Holford, Burne and Serotonin Pills

March 20, 2010 at 5:25 pm (Bad Science) (, , , , , , , , , )

Here, Jerome Burne is given space on Patrick Holford’s blog to defend homeopathy by attacking drugs that are part of conventional medicine.

I want to focus on the discussion of SSRI drugs for depression, but first I will briefly comment on a couple of the other aspects of the article.

Firstly, there is the attempt to criticise an evidence check on homeopathy (a report of the commons Committee on Science and Technology specifically addressing homeopathy) for “not going far enough” and tackling non-homeopathic medicines that the author takes issue with.

Secondly, there is the conclusion to the article:

So there is nearly £300 million being spent on drugs with serious questions marks hanging over them. Is bringing the big guns to bear on homeopathy, which certainly never harmed anyone, really the best way to cut our drugs bill?

The italics are mine, the omission is Burne’s – he neglects to address the indirect harms caused by homeopathy. The misleading of patients who are entitled to expect to be fully informed of the nature of remedies in order to give informed consent is one indirect harm.

Another is rather more serious – the potential for respectability to be conferred upon homeopathic remedies by what might be seen to be NHS approval of this alternative medicine. If homeopathic medicines are seen as efficacious, we might expect to see more of this: What’s The Harm?

Thirdly, the title of the Burne article is sheer class. “Save NHS money on ineffective drugs, not homeopathy” implies, after all, that we should save money on drugs that sometimes actually work – and leave the demonstrably ineffective homeopathic remedies alone.

Surely “Save NHS money on ineffective drugs and homeopathy” would have made more sense?

Serotonin Pills, Money, Evidence, Holford, and Burne

Burne writes, of a study of SSRI anti-depressants, that:

it found that these drugs were only effective when given to the relatively small number of people with severe depression. For the millions of others taking them they were no better than placebos.

While I am pleased to see that Jerome Burne is writing – on Patrick Holford’s website – about the value of treating mild to moderate depression with pills, it is worth noting that Patrick Holford has himself promoted pills for depression.

While criticising the evidence check for focussing on homeopathy and ignoring conventional drugs, Burne himself concentrates on SSRIs and ignores remedies such as tryptophan and 5-hydroxy tryptophan (5-HTP). Burne also begins each paragraph with a note on the amount spent on each drug he criticises.

Patrick Holford, a popular writer and founder of the Institute for Optimum Nutrition (ION), recommends in one of his books (Optimum Nutrition for the Mind) the following:

St John’s Wort 300mg 0.3% hypericin, to be taken 2-6 times daily, making that a total intake of 600-1800mg at a cost of 15p per capsule – which means you could be paying from £2.10 up to £6.30 per week (or £9 to £27 per month).

Holford also recommends 5-HTP at 200-600mg daily – costing up to 28p for a 100mg pill. Assuming that one buys the larger pack at 26p per pill, this would cost between £15 and £50 per month. The two together could cost almost £75 per month.

Given Jerome Burne’s enthusiasm for studies looking at whether a treatment has a benefit beyond placebo and his concern at money being wasted on ineffective treatments, I would be interested in his thoughts on the use of 5HTP and St John’s wort as alternatives to SSRI anti-depressants.

Here’s some evidence on 5HTP and St John’s wort:

Further studies are needed to evaluate the efficacy and safety of 5-HTP and tryptophan before their widespread use can be recommended. The possible association between these substances and the potentially fatal Eosinophilia-Myalgia Syndrome has not been elucidated. Because alternative antidepresants exist which have been proven to be effective and safe the clinical usefulness of 5-HTP and tryptophan is limited at present. [Cochrane review of 5-HTP / Tryptophan.]

The Cochrane review of St John’s wort seems more optimistic:

The available evidence suggests that the hypericum extracts tested in the included trials a) are superior to placebo in patients with major depression; b) are similarly effective as standard antidepressants; c) and have fewer side effects than standard antidepressants. [Cochrane review of St John’s Wort.]

Although there are some notes of caution sounded in the paper. For instance: “The association of country of origin and precision with effects sizes complicates the interpretation.” I wrote a blogpost about the association of country of origin here: Cultural Bias in Scientific Research.

The authors of the Cochrane review of St John’s wort also note that:

St. John’s wort products available on the market vary to a great extent. The results of this review apply only to the preparations tested in the studies included, and possibly to extracts with similar characteristics. Side effects of St. John’s wort extracts are usually minor and uncommon. However, the effects of other drugs might be significantly compromised.

I look forward to reading Jerome Burne’s thoughts on the evidence relating to 5HTP and St John’s wort, and the cost to the consumer of purchasing these remedies.

More

A PDF of the Jerome Burne piece on Holford’s website. Recent discussion of serotonin over at the 21st floor, a blog post about boosting your serotonin, Bad Science on serotonin, and PJ on serotonin.

