Except for you & me, and I'm not too sure about you!
Please note: "Why have we become increasingly distrustful and afraid?" is far more accurate, but nowhere near as attention-grabbing.
Adam Curtis has a few ideas.
For more Adam Curtis videos, see http://www.youtube.com/results?search_type=videos&search_query=%22Adam+Curtis%22
Tampilkan postingan dengan label Experts. Tampilkan semua postingan
Tampilkan postingan dengan label Experts. Tampilkan semua postingan
"Experts"...again!
As mentioned in A slight hitch, Part 2., I attended a "robust" meeting with social services, representatives of the nursing home, mum's Community Psychiatric Nurse and mum's Memory Clinic consultant. Although the meeting didn't go quite as I'd hoped, the outcome was good as the standard of care at the nursing home has improved. She's moving to a better nursing home on Monday 15th March anyway as I'd had enough of the shenanigans with the management that runs the current nursing home.
After the meeting, I had a long chat with mum's Memory Clinic consultant. He explained that I couldn't give mum supplements based on weak evidence e.g. in-vitro studies, animal studies or epidemiological/observational human studies showing associations between "A" & "B". There had to be a sufficient number of large Randomised Controlled Trials (RCTs). Fair enough.
I recently e-mailed the consultant including a couple of links to RCTs showing the positive effect of Vitamin D3 on mood. He e-mailed back saying that the evidence was still weak and he linked me to The Cochrane Collaboration web-site and also to the book Evidence Based Medicine - How to Practice and Teach EBM. I bought the book and took a look at the web-site.
Due to a bug on Amazon, looking inside the above book showed me a completely different book which contained a very interesting piece of information.
The Flecainide Story
Pre-Ventricular Contractions (PVCs) are a fancy name for cardiac arrhythmias. PVCs often result in Ventricular Fibrillation (VF) & death during heart attacks. A crossover study done in the US in the 1980s showed that Flecainide drastically reduced PVCs compared to placebo. Flecainide was approved by the US Food & Drugs Administration (FDA) and prescribed to hundreds of thousands of American heart attack patients (though it never caught on in Europe or Australia).
Unfortunately a later study, the Cardiac Arrhythmia Suppression Trial (CAST) showed that, over an 18 month period, about 12% of patients taking Flecainide died compared to about 5% of patients taking placebo. Oh, whoops! It took quite a while for the bad news to be accepted (as nobody likes bad news especially when it adversely affects drug sales & profits) and for Flecainide to be taken off the market. In the meantime, tens of thousands of Americans died unnecessarily. This is what happens when "experts" focus on one outcome only and ignore the rather more important outcome of all-cause mortality.
Statins reduce cardiac deaths in men under 50 who have had one or more heart attacks. There's a statistically-insignificant reduction in all-cause mortality though as deaths from other causes increase. There's also no statistically-significant all-cause mortality benefit to men over 50 or all women who have had one or more heart attacks, or people who haven't had a heart attack. However, that hasn't stopped statins being prescribed to all and sundry, whether young or old, whether male or female and whether having had a heart attack or not.
The Cochrane Collaboration web-site was most interesting. During my long chat with mum's Memory Clinic consultant, he explained that mum was prescribed a cholinesterase inhibitor (Donepezil a.k.a. Aricept) as there was strong evidence for its benefit. I found Donepezil for dementia due to Alzheimer's disease which indeed confirmed the benefit to patients with Alzheimer's Disease (AD). The thing is, mum doesn't have AD. She has Dementia with Lewy Bodies (DLB). I then found Cholinesterase inhibitors for dementia with Lewy bodies, which concluded:-
"Patients with dementia with Lewy bodies who suffer from behavioural disturbance or psychiatric problems may benefit from rivastigmine if they tolerate it, but the evidence is weak." (emphasis added by me).
There is a condition called Parkinson's Disease Dementia (PDD) which is similar (but not identical) to DLB and I found Cholinesterase inhibitors for Parkinson's disease dementia which concluded:-
"Rivastigmine appears to improve cognition and activities of daily living in patients with PDD."
Rivastigmine is similar (but not identical) to Donepezil. There were no reviews showing the effect of Donepezil on DLB.
