Wednesday, March 24, 2010

A bitter pill for the supplement industry.

There are any number of sins committed under the giant circus tent of self-help, but for sheer repeat-offender chutzpah, it's hard to beat the supplement industrywhich each year sells America all those vitamins, herbs and so-called nutraceuticals. A $23.7 billion slice of the alternative-medicine (or "CAM") pie*, the supplement industry is also a major manifestation of SHAM, though it's seldom treated as such because (a) it involves a tangible product (unlike, say, "positive energy") and (b) proper nutrition has long been an important area of overall health management; ergo, vitamins and minerals benefit from that mindset. I myself have given supplements short shrift on this blog, and that's a serious oversight. Purveyors of health tonics and potions were, after all, the original (and literal) snake-oil salesmen, and evidence suggests that not much has changed. Nowadays they tap into (and prey upon) the widespread passion for "self-determination" in all areas of life; they sell the message that you know more about managing your own health than all those silly doctors and (real) nutritionists do. It's a message that, I might add, enjoys the government's imprimatur in the form of the National Center for Complementary and Alternative Medicine, which since 1992 has served as the supplement industry's coziest friend and biggest all-around cheerleader inside the Beltway. Although the pesky science that some NCCAM killjoy must have felt obliged to include on its Web site makes clear that most herbs and supplements can't be counted on to do much good, and may do plenty of bad, the mere fact that an NIH sub-unit has a site devoted to "informing" us about supplementsand that it kicks off its section on same with a line like, "Many people take dietary supplements in an effort to be well and stay healthy"is telling. (For a succinct example of the Kafkaesque discord between NCCAM's overall philosophical position in favor of supplements and its own grudging presentation on the relevant science, check out the last few graphs of my December 2008 piece for The Wall Street Journal, "The Touch That Doesn't Heal.")

Since the advent of The Secret in particular, vitamin and herb manufacturers
no dummieshave increasingly framed their products as helpful catalysts in that all-important crusade to bring mind and body into proper harmony with the Universe: psychic fuel. In sum, the dietary supplement movement represents one more major step away from orthodoxy and commonality of thought and fact.

However, in line with the general climate of skeptical revisionism that SHAM helped launch (if I do say so myself), dietary supplements are now coming under greater scrutiny as well. This is hardly to say that skepticism of vitamins, herbs and nutraceuticals did not exist prior to my book. Notably, for decades, Quackwatch founder Dr. Stephen Barrett has been waging a one-man war against irresponsible claims for vitamins and dietary supplements. But somehow it was the supplement industry that seemed to hold the high ground, capturing and holding the public imagination while ironically succeeding at making serious medical types like Barrett sound like the real outliers
—as well as heretics, naysayers and cultural dinosaurs.

Which is why it's especially gratifying to see the mood of revisionism sweep its way into a magazine like Reader's Digest. It began a few Novembers ago when RD ran "The Vitamin Hoax," by senior medical researcher Neena Samuel. The current (April) issue contains another eye-opening article, "5 Vitamin Truths and Lies," by the same author. [SEE NOTE BELOW] It's apparent that RD is doing some fancy footwork at times, not wanting to burn the magazine's bridges to the industry altogether
given that supplement manufacturers spend oodles on advertising, no small portion of it in pop magazines, like RD, that cater to an older crowd. But it's not hard to read between the lines: Samuel is telling us in a big-screen format what Barrett and a small circle of others have been preaching from the wilderness for years: that if you don't get these nutrients via your regular (food) diet, then all the pills in the world probably won't help you. They're not going to prevent or cure any major diseases. And they may even cause health problems you didn't have to begin with.

As you might imagine, the supplement industry isn't happy about this. Some fume that RD is in the pocket of Big Pharma due to all that glossy D-T-C drug advertising featured in the magazine's pages. (Pharma's interests here are evident: If people think they can cure themselves "naturally," they're less likely to buy prescription drugs.**
) And, as noted, before we nominate Reader's Digest for sainthood, we should keep in mind that RD itself was singing the praises of supplements not all that long ago. Popular media like to have it both ways, riding the wave of fads, hawking the latest crazes, then later "exposing" those fads with a shameless, sanctimonious zeal...exactly as if they've been on the side of the angels all along.

No one demonstrates that better than our old pal Larry King, with his before-and-after coverage of the whole James Ray mess.
S

NOTE:
One of our contributors was nice enough to inform me that I got this wrong: The actual author of the current piece is Christie Aschwanden, not Ms. Samuel.

* not usually counted in formal measures of the size of the self-help industry per se.

** although it's not quite that simple, as many of the major pharmaceuticals also manufacture, or have subsidiaries that manufacture, dietary supplements. So they make money either way/both ways.

50 comments:

Jenny said...

Hi, Steve. I recently bought a product called Miracle Fruits of the World, a "dietary supplement" containing various fruits and even green tea. My daughter has been trying to get me to take vitamins regularly, even buying some of those One a Day gummy ones, thinking that if it tastes like candy I might go for it. (How's that for role reversal? Ha! She is 19.) I generally do not like taking anything at all, whether it be vitamins or pharmaceuticals of any type. But something about the "miracle" fruit juice seemed appealing, so I bought it. The taste is okay and I seem to feel better on the days that I drink it. Was just curious about your take on such a thing. Would you put it in the same category as these other supplements?