Holford’s conclusion at the end of the chapter on Overcoming Depression begins:

In summary, if you are experiencing chronic or severe depression:

See a clinical nutritionist who can check for any biochemical imbalances, and devise a nutritional programme to improve your mood. This may include supplements of St John’s wort, 5HTP…

25 Comments

  1. Cybertiger said,

    Britain now spends about £2 billion on the whole cholesterol fandango with meaningless blood tests and worse than useless cholesterol lowering drugs. What a massive con-trick! And jdc523 witters on about the evils of St John’s Wort. Give me strength.

    PS. Wot happened to yesterday’s e-pistle on Linda Lovelace?

  2. Cybertiger said,

    Trick or treatment? Jerome Byrne did cover the cholesterol lowering con-trick with Ezetimibe and the virtually useless statin-combo.

    “Ezetimibe – cholesterol lowering £66 million

    The same top journal that recommended that aspirin should no longer be used to lower heart attack risk also recently produced a report that was much less widely publicised about this drug given along with statins to patient with a raised risk of heart disease. The journal found that although it lowered cholesterol there was no evidence at all that it made anyone live any longer or – amazingly – that you would have any fewer heart attacks if you took it. It concluded “The long-term benefit, if any and safety profile of ezetimibe (alone or in combination) are not known.”

    So not very good evidence there then.”

    But Jerome did not mention the cancer causing potential of the cholesterol lowering drugs … which was covered here in the BMJ in September 2008.

    http://www.bmj.com/cgi/content/full/337/sep03_3/a1493

    Of course, the pharmaceutical-industrial-complex have gone all quiet about the risks of these near useless drugs in the absurd ‘war on cholesterol’.

  3. jdc325 said,

    “PS. Wot happened to yesterday’s e-pistle on Linda Lovelace?”
    Ha, now there’s a question I can answer. For Ada Lovelace Day, they’re asking people to blog on the 24th March about a woman who’s made a contribution to science/technology. I drafted something and accidentally pressed ‘submit’ instead of ‘save draft’. The post will be up on Wednesday.

  4. Phil H said,

    The serotonin hypothesis is fascinating from a historical / cultural perspective and speaks a great deal about our desire to reduce complex affective states to simple biochemistry. Of course, both 5-htp and St Johns Wort are (proposed) serotogenic substances, just like the evil SSRIs, and there’s no reason to suppose they’d be any more effective. The hypothesis itself is on shaky ground, and any benefit from a serotonin boost is very likely from the long-term effect that it has on other transmitter systems and hormones, which may well make more effective pharmacological targets.

    One thing to watch out for with any article on ‘depression’ is a lightfingered approach to terms, with authors meaning ‘mild depression’ (or even ‘induced negative affect’) in one sentence before deftly switching to ‘major depressive disorder’ in the next. Needless to say, there’s a world of difference between feeling a bit low and feeling so swallowed with grief that you can barely speak. Some peer-reviewed papers are just as guilty of this as Holford and his ilk, and this sloppy approach to clinical definition drives me nuts.

  5. jerome burne said,

    First a clarification. I was not “given space to defend homoeopathy”. Its assumptions clearly don’t fit current biochemical understanding and I’m certainly in no position to pass judgement on the stack of rival meta-analyses that each side swear by. What does seem universally agreed is that taking it is not going to do any harm and I’ll come to that ludicrous list of supposed homoeopathic dangers in a moment.

    My intention was simply to point out that if it is wasting money on placebos that you are worried about, then there are far vaster savings to be made on the regular drugs bill. What’s more the evidence base for a number of them looks decidedly shaky. I was of course aware that the purpose of the Commons review was to consider homoeopathy only; I was merely moving the issue on.

    You claim I ignore the “indirect harm” caused by homoeopathy. The reason is that my piece only used homoeopathy as a starting point. However the points you make really don’t stand up. The first claim is that homoeopathy misleads “patients who are entitled to expect to be fully informed of the nature of remedies” they are taking. How many of the millions given SSRIs for social anxiety or problems with the menopause or just because they are “tired all the time” are told that major large scale analyses have found them no better than a placebo?

    As for the link to the site that is supposed to show the dangers of believing in homoeopathy – what a joke. One of the 437 examples was the American president who died in 1923! If you have got to go that far back to get the numbers up you are certainly not in the major league when it comes to dangers. Licensed drugs can manage that in a few months. Someone with a throat infection which didn’t improve with homoeopathy – if not being helped with a treatment was grounds for warnings every single GP’s surgery should have a big warning sign over it. A drug is considered really successful if 50% of those who take it benefit.

