me to take these medicines when there is no obvious benefit? I doubt it.

I hope you are wrong about routine testing. Not so long ago, diabetics taking medication did were not given meters and test strips. I remember taking a member of my family into Boots and buying them a meter. A year or two later the GP prescribed the test strips. That meter allowed the person to discover how their blood sugar concentration varied according to diet and exercise and to learn to detect the symptoms of low blood sugar in so that they could take appropriate action.

It is very expensive to produce new drugs and there is a risk that they will never be launched or could be withdrawn due to problems. If I was running a pharmaceutical company I might be tempted to move into in vitro diagnostics for home or GP use, to make testing easy and hopefully cheap.

If there is evidence that a significant number of people have some sort of deficiency, surely the best solution is to give dietary advice. I would advocate recommending foodstuffs that are familiar and commonly available rather than anything unfamiliar (e.g. seaweed) or from a specialist shop or other supplier.

I am all in favour of people understanding more about nutrition and the importance of a good diet. The first thing that everyone needs to learn is that most of us do not need supplements and we MUST get away from the idea that it is good to take supplements or drugs unless there is a need.

That’s it, and you will not change my mind. If tests show that I am deficient in something or there is a strong likelihood, then I will happily take the pills.

 
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chrisb

Thank you Alan,
I am pleased to hear that you would support any challenge to Big Pharma claims and as you are not able to do so yourself (and who is going to support my efforts?) this needs to be addressed and sooner rather than later.

It is true to say of course that Big Pharma is prohibited by law from advertising Prescription only Medicines to the public, but you seem to be unaware that this is not the case in the United States where there is a constant barrage of infomercials 24/7.

I think it is unfair to say that the public are subjected to misinformation from the purveyors of AltMed and tarring all AltMed with the same tainted brush but I fully understand you point of view.

A little old minion like me taking on the might of Big Pharma………………a present day David (no not that David) versus Goliath!!…….Hmm……….hardly.

As you say AltMed practitioners are poor at recording adverse effects and this is where proper regulation should be implemented, but they tend to stay in business over the years. Surely, if they were out and out quacks this would have been discovered long ago and some of them at least would have done so. I know of one local Naturopath to me who has been in practice for over 30 years and doing very nicely thank you. I don’t think the public could be that gullible……..could they?

Like many people, I only found my way to an alternative practitioner through recommendation, and as a last resort, AND after going the rounds of Orthodoxy beforehand for almost a year of incapacity to find my solution.

 
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Alan Henness

chrisb said:

“It is true to say of course that Big Pharma is prohibited by law from advertising Prescription only Medicines to the public, but you seem to be unaware that this is not the case in the United States where there is a constant barrage of infomercials 24/7.”

No, I am perfectly aware of this and I have already pointed this out much earlier in the comments on this article. However, since I am in the UK, there is very little I can do about that. Perhaps you know someone in the US who could tackle it?

“I think it is unfair to say that the public are subjected to misinformation from the purveyors of AltMed and tarring all AltMed with the same tainted brush but I fully understand you point of view.”

The reason they are considered alternative is because they do not have the robust evidence to substantiate their claims, so by definition any claims they make must be misleading. As someone said earlier: what do you call alternative medicine that’s been proven to work? Medicine.

“A little old minion like me taking on the might of Big Pharma………………a present day David (no not that David) versus Goliath!!…….Hmm……….hardly.”

Then why do you seem to expect me to do it? :-)

“As you say AltMed practitioners are poor at recording adverse effects”

Many deny there can ever even be any adverse effects because their therapy is so gentle, so natural, so holistic, so ancient, so widely used.

“…and this is where proper regulation should be implemented”

No, proper regulation is neither desirable nor necessary to protect the public. There are already laws, if properly enforced, that can do that: the Consumer Protection from Unfair Trading Regulations 2008, for example, or assault or manslaughter/murder laws if it tragically ever went that far. What statutory regulation does is give undeserved legitimacy to AltMed practitioners that further misleads the public into thinking the AltMed has some kind of Government approval when it does not.

“but they tend to stay in business over the years. Surely, if they were out and out quacks this would have been discovered long ago and some of them at least would have done so. I know of one local Naturopath to me who has been in practice for over 30 years and doing very nicely thank you. I don’t think the public could be that gullible……..could they?”

It’s not gullibility. Why would anyone ever fall for a Nigerian 419 scam, or any of the numerous ‘get rich quick’ MLM scams? It’s just a lack of knowledge and understanding and it’s not the public’s fault. People can be easily misled by persuasive marketing and there needs to be some protection from this. But many – almost certainly most – proponents of AltMed are not scammers or fraudsters; I’m sure they fervently believe they are doing good – it’s just that there is scant or no evidence for what the are providing. And if they don’t have that evidence, why should they be allowed to mislead the public?

 
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chrisb

Alan,
I was trying to be conciliatory as opposed to being confrontational, which I find most of your post is.
At least wavechange has had a much more conciliatory position of late.
Maybe we should all visit ACAS to resolve our differences.

Actually, AltMed is considered to be alternative because of the failures in modern medicine, after all, if their methods of treatment were that successful then it is highly unlikely that anyone would consider Alternatives at all.
Many alternatives (but not all) have a history in the successful treatment of disease dating back for thousands of years, such as Ayurvedic Medicine, TCM, Natural Hygiene, Nutritional Medicine as in Orthomolecular Medicine and so on. The problem lies not with these modalities of health recovery, but the rejection of them by Orthodoxy, where much of it is actually “evidence-based” with scientific studies to support those claims. If anecdotal evidence or “off-label-use” for medicines is allowed and widespread within Allopathy, with no scientific backing, then I say “what is good for the goose is…………
This can be construed as Hypocrisy.

Why do I expect you to do to take on Big Pharma?
Because you may have more influence than I do perhaps?

BTW, if AltMeds have no Government approval then one wonders why Acupuncture is available on the NHS for example.

Alan, scams are scams and alt medicine is alt medicine

I admit though that some altmed’s are dubious with no evidence, and it these that need tightening-up or exposed for what they are, but I will say it again unless this evidence fits in with current medical thinking it is discarded as nonsense or quackery.
If you research IV Vitamin C Therapy as a treatment modality for cancer, you will find that it has a wealth of scientific evidence in its support, and as endorsed and practiced by Professor Ian Brighthope in Australia. It works, but is rejected by Mainstream generally despite this.

 
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Alan Henness

chrisb said:

“I was trying to be conciliatory as opposed to being confrontational, which I find most of your post is.”

I don’t see that what I said was particularly confrontational: I have tried to (politely) counter your arguments. If the robustness of my arguments come across as confrontational, then I’m sorry.

“Actually, AltMed is considered to be alternative because of the failures in modern medicine, after all, if their methods of treatment were that successful then it is highly unlikely that anyone would consider Alternatives at all.”

I hope you can see the problem with your syllogism (please correct me if I have misunderstood what you were saying):

P1 If modern medicine was successful, then people wouldn’t consider alternatives.
P2 There are failures in modern medicine.
C1 Therefore AltMed is considered alternative.

I’m not sure that gets us anywhere, except to highlight the paucity of evidence for AltMed. The fact that people use, or have used for millennia a particular treatment does not say anything about the evidence for it. If it is popular, then that should inform a decision to investigate it. That’s what has happened and what’s not shown itself to be effective is jettisoned.

