30 Mayıs 2013 Perşembe

The danger of science denial: It happens even on Science-Based blogs.

Poor Benjamin Franklin. I know how he felt! ;-)
I do not believe that he wanted to be doing that!
This post will be highly critical of Dr. David Gorski MD, as some of his comments have been either trolling, downright stupid, or both. They're definitely in denial of science. This post is intended to encourage Dr Gorski to leave comments here, as I will never leave any further comments on any blogs that he edits, for reasons mentioned previously. I will be copying comments from his blogs and pasting them here, with my comments after. If this is considered to be "bad form", I really don't care. Leaving derogatory comments about me on blogs on which the commenters know that I will never return (because I told them so) is definitely "bad form".

I will also be quoting other commenters on Dr Gorski's blog, for the same reason. Everyone is free to leave comments here, that meet my fairly lax moderation criteria. In Vitamin D, cancer, cliques and flouncing. , a commenter from Dr Gorski's blog called flip was initially whitelisted, to allow his comments to appear without me having to moderate them. I eventually blacklisted flip after I detected intellectual dishonesty. That's how I roll. If you don't like my rules, don't let the door hit you on the way out! By the way, calling me a liar on here is a sure-fire way to get yourself blacklisted.

I've just turned Blogger word verification back on, as although Disqus automatically deletes anonymous comments containing links, I still get email notification of them. I've been getting a lot of email notifications. This may or may not have an effect on commenters.

Firstly, please read http://www.sciencebasedmedicine.org/index.php/a-closer-look-at-vitamin-injections/#comment-127850 , as it's my "letter of resignation" from that blog. With that in mind, read on.

# David Gorski on 27 May 2013 at 9:49 am
Regarding Lappe et al, one notes that that study is not the be-all and end-all of vitamin D research. It’s an old study, for one thing. Also, cancer was not its primary endpoint. Finally, there was no vitamin D alone group, as I recall, only a vitamin D + calcium group, a calcium group, and a placebo group.
There is a recent review of the literature from the Endocrine Society, which includes Lappe et al and puts it into context:
*quoted text redacted*

# Nigel Kinbrum on 27 May 2013 at 11:16 am
David Gorski said…
Regarding Lappe et al, one notes that that study is not the be-all and end-all of vitamin D research. It’s an old study, for one thing.
Irrelevant.
Also, cancer was not its primary endpoint.
Irrelevant.
Finally, there was no vitamin D alone group, as I recall, only a vitamin D + calcium group, a calcium group, and a placebo group.
Irrelevant.

# David Gorski on 27 May 2013 at 12:28 pm
Finally, there was no vitamin D alone group, as I recall, only a vitamin D + calcium group, a calcium group, and a placebo group.
Irrelevant.
How so? It’s actually very, very relevant, as is the issue of cancer not being a primary outcome measure of the study. That you don’t understand why these issues are so relevant indicates to me that you don’t understand clinical research very well.

#Nigel Kinbrumon 27 May 2013 at 1:42 pm
David Gorski said…
Finally, there was no vitamin D alone group, as I recall, only a vitamin D + calcium group, a calcium group, and a placebo group.
Irrelevant.
How so? It’s actually very, very relevant, as is the issue of cancer not being a primary outcome measure of the study. That you don’t understand why these issues are so relevant indicates to me that you don’t understand clinical research very well.
1) The RCT used Ca + D. Therefore, the conclusions apply to Ca + D. If they’d wanted to test D alone, they would have. They didn’t. Why don’t you write a letter of complaint to Joan M Lappe about it?

2) Whether the outcome was primary, secondary, tertiary, quaternary or n’ary is irrelevant because the parameter in question (all-cancer diagnoses) was still accurately recorded. That you can’t understand such a simple concept boggles my imagination.

#David Gorski on 27 May 2013 at 2:34 pm
As I’m leaving permanently, what’s the point?
Ah, flouncing off again. It’s probably long overdue. I’ve been getting a few complaints about you here as well. Perhaps you should ask yourself why complaints seem to follow you wherever you go.
“Whether the outcome was primary, secondary, tertiary, quaternary or n’ary is irrelevant because the parameter in question (all-cancer diagnoses) was still accurately recorded. That you can’t understand such a simple concept boggles my imagination.”
I rest my case that you do not understand clinical trial methodology and interpretation. I couldn’t have demonstrated it better myself to anyone who actually does understand clinical trial methodology and interpretation. Thanks!