    The most bizarre case – classified under the heading of “time wasted on useless treatments” – complained that “radiation and chemotherapy failed to halt the spread of the disease, as did alternative homoeopathic treatment.” First of all it clearly classifies radiation and chemotherapy as a “useless treatment” – not your point I suspect – and anyway have you seen figures on the benefits of adjuvant chemotherapy? Ten percent is putting a good spin on it. The charge sheet even includes someone who died from liposuction given by a homoeopath. As a famous tennis player used to yell: “You cannot be serious”.

    You objected to the title on the grounds that it implied “we should save money on drugs that sometimes actually work – and leave the demonstrably ineffective homoeopathic remedies alone.” All I can say is that it seems you haven’t read the piece. Have another look. SSRIs no better than a placebo for most. Ezetimibe no evidence it reduces cardiovascular risk at all etc.

    It’s the simplistic Manichean view that is so irritating about this whole assault on CAM in general. Medicine is not a science although it has lots of scientific elements, a lot of what doctors do is not very effective (a lot of course is), that is why people go looking elsewhere. A lot of what is done elsewhere may not work well either. Let’s by all means get evidence for what works but the relentless pillorying of the relatively small CAM segment and the pretence that the mainstream is all buttressed with evidence is wilfully ignoring the elephant in the room.

    The concerns you raise about treating depression with 5-HTP or St John’s Wort aren’t relevant to the purpose of my article – which you haven’t even begun to address. However the evidence you present hardly suggests a serious problem. One review of 5-HTP says “further studies are needed” – given that the funding for non-drug treatments is minuscule that is hardly surprising. As for the price, the maximum you quote is £27 a month or £324 a year – try getting a branded placebo SSRI for that price.

    The other review you quote says that St John’s Wort is superior to a placebo in patients with major depression and has fewer side effects than SSRIs. If it’s irresponsible to base treatment on that, you will have to get rid of an awful lot of prescription drugs.

    I’ve responded at length because these postings stay on the web indefinitely and search engines throw them up but I really feel it is a waste of time. I wrote a piece that raised serious issues about the ineffectiveness and possible dangers of a number of widely used drug treatments. In response you address none of that but instead make points such as that a sick person was treated by a homoeopath over 80 years ago and didn’t survive or that a supplement can cost over 300 pounds a year.

  6. Holford, Burne and homeopathy on the NHS « Holford Watch: Patrick Holford, nutritionism and bad science said,

    […] Burne and homeopathy on the NHS Jump to Comments JDC has just put up an excellent post about Holford, Burne and Serotonin pills: noting that, while Jerome Burne is given space on Holford’s blog to argue for the need to […]

  7. Cybertiger said,

    A win on points? No, that was a clean knock out. Well played that man, Jerome Burne.

  8. jdc325 said,

    Hello Mr Burne, and thank you for taking the time to comment.

    First a clarification. I was not “given space to defend homoeopathy”.

    Then perhaps you should ask for the headline to be amended – it certainly seems to me that it implies that you would prefer the NHS to reduce spending on the drugs you refer to rather than reduce spending on homeopathy. Perhaps the headline I suggested in my blogpost would be acceptable to you? “Save NHS money on ineffective drugs and homeopathy.” I am not sure who decided on the headline for your piece, but I think it was ill-chosen.

    …that ludicrous list of supposed homoeopathic dangers

    Personally, I think that you are quite right to query the value of the What’s The Harm page on homeopathy. Some of the cases listed there do seem to refer to the dangers of homeopaths prescribing various treatments other than homeopathy. There are cases listed, however, which clearly demonstrate the dangers of promoting homeopathy.

    You objected to the title on the grounds that it implied “we should save money on drugs that sometimes actually work – and leave the demonstrably ineffective homoeopathic remedies alone.” All I can say is that it seems you haven’t read the piece. Have another look. SSRIs no better than a placebo for most. Ezetimibe no evidence it reduces cardiovascular risk at all etc.

    I said “drugs that sometimes actually work” – SSRIs are clearly in this category. They are effective for those with severe depression (as you state yourself in your article). Homeopathy is simply not effective. While there may be an argument that SSRIs are over-prescribed and spending on these drugs should be reduced (an argument I am sympathetic towards), the argument that the NHS should cease to fund homeopathy is, to my mind, clear cut. Would you agree with this?

    The concerns you raise about treating depression with 5-HTP or St John’s Wort aren’t relevant to the purpose of my article – which you haven’t even begun to address. However the evidence you present hardly suggests a serious problem. One review of 5-HTP says “further studies are needed” – given that the funding for non-drug treatments is minuscule that is hardly surprising. As for the price, the maximum you quote is £27 a month or £324 a year – try getting a branded placebo SSRI for that price.