Steve Salerno said...

Geez, Jenny, I dunno. It certainly sounds healthy enough based on the site. And I drink sports drinks that promise to replenish essential minerals and the like. I don't think that's the same thing as mega-dosing with vitamin and nutraceutical products that claim to combat every disease known to man.

What's interesting, though, is that even antioxidants--touted in your "miracle" juice--recently have come under fire as over-hyped, under-tested.

RevRon's Rants said...

Steve, I'm pretty much resistant to taking any kind of medicine, especially those that are touted to cure everything AND make me irresistible to the wimmens. Figure I got more than my quota in my depraved youth.

For years, I've had a recurring case of bronchitis at least once a year, and frequently twice. Used to hit the doc-in-the-box and load up on antibiotics and expectorant (nuclear ny-quil, if you know what I mean). Several years ago, on the advice of a friend, I tried taking Emergen-C when I felt the chest tightness and fever. Within a day, the symptoms were gone, and didn't return. Same thing has happened several times since then.

I don't buy that it's a placebo effect. All I care about is the fact that I haven't had to take antibiotics in years now. And while I don't go in for supplements as a rule, I'm sold on this one. Now, if I'd just put down the cigarettes, I might not need the Emergen-C any more!

Anonymous said...

"Very expensive wee" is my brother's considered opinion, he's a professor of microbiology who has spent his career in medical research.
Nevertheless, I still pill-up on occasion if it makes me feel better, I just don't kid myself that it does any longterm good.

roger o'keefe said...

I like the more informative aspect of the new and improved Shamblog, but it's funny to me that far fewer people seem to be commenting since the change in format and approach. I wonder if that tells us that most people would rather get themselves all worked up on some spirited debate than actually learn something new?

You don't have to publish this, Steve. I was just wondering out-loud.

Steve Salerno said...

Roger: I can't say I haven't wondered, myself. Overall average readership is slightly up--a few hundred extra visitors per week. But you're right, the volume of comments is off by a good margin. Some of these things are hard to figure.

Duff said...

At least Larry King had the guts to cover the post-sweatlodge aftermath. Oprah seems to be pretending like she never catapaulted Ray into fame. One could see King's willingness to cover Sweatgate as owning up to his own influence in creating the situation in the first place.

I do think supplements are a massively unregulated and unproven industry. Unfortunately corruption doesn't stop there. Much of psychiatry is based on unproven or highly debatable science (although psychiatry is thankfully a highly regulated practice). SSRI's are now being debated as to whether they are no better than placebo for depression, or only very slightly better. If all new age "cures" for depression fall into the category of placebo, and some are cheaper than a monthly supply of SSRI's (with no protocol to ever come off the drug, as is all too common), is this worse than taking a questionable medication?

Duff said...

I'll add this thought as well--it seems to me that the problem is making claims that aren't backed by reality. Self-help and CAM approaches often claim miracles, which is claiming far, far too much. Pharmaceuticals are required to post common side-effects which seems to escape from this criticism. Yet consumers still believe that drugs are effective treatment, which sometimes isn't the case, as we are discovering with SSRI's in the treatment of depression (although SSRI's do seem to be more effective than placebo in cases of severe depression specifically).

Yet it gets confusing, because the ritual act of believing in one's own healing creates hypnotic suggestion, which accounts for some or all of the healing benefit. Even with effective prescription drugs, placebo usually accounts for 70-80% or more of the positive benefit. Yet clearly the benefit isn't a miracle cure--either from the placebo effect or the biochemical effect.

So what do we do? Busting the bubble of delusion allows us to see reality more clearly, which means we are more likely to find out what is truly effective. But in doing so, we run the risk of also preventing people from benefiting from the placebo effect while we figure out what works. For instance, if we tell depressed patients that SSRI's have not been proven to be more effective than placebo, they might stop taking their medication, thus no longer getting the *placebo* benefit of thinking that the magic pill was helping them! There is a cost to taking a skeptical stance that I rarely see as part of the discussion in these things.

Duff said...

One more piece for discussion--while supplements are a $23.7 billion slice of the US economy, SSRI's alone are a $9.7 billion industry. Most vitamins are water soluble and have few negative side-effects from taking mega doses. SSRI's have a litany of side-effects from sexual disfunction, anxiety, insomnia, to increased suicide risk! (And this is for treating people with depression!)

Which is worse--taking a vitamin placebo or an SSRI placebo? (assuming neither does anything)

Of course, I'm not in favor of expensive sugar pills. I prefer my placebo in the form of Ben and Jerry's ice cream, a self-medicating treatment I've found that works well for the occasional blues. :)

Steve Salerno said...

Duff: Look, SSRI abuse is a pet peeve of mine as well. If you buy the language of the ads, just about everyone is depressed. And yes, the side effects can be horrific (as I noted some time back in a facetious SHAMblog post about a new antidepressant that had just been introduced; I forget which).

But at least authentic pharmaceuticals go through some vetting, even though you and I might quibble with the whole drug-approval process.

Duff said...