You sir, are an asshole. I spelled it the American way, just for you!

I rest my case that you're either trolling, or stupid, or both. Whether the outcome is primary, secondary, tertiary, quaternary or n’ary is completely and utterly irrelevant. It always has been and it always will be. You're effectively saying that only the first item in a shopping list should be bought because all of the other items in the shopping list are irrelevant. Bullshit!

Denice Walter May 27, 2013
@ Marc Stevens Is Insane:
I believe that Nigel is like two bright guys I know: they are well educated and professional in fields outside of SBM/ life sciences (business). Thus they read alt med ‘research’ (also see today’s post by Orac) and don’t get how it DOESN’T work in reality. It sounds like nutrients can do all of these wonderful things – that they can’t- at least not in RL. But the woo-meisters don’t tell you that part. We do.

So of course they think that these products are very useful- and they need celtic salt or ground organic flaxseed- as I know all too well.

However, if they’re smart- we can talk to them:
explaining how that *in vitro/ in vivo* thing works.
Or- as I often do- illustrating how much of the so-called science they read ( woo) is actually more accurately called “advertising copy”.

Businessmen seem to grok that.

Denice, seriously? I'm disappointed. I thought that you were one of the few reasonable posters on Gorski's blog and then you go and write that crap?

I do not read "alt med ‘research’", unless you're calling what's on PubMed "alt med ‘research’"? I've been reading studies on PubMed for years, so I know about the use of shoddy methodology to fudge results. The Lappe study doesn't use shoddy methodology. It's a Randomised Controlled Trial using double-blinded placebos and randomly-selected subjects who were post-menopausal women. Try to pick holes in it.

flip May 29, 2013
Hmmm… it occurs to me I probably haven’t been that overt about one other thing:

Lilady, I am sorry that you were called those things, and I certainly don’t think you should have been called names. I do think Nigel was wrong and do think he should be called out for it.

And I’m sorry for not making that clearer before.

flip, I'm not going to question your intelligence. However, why you're apologising to lilady boggles the imagination. lilady is a despicable human being. She pushed me to the point where I called her rude names, names that were not misogynist and for which I apologised. I explained about "twat" on SBM. I even posted a link to Wiktionary! You don't read things thoroughly before commenting.

Marc Stephens Is Insane May 31, 2013
Oooooh, Nigeepoo is ANGRY! He’s pulled a DJT, posting a “rebuttal” to all the comments here and on SBM. I’m suprised it’s taken him this long.

He’s calling Orac an a**hole and stupid, among other things. He’s invited us all to comment on his blog because he has an “open moderation policy” and “allows all comments.”

http://nigeepoo.blogspot.com.au/

I see that you idiots on RI are still reading my blog. I'm not the slightest bit angry, so you can give the projection crap a rest. For the record, most of you come across as assholes. You can't even quote me correctly. I said that I have fairly lax moderation criteria. Do try to get something right, for once in your miserable lives.

Anyway, you lot are now boring me with your never-ending inability to discuss things either accurately or rationally, so I'm not going to bother polluting my blog with any more of your crap.

P.S. I still occasionally read the comments on Gorski's blogs, so for the benefit of you peeps who read mine:-
1) "Black-list" means exactly what it says. It means that you're banned from posting comments.
2) The Lappe et al 2007 study was a good study. Just because some Messiah-like person says that it's a bad study and applies false reasoning to back himself up, doesn't make him right and me wrong. As I've previously pointed out, surgery's not exactly rocket science is it? I designed complicated electronic communications systems for 29 years. Just saying! ;-) Denice, I've got nothing against you. You've just been drinking Gorski's Kool-Aid for way too long. That's not a euphemism, by the way! :-D

Look what I just found. Exposing Dr. David H. Gorski, M.D., Ph.D. who believes he can use a cloak of anonymity and character assaults to discredit opposing views. Sorry Doc, but your game is up.

He's not the Messiah. He's a very naughty boy! :-D

28 Mayıs 2013 Salı

\ curves and U curves: Vitamins D3 and K2 again.