“Many alternatives (but not all) have a history in the successful treatment of disease dating back for thousands of years, such as Ayurvedic Medicine, TCM, Natural Hygiene, Nutritional Medicine as in Orthomolecular Medicine and so on. ”

Ignoring the appeal to antiquity (blood letting is ancient), the question this raises is: where is the robust evidence for TCM, ayurvedic, etc?

“The problem lies not with these modalities of health recovery, but the rejection of them by Orthodoxy, where much of it is actually “evidence-based” with scientific studies to support those claims.”

Who is this ‘Orthodoxy’ who rejects robust evidence? And where is this robust evidence?

“Why do I expect you to do to take on Big Pharma?
Because you may have more influence than I do perhaps?”

You presume too much – I have no such influence. And I believe I am entirely free to do whatever I want in my spare time – as you are in yours.

“BTW, if AltMeds have no Government approval then one wonders why Acupuncture is available on the NHS for example.”

Historically, acupuncture used to be seen as being effective for some conditions. Now more trials have been done, we know that sticking needles in people has no effect for most conditions and – at best – marginal and possibly not therapeutically significant in OS of the knee and in reducing nausea. That’s it. That’s all the most robust evidence says: that verum acupuncture is no better than sham acupuncture and it doesn’t seem to matter whether the needles are inserted. And there is no evidence for the meridians that many acupuncturists claim exist in the body. No doubt further studies will be conducted and we’ll need to see what they come up with.

I do not have figures to hand, but I would expect there to be less acupuncture paid for by the taxpayer now than in the past because of the lack of evidence – just as I would expect to see less prescribing of a drug that we now know is barely effective.

“Alan, scams are scams and alt medicine is alt medicine”

I think I said much the same thing: there are undoubtedly some AltMed practitioners who are frauds, but I suspect they are a very small minority. The vast majority genuinely believe in what they are doing. The problem is that there is just not the robust evidence to support many of the claims that are being made.

“I will say it again unless this evidence fits in with current medical thinking it is discarded as nonsense or quackery.”

No. The evidence either shows that an intervention has an effect that is statistically/therapeutically significant or it doesn’t. If it doesn’t, then either better trials need to be conducted or the treatment abandoned. However, there is still the problem of prior plausibility for most AltMed – is that what you mean when you refer to ‘current medical thinking’? If so, then you cannot expect ‘current medical thinking’ to re-write the medical text books just because acupuncturists claim that acupuncture ‘works’ if you stick needles on acupuncture points, particularly when the robust trials of acupuncture show there is nothing really to it. Or physicists, chemists and biologists to re-write just about every science text book just because homeopaths claim their ‘medicine’ works on the ‘like cures like’ principle and that water has a memory when it’s been shaken, not stirred.

 
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Stuart

“I will say it again unless this evidence fits in with current medical thinking it is discarded as nonsense or quackery.”

No. This isn’t how science works, if the evidence is strong enough it become mainstream and it doesn’t matter how implausible something appears. Florence Nightingale’s ideas were not accepted widely at first, her ideas were deifnatley not mainstream. But through persistence, good evidence gathering and stats she showed she was correct.

You seem to think being open minded is about believing anything is possible. Rather its about the ability to think critically and change what is accepted in the light of new good quaility evidence when it emerges.

Att med is dismissed because the evidence is weak, or because the practitioners special plead that its somehow ‘different’ and doesn’t need to confrim to the same evidence standards.

 
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wavechange

chrisb

You mention that I have been more conciliatory recently, but my views remain the same as before. At one stage I pulled out of the discussion because one or two people were having a heated argument, and I don’t want to be involved in any discussion of that sort.

The deficiencies of the NHS are relevant in relation to nutrition but claims, whether they are right or wrong, about prescription drugs killing people is totally irrelevant to nutrition and its management. I don’t see that what the pharmaceutical companies get up to is particularly relevant either, but perhaps I have missed something.

I am very disappointed that I have not advised from the NHS. A nurse who observed that I was a bit overweight once asked me about my diet. I explained that I ate a balanced diet but rather too much of it! If we agree on one thing, it is that diet is important for good health. Someone has to be giving advice now that X% of the population is overweight, Y% overweight or obese, and Y% has type II diabetes. You will know the figures and I would have to look them up. Busy GPs are bad enough at pushing pills, conditioning us into expecting that the answer to health problems is to take a pill. NTs want us to take pills with perhaps 20 odd vitamins and minerals, whether we need them or not.

Basically I agree with the points that Alan is making, though I am trying to listen, learn and be polite. :-)

 
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Adam

Alan, do you think so-called evidence based medicine and related clinical decision-making is always based on RCTs, systematic reviews or meta-analyses – which currently sit proudly at the pinnacle of the hierarchy of evidence? If so, how come the following piece by two eminent Australian teaching hospital clinicians became the most-viewed BMJ paper of 1999? http://www.bmj.com/content/319/7225/1618.full

 
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Alan Henness

Adam said:

“Alan, do you think so-called evidence based medicine and related clinical decision-making is always based on RCTs, systematic reviews or meta-analyses”

No.

 
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chrisb

Thank you Adam, I love your post.

Alan,
I agree with all three syllogisms.
P1 If modern medicine was successful, then people wouldn’t consider alternatives.
P2 There are failures in modern medicine.
C1 Therefore AltMed is considered alternative.

The paucity of evidence for AltMed only means that you have ignored any meaningful research To begin with you could always look at my previous posts in this discussion as a small sample.

Now come on Alan, do you really suppose that if a particular remedy, which has been used for millennia, has no basis in its efficacy? Experience tells us, and so for that matter does commonsense, that any therapy that did not work would be discarded within a very short time-frame. Please ponder that awhile.
You’ll have to excuse me for my late reply as I had to use a dictionary.

Ah yes, that all important evidence. Well here is some of it…………….
http://chinesemedicinenews.com/2009/03/14/acupuncture-is-grounded-in-science-not-myth-and-magic/
http://chinesemedicinenews.com/archive-page/

No I am not appealing to antiquity such as using leeches used by the Medical profession, or a particular brand of cigarettes they used to tout either.

By orthodoxy I mean established medicine as in mainstream medicine or western medicine or whatever you prefer to call it really
I have alluded to “this robust evidence” in previous posts as a sample, but really don’t have the time or the inclination to do so now. My “chi” is at a low ebb and I will need to rest to recover it shortly.

I referred to acupuncture a moment ago and in previous posts so I suggest you look there. It also mentions the mistakes of western medicine in searching for “meridians”.

Undoubtedly, there are some AltMed practitioners who are frauds and a small minority

“The problem is that there is just not the robust evidence to support many of the claims that are being made”.

Sometimes, but not always by any means; so when Adam asked you if you thought that so-called evidence-based medicine and related clinical decision-making is always based on RCT’s, systematic reviews or meta-analyses you said no.
So what prey do you base robust-evidence on??

Mind you, interventions that do have a consistent therapeutic effect and that do not fit the current medical paradigm have largely been discarded ie IV Vitamin C Therapy for example.

Prior plausibility for most AltMed? so whose plausibility are we referring to here.??

Alan, it is not about “claiming” if a therapy works, but about being evidence-based, and there is a wealth of evidence-based therapy within quite a number of AltMed’s that is still not acceptable within Mainstream.
Don’t rock the boat otherwise we may have to rewrite the text books folks.