    The review of 5HTP states that: “Further studies are needed to evaluate the efficacy and safety of 5-HTP and tryptophan before their widespread use can be recommended.” It is worth noting that the authors have concerns about the possible association of 5HTP and tryptophan with the potentially fatal Eosinophilia-Myalgia Syndrome and that they state that: “Because alternative antidepresants exist which have been proven to be effective and safe the clinical usefulness of 5-HTP and tryptophan is limited at present.” Given the conclusions of this review, would you care to justify the recommendations made by Patrick Holford and others in respect of 5HTP and tryptophan?
    As for the price, the £27 I quoted was the maximum for St John’s wort rather than 5HTP (which would be over £45 per month at the higher recommended dose). Mr Holford recommends taking both SJW and 5HTP – which would lead to a cost of around £75 per month: around £900 per year rather than £324 per year.

  9. jdc325 said,

    I have one or two questions I’d like to ask if you can spare the time to discuss this further, Mr Burne.

    1. Do you endorse the recommendations made by Patrick Holford in his book Optimum Nutrition for the Mind that I refer to in my post?

    2. If you do endorse these recommendations, on what do you base your support for them?

  10. Phil H said,

    Hang on – “Mr Holford recommends taking both SJW and 5HTP” – BOTH?! It that wise? Could that not place undue stress on the serotonin system (leading to the badness that is serotonin syndrome)?

    Regarding the dangers of homoeopathy – I’m surprise that you haven’t heard of the various malaria stings which have cropped up in the media recently, Jerome – or the notorious Society of Homoeopath’s World AIDS Day conference discussing homoeopathic treatment of HIV (and of course the dangerous ‘trials’ of homoeopathic ‘medications’ in Africa) – but maybe you missed the death of an infant?

    http://bit.ly/qJsq1

    Ignorance kills.

  11. jdc325 said,

    @Phil H

    Thank you for the thought-provoking comment.

  12. Cybertiger said,

    “Save NHS money on ineffective drugs …”

    Why not start saving on statins? Statins do not protect against heart disease by lowering cholesterol …

    … and they don’t appear to help women at all.

    http://www.bmj.com/cgi/content/full/334/7601/983

    “In the studies of primary prevention neither total mortality nor serious adverse events have been reduced.7 A meta-analysis published in the Lancet found that statins even failed to reduce coronary heart disease events in women. Of greater concern is that a further meta-analysis of statins in primary prevention suggested that overall mortality may actually be increased by 1% over 10 years (in both men and women).”

    Scary stuff. And Malcolm Kendrick goes on to mention the costs of statins and the whole cholesterol fandango,

    “Statins currently represent the single greatest drug expenditure in the National Health Service. In 2006, the cost in England was £625m (918m; $1.2bn).11 Statin prescribing is increasing by 30% each year, which means that in 2007 the cost of statins could well reach £1bn. However, this is only the direct drug cost. Combining additional expenditure resulting from activities such as blood tests, dispensing costs, and increased general practice consultations, this figure could easily double to around £2bn.”

    And then the effectiveness in men,

    http://www.bmj.com/cgi/content/full/336/7637/174-d

    So not very good evidence there then. It all makes one wonder whether homeopathy would be safer, more effective and a whole lot cheaper than than the cholesterol depleting drugs. There really is no wondering: the evidence is conclusive – homeopathy is better than statins.

  13. jdc325 said,

    Hang on – “Mr Holford recommends taking both SJW and 5HTP” – BOTH?! It that wise? Could that not place undue stress on the serotonin system (leading to the badness that is serotonin syndrome)?

    I cannot be certain that my reading of ONM is correct – but yes, it did seem to me as if Mr Holford recommended taking both SJW and 5HTP. I can’t find any mention of serotonin syndrome in the book, or any caution to avoid taking SJW and 5HTP together.

  14. Phil H said,

    I should stress that I’ve no idea if it’d be a realistic risk, but in a way Holford is caught between the devil and the deep blue. My intuition is that dietary 5-htp would not lead to an increase in synaptic serotonin, and so there would be no harm.

    Of course, if my intuitions are correct (it happens, sometimes), then 5-htp would also be a useless treatment under the serotonin hypothesis. So either it has a chance of working, and mixing the two could lead to serotonin syndrome – or it has no chance of working and oyu’re wasting your money.

    Sorry, I could ramble on about serotonin and depression forever…

  15. Jerome Burne said,

    If we can pull back for a second. Why on earth do people take any form of CAM – homoeopathy, supplements etc? It is clearly bonkers. The NHS gives us medical treatment for free and what is more its treatments have been thoroughly tested so that there is a good evidence base that it is safe and effective. How mad to start paying for treatments that don’t have extensive testing and which you have to seek out via friends or websites. It’s so much more time consuming.

    The reason, and this is the point that opponents of CAM seem to have a hard time understanding, is because people (usually) have gone through what is on offer and either it hasn’t worked or they can’t stand the side-effects of drug treatments. It is really that simple. It has nothing to do with going back to the dark ages, or not understanding science, some CAM critics have suggested. CAM involves people in varying degrees of desperation trying to find something that makes them feel better. It is very rational and pragmatic.