Ok, didn't know your position on SSRI's. Sorry if I came off too strong! Your posts get me thinking, is all. :)

Is the problem lack of testing though, or claims of efficacy *with* untested medicine? It seems to me it is the latter. I wouldn't want to prevent individuals from experimenting with unusual cures, especially since the placebo effect itself comes in many strange forms. Yet I would like to prevent against claims of efficacy for things that have no evidence.

Rational Thinking said...

Duff wrote:

"if we tell depressed patients that SSRI's have not been proven to be more effective than placebo, they might stop taking their medication, thus no longer getting the *placebo* benefit of thinking that the magic pill was helping them!"

Peter Breggin has made some very interesting observations on this point. He writes that he 'realized that all psychoactive drugs produce an effect that can be called medication spellbinding, or, more technically, intoxication anosognosia. Anosognosia means the inability to recognise illness in onself'.

He also comments 'All psychoactive drugs - that is, all drugs that affect the brain and mind - tend to hide or to mask their harmful mental effects from the individuals who use them. Often these drugs make spellbound individuals feel that they are mentally improved when they are in reality mentally impaired'.

So in reality, often those who believe they are getting a benefit from the drugs, whether placebo effect or real, are in fact getting neither. What they are experiencing is mental impairment. The placebo effect, in this case, is not a beneficial one.

Food for thought.

Anonymous said...

Steve -- Christie Aschwanden, not Neena Samuel, wrote the second RD article on vitamins. You don't need to post this, but could you fix those references in your original post? Thanks.

Steve Salerno said...

Anon: I'll put a footnote in, but I'd rather leave the memorial to my own incompetence. We all make mistakes, and we should own up to them.

Anonymous said...

RT, thanks for the food for thought via Peter Breggin. When it comes to psych drugs, he's someone I listen to.

Barbara

Anonymous said...

Following on from the efficacy or not of SSRI's, there is a small but growing professional view that depressed people are not suffering an impairment but in fact are seeing things in a more clear and realistic fashion than the generally accepted view.
I am not suggesting scrapping the anti-depressant meds that many rely on for a degree of equilibrium but that perhaps a lot of the distress that accompanies depression has more to do with being at odds with the social norms. Expectations that the sufferer see the world as eternally upbeat and eternally benign and an insistence on not seeing the random and real inequalities that surround us can only enforce the feeling of alienation that is characteristic of clinical depression, a 'stranger in a strange land'.

Steve Salerno said...

Anon: So what we're saying here is that depressed, suicidal people are merely responding to the world as it really is? They're not pessimists but realists?

Makes me want to go grab some Prozaz.

Karl said...

I disagree with you on this issue

Sham exists equally in the area of allopathic medicine and the enormously powerful pharmaceutical industry whose clutches on government via their lobbyists would exceed that of the influence of manufacturers of nutritional supplements.

And pharmaceutical companies have a shameful legacy of harm to the hapless users of its products. Thalidomide and Viox come readily to mind.

While there are a lot of fraudulent claims made by alternative health practitoners and the potions they recommend, they still offer a better opportunity to maintain or regain health.
Modern medicine seems resolutely fixated on cure rather than prevention: cut, burn or drug. A luxury that health systems around the world can increasingly no longer afford.
Criticism of supplements and indeed of procedures such as chiropractics are defending their own turf. So it is criticism borne out of vested interest

And some of the substances touted by complementary medicine have been in use successfully for centuries.

Steve Salerno said...

Karl, I am not thrilled with allopathic healthcare either--and if I ever manage to get this new book proposal off the ground, you'll see just how un-thrilled I am. But your argument--"Well, allopathic has its faults, too, so it's no different from CAM"--is used far too often by intelligent people who should know better (and probably do know better, but have an agenda to sell or a significant emotional investment in the matter).

Say what you will about traditional medicine, at least--in most cases--it rests on a scientific foundation. It has met a certain bar in terms of clinical proof and repeatability of effect. Where is the evidence (other than anecdotal and "religious," if you will) for CAM/integrative medicine? I could not agree with you more about the twisted emphasis of the allopathic approach--treatment rather than prevention--but where is the evidence supporting the preventive efficacy of herbs, supplements and holistic mind-body woo-hoo? And what really drives me up a wall is that when you confront some of these alternative practitioners (as I have done on a number of occasions in the course of my journalistic career), they will say things like, "My art does not answer to traditional science. It exists on a higher plane, and has done so for centuries, and those of us who believe in it understand its special potency."

Riiiight.

I could use basically the same justification for the Easter Bunny.

RevRon's Rants said...

"Often these drugs make spellbound individuals feel that they are mentally improved when they are in reality mentally impaired'."

One very significant exception to this statement can be found in the group of major tranquilizers used to treat schizophrenics. Drugs such as Chlorpromazine and Thioridazine effectively slow down the runaway train of psychotic thought processes, with the effect of eliminating auditory and visual hallucinations. While a patient on high dosages may well appear "snowed," they are at least lucid and capable of integrating with their social environs. They may well appear impaired when compared to a "normal" person, but are in reality much more functional than they would be without medication.

Rational Thinking said...