Here are some curves relating to Vitamin D. Ref: http://www.ncbi.nlm.nih.gov/pubmed/23601272
Hazard Ratios (HRs) vs serum Vitamin D level
The solid lines are the 95% confidence intervals (CI) & mean for all-cause mortality. 95% CI's are the values within which 95% of the subjects tested fall. 2.5% fall below the lower CI and 2.5% fall above the upper CI. The dashed lines are the 95% CIs & mean for coronary heart disease (CHD) mortality. Most of the curves follow a \ curve, indicating that more Vitamin D is better, up to 66ng/mL (150nmol/L, the level that I'm at). The interesting curve is the upper dashed line, which follows a U curve.

The U curve indicates that a Vitamin D level of greater than 30ng/mL (75nmol/L) increases the Hazard Ratio (HR) for CHD in the top 2.5% of subjects only, relative to 30ng/mL, even though the mean HRs for CHD & all-cause mortality (the more important parameter) are decreasing, up to 66ng/mL. What's occurring?

See Vitamin K. The increase in HR for CHD mortality above 30ng/mL in the top 2.5% of subjects only is almost certainly due to calcification within artery walls, due to under-carboxylation of osteocalcin in bone Matrix Gla Proteins, caused by insufficient Vitamin K2 rather than excessive Vitamin D. This is why I supplement with Vitamin K2. See also Vitamin D toxicity redefined: vitamin K and the molecular mechanism.

27 Mayıs 2013 Pazartesi

Is Coenzyme Q10 a supplement or a drug? It all depends.

This is the molecular structure of Coenzyme Q10.
Ubiquinone
I saw the following Tweet by Evelyn Kocur. Back in October 2009, a trial was started, to test the effect of CoQ10 supplementation on congestive heart failure (CHF). See Coenzyme Q10; an adjunctive therapy for congestive heart failure? See also Overview on coenzyme Q10 as adjunctive therapy in chronic heart failure. Rationale, design and end-points of "Q-symbio"--a multinational trial.

The results of that trial have just been made public, but are not yet available on PubMed. See First Drug to Significantly Improve Heart Failure Mortality in Over a Decade. Wait, what? Back in 2009, it was a supplement. Now, because it works, it's a drug.

Supplementation in meaningful amounts of a substance that the body needs but lacks makes the body work better. Who knew?

26 Mayıs 2013 Pazar

Bandaoke with Jukebox at the Falkners Arms, Friday 5th April 2013.

This was Jukebox's 1st time performing this song live and my 1st time singing it at the correct pitch (at karaoke, I would have the pitch shifted down 2 keys). Ouch!


Flogging a knackered horse, metaphorically-speaking.

Q. What do you get when you flog a knackered horse?
A dead horse.
A. A dead horse. Like, duh! However, some people do this to themselves.

Coffee is a Central Nervous System (CNS) stimulant. A coffee first thing in the morning after getting out of bed gives you "get up and go". What happens if you carry on drinking coffees or "Energy Drinks" throughout the day? Guess!

23 Mayıs 2013 Perşembe

Don't worry, be happy.

Oh, all right then!

I was chatting to the check-out guy in the Co-op about the sad goings-ons in Oklahoma and he said: "If we shed a tear for every person in the world that's suffering, we'd never stop crying." I try to avoid watching or reading World News. It's just one bad or sad thing after another. As I have no control over bad or sad things that happen around the world, what's the point in bringing myself down by knowing about all of them? Local News is a bit more relevant. I try to concentrate all my effort into keeping my life running smoothly.

If something really bad is about to happen to me or happens, I do everything in my power to make things better. If the really bad thing is completely beyond my control, I have to accept it. There's no point in wasting time going through Kübler-Ross stages 1 to 3 (denial, anger, bargaining). Stage 4 (depression) is a tricky one, as sometimes it just happens.

Finally, I treat people the way I'd like them to treat me. If they treat me respectfully, I do likewise. If they treat me disrespectfully, they get 1-2-3 Magic!

I've just installed f.lux, which adjusts the colour "temperature" on my lap-top screen, to suit the time of day.

Prevention vs Cure, quackery, bias and conflict of interest.

I believe in the maxim "Prevention is better than cure".
Image from www.nationalarchives.gov.uk

Some definitions:

Prevention. Cure. Quackery. Bias. Conflict of interest. Logical fallacies. In the case of the maxim, prevention means hindrance, as it's impossible to 100% stop illness from occurring. To someone who already has an illness, the maxim is obviously moot!