No. The evidence either shows that an intervention has an effect that is statistically/therapeutically significant or it doesn’t. If it doesn’t, then either better trials need to be conducted or the treatment abandoned. However, there is still the problem of prior plausibility for most AltMed – is that what you mean when you refer to ‘current medical thinking’? If so, then you cannot expect ‘current medical thinking’ to re-write the medical text books just because acupuncturists claim that acupuncture ‘works’ if you stick needles on acupuncture points, particularly when the robust trials of acupuncture show there is nothing really to it. Or physicists, chemists and biologists to re-write just about every science text book just because homeopaths claim their ‘medicine’ works on the ‘like cures like’ principle and that water has a memory when it’s been shaken, not stirred.

 
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Alan Henness

chrisb said:

“I agree with all three syllogisms.
P1 If modern medicine was successful, then people wouldn’t consider alternatives.
P2 There are failures in modern medicine.
C1 Therefore AltMed is considered alternative.”

It’s just the one syllogism. :-)

“The paucity of evidence for AltMed only means that you have ignored any meaningful research To begin with you could always look at my previous posts in this discussion as a small sample.”

Perhaps I should have prefixed ‘evidence’ with ‘robust’. Yes, even an anecdote is evidence, it’s just not robust and certainly not something anyone should be using to base health claims on.

“Now come on Alan, do you really suppose that if a particular remedy, which has been used for millennia, has no basis in its efficacy? Experience tells us, and so for that matter does commonsense, that any therapy that did not work would be discarded within a very short time-frame. Please ponder that awhile.”

Yes, I really do suppose that. Experience tells us that most of the ideas we’ve had over the millennia are utterly wrong: experience tell us the sun circles the earth, but we discovered it didn’t after careful observation and experiment; the stars are not pinpricks of light in some heavenly sphere; atoms are not the most fundamental of particles; bloodletting is not a cure for all ills; and ill-health is not caused by an imbalance in the four humors, which, I’m sure, seemed entirely common sense to Socrates.

Our experience and common sense are frequently completely wrong, which is why we must devise trials that as far as we are able, eliminate the possibility that we are fooling ourselves.

“Ah yes, that all important evidence. Well here is some of it…………….
http://chinesemedicinenews.com/2009/03/14/acupuncture-is-grounded-in-science-not-myth-and-magic/
http://chinesemedicinenews.com/archive-page/

Would you expect anyone to accept what a pharmaceutical company says on its website about one of its products? Then why place any credence on what that site says?

Even if the first article is correct and there is some scientific basis for acupuncture, you still have to face up to the fact that robust trials of its efficacy draw a blank: for example it does not improve fertility; it does not treat addiction; it does not cure irritable bowel syndrome.

“By orthodoxy I mean established medicine as in mainstream medicine or western medicine or whatever you prefer to call it really
I have alluded to “this robust evidence” in previous posts as a sample, but really don’t have the time or the inclination to do so now. My “chi” is at a low ebb and I will need to rest to recover it shortly.”

:-)

“I referred to acupuncture a moment ago and in previous posts so I suggest you look there. It also mentions the mistakes of western medicine in searching for “meridians”.”

So, do you think there are ‘energy channels’ through our bodies that have never been seen or detected? Even if they existed, can you propose a mechanism by which they control out health; a mechanism by which they become blocked; a mechanism by which sticking needles in the body ‘unblocks’ them; how an acupuncturist knows where to stick the needles and how unblocking these channels has an effect on our health?

“Undoubtedly, there are some AltMed practitioners who are frauds and a small minority

“The problem is that there is just not the robust evidence to support many of the claims that are being made”.

Sometimes, but not always by any means;”

Which do you think has robust evidence?

“so when Adam asked you if you thought that so-called evidence-based medicine and related clinical decision-making is always based on RCT’s, systematic reviews or meta-analyses you said no.
So what prey do you base robust-evidence on??”

Those are certainly a very good basis with which to determine the evidence, but they are by no means the only ones. However, in the context of what we’re talking about – claims being made to the public – it matter not one jot whether I personally think that there is no evidence for, say, acupuncture. What does matter is what organisations like the ASA think of the evidence and the MHRA control claims for herbal and homeopathic products as well as pharmaceutical drugs. So what matters in advertising to the public is whether bodies like these allow particular claims.

“Prior plausibility for most AltMed? so whose plausibility are we referring to here.??”

There comes a point where we have to decide whether we keep our minds open to absolutely anything and everything, rejecting nothing whatsoever (it’s the faeries at the bottom of my garden who cured me, honest!) or draw the line when, for example, what homeopathists claim for their sugar pills would literally mean the overturning of most of physics, chemistry and biology. There would be umpteen Nobel prizes for anyone who could show how homeopathy worked (assuming that it did – which it doesn’t) Yes, the moon could be made of green cheese, but there is no earthly reason why anyone should believe that.

“it is not about “claiming” if a therapy works, but about being evidence-based, and there is a wealth of evidence-based therapy within quite a number of AltMed’s that is still not acceptable within Mainstream.”

You keep repeating this false dichotomy: there is just treatments for which there is good evidence and those for which there is not. If there is good evidence, it is mainstream.

“Don’t rock the boat otherwise we may have to rewrite the text books folks.”

I don’t completely discount the possibility that someone could show conclusively and repeatedly that, say, reiki works and come up with a testable mechanism of action. Until they do, however, forgive me if I don’t keep an open mind about it and meanwhile demand that its proponents provide robust evidence for their claims.

 
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Katie

Ok Stuart, Alan ….

If the RCT is the way forward who is going to provide funds. Tthe latest study by Hollis on requirements for vitamin D in pregnancy was double blind and randomised and cost in excess of 10m who is going to pay for such studies – not established medicine, pharmaceutical companies are not interested

second who says that this type of study/evidence is relevant for all nutritional/dietary prescription it was designed originally for testing drugs

 
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chrisb

Way to go Katie,
Absolutely agree with you.
Unless there is a financial incentive in terms of profit then studies are ignored. For example, Pharmaceutical companies know about the benefits of Vitamin D, so instead of using this natural compound, they came up with their own analogue and charge loads more for it.

 
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Alan Henness

Katie said:

“who is going to pay for such studies”

I have no idea (although I’ve already suggested one possible source). But it’s not up to me to find the money or even to suggest ways – I’m not the one making the claims.

 
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Katie

10 m dollars!!!!

 
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Katie

I dont think it is like that exactly Alan. A good study can be done with significant results but then other researchers are very slow to pick up on it as there isnt the funding (big pharma not interested in vitamins). The good study just gets left in limbo if you like

 
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Alan Henness

Katie said:

“A good study can be done with significant results but then other researchers are very slow to pick up on it as there isnt the funding”

Well, maybe someone needs to find the funds if they are going to be selling whatever it is to the public, don’t you think?

“big pharma not interested in vitamins”

You are aware that Seven Seas, one of the largest manufacturers of vitamins pills, supplements and fish oils are owned by Merck, one of the largest of the Big Pharma companies, aren’t you?

 
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chrisb

We still haven’t got away from the deficiency mentality of nutrients, rather than the therapeutic qualities of the same……………………..

Take Iodine for example.
by Rachael Olivier MS, ND PhD.
“Iodine A Need For Optimization” with study notes at the end.
Scroll down to the pdf file link with the same title and references at the end………………..
http://www.nleducation.co.uk/seminars/david-brownstein-md-thyroid-health-and-iodine/

 
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Katie

Wavechange

If you were deficient and If you would then happily take the pills (or as you say emphasize a specific food to get access to more of a specific nutrient) you will never know if you stick with the NHS limited testing – you would need to do a private test – and who knows you might not regret it you might just NOT be one of the ‘most’ people that you describe.