So "experts" can prescribe medications based on weak/no evidence but I can't give mum supplements based on weak evidence. I'm not going to e-mail the consultant pointing this out as he may withdraw Donepezil and it does actually have a slight benefit. I'm going to print the above studies and use them to try to persuade mum's new GP (when mum's moved to the new nursing home) to permit me to supply mum with supplements based on my evidence.
I also found Omega 3 fatty acid for the prevention of dementia which stated:-
"Background
Accruing evidence from observational and epidemiological studies suggests an inverse relationship between dietary intake of omega 3 polyunsaturated fatty acid (PUFA) and risk of dementia. Postulated mechanisms that might qualify omega 3 PUFA as an interventional target for the primary prevention of dementia include its anti-atherogenic, anti-inflammatory, anti-oxidant, anti-amyloid and neuroprotective properties.
Main results
There were no randomized trials found in the search that met the selection criteria. Results of two clinical trials are expected in 2008.
Authors' conclusions
There is a growing body of evidence from biological, observational and epidemiological studies that suggests a protective effect of omega 3 PUFA against dementia. However, until data from randomized trials become available for analysis, there is no good evidence to support the use of dietary or supplemental omega 3 PUFA for the prevention of cognitive impairment or dementia."
It's now 2010 and there are still no results from RCTs showing. So, omega-3 PUFAs will not be prescribed despite the evidence from biological, observational and epidemiological studies. Luckily, I keep mum's mini-fridge stocked with smoked salmon and I will request that the new nursing home gives mum a salmon meal twice a week.
After the meeting, I had a long chat with mum's Memory Clinic consultant. He explained that I couldn't give mum supplements based on weak evidence e.g. in-vitro studies, animal studies or epidemiological/observational human studies showing associations between "A" & "B". There had to be a sufficient number of large Randomised Controlled Trials (RCTs). Fair enough.
I recently e-mailed the consultant including a couple of links to RCTs showing the positive effect of Vitamin D3 on mood. He e-mailed back saying that the evidence was still weak and he linked me to The Cochrane Collaboration web-site and also to the book Evidence Based Medicine - How to Practice and Teach EBM. I bought the book and took a look at the web-site.
Due to a bug on Amazon, looking inside the above book showed me a completely different book which contained a very interesting piece of information.
The Flecainide Story
Pre-Ventricular Contractions (PVCs) are a fancy name for cardiac arrhythmias. PVCs often result in Ventricular Fibrillation (VF) & death during heart attacks. A crossover study done in the US in the 1980s showed that Flecainide drastically reduced PVCs compared to placebo. Flecainide was approved by the US Food & Drugs Administration (FDA) and prescribed to hundreds of thousands of American heart attack patients (though it never caught on in Europe or Australia).
Unfortunately a later study, the Cardiac Arrhythmia Suppression Trial (CAST) showed that, over an 18 month period, about 12% of patients taking Flecainide died compared to about 5% of patients taking placebo. Oh, whoops! It took quite a while for the bad news to be accepted (as nobody likes bad news especially when it adversely affects drug sales & profits) and for Flecainide to be taken off the market. In the meantime, tens of thousands of Americans died unnecessarily. This is what happens when "experts" focus on one outcome only and ignore the rather more important outcome of all-cause mortality.
Statins reduce cardiac deaths in men under 50 who have had one or more heart attacks. There's a statistically-insignificant reduction in all-cause mortality though as deaths from other causes increase. There's also no statistically-significant all-cause mortality benefit to men over 50 or all women who have had one or more heart attacks, or people who haven't had a heart attack. However, that hasn't stopped statins being prescribed to all and sundry, whether young or old, whether male or female and whether having had a heart attack or not.
The Cochrane Collaboration web-site was most interesting. During my long chat with mum's Memory Clinic consultant, he explained that mum was prescribed a cholinesterase inhibitor (Donepezil a.k.a. Aricept) as there was strong evidence for its benefit. I found Donepezil for dementia due to Alzheimer's disease which indeed confirmed the benefit to patients with Alzheimer's Disease (AD). The thing is, mum doesn't have AD. She has Dementia with Lewy Bodies (DLB). I then found Cholinesterase inhibitors for dementia with Lewy bodies, which concluded:-
"Patients with dementia with Lewy bodies who suffer from behavioural disturbance or psychiatric problems may benefit from rivastigmine if they tolerate it, but the evidence is weak." (emphasis added by me).