    In this context it is worth making the point that drug medicine can be pretty dangerous – one figure is 10,000 deaths and around 500 million spent treating adverse drug reactions in the UK. The concerns of these patients are not trivial.

    So the first question anyone who wants to clear out homoeopathy and the rest has to ask themselves is – what do we have to offer those who have tried all the antidepressants, and the corticosteroids and the NSAIDS and have had no benefit or feel shit from it? Some hard-liners seem to suggest that if that is your problem then you need psychological help because you clearly aren’t ill, but that can’t really be considered good medicine, can it?

    So with that in mind – should we get rid of homoeopathy? Personally it seems to me a really trivial issue compared with the sort of problems I highlighted originally. Also many doctors say that for a range of conditions such as some gastrointestinal disorders or fibromyalgia they don’t really have anything that works – certainly not that has a proper evidence base. They do what they can – medicine is not a science, it’s not like repairing a car, it has a lot of craft, Biology is messy and full of surprises. If you are concerned about evidence focus on trying to bring down those 10,000 deaths. I might be prepared to be harsher on homoeopathy if I felt there was a level playing field as far as studies went. And as I said what else do you have to offer? Just more of the same?

    On tryptophan you say the review says more studies needed before widespread use can be recommended. That doesn’t seem to rule out an individual making a perfectly rational choice to try it. It reflects the fact that the funding is not available for such trials. How long do you wait for the studies to be done? As for the dangers I can’t do better than quote this (apologies for the length) but I think it is a pretty convincing rebuttal and as GBS said “I don’t have time for the short version”

    “A submission from the Institute for Optimum Nutrition Scientific Committee on Tryptophan to the UK Food Standards Agency regarding the removal of the ban on L-tryptophan food supplements specified in The Tryptophan in Foods Regulations 1990 (Statutory Instrument 1990 No. 1728)
    July 2002

    Executive summary

    Prior to the 1989/90 Eosinophilia Myalgia Syndrome (EMS) epidemic, L-tryptophan was used extensively (by around 30 million consumers) with very few cases of EMS or EMS-like symptoms ever reported (around 10). After the removal of L-tryptophan from the market in 1990, isolated idiopathic cases of EMS in individuals not taking L-tryptophan or 5HTP continued, casting doubt on the relevance of pre-epidemic cases to safety assessments of L-tryptophan.

    Where L-tryptophan has been reintroduced, either as a POM (UK and elsewhere) or an OTC food supplement (Belgium & Holland), considerable vigilance and detailed surveillance has failed to record a single case of EMS resulting from the supplementation of L-tryptophan. Indeed, not one case of EMS has ever been traced to an uncontaminated batch of L-tryptophan. It is therefore asserted, and clear from the available evidence, that the 1989/90 EMS epidemic was solely the result of L-tryptophan containing a contaminant – ‘peak E’ – resulting from the production processes at a single Japanese manufacturer, Showa Denko KK.”

    I certainly wouldn’t agree with the Cochrane’s comment that: “Because alternative antidepresants exist which have been proven to be effective and safe the clinical usefulness of 5-HTP and tryptophan is limited at present.” There is a big literature about the suicide risks (not to mention evidence about the drug companies penchant for hiding unfavourable data) and evidence of withdrawal problems (denied by the companies for years until they came clean after a Panorama program and admitted about 20% may have problems it). For a harrowing account of how you can spiral down into severe psychosis following antidepressant prescribing see a book published in September “Dying for a Cure” which has detailed references of the way these drugs can make matters worse for some.

    Which of course is why some people turn a nutritional approach. And here arises another issue rarely addressed by CAM opponents which is that CAM is not another sort of drug. It is not a question of take an SSRI or take a homoeopathic remedy or take tryptophan. If you look at what Patrick Holdford recommends for depression it is a sophisticated combination – tryptophan which needs to be taken with b-vitamins, magnesium and zinc to produce serotonin; along with omega 3 fats which have some evidence for benefit on depression; as well as keeping down blood sugar with a low glycaemic diet and exercise as well. For many that approach is very preferable to taking prozac and is very likely to leave them considerably healthier.

    It is perfectly true that there have not been RTCs with a 1000 people followed over five years to see if this works better than a placebo. Now that might a problem for nutritional medicine but it should also be considered a problem for the evidence-based medicine approach designed to deal with single molecule drugs.

  16. Prateek Buch said,

    Fascinating discussion – thanks jdc325 for the post, and Jerome Burne for engaging in the following thread. Mr. Burne, it seems to me that you’re saying that the just because the NHS spends money of things that turn out later not to be effective, that it’s justifiable to spend public money on homeopathy too. Sorry, not sure I agree.

