Dr. Haase & Mr. Why

Colon Cancer is a serious illness which is effectively found, and often treated by screening colonoscopy….  and yes, sticking your bum out and looking inside makes for the type of uncomfortable conversation that easily makes it the Butt of many jokes.  Ha.  Couldn’t help that. 

Peter Yarrow of Peter, Paul & Mary has teamed up with CBS to deliver a serious health message to CBS viewers and audiences beyond: be screened for colon cancer.   Thanks to KevinMD.com for passing on this tidbit!

And because there always need to be a bit of balance…  after that sweet, happy ballad… here is Bill Connolly’s hilarious description of his Colonoscopy prep in the UK.   It is pretty crude, but hey, what do you expect given the subject matter… there… you are warned… proceed at your own risk.     After you have laughed a good laugh, suck it up and call your doctor to arrange a colonoscopy – it could truly save your life.

I just think it is rediculously funny how some doctors have a bias AGAINST vitamins and foods.    I mean REALLY!   Now there is even more information for them to ignore.

Yesterday, at the American Association for the Study of Liver Diseases Conference, Dr. Sanyal presented the following abstract …  “A randomized controlled trial of Pioglitazone or vitamin E for nonalcoholic steatohepatitis (PIVENS)”

Yea, lots of big words… but it all pertains to my last post.   NASH or “inflamed fatty liver” was found to be helped by vitamin E  more than an expensive drug.

About 43% of NASH patients in a randomized, placebo-controlled trial met the study’s primary endpoint — a composite of improved liver function, decreased ballooning, and stabilization of fibrosis — after about two years of vitamin E treatment, compared with less than 20% of patients on placebo (P<0.001), according to Arun Sanyal, MD, of Virginia Commonwealth University in Richmond.  Some 35% of patients assigned to pioglitazone in the 247-patient trial met the same criteria (P<0.04 versus placebo), Sanyal reported.

Interesting… they designed the study in a very unusual way…  to be very specific so that half-fast results would not likely get credit.   Mr. WHY wonders if this was done because one of the treatments was a vitamin.  Because the author probably knew how single-vitamins are not very potent, that it is the combinations of several synergistic vitamins that harbor the most power.   But OOPS!

Despite the apparent significance, pioglitazone failed to meet the primary endpoint because the trial design stipulated a P value of 0.025 or less relative to placebo, he said.

It was the sponsoring drug that failed to make the cut.     Now, this is an abstract, presented at a meeting, which means that it may never get published in a journal.    The sad fact is that many studies do not get published because what they reveal is not always beneficial to the sponsoring organization  -  this is a big problem in the U.S. where most medical study money comes from private industry.

The type of vitamin E was a “natural vitamin E” as well – not the crappy “d-l-alpha tocopherol” which, because it is cheap to synthesize, gets put in most multi-vitamins.   This is very important, as the body runs on only “original manufacturer’s replacement parts” – not cheap knock-offs that may actually gum-up the system.    Details matter!

To be fair to the drug studied (pioglitizone) if this study had less stringent criteria for defining “what worked” it would have made the cut as well as vitamin e…. but still not be as good.    However the authors stated,

“As expected, pioglitazone had two effects not seen with [vitamin e or placebo]. Patients on the drug showed significant weight gain — about 5 kg [12 lbs] on average [over the 2 years of] the study, compared with less than 1 kg for placebo and vitamin E — and a lessening of insulin resistance as measured by HOMA-IR scores.

Isn’t this interesting, the drug caused insulin resistance to improve and weight (fat) gain to worsen!    We know insulin resistance is a prelude to Diabetes Type 2…. and obesity is associated with Type 2 Diabetes…. so what is up with this?     The answer may surprise you.     That my friends, is a WHY for another day!

You can read more about this study here.

letsthink, You are correct that for groups of individuals DBRPCT’s are great at ferreting out the differing effects of singular interventions upon that group.

But that was not my point. My point is that in the practice of medicine we treat unique individuals who each have a different epi-genetic pattern and a unique environment. THIS is the patient that is before us. It is the sub-segmentation of that data that really gives us the most information, but the pharm companies are reluctant to tell us exactly WHO in the group got the MOST benefit, and who within the group of average improvement was actually HARMED.

Remember, that one cannot PROVE a negative. One can prove the null hypothesis true, but that does not take into account all confounding variables that may not be accounted for within the current model (which may or may not be randomness). This reality does not need to make us therapeutic nihilists, but instead it reinforces the fact that medical science is in but infancy, and that wisdom still plays a greater role than does information in a vacuum.
Read the Article at HuffingtonPost

From user ‘allopathy’……
This idea that doctors shun anything that isn”t drugs or surgery is a straw man. Doctors are in the business of giving reliable, proven advice to their patients. Of course that includes things like exercise, preventative care, proper nutrition and stress relief. Yes, there is even room in modern medicine for things like meditation, and positive thinking, so long as we don”t start assigning to them magical powers and overhype their benefits. Modalities must be proven to work under strictly-controlled laboratory conditions. If your treatment-of-choice can”t pass muster, it”s because it doesn”t work. It”s not because “Big Pharma” is conspiring to keep supplement X or method Y off the shelves and out of doctor”s offices.

Our health care system is far from perfect and has many flaws. This doesn”t mean the treatment itself is bogus. To say otherwise, as Mr. Chopra has done, is to confuse two completely separate issues

Additionally, to say that science ignores anecdotal evidence is completely wrong. Anecdotal evidence is the starting point for in-depth research, but it is not, nor should it be, the final word. As Mr. Chopra pointed out, the placebo effect comes into play 30% of the time. We need to be able to separate the placebo effect from the actual effect. The human mind is more fallible then we imagine, making anecdotal evidence suspect. We must take extraordinary care when dealing with such claims, and only through rigorous, controlled research protocols can we get to the truth.

Allopathy, Ah, I remember the heady days when I started the evidence-based-medicine club at a major teaching university. So full of hope I was that we as a profession would only apply “modalities …proven to work under strictly laboratory conditions”.

But the only things that can be tested well with a double-blind-placebo-controled-multi-center (DBPCMC) study are single, simple interventions like drugs or a single nutrient, and rarely a surgical procedure. It is too simple of a model for complex, interconnected, dynamic humans. Humans adapt, humans heal, humans bring bias to the treatment room.

It (a DBPCMC) is like studying the effects of a single parenting behavior upon the effect of the behavior of the grown child… It takes huge studies many years, many dollars, to find a statistically significant change that may have no bearing on actual clinical outcomes in that individual!!!

What is the job of a doctor? If it is to be the dispassionate and ‘correct’ expert advisor then your approach is correct. I have chosen to believe that my job as a doctor is to act in the best interest of my patients, to be more of a healer than technician, to honor the evidence, but never quit asking WHY and to let individual RESULTS be the sine qua non of my success in this realm.
Read the Article at HuffingtonPost