Ron -

The problem is not that observable function may be improved, but rather with the mechanism of functioning of neuroleptics (antipsychotics) such as chlorpromazine and thioridazine.

Breggin & Cohen, again:

'Neuroleptics have their main impact by blunting the highest functions of the brain in the frontal lobes and the closely connecting basal ganglia. They can also impair the reticular activating or "energizing" system of the brain. These impairments result in relative degrees of apathy, indifference, emotional blandness, conformity, and submissiveness, as well as a reduction in all verbalizations, including complaints or protests. It is no exaggeration to call this effect a chemical lobotomy."

So whilst the observable effects may be viewed as 'positive' - the cost to brain functioning is extremely high. And the patient, by virtue of being on the medication, cannot give an accurate report of the effects because his or her brain functioning is impaired.

Karl said...

Post 1
But your argument--"Well, allopathic has its faults, too, so it's no different from CAM"--is used far too often by intelligent people who should know better (and probably do know better, but have an agenda to sell or a significant emotional investment in the matter).
>Criticism of alternative /complementary medicine is often levelled by people who have a vested interest in the allopathic arena. So I am just returning the favour. And Steve, you have a significant emotional investment in the matter so your opinions are hardly impartial.
>I am not stating that allopathic is no different from CAM, I am stating that it is worse in many instances. So much for the “do no harm” mantra of medicine. While modern medicine has made enormous beneficial strides in surgical procedures and in some pharmaceutical areas it still continues to do enormous damage, something that is borne out by the enormous number of malpractice claims and the ongoing problem of dangerous drugs.

Say what you will about traditional medicine, at least--in most cases--it rests on a scientific foundation. It has met a certain bar in terms of clinical proof and repeatability of effect.
>Critics argue the bar is set way too low when according to JAMA in July, 2000, the third leading cause of death was the American Medical System. Drugs often create more complications than help.  These complications are brushed aside as side effects. Probably Big Pharma even treats them as collateral damage.
 
Where is the evidence (other than anecdotal and "religious," if you will) for CAM/integrative medicine?
>I am unclear as to what or who you are referring to with the use of the word “religious”. With integrative medicine such as osteopathy if a person goes along to see a practitioner complaining of a sore back following a car accident and comes away with the problem solved ie a pain free back, does that answer your question of proof. The clinical proof rests with the people who get relief from their pain. And pain is one of the areas where allopathic treatment struggles to offer sufferers anything other than drugs to mask the pain.

"I could not agree with you more about the twisted emphasis of the allopathic approach--treatment rather than prevention--but where is the evidence supporting the preventive efficacy of herbs, supplements and holistic mind-body woo-hoo?"
>There is a lot of information detailing the effectiveness of herbs.Ginkgo Biloba, to mention one herb, is widely prescribed in Europe to arrest cognitive decline. My father who died of Alzheimers aged 84 was using a doctor-prescribed drug to help his failing memory, a drug which did nothing.
And what really drives me up a wall is that when you confront some of these alternative practitioners (as I have done on a number of occasions in the course of my journalistic career), they will say things like, "My art does not answer to traditional science. It exists on a higher plane, and has done so for centuries, and those of us who believe in it understand its special potency."
>Some forms of alternative or complimentary medicine/therapy is dubious, I even admit. I am not even suggesting that all allopathic healthcare is deleterious. If you have a stroke or car accident I wouldn’t recommend visiting a naturopath, I’d get to a local hospital quick smart.

Karl said...

Post 2

Purveyors of health tonics and potions were, after all, the original (and literal) snake-oil salesmen, and evidence suggests that not much has changed.
>You providing the evidence would be useful.
Nowadays they tap into (and prey upon) the widespread passion for "self-determination" in all areas of life; they sell the message that you know more about managing your own health than all those silly doctors and (real) nutritionists do.

>Are you suggesting that we shouldn’t be self-determined in all areas of our lives? Who should do the determining. And few doctors know much about nutrition, let alone are experts in that area . Real nutritionists (and dietitians) advocate eating healthy diets. And nutritionists often recommend using nutritional supplements as an adjunct to a healthy diet and exercise.

Although the pesky science that some NCCAM killjoy must have felt obliged to include on its Web site makes clear that most herbs and supplements can't be counted on to do much good, and may do plenty of bad,
>Certainly cheap concoctions of herbs and vitamins made in a lab are probably worthless and can sometimes do damage if taken in conjunction with prescribed medications.And I would be wary of ingredients sourced from China and other parts of the world that are heavily polluted. Junk supplements are like junk food. They are of little value.


Since the advent of The Secret in particular, vitamin and herb manufacturers—no dummies—have increasingly framed their products as helpful catalysts in that all-important crusade to bring mind and body into proper harmony with the Universe: psychic fuel.
> Some evidence of this to support your comment would be great.
In sum, the dietary supplement movement represents one more major step away from orthodoxy and commonality of thought and fact.

> That paragraph is waffle.





Karl said...