Pharmaceutical companies are not in my opinion going to look into setting up tests for nutritional deficiencies – nutrition is not their agenda.

Supplements – it makes sense to think a lot of people might need them – if the definition is something you need – how many young busy people do you know who eat the 5 a day? who eat proper regular meals and who dont consume loads of anti-nutrients like alcohol, caffeine etc?
Further what about the functional need for a nutrient ? that is the amount required to normalise a specific enzyme system – not the amount required to give you a normal blood test result? That is a very interesting branch of science that needs developing but not the pharmaceutical companies’ agenda.

 
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Katie

Wavechange and all .The ideal scenario is evidence for every single supplement one might take.. The debate about supplements is I admit quite specialised so in a sense it is separate from the issue of an overweight nation I agree that the obesity problem is the biggest health problem we have – with its links to disease including cancer – why cant we just do what Finland did!

 
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wavechange

Never mind every supplement one might take, because there plenty of brands and competition for our money. What matters more is the deficiencies we might have and whether or not we have them.

If Finland can convince their population to eat a health diet, then it is at least worth a go. I fear that we might need to involve a celebrity or two, which doesn’t bear thinking about, but it could be worth it. The money the NHS saves on drugs needed to treat people that have made themselves ill by eating could help pay for some of the tests for nutrient deficiencies. :-)

 
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Katie

Alan Firstly, its not even about selling to the public – its about getting enough academic interest to repeat and review studies so that doctors can prescribe – esp in the case of vit d and pregnancy whose going to pay for these studies – its painfully slow progress when it comes to nutritional matters due to lack of commercial interest and funding

Fish oil is not strictly a vitamin but I correct myself big pharma is interested in supplying some selected supplments but I dont see much evidence in big pharma investng in furthering nutritional research.

 
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Alan Henness

Katie said:

“its not even about selling to the public”

But that’s who the vast majority of CAM practitioners advertise and sell to, isn’t it? And until they have the robust evidence, do you not think it prudent to reign in what they claim to be able to do? If they have the robust evidence, then fine. I hope you don’t think it’s OK for someone to make a claim that they can’t back up? Is it OK for a CAM practitioner to claim to treat any given medical condition/deficiency/disease/etc because they think they can treat it? We don’t even allow double-glazing companies to make claims they can’t back up – why should we allow a CAM practitioner to do the same, particularly when the consequences could be a lot worse than having some draughty windows?

“its about getting enough academic interest to repeat and review studies so that doctors can prescribe”

If and when homeopaths or whoever come up with the evidence for their therapy, then we can worry about persuading doctors to prescribe it.

I’ll ask again: is it acceptable to make health claims to the public that cannot be substantiated?

“esp in the case of vit d and pregnancy whose going to pay for these studies”

My first port of call would be those profiting from the sale of any treatment. But there have been several recent studies into vitamin D reported recently, haven’t there – and not all research is done by Big Pharma by any means.

“its painfully slow progress when it comes to nutritional matters due to lack of commercial interest and funding”

Back to the thorny question that has to be answered by those who want to advertise and sell…

According to this report by the US National Centre for Complementary and Alternative Medicine (which is part of the National Institutes of Health), Americans alone spend about $34 billion (that’s billion, not million) annually on alternative medicine, and this study says American’s spend $4 billion (again that’s billion, not million) on dietary supplements. It’s not for me to say where funding might come from or how to persuade those who benefit from these sales to do more research, but this certainly isn’t some impoverished cottage industry – it’s Big Business, just like Big Pharma – and as I said, both of these at the same time.

“but I correct myself big pharma is interested in supplying some selected supplments but I dont see much evidence in big pharma investng in furthering nutritional research.”

That’s unfortunate because I’m sure there is much more to be understood.

 
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Guy

With regard to the ongoing NHS reforms, I was initially surprised by the reluctance of many doctors to support the changes even though the new policies would give them a much bigger voice in healthcare management than they currently have. However two other principles of the reform might cause more worries, the first is the need for commissioning bodies to seek the services of a much wider range of providers and the second is concerned with improving patient choice. Combining these changes with the much wider move to localism and Big Society and you have a situation where doctors have more autonomy to try local initiatives and to innovate in how they improve the health of their communities.
Recently housing developers have been spitting nails at the government since their london-based lobbyists are now irrelevant now that housing decisions are once again taken at a local level. Big pharma will also have realised that they will now have to get on their bikes and travel the country in order to bully every commissioning board individually rather than just handing the government their next policy of what doctors can and can’t do. The doctors who are currently opposing the reforms might be unwittingly doing the bidding of big pharma or might be just simply mediocre and uncomfortable with the notion of having to innovate for a living.
The government have already broken the lobbying power of the banks and the massive scale of healthcare costs will ensure that reform in this area will be relentless. Of course there is also the European angle which has not improved much due to the highly corrupt nature of the Brussels decision making process. However Daniel Hannan and other eurosceptics are gaining power every day. It will not be long before the UK simply ignores new Brussels dictats (like the French have been doing for years).
Everyone in the UK is now working harder for less money and this situation is likely to prevail for the next decade or so (while we pay off our past excesses). It is more important than ever that we have a strong and healthy nation to rise to this challenge. We can choose a healthy nation or a bigger sickness (healthcare) industry. We cannot have both.

 
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Katie

Chris B
Its a big step to explain the difference between correcting a deficiency and evaluating potential optimal nutritional requirements – when we are arguing if deficiencies even exist I fear its not for this conversation .I think functional medicine will go from strength to strength though it may take time.

If we are still struggling to get reasonable nutritional advice for our pregnant women and to ensure them enough vitamin D and other groups of people like people in hospital/school children basic needs in terms of a healthy diet there is a lot of work to do ……..

 
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chrisb

Hi Katie,
yes I do agree with you that it’s a big step to explain the difference between correcting a deficiency, and evaluating potential optimal nutritional requirements – when we are arguing if deficiencies even exist; but I have highlighted just three nutrient deficiencies in a recent post on Iodine, Vitamin D and Folic-acid, where deficiencies are responsible for the causation of disease.
The (RDI) for nutrients is the minimal amount needed to avoid deficiency—not the maximum amount required for good health.
I originally raised the issue of “optimal amounts” because the discussion was mostly centered on “deficiencies” and that we can get all the nutrition we need from a “balanced diet”, but that view has been challenged in that a “balanced diet” is still nutrient-deficient because of nutrient-depleted soils…………………
http://www.globalhealingcenter.com/effects-of-pesticides/nutrient-depleted-soil
http://www.natural-health-information-centre.com/depleted-soils.html

The conclusion here is very interesting………
http://www.canadianlongevity.net/misc/mineral_depletion.php
http://myzealdrink.ericrfisher.com/nutrient-depleted-soil-cause-nutritional-deficiencies.html/
http://www.dailypaul.com/92623/1936-us-senate-report-soil-depleted-99-of-americans-nutrient-deficient

In other words, how are we expected to receive adequate nutrition from even the best diet, when the soils in which we grow our crops are nutrient-depleted.?
In conclusion, I think that supplementation (although not ideal) has become a necessity for anyone wanting to regain or maintain their health.

 
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chrisb

On the subject of deficiencies and whether supplementation is considered to be necessary or not.

