Wednesday, August 21, 2013

Evidence vs The Evidence


In a comment after an article about naturopathy,  http://rosemary-jacobs.blogspot.com/2013_08_01_archive.html, I wrote, “NDs terrify me. They routinely use products that have never been evaluated for safety or efficacy. One or more of these substances could be totally useless but as lethal as cigarettes. By the time that is discovered, it will be too late to save many from premature deaths. http://rosemary-jacobs.blogspot.com/2012/05/deadly-folk-medicine.html”. The link was to an article I had written about deadly folk medicine that included references supporting my claim about the dangers of natural remedies and why they had to be  rigorously tested and evaluated for safety and efficacy before being used routinely. 

A student at an accredited naturopathic school who realized I was referring to NDs, naturopaths, with degrees from 4-year accredited schools like the one he attended replied, “The stats say ZERO deaths from natural products - that is the evidence.” He offered this reference, http://orthomolecular.org/resources/omns/v06n04.shtml

My response was that his reference wasn’t ‘the’ evidence. It was a piece of the evidence. As such, it had to be checked and verified and then reviewed in the context of all the other available evidence relevant to the topic.

As soon as I clicked on the student’s link to the orthomolecular medicine site and saw the title of the article, “No Deaths from Vitamins, Minerals, Amino Acids or Herbs”, I knew that something had to be wrong because it contradicted the evidence I already had. It contradicted the evidence presented in my article above as well as with all the other numerous well documented reports of deaths caused by supplements like ephedra and the laxative teas. It contradicted what I had learned when I had spoken with survivors of two of the dead victims and some of the lawyers who had represented them.

So what was the problem? How had the authors and the student missed those deaths?  Well if you read the article, you will find that the authors based their conclusion that supplements are safe and haven’t killed anyone on just one piece of evidence, reports of deaths received by US Poison Control Centers in one year, 2008. 

But would anyone with an ounce of common sense who wanted to know the facts draw a conclusion based on that one report alone? I doubt it. I think most people, would say, Wait a minute. Were there any natural product deaths reported to the US Poison Control Centers in any other years? Were there any reported to it in the last 20 years? Were there any natural product deaths reported anywhere else such as to the FDA?Were there any supplement deaths reported in the medical literature or in the press? And even if a thorough investigation couldn’t find any, would rational people conclude that there couldn’t be any in the future? I doubt it. I think they’d understand the cigarette analogy. They’d understand that some substances take decades to kill their victims. 

But if readers discovered what I already knew, that supplements have already killed people, do you think they’d wonder why the site and the student excluded those death reports; why out of several reports they had chosen only one - the one that supported the conclusion that the products they promote are safe? Do you think that they’d ask themselves if anyone actually looking for factual information on the lethalness of supplements would exclude pieces of evidence that showed they had killed people? 

If you review the entire orthomolecular medicine site, not just the page the student linked to, you’ll find additional claims not supported by objective evidence. For instance, look at what the ortho site has to say about Max Gerson, MD and his Gerson Therapy, http://orthomolecular.org/history/index.shtml. Compare that to what the American Cancer Society says about him and his Therapy. http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/dietandnutrition/gerson-therapy. Notice specifically what it says about adverse reactions including deaths associated with coffee enemas which are a part of Gerson Therapy.

Also look at what the ACS has to say about orthomolecular medicine. http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/herbsvitaminsandminerals/orthomolecular-medicine. Specifically, under the heading “overview”, “Available scientific evidence does not support the use of orthomolecular therapy for most of the conditions for which it is promoted.”  