Last post

However, in line with the general climate of skeptical revisionism that SHAM helped launch (if I do say so myself), dietary supplements are now coming under greater scrutiny as well. This is hardly to say that skepticism of vitamins, herbs and nutraceuticals did not exist prior to my book. Notably, for decades, Quackwatch founder Dr. Stephen Barrett has been waging a one-man war against irresponsible claims for vitamins and dietary supplements. But somehow it was the supplement industry that seemed to hold the high ground, capturing and holding the public imagination while ironically succeeding at making serious medical types like Barrett sound like the real outliers—as well as heretics, naysayers and cultural dinosaurs.

> Barrett is hardly fighting a one-man-war. His pal Mc Cain (who nearly inflicted Palin on the USA and the world, indicating the depth of his intellect) seems to be doing the heavy lifting inside the Beltway on behalf of critics of complementary medicine.
This doctor makes some excellent points about Barrett
http://www.raysahelian.com/quackwatch.html


Which is why it's especially gratifying to see the mood of revisionism sweep its way into a magazine like Reader's Digest. It began a few Novembers ago when RD ran "The Vitamin Hoax," by senior medical researcher Neena Samuel. The current (April) issue contains another eye-opening article, "5 Vitamin Truths and Lies," by the same author.

>Ah yes, Readers’ Digest that bastion of honesty aka tabloid trash publisher. Read these three links regarding the two articles you have listed.

http://www.suddenlysenior.com/braunreadersdigest.html

http://www.supplementsandnutritionguide.com/blog/vitamin-hoax-or-big-pharma-hoax/

http://www.naturalnews.com/022586.html

You point out RD’s fancy footwork but still choose to use the articles as proving the truth of your diatribe. Incidentally the author of the latest article is doing some fancy footwork of her own. She is an editor of Health Magazine which, if you check out on the web, has articles in which supplements, and shock horror, practices like yoga are recommended. I think the term that applies to her is running with the hares and hunting with the hounds.

Samuel is telling us in a big-screen format what Barrett and a small circle of others have been preaching from the wilderness for years.
>Hardly a wilderness. There are still a sizable number of doctors like Barrett who feel threatened and are not backward in voicing their displeasure. They don’t want to give up the freebies proffered by Big Pharma. However many doctors are coming to realise that complementary medicine is indeed just that. Something that complements or provides options to remedy the shortcomings of allopathic medicine which in many instances can only mask symptoms at best or do nothing at worst.
: that if you don't get these nutrients via your regular (food) diet, then all the pills in the world probably won't help you. They're not going to prevent or cure any major diseases. And they may even cause health problems you didn't have to begin with.


: that if you don't get these nutrients via your regular (food) diet, then all the pills in the world probably won't help you. They're not going to prevent or cure any major diseases. And they may even cause health problems you didn't have to begin with.
>Certainly in Australia manufacturers of supplements aren't allowed to state that they prevent or cure diseases. I think the same is true in the US. And as my links point out, the reason why people take supplements is because food no longer provides all the nutrients people require.And I have yet to read anywhere anyone advocating using supplements to replace a poor diet. All the supplements in the world will do little to remedy a MacDonalds or KFC supersize-me lifestyle. 


RevRon's Rants said...

RT - I agree that the psychotic patient's "highest brain functions" are impaired by antipsychotic drugs. However, the biggest problem the psychotic patient suffers is the inability to process the accelerated rate at which those higher functions occur. The inability to discern between the incessant, rapid-fire flow of thoughts, as well as the ability to discriminate between multiple sources of stimuli are hallmarks of a psychotic episode. The major tranquilizers I mentioned - among others - sufficiently slow thew patient's mental functions, thereby allowing him/her to process ideas and stimuli without being overwhelmed. An appropriate analogy would be the individual who suffers from high blood pressure. The medications used to treat the pathology frequently have secondary effects, and work by diminishing the function of the circulatory system, bringing it into a rhythm sufficient for physical function, yet not so hyper-functional as to compromise the patient's overall health or functionality.

Steve Salerno said...

This discussion has taken an interesting turn. Any healthcare/mental-health professionals out there who'd like to weigh in?

Rational Thinking said...

Ron -

I don't think we're in disagreement on this. Your point that these neuroleptics 'work' to some extent to control symptoms is not in dispute. It is the mechanism whereby that effect is achieved that is my concern. I'm researching this area at the moment, so reading a lot of material right now.

Specifically in relation to schizophrenia and psychosis, Joanna Moncreiff states in 'The Myth of the Chemical Cure':

'neuroleptic drugs dampen down all spontaneous thought and action and their effects are not restricted to psychotic phenomena'.

It's a sledgehammer to hit a nail, in my view. Neuroleptics may be the best we have available at the moment, but they are in no sense a treatment for the disease - they are simply a form of chemical restraint, used to suppress symptoms. I'm not disputing that in a crisis situation they can be useful.

Anonymous said...

Ah, chlorpromazine, fondly known amongst medical professionals as 'the chemical cosh' as that is the immediate effect it has on the patient.
Long term usage gives rise to appalling side effects, some reversible many, like tardive dyskinesia, not.
Try these, the worst are at the bottom of the page. Use of this on humans is equivalent to the usage of electric shock treatment, but it keeps 'em quiet for a while:


http://www.drugs.com/sfx/chlorpromazine-side-effects.html

Your best bet is to try, at all costs, to avoid becoming psychotic.