The Medical profession eventually came round to the view in the late 70′s early 80′s to provide folic acid supplements for all mums to be, but in much much higher doses than could be obtained from the diet, in the prevention of neural tube defects. Our advice came too late, and we lost a child with Spina Bifida at the 20 week stage through a normal induced delivery, only to witness her die a few hours later. This situation was preventable, but ignored by the Medical establishment until the need became obvious.
Folic-acid or Folate is a B Vitamin.

In addition Iodine deficiency has become so widespread that we now have fortified iodized salt (a supplement in your diet no less).
The RDI for iodine is a paltry 150mcg per day when the Japanese consume up to 50 times that amount and with a much lower incidence of cancer and fibrocystic disease of the breast than Americans who consume 50 times less on average………….
http://www.lewrockwell.com/miller/miller20.html

Also the Worldwide pandemic of Vitamin D deficiency and where optimum doses as opposed to RDI’s act as a prophylactic against many serious diseases, so unless you can sit in the sun everyday a supplement is advisable. D3 supplements are chemically identical to the cholcalciferol produced within the skin from sunlight exposure.

These are just three examples of the need for quality supplementation because of dietary inadequacies from nutrient-depleted soils and lifestyle choices.

As time marches on it is odds on that there will be other nutrient-deficient discoveries and associated diseases that were preventable if only supplementation had been recommended earlier. How many life-threatening disease states do we have to endure before commonsense and rationality takes a foothold?
For the Medical authorities to ignore the nutritional evidence, is bordering on the criminal if not an indirect act of genocide.

 
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Katie

It is time for a national (optimal) healthcare industry using both nutrition diet exercise and in moderation drugs and surgery.

 
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wavechange

Katie

Do you understand the biochemical role of vitamins or why we need very small amounts of certain chemical elements (minerals)? Do you understand terms such as coenzyme, prosthetic group and cofactor? Do you understand the specific effects of ‘anti-nutrients’ or are you just imagining that they have some bad effect on our entire metabolism? What do you mean by ‘normalise a specific enzyme system’? I have done a lot of research on enzymes but I still don’t understand what you are talking about.

A GP is not a specialist in nutrition, as I’m sure you will agree, but I reckon that a consultant specialising in nutrition and a NT should know about biochemistry and physiology, and have a grounding in immunology. I hope you agree.

You are absolutely right that I don’t know if I have any nutritional deficiencies and until routine testing becomes the norm or my GP suggests I should take supplements, that will continue.

I really don’t want to take multivitamin or pills that have more chemicals than a box of Pringles (made by Unilever, the washing powder manufacturer). Kindly stop trying to persuade me. I am not trying to stop you taking your chemical concoctions. If you are not risking your health you might be wasting your money.

Sorry if this is a bit rude. I was provoked. :-)

 
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PollyB

There are professionals who are qualified in nutrition AND in biochemistry, physiology and immunology. They are known as dietitians.

 
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wavechange

Indeed, and the Which? report was critical of NTs, not dieticians.

 
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David Colquhoun

I can’t resist one last comment.

It’s been said that Big Pharma isn’t interested in vitamins, because there isn’t much money in them.
Neither part of this is true.

Most vitamins are manufactured by Big Pharma, and marketed by supplement companies which they own. It is very attractive to the less honest parts of Big Pharma that when they sell a compound as a “supplement”, rather than as a “drug”, they are not required to produce any evidence that the products are effective. That brings us straight back to the problem of evidence, or rather the lack of evidence, which is at the heart of the lengthy arguments that have gone on here.

Make no mistake about it, alternative medicine is a huge business, and it is every bit as ruthless at deceiving consumers as every other huge business.

The other important point, is that the bad behaviour of some drug companies (eg GSK and SSRIs, or the Vioxx case) are deeply shameful. But I must point out that these scandals have been unearthed by conventional doctors and scientists, and the results published in conventional journals. The alternative medicine industry has done very little of the digging. I have written myself about these scandals, and Ben Goldacre, the scourge of all nonsense, is in the process of writing a book on that topic. I’m sure that I’ll be as informed and entertained as much by that book as a I was by his first book, Bad Science. I can recommend especially the chapter in the latter on Gillian McKeith and the chapter on Patrick Holford. These two chapters show only too clearly what can go wrong in the nutrition industry.

 
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wavechange

There may be a case for giving up and letting them get on taking their pills and buying shares in the companies that make them. :-)

Hope you are recovering well from the op.

 
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chrisb

David,
you say that “most vitamins are manufactured by Big Pharma and marketed by supplement companies which they own”.
I know that Solgar was purchased from Wyeth by NBTY in 2005.

If true, and I don’t doubt that it is, at least we know that vitamins and other supplements manufactured by Big Pharma will be “pharmaceutical grade” and therefore of a high quality.

David, you also say……………………….
“they are not required to produce any evidence that the products are effective. That brings us straight back to the problem of evidence, or rather the lack of evidence”,

Okay, but why would Big Pharma want to produce any evidence that vitamins/minerals are effective in combating disease or improving health? as this would counter their main manufacturing and research efforts into drugs and the mainstay of their “business with disease” and the profits they make. Supplement profits are considerably less than pharmaceuticals profits.Therefore there is little incentive to do any research into Vitamins and other supplements as to their efficacy.

Mind you the studies that have been done on Vitamins and other supplements have been designed to show them as being ineffective or even dangerous so as to turn people away from them anyway, and therefore support of their primary business of the use of pharmaceuticals.
Please turn on your speakers
http://www.jonbarron.org/heart-health/dietary-supplements-vitamin-e
http://www.lef.org/featured-articles/1014_Flawed-Study-Used-To-Discredit-Multivitamin-Mineral-Supplements.htm
http://wrightnewsletter.com/2011/10/24/truth-flawed-vitamin-e/
http://rubinmedical.com/articles/vitamin_c_flawed.pdf
http://www.huffingtonpost.com/dr-mark-hyman/how-dietary-supplements-r_b_641130.html

Ad infinitum

 
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Katie

David the problem is we just can’t agree on basics for example does a supplement need to be treated in the same way as a drug? we have different opinions so we find little mutual ground..

Further, I don’t agree at all in promoting a book like Ben Goldacres as it slings mud at individuals – I dont think that is right at all and petty – even if the individuals in question are less than professional – This book was on the reading list at a well known uni and I challenged it. The head of department agreed with me and said he would supervise more closely what goes on the reading list in future – he said he thought that Goldacre sometimes accused people of lack of evidence when he himself didnt have the evidence to make the claim

Where we do agree is that there are supplement companies in it for making alot of money no one can deny the billions being made but there are so many companies i dont see one individual company being that rich and I dont thinnk its right to condemn nutritional therapists and companies who are acting professionally

 
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PollyB

Yes – a supplement should be treated as a drug. They are synthetic artifical chemicals that are not identical to foodstuffs containing the same (but natural) nutrient. They are available singly and in much higher doses than could be obtained from food. They don’t come with the benefits of food – fibre, phytochemicals etc are only found in the foodstuff itself.
Supplements have been shown to work differently in the body to the natural nutrient. Folic acid for example is different to folate (and some people are not even able to metabolise folic acid to folate in the body).
Some supplements can be dangerous. There is some evidence that antioxidant supplementation could increase mortality of certain cancer patients. I think that supplements should absolutely be treated like medicines and subject to the same rigorous testing.
NTs are not behaving professionally by selling or recommending supplements. They could behave professionally by reviewing the evidence. They could stick to recommending healthy varied diets and since they have the luxury of only seeing clients who are well-motivated (after all they are paying for it), they could have a real role to play in the health of the nation.