Quackery:

I have been accused of quackery. Despite having provided evidence to refute the claim, the person has refused to retract the accusation or provide proper evidence (other than Logical fallacies) to support it. EDIT: I blocked the person on Twitter. I am no longer on that person's quackery list.

Bias:

A long time ago, I mentioned a study Intensive lipid lowering with atorvastatin in patients with stable coronary disease.

"RESULTS: The mean LDL cholesterol levels were 77 mg per deciliter (2.0 mmol per liter) during treatment with 80 mg of atorvastatin and 101 mg per deciliter (2.6 mmol per liter) during treatment with 10 mg of atorvastatin. The incidence of persistent elevations in liver aminotransferase levels was 0.2 percent in the group given 10 mg of atorvastatin and 1.2 percent in the group given 80 mg of atorvastatin (P&lt:0.001). A primary event occurred in 434 patients (8.7 percent) receiving 80 mg of atorvastatin, as compared with 548 patients (10.9 percent) receiving 10 mg of atorvastatin, representing an absolute reduction in the rate of major cardiovascular events of 2.2 percent and a 22 percent relative reduction in risk (hazard ratio, 0.78; 95 percent confidence interval, 0.69 to 0.89; P&lt:0.001). There was no difference between the two treatment groups in overall mortality."

"CONCLUSIONS: Intensive lipid-lowering therapy with 80 mg of atorvastatin per day in patients with stable CHD provides significant clinical benefit beyond that afforded by treatment with 10 mg of atorvastatin per day. This occurred with a greater incidence of elevated aminotransferase levels."

Unfortunately, the statement "There was no difference between the two treatment groups in overall mortality." is incorrect. According to the full study (hidden behind a pay-wall) there were 26 more deaths in the 80mg/day group than in the 10mg/day group. That's not statistically significant, as the group sizes were ~5,000 each. However, the statement didn't mention statistical significance.

Therefore, the statement "Intensive lipid-lowering therapy with 80 mg of atorvastatin per day in patients with stable CHD provides significant clinical benefit beyond that afforded by treatment with 10 mg of atorvastatin per day." is also incorrect. Dying is worse than having major cardiovascular events (heart attacks & strokes), which are survivable.

Why is there a disparity between the publicly-viewable abstract, the full study and reality? From the full study:-

"Funding for the study was provided by Pfizer Inc., New York, New York. Dr. Shepherd has received consulting fees from AstraZeneca, GlaxoSmithKline, Merck, Oxford Biosensors, Pfizer Inc., and Schering-Plough, and lecture fees from AstraZeneca, Merck, and Schering-Plough. Dr. Kastelein has received consulting fees and lecture fees from Pfizer Inc., AstraZeneca, Merck, and Schering-Plough, and grant support from Pfizer Inc. and AstraZeneca. Dr. Bittner has received consulting fees from CV Therapeutics, Novartis, Pfizer Inc., Abbott, and Reliant, and grant support from Pfizer Inc., Atherogenics, Merck, Kos Pharmaceuticals, Abbott, CV Therapeutics, and the National Institutes of Health. Dr. Deedwania has received consulting fees and lecture fees from Pfizer Inc. and AstraZeneca. Dr. Breazna, Dr. Wilson, and Dr. Zuckerman are all employees of Pfizer Inc. Mr. Dobson is an employee of Envision Pharma Ltd., which was a paid consultant to Pfizer Inc. in connection with the development of the manuscript. Dr. Wenger has received consulting fees from CV Therapeutics, Sanofi-Aventis, Schering-Plough, AstraZeneca, Abbott, Merck, and Pfizer Inc., and grant support from Pfizer Inc., Merck, and the National Heart, Lung, and Blood Institute."

Atorvastatin is manufactured by Pfizer Inc.

Conflict of interest:

I like the article Is Vitamin D Shooting Me in the Foot?, because Dr. Ken D. Berry prescribes his patients an effective dose of Vitamin D3, even though it results in him losing money due to the drastic reduction in the number of benign skin cancers for him to freeze-off. Now, that's what I call integrity!

Can a breast cancer surgeon (who receives payment for curing breast cancer using surgery) give a truly impartial opinion on other cancer cures, or cancer prevention? Does he always clearly state his competing interest? I think not!