    It is true to say that in the case of some medicines prescribed today, the evidence-basis for their efficacy in some circumstances is indeed quite weak – SSRIs and statins being relevant examples. It is also true, however, to say that the pursuit of evidence and the subsequent modification of prescribing behaviour represents the absolute pinnacle of evidence-based medicine – a process that is stubbornly jettisoned by practitioners of many forms of CAM.

    Allow me to expand. A research team finds that a build-up of molecule A is associated with disease X. Another team finds that a new compound, B, reverses the build-up of A in cells/mice/dogs. They apply for Phase I/II/III trials, showing successfully that the drug is safe and does indeed reverse the build-up of X. So far, so evidence-based, yes? Then, five years after B is approved for clinical use, a third research team looks at all the data from lots of studies following patients that use drug B. they find that in fact, the molecule doesn’t reduce A for all people or that reducing A doesn’t alter disease X all that much. What follows is critical – for medicine to claim it is evidence-based, it should alter its prescribing practices to reflect evidence from meta-analyses and prescribe according to the best-available evidence.

    This process is how modern medicine works – and is the antithesis of how homeopathy and most ‘alternative’ medicines work. If drug B is indeed no better than placebo, then prescribing patterns should alter to reflect that – whereas in h’pathy and so on no such self-reflective behaviour takes place, just denial of the best available evidence.

  17. Cybertiger said,

    @Mr.Buch

    Weasel words from another clever anti-CAMster! One can only marvel at the lack of intellectual subtlety deployed by all the little rodent automatons of the anti-camster clan.

  18. Cybertiger said,

    Mr. Buch said,

    “It is true to say that in the case of some medicines prescribed today, the evidence-basis for their efficacy in some circumstances is indeed quite weak – SSRIs and statins being relevant examples.”

    God, give me strength! The great snake-oil peddlers all but want the statins tipped into the water supply so that EVERYONE in EVERY circumstance can pay for that bogus elixir of life. The statins are the biggest cash converters in the history of medicine and they’re a massive hoax/scam/con. And Mr. Buch thinks there is a problem in spending a pittance of public money on homeopathy. The Buch’s of this world make me weep.

  19. Phil H said,

    “It is not a question of take an SSRI or take a homoeopathic remedy or take tryptophan; ”

    Sorry, I must take issue with this – any GP worth their salt will suggest counselling, psychotherapy or psychiatric care. They would at the very least enquire as to social, personal and job-related problems in someone’s life. It is most certainly NOT a question of ‘SSRIs or alt med’.

    Yes, I agree that people are drawn to CAM because medicine is imperfect and there is still a great deal we cannot treat, leading to frustration. I believe it’s a point of view shared by most in the sceptic community. When you have a GP on one side saying ‘there’s not a great deal we can do’ and a CAMster on the other hand saying ‘you need your energy profile balancing’, then it’s natural to go with the definite explanation – people like definite explanations, and they like to feel in control. But that doesn’t mean such fake-explanations and placebos should be available on the NHS.

    …and finally

    “tryptophan which needs to be taken with b-vitamins, magnesium and zinc to produce serotonin along with omega 3 fats which have some evidence for benefit on depression; as well as keeping down blood sugar with a low glycaemic diet and exercise as well”

    (You forgot to add ‘and which are sold by a company which he has a financial interest in’)

    A) Is there any evidence that this cocktail leads to increased synaptic serotonin levels in mammalian, let alone human, brain? If I swallow a load of testosterone precursors I excrete them rather than ending up juiced up like a pro-bodybuilder. As far as I know testosterone, unlike serotonin, is not immediately fatal in high doses.

    B) If they do increase serotonin levels, why would this be any more effective than SSRI treatment, given that both treatments are based on the same (flawed) hypothesis?

    C) Given that the increase in serotonin is only an effective treatment for those with major depressive disorder, is it really ethical or practical to expect someone who can barely speak, talk or think to swallow up to five pills, change their diet and start an exercise regime?

  20. Cybertiger said,

    “Is there any evidence that this cocktail leads to increased synaptic serotonin levels in mammalian, let alone human, brain?”

    The generalised synaptic deficit in this commentator is all too painfully obvious.

  21. The 21st Floor » Blog Archive » Bad Argument IIII (Or is it IV?) said,

    […] have argued elsewhere that “Save NHS money on ineffective drugs and homeopathy” would make for a better headline. While I would welcome an investigation into the savings that […]

  22. Jerome Burne said,

    I hear the sound of shifting goal posts here. Actually the first response to my article didn’t so much move goal posts as simply ignore my main point – that a number of expensive prescription drugs have either been shown not to be effective or to be positively dangerous and yet they continue to be widely used at considerable cost.

    Instead the author made essentially two points – that I had ignored the dangers of homoeopathy, even though the article had nothing to do with homoeopathy – and that tryptophan might be dangerous. I showed the evidence given for the “dangerous homoeopathy” argument was silly and that there was convincing evidence for no danger for tryptophan.