 
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Katie

Alan you missed my point – my point was progress has been painfully slow in coming to any conclusions about vitamin D prescribing by DOCTORS as there is in my opinion less interest in nutrition than in drugs within the medical profession and pharmaceutical industries – Thats not to say that innovative hospitals like Northwick Park have not been actively involved in getting the vitamin D story onto the government agenda

 
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Katie

wavechange

Points not in order-

I agree an NT should have a grounding science as you describe

Your choice over the nutritional testing of course – I suppose as a fellow asthma sufferer (as it think it has helped me) I wanted to share this with you as I think it there is a small possibliity it may be of help to you as you seem to be (80% of the time) a polite open minded person. I dont think that widespread nutritional testing will be available for years and years.

An example of testing vitamins by enzyme fucntions is Vitamin B6. Requirements can be assessed using enzyme activity as a benchmark An example is to measre glutamic-oxalocetic transaminase [EGOT]) before and after a dose of vitamin B6. This is to determine a functional amount required. This is individual to the person – better than guesswork and surely better than prescribing HUGE doses of B6 for women which is what medical professionals used to do.

By the way Pringles cant be compared to a multivit surely – they used to instantly bring my daughter out in the most horrible itchy eczema!

Perhaps we can have a more fruitful discussion one day on an asthma blog

 
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wavechange

Good to read some science.

Let us agree to disagree. My asththma is very well controlled by drugs prescribed by GPs who have a good understanding of th condition. Maybe diet and non-
prescription treatment could help but perhaps I have higher priorities.

Stay well and best wishes.

 
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Katie

Polly no a supplement is not always a synthetic chemical – its important to distinguish – for example a sewweed supplement, a phytonutrient , a spice, a fish oil , a fibre extract – these are not synthetic!!

 
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PollyB

No but they are still substances extracted from the natural foodstuff and taken in isolation of that foodstuff.
Fish oil supplementation has an evidence base (along with some conflicting evidence that does not support it) but it is still preferable to consume oily fish itself (containing protein, vitamins, minerals and other fatty acids) than to take supplements.
I am not saying supplements are totally unnecessary but that their use should be regulated and that people should be encourage to get their requirements from their diet in preference to supplements if possible.

 
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chrisb

Polly B,
http://www.huffingtonpost.com/dr-mark-hyman/how-dietary-supplements-r_b_641130.html

The Lewin Group. (2006). An evidence-based study of the role of dietary supplements in helping seniors maintain their independence. Prepared for: The Dietary Supplement Education Alliance.

(ii) Fairfield K.M., and R.H. Fletcher. (2002). Vitamins for chronic disease prevention in adults: Scientific review. Journal of the American Medical Association. 287:3116-3126.

(iii) Willett W.C., and M.J. Stampfer. (2002). What vitamins should I be taking doctor? New England Journal of Medicine. 345 (24):1914-1916.

 
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Stuart

http://www.huffingtonpost.com/dr-mark-hyman/how-dietary-supplements-r_b_641130.html

Huff Post. LOL.

The Lewin Group. (2006). An evidence-based study of the role of dietary supplements in helping seniors maintain their independence. Prepared for: The Dietary Supplement Education Alliance

“in CERTAIN instances, supplements are an inexpensive and safe way to improve health status and reduce health care and other expenditures”. So not for everyone then? Good to see a rigourous independant study with no conflict of interest. Oh…..The Dietary Supplement Education Alliance……shame.

(ii) Fairfield K.M., and R.H. Fletcher. (2002). Vitamins for chronic disease prevention in adults: Scientific review. Journal of the American Medical Association. 287:3116-3126.

Refers specifically to benefits to some groups “vegans, alcohol-dependent individuals, and patients with malabsorption are at higher risk of inadequate intake or absorption of several vitamins”. Says nothing about general benefits to people with a balanced diet.

(iii) Willett W.C., and M.J. Stampfer. (2002). What vitamins should I be taking doctor? New England Journal of Medicine. 345 (24):1914-1916

Good to see this is widely accepted advice on Vit E and no-one disagrees. Except here tp://www.nejm.org/doi/full/10.1056/NEJM200206133462416#t=article

 
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ExR&D

PollyB says:

“They [supplements] are synthetic artifical chemicals that are not identical to foodstuffs containing the same (but natural) nutrient.”

I hope this is not what dieticians are learning on degree courses.

Fish oils – how are they synthetic? How is a supplement with extract from blackcurrants synthetic? How are herbal supplements synthetic? Vitamin E – there are synthetic versions and natural versions.

PollyB’s statement may be true of supplements produced by companies owned by Big Pharma but it is not true of Higher Nature, an independent company. Higher Nature produces a range of True Food supplements. If anyone wants to find out more, then do contact Higher Nature.

When I was diagnosed with iron-deficiency anaemia my intuition told me to reject the iron tablets available on the NHS. These tablets are inorganic, poorly absorbed and promise undesirable side-effects. I chose instead to take Spatone, a 100% natural iron supplement, that comes in individual sachets. It is a mineral water from North Wales, discovered more than 20 years ago and was found to contain high levels of easily absorbable iron.

Spatone is a perfect example of “discovery” rather than “invention.” Why can’t we discover more and invent less? (Oh, I forgot – it’s a money thing.)

 
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Stuart

“my intuition told me to reject the iron tablets available on the NHS.”

Intuition is often a very poor basis for decision making when it comes to health.

I suspect your use of Spartone has more to do with an ‘appeal to nature’ than your conclusions about the chemistry.

 
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ExR&D

PollyB says:

“There are professionals who are qualified in nutrition AND in biochemistry, physiology and immunology. They are known as dietitians.”

Are student dieticians encouraged to have an open mind and to feel free to question openly what they are being taught?

 
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PollyB

Yes absolutely. Training includes modules that teach critical appraisal of the literature. Questioning and debate is actively encouraged. Assignments are expected to include references from research literature (primary research and review, meta-analyses etc) and critical analysis of the methodology of any research cited. Epidemiology (and its limitations) is taught as is a broader base of public health nutrition.
Dietitians are expected to have good knowledge of the evidence (no cherry-picking allowed) and have a compulsory requirement to keep their level of knowledge up to date.

 
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Stuart

“Are student dieticians encouraged to have an open mind and to feel free to question openly what they are being taught?”

How do you define open minded?

 
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Katie

I dont think we ever disagreed that nutrients should ideally come from foods in the diet. The fish oil one highlights a problem though – fish may be too high in contaminants for an individual to receive enough omega 3 for their particular needs – supplements may be needed

 
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PollyB

The contaminant risk is much lower in the smaller, shorter-lived fish such as mackerel and sardines. The contaminants build up in the larger fish (since they eat the smaller ones).
I know it is not a usual part of our modern British diet to consume mackerel and sardines regularly but it is important to encourage their consumption.

 
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wavechange

That makes sense, PolyB. Just use the available information and apply some common sense.

 
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Katie

polly yes but there are restrictions set by Food Standards Agency arent there and these affect primarily females who have to restrict intake and therefore may not receive enough for their needs if you see them as individuals with different needs like I do and so do most NTs

 
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Stuart

Don’t think anyone would disagree with that Katie.

The problem is that many NTs seem to quickly recommend supplements without considering giving the type of advice that PollyB has given first.