But that isn’t the end of the story. In addition to death reports, there are many documented cases of injuries natural products used as remedies have caused. Look at what Consumers Union has to say about their safety even during the period that included 2008 when the ortho site said there were no deaths caused by them. http://foodpoisoningbulletin.com/2013/consumers-union-endorses-dietary-supplement-labeling-act/#comments

I personally also know that there are many documented cases of argyria, skin discolored by silver, caused by oh so natural silver “dietary supplements” that CU never mentioned. I predicted these back in 1995 when I learned that silver was being sold as a supplement, a “natural antibiotic”. It is the very thing that got me to investigate supplements and natural “remedies” and to discover the deaths and injuries they have caused and may possibly cause in the future. I have spoken to and seen some of the silver victims, their lawyers, doctors, friends and families. I’ve read of other cases of argyria in medical journals and in the media. I’ve been interviewed by the same journalists who interviewed Paul Karason and Stan Jones. I’ve reported extensively on the problem. Here’s just one example, http://rosemaryjacobs.com/naturopaths.html

“Evidence” is a word used professionally by scholars like historians and economists as well as by cops, lawyers, prosecutors, judges, journalists, scientists, and doctors who practice evidence-based medicine (EBM). They take courses to learn what specifically constitutes reliable evidence in their fields. They all learn that you can’t “cherry-pick” evidence, you can’t selectively choose that which  supports your views while excluding that which does not.

But the concepts of evidence and proof aren’t alien to the guy in the street who uses them intuitively to varying degrees in his daily life. When he wants to buy a car, he asks his friends if they like theirs and probably checks magazines that he considers unbiased and reliable like Consumers Report to see what their investigations have uncovered and to see if they verify the claims that salesmen make. If he sees a news report about a local businessman accused of sexually harassing a female employee, he doesn’t draw a conclusion based on that report alone. He considers everything he knows about the situation and the guy and the gal. If he knows many women who have worked with the man over the years who respect and admire him and if he knows that the woman has a history of making false accusations against people, he doubts her claim. Intuitively he knows that one piece of evidence isn’t ‘the’ evidence. He knows that it can’t be viewed in isolation but only as a part of all that a good investigation uncovers. He knows that all the relevant facts have to be independently verified and that the sources providing them have to be considered to see if they have a financial, philosophical or emotional interest in the topic which could make them prone to either unconscious bias or to deliberately lie or deliberately mislead people. 

Life doesn’t come with guarantees but if we want to stack the odds in our favor the best thing we can do is learn where to find and how to weigh and evaluate evidence, the whole body of relevant evidence, so that we can make truly well informed decisions about the things that are important in life like drugs and therapies.

Scholars have recently recreated the view that General Robert E. Lee had of the Gettysburg battlefield and concluded that it is very likely that he lost there because his battle plan and the decisions he made were based on very incomplete evidence. They were based on the number and location of Union troops seen by him and his scouts who used high parts of buildings like the cupola atop the Lutheran Seminary as lookout posts as well as reports from cavalry reconnaissance troops. Unfortunately for them they didn’t see the large numbers of enemy soldiers who were blocked from view by the hilly terrain. Not seeing the superior number of Union forces, not obtaining all the facts, had dire consequences for the Confederates. 
http://www.smithsonianmag.com/history-archaeology/A-Cutting-Edge-Second-Look-at-the-Battle-of-Gettysburg.html

Of course, there are times in life, especially in war and emergency situations when we simply have to make a quick decision, times when we have to choose from several options even though we don’t have all the relevant facts. At those times, we cross our fingers and go with the evidence we have and our intuition knowing that there are serious consequences to whatever we decide even if it is to do nothing at all. 

However, most situations we face in life aren’t like that - something people in most professions know very well, especially scientists and those who practice evidence-based medicine. That is why medical scientists study drugs and therapies before they are used routinely. It is why those who practice EBM routinely use approved drugs that have been well studied. It is why medical scientists devise ways to test drugs and therapies scientifically, as unbiasedly as possible, to obtain the facts, the body of evidence, that enables them to make treatment decisions that increase the odds of helping not harming patients. 

That doesn’t mean that no one will ever be injured or killed by a well studied drug or therapy. It just means that by limiting our routine use of drugs and therapies to those that have been well studied that we will greatly increase the chances of our benefiting from them rather than being harmed by them. It will decrease the odds of our playing Russian roulette with our lives and health. It will reduce the guesswork and the risk that involves. This I believe is all we can reasonably hope for in life. This is why I believe in scientific or EBM and why the unscientific naturopathic alternative terrifies me.  
http://rosemary-jacobs.blogspot.com/2013/07/naturopaths-alternative-or-naturopathic.html

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