There is a condition called Parkinson's Disease Dementia (PDD) which is similar (but not identical) to DLB and I found Cholinesterase inhibitors for Parkinson's disease dementia which concluded:-
"Rivastigmine appears to improve cognition and activities of daily living in patients with PDD."
Rivastigmine is similar (but not identical) to Donepezil. There were no reviews showing the effect of Donepezil on DLB.
So "experts" can prescribe medications based on weak/no evidence but I can't give mum supplements based on weak evidence. I'm not going to e-mail the consultant pointing this out as he may withdraw Donepezil and it does actually have a slight benefit. I'm going to print the above studies and use them to try to persuade mum's new GP (when mum's moved to the new nursing home) to permit me to supply mum with supplements based on my evidence.
I also found Omega 3 fatty acid for the prevention of dementia which stated:-
"Background
Accruing evidence from observational and epidemiological studies suggests an inverse relationship between dietary intake of omega 3 polyunsaturated fatty acid (PUFA) and risk of dementia. Postulated mechanisms that might qualify omega 3 PUFA as an interventional target for the primary prevention of dementia include its anti-atherogenic, anti-inflammatory, anti-oxidant, anti-amyloid and neuroprotective properties.
Main results
There were no randomized trials found in the search that met the selection criteria. Results of two clinical trials are expected in 2008.
Authors' conclusions
There is a growing body of evidence from biological, observational and epidemiological studies that suggests a protective effect of omega 3 PUFA against dementia. However, until data from randomized trials become available for analysis, there is no good evidence to support the use of dietary or supplemental omega 3 PUFA for the prevention of cognitive impairment or dementia."
It's now 2010 and there are still no results from RCTs showing. So, omega-3 PUFAs will not be prescribed despite the evidence from biological, observational and epidemiological studies. Luckily, I keep mum's mini-fridge stocked with smoked salmon and I will request that the new nursing home gives mum a salmon meal twice a week.
I am NOT the anti-carb!
On a messageboard far, far away I was told:-
"While cakes and biscuits might be regarded primarily as treats, bread and pasta are staple foods, which form an important part of the diet of growing children, who are recommended by experts to get a fairly high proportion of their calories from carbohydrates, including wheat flour.
It is normal and healthy for children to have sandwiches and pasta as part of their meals, and pizza and pastry in moderation are perfectly appropriate. As are occasional treats.
I don’t suppose that I am the only person who is tired of your ceaseless evangelising on behalf of your own diet. But it is one thing to feed yourself as you please, and to talk about it if you wish, it is quite another to suggest that there is good reason for people to adopt your personal principles and ignore the advice of paediatricians, dieticians, and properly constituted advisory bodies when feeding children."
Also
"I'm sorry Nigel, but you do give the impression of being on a one man crusade against wheat in our diets. You are also making the assumption that we all eat refined wheat. What about wholemeal bread, wholegrain cereals, wholemeal pasta? You are also assuming that we all buy sliced white bread. I make most of my bread in my bread machine, using organic flour. I know what goes into my bread, and it tastes so much better than supermarket bread.
Pasta need not be made from wheat, for example rice noodles and rice and corn pasta for coeliacs.
So many cuisines have wheat products in their diets. Obviously there are the different breads - nan, pitta, flatbread, tortilla wraps etc; a huge array of pastas, cous-cous; bulgar wheat. Wheat is also used in so many religious/celebratory foods - the bread at holy communion, Christmas/simnel/birthday cakes etc. I could go on."
Plus
"Most widespread cultures have one or two staple carbohydrates, predominantly grains, that are the basis of the normal healthy diet.