    So these objections have been abandoned and the goal posts now involved an attempt to make an evidence-based case for SSRIs. This follows one of the common lines of attack on CAM, which is to wheel out an idealised, almost Platonic in its abstract perfection, model of how evidence based medicine works and then to complain that CAM doesn’t follow it. It is a terribly naïve claim because in the real world drug trials don’t work like that. What’s more I can’t believe anyone who looks at this field for a moment can seriously believe they do.

    You claim that there is a “pursuit of evidence and subsequent modification in prescribing behaviour”. There should be but this is really not the way things have worked with SSRI. The story instead is one of attempts by the companies to conceal evidence of poor results and dangers of these drugs which is long and shocking.

    Way back in 1990 there were concerns over suicide links and the main researcher suffered severely for it (For details see: Side Effects: A prosecutor, a whistleblower and a best selling antidepressant on trial by Alison Bass). Results of studies on children in the mid-nineties were concealed; the company was fined in New York for this. This was followed by a four year investigation by the UK MHRA into the same data and the remarkable – some might say shocking – conclusion was reached that there was not enough evidence to bring a case. The first major trial showing SSRI’s were no little better than a placebo, using data prised from the FDA with the Freedom of Information Act, was published in 2000. Since then sales have continued on up

    Have you actually looked at the way SSRI trials are conducted? First a group of patients are given the drugs or a placebo and then those who respond too strongly to the placebo are excluded from the trial itself, along with a number of other groups such as the elderly as they might skew the results. The company only has to produce two trials showing improvement over a placebo and can discard as many as it likes of those that don’t. Results can be massaged – in one famous case involving children the drug was said to be “well tolerated”. Seven, I think, of those getting the drug had to go to hospital for treatment for side-effects. And so on.

    In order to be counted as better than a placebo the drug has to produce a 3 point improvement in the Hamilton rating scale, which has – from memory – about 20 points. That is a pretty low bar – improving sleep will pretty well do it. Finally there is an interesting phenomenon which means that those with stronger side effects show up as more effective.

    It works like this. All patients in a trial want to know if they are on the drug or the real thing. This is not so hard, you just watch for side-effects. Once you start getting dry mouth nausea etc you believe that you are on the drug and so the placebo effect kicks in to boost the drug’s effect. Trials with placebo that only mimic the drugs side-effects show the drug as no more effective. Are such trials run often? What do you think?

    I can’t help feeling that were homoeopaths and others to have access to the resources to pull stunts like these plus the services of a pharmaceutical marketing department their remedies could easily be packaged into best-sellers with an evidence base behind them.

    It is true that since the data showing that SSRI’s raised the risk of suicide in children that there has been a decline in the prescribing of these drugs to children. Evidence based medicine at work you might say. But then do you know what has replaced them? Heavyweight antipsychotic tranquilizers prescribed off label – in other words with no evidence base to show that they are effective in this group of patients. They are a much nastier type of drug whose side effects include rapid and dangerous weight gain.

    And yet you still hold this up as a system that is to be preferred over one that gives fish oils and B vitamins and a neurotransmitter precursor found in food. And to they work, you ask? Well the manufacturers don’t have the luxury of running trials with large numbers until they get the results they want and excluding placebo responders as they go, but yes there are a number of trials showing benefit for folic acid, for omega 3’s and for tryptophan.

    And while we are on the nutrition approach, I never understand the slur on Holford that because he has connections with companies that sell vitamins, you can’t believe him. Have you looked at the connections between researchers and drug companies? Don’t you know about ghost writing? Who do you think runs most of the trials providing the “evidence base” for drugs? Do you know how much more likely such studies – and these are the ones used to get a licence – are to produce favourable findings for the drug? Four times more likely. Holford doesn’t fund any of the trials he reports on.

    The system for producing evidence based medicine that you seem to have complete trust in has serious flaws and will remain so until you have an effective system of regulation and licensing, rather than the light touch model, funded almost entirely by the drug companies that we have at the moment. And that is not just me saying that, it is the conclusion of commissions of enquiry into the system by official bodies in the UK, the USA and Canada.

    I return to my original point. Is you are seriously worried about lack of evidence, treatments that don’t follow evidence, commercial interests skewing treatment decisions, money spent on ineffective or dangerous drugs point your fire at the companies and lobby for an effective and transparent system of regulation. Going after CAM is just shooting fish in a barrel.

  23. Jerome Burne said,

    I hear the sound of shifting goal posts here. Actually the first response to my article didn’t so much move goal posts as simply ignore my main point – that a number of expensive prescription drugs have either been shown not to be effective or to be positively dangerous and yet they continue to be widely used at considerable cost.