RevRon's Rants said...

"It's a sledgehammer to hit a nail, in my view. Neuroleptics may be the best we have available at the moment, but they are in no sense a treatment for the disease - they are simply a form of chemical restraint, used to suppress symptoms. I'm not disputing that in a crisis situation they can be useful."

The sledgehammer analogy is apropos, and certainly accurate. Unfortunately, the neuroleptics are the only viable tools currently available for suppressing psychoses, *both acute and chronic.* Back when I was working psych, there was some promising research being done whereby minuscule amounts of electric current were applied to specific areas of the prefrontal lobe. The resulting sensation of pleasure effectively overrode the psychotic processes, but the researchers discovered that it was nearly impossible to accurately map the regions to be stimulated in individual patients. Still, I would think that such an approach holds promise.

Ironically, some of the more noticeable side effects can actually play into a patient's delusions. I remember several patients who exhibited moderate to extreme Parkinsonian symptoms (such as tonic / clonic paralysis of the neck and extreme extension of the tongue), and felt that the staff was exerting some form of psycho-kinetic control over them. It would actually have been funny, had the patients not been so fearful.

Jenny said...

Hi again, Steve. I am a mental-health professional in training, recently graduated from a master's program in counseling and with 3,000 intern hours and the state licensing test still ahead of me. So, as you can imagine, this topic of "Selective Serotonin Reuptake Inhibitors" (SSRIs) interests me. 

Rational Thinking mentioned a particular drug being a "form of chemical restraint, used to suppress symptoms." 

My position with people (clients) I have counseled thus far in my practicum, at a residential drug and alcohol recovery treatment center for women, was to be neutral with regard to SSRIs, neither recommending nor discouraging them. Mainly, this is because my license does not grant me the ability to prescribe them or any other type of medication. At the same time, when I thought it was appropriate, I would remind clients that the decision to take medicine that had been suggested to them by someone who is licensed to prescribe it is theirs (not the professional's) to make, regardless of whatever diagnosis had been made or how strongly the drugs had been recommended.

I do not believe it is my place to interfere in anyone's relationship with another mental-health professional, but at the same time I urged people to inform themselves beyond what they had been told, to research the drug they were thinking about taking or already taking, consider the side-effects and weigh them against the perceived benefits, look at what the long-term effects might be, the cost, etc. 

In other words, without advising them to avoid taking a prescribed drug if it could be avoided, I encouraged them to consider the wisdom of doing it, putting the decision entirely in their hands: first, the decision to think long and hard about it, and then (of course) the decision to actually take the drug or drugs. 

I saw many people who had been taking multiple prescriptions and who had no intention of giving them up. In my opinion, they had just traded one addiction for another. Personal choice is important here. That and taking responsibility for choices made.

LizaJane said...

Perhaps the drop in comments reflects a reluctance to sound off on something you really just don't know anything about? Perhaps you're educating, but people aren't commenting because they "just don't know" or don't feel qualified. If it's fact you're dealing with, not opinion, it's harder to offer an opinion. Y'know? It's possible.

SustainableFamilies said...

I have the same concerns about both allopathic and holistic medicine. Some of what is being marketed to people CAN harm them.

The FDA hid about one third of the most prominent studies on anti-depressants... the ones that had negative results ie demonstrated that the psych meds failed to achieve a better response than the placebo.

The recent JAMA study is pretty telling and a lot of smart minds are scratching their head over what it all means. The JAMA study demonstrated that 4 out of 5 people who improve on anti-depressants would have improved as well or better on a placebo.

That's pretty... depressing.

Just because anti-depressant are horrible for you (ok that's opinion lol) it does NOT NOT NOT mean that herbal supplements are going to cure you! You can injure yourself with them!

Last Psychiatrist, Neuroskeptic, and Furious Season blogs have all been covering interesting commentary on placebo and psych med studies.

Anonymous said...

SustainableFamiles,

I agree. It's the same old case of desperate people desperately seeking cures/answers/solutions and so there is no dearth of charlatans to fill that need. Buyer beware, allopathic or alternative.

Steve Salerno said...

Anon and SF: I can't find much to argue with there. In a free-market society, alas, desperation and vulnerability are too easily commercialized/commodified.

Anonymous said...

The results achieved by the placebo effect almost make the case for homeopathy, which is a completely bogus discipline. One of the benefits of homeopathy is the amount of time and personal attention the practitioner gives to the patient; that personal focussed attention is an increasingly rare commodity in the the medical world and in the wider western society.
I know myself that genuine MD's often prescribe Vitamin C or a similar sugar pill to a patient who is hooked on the pill-taking-cure regime, because they don't have the time or patience to devote to the anxieties the patient is really expressing.
Traditional societies had rituals and rites of passage to address these existential anxieties in a matter-of-fact way that may not have been scientific but did serve a human purpose in that they placed the individual securely within a framework greater than themselves.
As Franz Kafka notably said: "You are free and that is why you are lost"

About Just Me in T said...

Readers Digest is read by millions of people world wide, and is used a a so called reliable source of information.

I have written an OBITUARY for RD today in response to the article against vitamins.