In Europe and Northern American those staples are wheat and potatoes. It is hence making a rod for your own back, and entirely unnecessary, to try to feed a child without both of these unless they have specific issues such as Coeliac disease - ask the parent of such a child just how difficult it is. Your argument that the eating of wheat is what makes westerners fat is entirely specious, as few of the more lean members of the culture have eschewed wheat, and your suggestion that the recommendations based on the food pyramid have failed at the population has got more obese since the pyramid was devised is a twisting of the facts – all the relaible evidence shows that the people who stick to the recommendations are just fine, it’s those that don’t follow the guidelines who become obese. The guidance in no way is a cause of the obesity epidemic.
In most of Asia the staple is rice (which, as eaten, is a refined grain incidentally, I don't know why you think it isn't)."
The above raises so many points that it's hard to know where to start. The beginning is probably the best place. WARNING! The following contains some irony.
"Experts" tell us what we should and shouldn't eat. That's worked so well, hasn't it? It's easy to blame people for not following the very guidelines that make them over-eat. It's their own stupid fault! "Experts" scoffed at Dr. Ignaz Semmelweis. He was more right than wrong though and modern medicine now uses sterile practices. "Experts" scoffed at James Lind and it took 42 years before the British navy adopted lemons or limes as standard issue at sea. So we know where "experts" can shove their dietary advice ... somewhere where the sun doesn't synthesise Vitamin D.
I don't try to get everybody on a low-carb diet. Jeez! Firstly, we are not all the same. Everyone has a different requirement for carbohydrate. As I wrote in Carbohydrates: Dogs' Doodads or Spawn of Satan?, "Right carbs, right amounts, right times." People don't do this, though. They eat the wrong carbs (powdered grains, mashed potato & other over-refined carbs like fruit juice) in the wrong amounts (way too much, as per "expert" advice) at the wrong times (virtually every meal, whether active or sedentary). Some random musings...
WHEATFLOUR: I guess it must be the lack of wheatflour that's pushed Orientals to the verge of extinction. Oh, wait...
LONGEVITY: Turn the clock back to a time before modern medicine and we wheatflour eaters had long average lifespans. Oh, wait...
BREAD: The vast majority of bread bought today is muck, mass-produced by the Chorleywood Bread Process. Even home-made bread is made from grain dust. See The problem with "Whole Grain" cereal etc. I don't consider white rice to be a refined grain as it still looks like a grain.
PASTA: When I was a lad, the only pasta we had was Heinz Spaghetti & Ravioli in tomato sauce. Now, pasta is a staple food in the UK? We all know how slim middle-aged Italians are. Oh, wait...
EXERCISE: When I was a lad, I used to run around in the street & playground like other kids. I was still fat. Exercise cannot compensate for poor diet (I ate lots of chocolate, cake & drank sugary Corona lemonade).
Why do we have to eat what farmers grow? Maybe if more people ate less powdered wheat products and more old-fashioned sourdough rye bread, farmers might start growing something else. There are plenty of carbohydrates that don't seriously disturb blood glucose levels, such as rice, rye, barley, quinoa, sorghum, millet, maize, sago, tubers, root veggies, bulbs, legumes & fresh whole fruits.
Nah, it'll never happen! Not while a) crap foods are dirt cheap and b) people keep following the dietary advice of "experts" like sheep ... or should that be lemmings?
See also Anthony Colpo's The Whole Grain Scam.
"While cakes and biscuits might be regarded primarily as treats, bread and pasta are staple foods, which form an important part of the diet of growing children, who are recommended by experts to get a fairly high proportion of their calories from carbohydrates, including wheat flour.
It is normal and healthy for children to have sandwiches and pasta as part of their meals, and pizza and pastry in moderation are perfectly appropriate. As are occasional treats.
I don’t suppose that I am the only person who is tired of your ceaseless evangelising on behalf of your own diet. But it is one thing to feed yourself as you please, and to talk about it if you wish, it is quite another to suggest that there is good reason for people to adopt your personal principles and ignore the advice of paediatricians, dieticians, and properly constituted advisory bodies when feeding children."
Also
"I'm sorry Nigel, but you do give the impression of being on a one man crusade against wheat in our diets. You are also making the assumption that we all eat refined wheat. What about wholemeal bread, wholegrain cereals, wholemeal pasta? You are also assuming that we all buy sliced white bread. I make most of my bread in my bread machine, using organic flour. I know what goes into my bread, and it tastes so much better than supermarket bread.