 
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PollyB

This is correct Katie – women of childbearing age should not consume more than 2 portions (2 x 140g) of oily fish per week. [Please see FSA and NHS websites for more details if that applies to you - some fish such as shark should be avoided, tuna should be limited to 2 steaks or 4 cans per week]

However, before offering supplements, further advice could also be given as to increasing omega 3 intake from other sources (flaxseeds, pumpkin seeds, walnuts, green leafy vegetables) and possibly reducing linoleic acid (omega 6) intake to help with the conversion of ALA from these vegetarian sources to DHA and EPA.

That to me would indicate seeing someone as an individual – working with the client to look at their whole diet and helping them adapt it to ensure they are obtaining their nutritional requirements.

 
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chrisb

Hello Alan,
that was a long one!!

To be honest I didn’t know the meaning of the word “syllogism” and had to use a dictionary, so apologies on that score.

Love your smileys btw.

“Robust evidence”?
The Lewin Group. (2006). An evidence-based study of the role of dietary supplements in helping seniors maintain their independence. Prepared for: The Dietary Supplement Education Alliance.

(ii) Fairfield K.M., and R.H. Fletcher. (2002). Vitamins for chronic disease prevention in adults: Scientific review. Journal of the American Medical Association. 287:3116-3126.

(iii) Willett W.C., and M.J. Stampfer. (2002). What vitamins should I be taking doctor? New England Journal of Medicine. 345 (24):1914-1916.
http://www.huffingtonpost.com/dr-mark-hyman/how-dietary-supplements-r_b_641130.html

Well the above is a small sample, but space is limited I’m afraid.

I am not an advocate of AltMed per-se with a blanket support for all of it, and some have said here that some of it (but not all of it) is probably based on “hocus-pocus” and should be investigated and shown to be so. What I object to very strongly is the “tar all of it with the same brush” mentality in spite of the “robust evidence” in support of it. I am mostly referring here to Nutritional Medicine or Orthomolecular Medicine and an example of just one study that has been discounted/ignored by Mainstream……………………
http://orthomolecular.org/library/jom/2008/pdf/2008-v23n02-p083.pdf

“Experience tells us that most of the ideas we’ve had over the millennia are utterly wrong”:
Yes, but the grass is still green and the sky is still blue, or do we need a scientific study to evaluate the reasons as to why this is.?

Do I think there are “energy channels” through our bodies that have never been seen or detected?
Possibly. But this was the ancients way of explaining “how” it worked and not necessarily “why” it does.

“We will remain dependent on the empirical experience and philosophical theories of the ancient Chinese until a method of point selection can be deduced from an understanding of the scientific mechanism of acupuncture. Science will, and should, provide an explanation for the observations of the ancient Chinese, but in the meantime we should not reject acupuncture just because we cannot explain it completely”.
http://www.acupropress.com/faq/faq1.html

“Scientific interest in acupuncture has led numerous investigators to conduct clinical trials to test the efficacy of acupuncture for various conditions, but the mechanisms underlying acupuncture are poorly understood”.
http://www.biomedcentral.com/1472-6882/6/25

So the question is not about IF acupuncture actually works, because it clearly does, but as to the “mechanism” as to “WHY” it works; that is the job of science Alan.

Much of what you have said Alan does not stand up to scrutiny, because if an AltMed has been demonstrated to work, and work effectively as a therapy, it is the role of science to discover this “WHY”, and not just discount it because there is no “acceptable evidence” that it IS efficacious.
All of this depends on whose responsibility and role it is to prove or disprove any particular therapy, and if medical science have stated that something is nonsense or quackery, it is really down to them to prove it one way or another.
This is also dependent on the premise “first do no harm”.

I agree with you………….
“There comes a point where we have to decide whether we keep our minds open to absolutely anything and everything”,

Absolutely: anything is possible until proven to be impossible.

 
avatar

Alan Henness

chrisb said:

“So the question is not about IF acupuncture actually works, because it clearly does, but as to the “mechanism” as to “WHY” it works; that is the job of science Alan.”

To cut to the chase, can you cite your best evidence that acupuncture clearly works? What, if anything, would persuade you that it doesn’t?

 
avatar

Stuart

So the question is not about IF acupuncture actually works, because it clearly does, but as to the “mechanism” as to “WHY” it works; that is the job of science Alan.

It doesn’t generally work for the majority of conditons. The few well controlled studies conducted aren’t conclusive (some for some against).

The way it usually goes is that you look for evidence of a repeatable measurable effect, and then worry about identifying a mechanism.

Using your rather bizarre logic we just assume everything works and just use science to look for a mechanism. Thats going to be rather time consuming don’t you think?

 
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Stuart

“But this was the ancients way of explaining “how” it worked and not necessarily “why” it does.”

Or as some people might say “making stuff up”

 
avatar

Guy

One view of supplements is that they have become a necessary part of modern life since we now consume food which has been intensively farmed in a wide range of conditions. While a potato might look like a potato, it has probably been grown in nutrient-depleted soil using only NPK fertilisers. If farming could be better regulated to deliver foods with known levels of micronutrients then we could be assured of receiving many of the nutrients that are in supplements. Even then, if you ask the average member of the public how many potatoes they need to receive the recommended 11mg of zinc (for example), then they will not know. It is clear that we DO need a wide variety of microminerals since they are cofactors in dozens of metabolic reactions (and nature does not tend to create ‘spare’ reactions which are not really necessary). Therefore nutritional supplements are a pragmatic solution to help a poorly educated public stay as healthy as possible. Better education, more food regulation etc is clearly a better solution but is a long way off.

 
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Stuart

This whole argument seems to rely on the fact that the nutritional value of food has decreased as a result of intensive farming, which is detrimental to health.

Do you have any links to evidence that this is the case?

 
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Katie

Stuart – if you mean about the fish – how many NT consultations have you attended that qualifies you to say that? I don’t think that is correct at all. NT at its best emphasizes foods, rationale for including them , how to prepare them – alot of time is spent discussing the diet

 
avatar

Stuart

No, not fish oil.

Simply noting that Which? found the NTs they visited generally recommended quite expensive supplements. Albeit a small sample, this in itself should lead to any decent NT asking their regulators to investgate those practitioners.

Have you ?

 
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Katie

Polly all that you suggest would be included in a good NT consultation. Biochemical testing for the omega 3 pathways might be included as well as not everyone appears to convert ALA into EPA and DHA effectively.

It looks like dieticians and NTs do have a lot in common it would be better to work together than argue

 
avatar

Katie

Guy I have sympathy with your views here on supplements. However, I think it iwould be wrong for the public to be encouraged to take them if they were not prepared to understand why they were taking them or willing to also look at improving their diet. I feel strongly about awareness and education. Having said that, I would hate for children to suffer physically and mentally becuase neither good food nor supplements were available to them via their parents. I also feel strongly about quality of supplements and that is always an obstacle for any national endeavour.

 
avatar

chrisb

Alan said……………………
“To cut to the chase, can you cite your best evidence that acupuncture clearly works?” What, if anything, would persuade you that it doesn’t”?

Yes, the patients who use it and the acupuncturists who apply it, plus the Medical Doctors who use it as well for example in pain management.

Medical Acupuncture…………………..
While acupuncture is often associated with pain control, in the hands of a well-trained practitioner it has much broader applications. Acupuncture can be effective as the only treatment used, or as the support or adjunct to other medial treatment forms in many medical and surgical disorders.The World Health Organization (WHO) recognizes the use of acupuncture in the treatment of a wide range of medical problems, including:

Digestive disorders: gastritis and hyperacidity, spastic colon, constipation, diarrhea.
Respiratory disorders: sinusitis, sore throat, bronchitis, asthma, recurrent chest infections.
Neurological and muscular disorders: headaches, facial tics, neck pain, rib neuritis, frozen shoulder, tennis elbow, various forms of tendinitis, low back pain, sciatica, osteoarthritis.
Urinary, menstrual, and reproductive problems.
Acupuncture is particularly useful in resolving physical problems related to tension and stress and emotional conditions……………………..