Sadly in the US most recent Edition (April 2010) an article has appeared that has regular readers of this magazine wondering if their own National Readers Digest maybe the next to close down

http://just-me-in-t.blogspot.com/2010/04/obituary.html

Steve Salerno said...

AJMiT: There is definitely a perception that RD has "turned on" its audience. After all, as I say in this post, the magazine for many years was in the vanguard of the pro-supplement movement, along with such others as Prevention, Modern Maturity (now AARP), etc. But my point remains: If, in order to keep subscribers, you're pandering to your audience by selling them half-truths and outright falsehoods month after month (as the magazines that stump for the vitamin/supplement industry do), then you probably didn't deserve to survive anyway.

All of these "nature-based" fads eventually collapse, once the science comes in. Silicon breast implants didn't cause systemic disease in women, vaccinations don't cause autism, and vitamins can't be shown to do crap, for most people.

RevRon's Rants said...

Steve, I was right with you up until you said, "Silicon breast implants didn't cause systemic disease in women." We attended the FDA hearings in D.C. on the question of lifting the moratorium on silicone breast implants, and were absolutely stunned when the FDA later decided to lift the moratorium. We watched as a number of women testified that they suffered from various autoimmune disorders (and all had their physicians' findings of such with them). To a person, their records had been either deleted or lost from the database which Mentor (the major manufacturer) had been required to compile on all implant patients during the course of the moratorium. The only records which were kept were those of women who had suffered no ill effects.

On the other hand, there were a number of witnesses in favor of lifting the moratorium - all either Mentor representatives, plastic surgeons, or some of the attending plastic surgeons' patients who had not had any problems, most of whom had been brought as "guests" of the plastic surgeons who testified. Prior to testifying, each witness was required to indicate whether they had any vested interest in the lifting of the moratorium, and each witness denied having any such interest... even the Mentor reps. The plastic surgeons established their expertise by stating that they had performed hundreds - even thousands - of implant surgeries, yet they also denied having any vested interest in the implants' availability. Now maybe I'm just being naive, but if a surgeon claims to have performed 5,000 implant operations, as one in particular did, and given their very conservative estimated fee per operation of $3,000, it just seems to me that $15 million in income does meet the criteria for vested interest in the outcome.

We worked closely with one client who had suffered a severe autoimmune disorder, and it looks like we might be working with another woman who continues to suffer from lupus, years after her ruptured implants were removed. Had these two women, along with the news reports, been our only source of information, I might agree with your conclusion. Based upon the preponderance of data presented, however - not to mention the amount of data that were either "lost" or deemed invalid - the statement that implants caused no lingering health challenges simply doesn't stand up.

Anonymous said...

I hope your upcoming book will feature a chapter or two on the great Swine Flu Hoax.
BTW did you rush out to get vaccinated?

Steve Salerno said...

Ron: Once again here, the burden of proof is on the person/people making the claim. I think it's very dangerous to arrive at the sorts of conclusions you propose based on knowing one or two people who have suffered with certain symptoms, or even (maybe especially) attending a proceeding where you have, all in one place, a few dozen, even a few hundred, women who have suffered with certain symptoms. Though being around such people in such settings is bound to be emotionally affecting, those are the precise circumstances where one must be most wary of the fallacy known to epidemiologists far and wide as the "Texas sharpshooter effect." A few seeming clusters here and there do not a "public health threat" make, particularly when people are self-selecting themselves as victims.

Please understand, Ron, that I'm not dismissing the pain and suffering of women who feel they were damaged by implants, nor am I even, necessarily, saying that they're absolutely, positively wrong. I'm simply saying that, despite courtroom victories that drove at least one major corporation into bankruptcy, they haven't proved their case to the satisfaction of the medical world.

RevRon's Rants said...

Wouldn't you agree, Steve, that the fact that in so many instances (and not just a few, or even a few dozen), the disappearance or deletion of records that supported the claims of untoward effects is at the very least, suspect?

Secondly, my own emotional response came well after the hearings, and not as a result of my exposure to the women's statements of suffering. To be honest, I approached the hearings with the suspicion that most of the women who were complaining were merely seeking attention, and likely had made up their health challenges. I'm not particularly proud of having entered the process with such bias, but there were other factors I'm not at liberty to discuss that encouraged such a perspective. I didn't get angry until I had the opportunity to review a stack of individual women's medical histories as provided by their physicians, to see the many instances of unfavorable study data that had been "lost" or mysteriously disqualified, and actually reviewed the deeply flawed rehashing of old data that was at the core of the manufacturer's case.

As to the "satisfaction of the medical world," would you really expect that world - comprised of plastic surgeons whose income is greatly enhanced by the availability of silicone implants, well-funded lobbying groups, and implant manufacturers - to turn its back on a veritable cash cow, when they are able to sustain that cash cow by distorting a bit of data? And given historical precedent, would you really expect the greater medical community (not directly involved in the implant controversy) to actively prosecute peer physicians for actions that have been effectively distorted in their public presentation?