    Instead the author made essentially two points – that I had ignored the dangers of homoeopathy, even though the article had nothing to do with homoeopathy – and that tryptophan might be dangerous. I showed the evidence given for the “dangerous homoeopathy” argument was silly and that there was convincing evidence for no danger for tryptophan.

    So these objections have been abandoned and the goal posts now involved an attempt to make an evidence-based case for SSRIs. This follows one of the common lines of attack on CAM, which is to wheel out an idealised, almost Platonic in its abstract perfection, model of how evidence based medicine works and then to complain that CAM doesn’t follow it. It is a terribly naïve claim because in the real world drug trials don’t work like that. What’s more I can’t believe anyone who looks at this field for a moment can seriously believe they do.

    You claim that there is a “pursuit of evidence and subsequent modification in prescribing behaviour”. There should be but this is really not the way things have worked with SSRIs. The story instead is one of attempts by the companies to conceal evidence of poor results and dangers of these drugs which is long and shocking.

    Way back in 1990 there were concerns over suicide links and the main researcher suffered severely for it (For details see: Side Effects: A prosecutor, a whistleblower and a best selling antidepressant on trial by Alison Bass). Results of studies on children in the mid-nineties were concealed; the company was fined in New York for this. This was followed by a four year investigation by the UK MHRA into the same data and the remarkable – some might say shocking – conclusion was reached that there was not enough evidence to bring a case. The first major trial showing SSRI’s were no little better than a placebo, using data prised from the FDA with the Freedom of Information Act, was published in 2000. Since then sales have continued on up

    Have you actually looked at the way SSRI trials are conducted? First a group of patients are given the drugs or a placebo and then those who respond too strongly to the placebo are excluded from the trial itself, along with a number of other groups such as the elderly as they might skew the results. The company only has to produce two trials showing improvement over a placebo and can discard as many as it likes of those that don’t. Results can be massaged – in one famous case involving children the drug was said to be “well tolerated”. Seven, I think, of those getting the drug had to go to hospital for treatment for side-effects. And so on.

    In order to be counted as better than a placebo the drug has to produce a 3 point improvement in the Hamilton rating scale, which has – from memory – about 20 points. That is a pretty low bar – improving sleep will pretty well do it. Finally there is an interesting phenomenon which means that those with stronger side effects show up as more effective.

    It works like this. All patients in a trial want to know if they are on the drug or the real thing. This is not so hard, you just watch for side-effects. Once you start getting dry mouth nausea etc you believe that you are on the drug and so the placebo effect kicks in to boost the drug’s effect. Trials with placebo that only mimic the drugs side-effects show the drug as no more effective. Are such trials run often? What do you think?

    I can’t help feeling that were homoeopaths and others to have access to the resources to pull stunts like these plus the services of a pharmaceutical marketing department their remedies could easily be packaged into best-sellers with an evidence base behind them.

    It is true that since the data showing that SSRI’s raised the risk of suicide in children that there has been a decline in the prescribing of these drugs to children. Evidence based medicine at work you might say. But then do you know what has replaced them? Heavyweight anti psychotic tranquillizers prescribed off label – in other words with no evidence base to show that they are effective in this group of patients. They are a much nastier type of drug whose side effects include rapid and dangerous weight gain.

    And yet you still hold this up as a system that is to be preferred over one that gives fish oils and B vitamins and a neurotransmitter precursor found in food. And to they work, you ask? Well the manufacturers don’t have the luxury of running trials with large numbers until they get the results they want and excluding placebo responders as they go, but yes there are a number of trials showing benefit for folic acid, for omega 3’s and for tryptophan.

    And while we are on the nutrition approach, I never understand the slur on Holford that because he has connections with companies that sell vitamins, you can’t believe him. Have you looked at the connections between researchers and drug companies? Don’t you know about ghost writing? Who do you think runs most of the trials providing the “evidence base” for drugs? Do you know how much more likely such studies – and these are the ones used to get a licence – are to produce favourable findings for the drug? Four times more likely. Holford doesn’t fund any of the trials he reports on.

    The system for producing evidence based medicine that you seem to have complete trust in has serious flaws and will remain so until you have an effective system of regulation and licensing, rather than the light touch model, funded almost entirely by the drug companies that we have at the moment. And that is not just me saying that, it is the conclusion of commissions of enquiry into the system by official bodies in the UK, the USA and Canada.

    I return to my original point. Is you are seriously worried about lack of evidence, treatments that don’t follow evidence, commercial interests skewing treatment decisions, money spent on ineffective or dangerous drugs point your fire at the companies and lobby for an effective and transparent system of regulation. Going after CAM is just shooting fish in a barrel.

  24. Jerome Burne said,

    Apologies – post sent twice – can anyone delete second one
    Regards

    Jerome

  25. Cybertiger said,

    jdc532 is only a minnow. I think the CAMsters should be barrel shooting big fat carp like the professors Colquhoun and Ernst.

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