A GP’s perspective on Medical Acupuncture……………………
http://www.tryacupuncture.co.uk/medical-acupuncture

From The University of Maryland Medical Center……………………..
http://www.umm.edu/altmed/articles/acupuncture-000345.htm
AND supporting research listed on their website…………………

Chen D, et al. Clinical study on needle-pricking therapy for treatment of polycystic ovarial syndrome. Zhongguo Zhen Jiu. 2007;27(2):99-102.

Cheuk DK, Yeung WF, Chung KF, Wong V. Acupuncture for insomnia. Cochrane Database Syst Rev. 2007;(3):CD005472.

Benzon: Raj’s Practical Management of Pain, 4th ed. Philadelphia, PA: Mosby Elsevier, Inc. 2008.

de Leon: Cancer Pain, 1st ed. Philadelphia, PA: Saunders Elsevier Inc., 2006.

Dickman R, Schiff E, Holland A, Wright C, Sarela SR, Han B, Fass R. Acupuncture vs. doubling the PPI dose in refractory heartburn. Aliment Pharmacol Ther. 2007; [Epub ahead of print].

Facco E, Liguori A, Petti F, et al. Traditional Acupuncture in Migraine: A Controlled, Randomized Study. Headache. 2007; [Epub ahead of print].

Flachskampf FA, Gallasch J, Gefeller O, et al. Randomized trial of acupuncture to lower blood pressure. Circulation. 2007;115(24):3121-9.

Haake M, Muller HH, Schade-Brittinger C, et al. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Intern Med. 2007;167(17):1892-8.

Hollifield M, Sinclair-Lian N, Warner TD, Hammerschlag R. Acupuncture for posttraumatic stress disorder: a randomized controlled pilot trial. J Nerv Ment Dis. 2007;195(6):504-13.

Itoh K, Katsumi Y, Hirota S, Kitakoji H. Randomised trial of trigger point acupuncture compared with other acupuncture for treatment of chronic neck pain. Complement Ther Med. 2007;15(3):172-9.

Kelly R. Acupuncture for Pain. American Family Physician. 2009;80(5).

Law S, Li T. Acupuncture for glaucoma. Cochrane Database Syst Rev. 2007;(4):CD006030.

Manheimer E, Linde K, Lao L, Bouter LM, Berman BM. Meta-analysis: acupuncture for osteoarthritis of the knee. Ann Intern Med. 2007;146(12):868-77.

Pilkington K, Kirkwood G, Rampes H, Cummings M, Richardson J. Acupuncture for anxiety and anxiety disorders — a systematic literature review. Acupunct Med. 2007;25(1-2):1-10.

Price S, Lewith G, Thomas K. Acupuncture care for breast cancer patients during chemotherapy: a feasibility study. Integr Cancer Ther. 2006;5(4):308-14.

Schneider A, Streitberger K, Joos S. Acupuncture treatment in gastrointestinal diseases: a systematic review. World J Gastroenterol. 2007;13(25):3417-24.

Sierpina V, Frenkel, M. Acupunture: A Clinical Review. Southern Medical Journal, 2005;98(3):330-337.

Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev. 2009;(1).

Lu W, Dean-Clower E, Doherty-Gilman A, Rosenthal D. The value of acupuncture in cancer care. Hematology/Oncology Clinics of North America. 2008;22(4).

Wu TP, Chen FP, Liu JY, Lin MH, Hwang SJ. A randomized controlled clinical trial of auricular acupuncture in smoking cessation. J Chin Med Assoc. 2007;70(8):331-8.

Read more: http://www.umm.edu/altmed/articles/acupuncture-000345.htm#ixzz1lzdCCBGv

AND…………….
“What, if anything, would persuade you that it doesn’t”?

Nothing really, because as you can see it actually does, unless both the (WHO) World Health Organization and the University of Maryland (for example) are mistaken, but I doubt it.

 
avatar

Alan Henness

chrisb said:

“Yes, the patients who use it and the acupuncturists who apply it, plus the Medical Doctors who use it as well for example in pain management.”

Would you be willing to accept the same incredibly low standards from Big Pharma? Or homeopaths? Or faith healers? If not, why not?

Are you aware these are examples of logical fallacies called ad populum and appeal to authority (or argumentum ad verecundium to give it its formal name)? There’s a good introduction to argumentation on the Nizkor Project where you can find out more about why such things are not acceptable.

And what Stuart said…

 
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chrisb

Stuart said…………

“The way it usually goes is that you look for evidence of a repeatable measurable effect, and then worry about identifying a mechanism”.

I refer to my earlier post in reply to Alan.

AND………
“Using your rather bizarre logic we just assume everything works and just use science to look for a mechanism. Thats going to be rather time consuming don’t you think”?

Your summary of my “bizarre logic” is illogical and elementary my dear Watson.
To accuse me of saying “anything works” and then just use science to look for a mechanism, is a gross distortion of what I actually said and has been misconstrued by you Stuart.
The actual translation is: if a healing modality such as acupuncture has been shown to work then we should look for the reasons as to “WHY” this is the case.

You comprehend the difference?

 
avatar

Stuart

It hasn’t.

First you need to show that something works. You simply assert that acupuncture works without any reason or evidence. I’ve commented on your evidnece previously and you’ve failed to address that.

I could do likewise with an absurd example :)

Sticking a potato to my head with selotape (other tapes are available) cures headaches. I say it does, its traditional, ancient and works using the ‘potato head paradigm’ which scientists don’t understand cos its all quantum and thingy.

Should I be getting angry at mainstream science for not looking for the mechanisms behind ‘potato head therapy’. Of course not, because there needs to be some decent evidence that it has an effect first. Otherwise you are simply wasting your time.

You’ve jumped the first step entirely and relegated science to working out the dirty mechanism stuff, and actually science is far better at doing the first step than we are.

 
avatar

chrisb

Now come on Stuart please………….
“But this was the ancients way of explaining “how” it worked and not necessarily “why” it does.”

Absolutely: this was the ancients way of explaining “HOW” it works, because that was the chosen way at that time of explaining “HOW”.
They didn’t have to know the reason “WHY” as long as it did. That is my whole point of contention Stuart.
It is only “NOW” when we have the available scientific expertise, to discover that mechanism.

AND,,,,,,,,,,,,,,,,,,,
“making stuff up”
I’ll interpret that as humor, and very good humor into the bargain.

 
avatar

Stuart

So if there mechanism was totally wrong (meridians, Chi energy) what on earth makes you think they were right about its efficacy?

Also, who says we have to understand the mechanisms for something to be effective?

 
avatar

chrisb

Stuart,
so what you are essentially saying is that the WHO (World Health Organization) and the University of Maryland Medical Center are both wrong? in their assessment and use of acupuncture.

Isn’t that rather audacious and presumptuous that you know better than they do?

 
avatar

Stuart

Yep that’s exactly what i am saying. And citing WHO is simply a call to authority. I judge based on the quality of the evidence and analysis.

Do you know what evidence WHO used in 2003 to assess the efficacy of acupuncture?

Go on……….

 

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