I admit to having become emotionally driven by this case, in no small part because the client with whom we were working was ultimately worn down, and abandoned her quest to bring the situation to the public's attention. In the final analysis, she was outmatched, far outspent, and because of the health problems she faced, she simply lacked the energy to continue the fight. As a result, I am certain that there will be a significant number of women - and even teenage girls - who will spend their physical well-being for a couple of years of "enhanced" appearance, without ever realizing the danger in which they are placing themselves. They have a right to know the whole story, but there's a lot of money being spent to ensure that they don't.

Anonymous said...

The most honest MD I ever came across (he'd seen a lot of WWII action) introduced me to this quote from Voltaire that he had hanging in his office:

“The art of medicine consists of amusing the patient while nature cures the disease.”

Steve Salerno said...

Anon 7:32: Hadn't heard/seen the quote, but I actually think there's a lot to that.

Dimension Skipper said...

Just because something is officially or legally deemed safe doesn't necessarily make it so.

And just because something is NOT officially or legally deemed safe doesn't necessarily make it UNsafe.

However, given a lack of trusted and verified evidence or testimony to the contrary it seems to me to make the most sense to try to err on the side of the most logical caution with re to those statements.
_____________

Not really relevant, but this brief Language Log item from today ends by quoting Dick Hamming (whom I personally never heard of till now, but they also referred to the same statement in 2004):

"Beware of finding what you're looking for."

Obviously that speaks to both sides of any debate in question.

Personally, I am willing to consider and even accept anecdotal evidence for some things, but only if it comes from sources I consider trustworthy and significant. Trying to judge inherent biases of those sources is what always clouds the issues. Random anonymous internet writings of dubious origin (possibly commercial) don't count as "research." (Just a general statement there with no particular pointedness at anyone affiliated with this venue.)
______________

WV: "sympul" (!)

Steve Salerno said...

DS: Where ya been? But good to have you back.

Dimension Skipper said...

Thanks. I never went away---I've still been reading. (Though I am actually taking a trip starting midweek so I will likely be unable to read much for a while as PC access will be intermittent.)

I just seem to be finding less to comment on with the new more focused format. That's just me.

To be honest when it comes to self-help gurus I'm not that much in the know and frequently have never heard of the "personalities" in question (nor could I ever see myself following their advice with any devoutness). Actually I've learned most everything I know about'em from here (or sometimes PBS if channel surfing). I have noticed when subsequently browsing in bookstores how they all seem to cross-pollenate each others' books. It kind of reminds me of fan web-rings, how you can keep following links/books ad infinitum, definitely a way to suck in the core audience.

Supplements fall into a more nebulous realm. Almost medical/science, but there are a lot of different sources one can find which contradict each other and in the end you're often left with the impression that the "experts" just don't know (so how can I?).

I can see where some supplements could have noticeable effects (either benefits or detriments). And of course they all include that famous fine print about how "None of these statements has been verified by the FDA and this product is not intended to diagnose or treat any medical conditions---in fact we're pretty much lying our a**es off here."

Still, I do take some supplements myself, but nothing all that exotic, mostly just vitamin/mineral stuff. I do think the tendency toward bias on medical issues is real, though I'm unsure how prevalent. Are surgeons really more likely to recommend operations? I don't know, but the general concept seems very plausible to me.

There are always risks when considering what one puts into his/her own body (or has done to it) and sometimes minimizing those risks is very tricky to manage as too often we (as they say) don't know what we don't know. (And just to reiterate for emphasis, often it appears that the so-called "experts" don't really know either, even though they can usually sound quite convincing in their ernestness.)

Anonymous said...

Everybody has a gimmick and an agenda, Steve. You have an agenda too. You may "allow" dissenting opinions but you're not going to post anything here that makes you and your book look like a complete waste of time or a total fraud. Or if you do post critical material you're going to rebut it and make it look silly somehow, or your fellow contributors, as you call them, will pile on and do your dirty work for you.

The supplement industry has an agenda. The allopathic community has an agenda. Doctors have an agenda, healers have an agenda. Everybody has an agenda, no one is pure. To act as if we represent the absolute right or someone else represents the absolute wrong when we ourselves know that we have an agenda, is the height of hypocrisy. Stop pretending otherwise.

RevRon's Rants said...

She's back!

DS - I've always been turned off by the so-called gurus' incestuous relationships, primarily because fo the way they pass the relationships off. Rarely do they acknowledge that they receive some kind of recompense from their endorsements, yet if one looks more closely, it becomes obvious that they're playing "hide the quid pro quo."

While the fan web-ring analogy is apropos, I'm a bit less generous in my assessment. I see it as more akin to a large-scale prostitution ring, where everybody is both hooker and pimp. In both examples, the customers get screwed - sometimes, more enjoyably than others.

H. Ghr said...

Following on from the efficacy or not of SSRI's, there is a small but growing professional view that depressed people are not suffering an impairment but in fact are seeing things in a more clear and realistic fashion than the generally accepted view. I am not suggesting scrapping the anti-depressant meds that many rely on for a degree of equilibrium but that perhaps a lot of the distress that accompanies depression has more to do with being at odds with the social norms. Expectations that the sufferer see the world as eternally upbeat and eternally benign and an insistence on not seeing the random and real inequalities that surround us can only enforce the feeling of alienation that is characteristic of clinical depression, a 'stranger in a strange land'.

E Xtenze said...
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