Pasta need not be made from wheat, for example rice noodles and rice and corn pasta for coeliacs.
So many cuisines have wheat products in their diets. Obviously there are the different breads - nan, pitta, flatbread, tortilla wraps etc; a huge array of pastas, cous-cous; bulgar wheat. Wheat is also used in so many religious/celebratory foods - the bread at holy communion, Christmas/simnel/birthday cakes etc. I could go on."
Plus
"Most widespread cultures have one or two staple carbohydrates, predominantly grains, that are the basis of the normal healthy diet.
In Europe and Northern American those staples are wheat and potatoes. It is hence making a rod for your own back, and entirely unnecessary, to try to feed a child without both of these unless they have specific issues such as Coeliac disease - ask the parent of such a child just how difficult it is. Your argument that the eating of wheat is what makes westerners fat is entirely specious, as few of the more lean members of the culture have eschewed wheat, and your suggestion that the recommendations based on the food pyramid have failed at the population has got more obese since the pyramid was devised is a twisting of the facts – all the relaible evidence shows that the people who stick to the recommendations are just fine, it’s those that don’t follow the guidelines who become obese. The guidance in no way is a cause of the obesity epidemic.
In most of Asia the staple is rice (which, as eaten, is a refined grain incidentally, I don't know why you think it isn't)."
The above raises so many points that it's hard to know where to start. The beginning is probably the best place. WARNING! The following contains some irony.
"Experts" tell us what we should and shouldn't eat. That's worked so well, hasn't it? It's easy to blame people for not following the very guidelines that make them over-eat. It's their own stupid fault! "Experts" scoffed at Dr. Ignaz Semmelweis. He was more right than wrong though and modern medicine now uses sterile practices. "Experts" scoffed at James Lind and it took 42 years before the British navy adopted lemons or limes as standard issue at sea. So we know where "experts" can shove their dietary advice ... somewhere where the sun doesn't synthesise Vitamin D.
I don't try to get everybody on a low-carb diet. Jeez! Firstly, we are not all the same. Everyone has a different requirement for carbohydrate. As I wrote in Carbohydrates: Dogs' Doodads or Spawn of Satan?, "Right carbs, right amounts, right times." People don't do this, though. They eat the wrong carbs (powdered grains, mashed potato & other over-refined carbs like fruit juice) in the wrong amounts (way too much, as per "expert" advice) at the wrong times (virtually every meal, whether active or sedentary). Some random musings...
WHEATFLOUR: I guess it must be the lack of wheatflour that's pushed Orientals to the verge of extinction. Oh, wait...
LONGEVITY: Turn the clock back to a time before modern medicine and we wheatflour eaters had long average lifespans. Oh, wait...
BREAD: The vast majority of bread bought today is muck, mass-produced by the Chorleywood Bread Process. Even home-made bread is made from grain dust. See The problem with "Whole Grain" cereal etc. I don't consider white rice to be a refined grain as it still looks like a grain.
PASTA: When I was a lad, the only pasta we had was Heinz Spaghetti & Ravioli in tomato sauce. Now, pasta is a staple food in the UK? We all know how slim middle-aged Italians are. Oh, wait...
EXERCISE: When I was a lad, I used to run around in the street & playground like other kids. I was still fat. Exercise cannot compensate for poor diet (I ate lots of chocolate, cake & drank sugary Corona lemonade).
Why do we have to eat what farmers grow? Maybe if more people ate less powdered wheat products and more old-fashioned sourdough rye bread, farmers might start growing something else. There are plenty of carbohydrates that don't seriously disturb blood glucose levels, such as rice, rye, barley, quinoa, sorghum, millet, maize, sago, tubers, root veggies, bulbs, legumes & fresh whole fruits.
Nah, it'll never happen! Not while a) crap foods are dirt cheap and b) people keep following the dietary advice of "experts" like sheep ... or should that be lemmings?
See also Anthony Colpo's The Whole Grain Scam.