Monday, March 21, 2011

A Supplementary

"Homines quod volunt credunt."

Julius Caesar

The following debate took place in the comments section of a post in nicoletta's weblog between c3rs3i, nicoletta and I - and I'm going to just post the whole thing here because I am on holiday and am far too lazy to write a real piece. Besides, I can't seem to post any new replies to the discussion for some reason so I'm going to just write my responses here. Anyone who is taking any kind of supplement or herb for health should find it a riveting read.

In the body of the post, the author expressed the following:

"I don't get why I'm such a tired person all the time. People my age are able to stay awake for hours at a time, pumping caffeine into their blood vessels, which seems adequate in sustaining two or three all-nighters in a row. I sleep soundly despite any dosage of coffee, tea or chocolate."

The rest is colour-coded for your easy reading pleasure. c3rs3i is byzantine some fluffy shade of purple, nicoletta is green and I am black because I'm cool like that.


c3rs3i: Might you be (slightly) depressed?
Or have you not had some sun in a while?
Either one can royally mess up your circadian rhythm.
Or could you be using sleep as an excuse to procrastinate? (I did).

My prescription is exercise, multivitamins (preferably gender specific ones), sun and laughter =)

nicoletta: Hmmm....let's start crossing things out. I certainly get enough sun - too much in fact (dangerous UV levels here in the southern hemisphere summer!!) since the weather here is gorgeous and I've been outdoors a lot. My mood seems to be alright - cheerfuller than the norm for me, thanks to the sunshine as well as the inordinate amount of sleep I get in. And, if I want to prorastinate, I'm usually very deliberate about it, and I'll be doing a whole lot of other things besides sleeping. Like reading, watching TV, listening to music for countless hours etc.

I'm on multivites as well. Nahh, I think I've somehow just sunk into a very relaxing lifestyle, which feels great but unfortunately needs to be done away with in the name of academic striving

k0k s3n w4i: Bah, multivitamins. Unless you're pregnant or living in Sub-Saharan Africa, there's really no reason why anyone needs to waste money on them. They are wasted on a system overloaded with micronutrients anyway. The supplements-for-healthy-life industry is really quite a scam. Excess of certain vitamins like A and D is worse than useless - they are harmful.

c3rs3i: You assume that non-conceiving people who have the means of sourcing nutrients naturally do the advantage of their circumstances justice.

And too much water/oxygen/anything kills too.

k0k s3n w4i: Precisely my point - too much of anything is bad for you, and speaking of assumptions, you're assuming that our host is not adequately nourished and that multivitamins will help with her fatigue. On what scientific basis are you recommending them?

It's damnably hard to be deficient of any nutrients in this day and age. You'd seriously have to go faaar out of your way to deprive yourself of any one. It's one of the great success stories of public health policies.

Besides, oxygen is free and water is almost so. Multivitamins, on the other hand, aren't. Most of the supplement industry at large is a scam. Just for an idea of how unscrupulous they are, take the popular cold/flu cure and prophylactic remedy, Echinacea, for example. even after they have been proven time and time again to be useless, the drug companies kept pushing them out because people kept buying them. Take a look at glucosamine which people take for osteoarthritis; studies have shown that it's useless as well but did the drug company go: "aight, this stuff doesn't do anything so we'll stop making them"? No, it's all for profit and because any substance carrying the label of a "supplement" is so laxly regulated, we really do have literally hundreds of tonnes of utterly useless crap on pharmacy shelves. It's a business that's worth billions and billions of dollars every year.

My mom's taking Vitamin C to prevent upper respiratory tract infections, which surprise, surprise, is also completely ineffectual for that purpose. I showed her the evidence and the studies, but that didn't change her mind either.

If nicoletta was taking supplements for some specific health problem under medical advisement, I'd understand but consuming them for general wellbeing is a waste of good money that can be better served for other purposes.


nicoletta: Nope, no specific health problem and no medical advice on supplements either. But I do live with my parents, and the parental prescription for my frequent bouts of illness and chronic cough especially in the winter, is cod liver oil pills! Delicious. I take other multivites irregularly, and all of them are just the leftovers from my pregnancy. I was warned expressly against taking Vitamin A, though - something about its potential in causing birth defects in developing fetuses.

I drew lines from fatigue and hit a couple of things for which I made remedial suggestions. Upon further revelations, they will clearly not help with her sleep issues because the underlying assumptions with regards the causes I made to start off have all been negated.

But if it were the case that she doesn't follow a somewhat balanced diet, I would stick by my recommendations of multivitamins. And I would base this recommendation on my personal experience whereby I used to feel constantly fatigued despite a lot of sleep and felt a marked improvement after. Perhaps it was a placebo effect, but if all the money I have paid has just gone to tricking my mind into behaving better, then I still think it's money well spent because I wouldn't have otherwise come out of it.

Scientific research collated based on a sample set of 1:
Am I highly deficient (without)?
- Doubt it.
Do I think I could/should provide my body with more nutrients besides what it gets from the lettuce in my sandwiches?
- Yes.
Why don't I eat a salad instead?
- I don't like to eat what I don't like to eat but I have put all my salad money in a piggie bank and exchanged it for multivitamins instead!
Doesn't anyone cook for me?
Can't I cook a nice balanced meal for myself?
Certainly, but I'm just a TAD busy at the mo.
If I eat well occasionally, I should be fine without multivits in the periods that I don't?
I don't doubt.
However, I am at work 8 hours a day and 6 hours in the library after and well... there's only so much you can expect from lettuce to keep you a lean-mean working-studying machine.
Oh, and I hate coffee. So if I can bring myself to drink that vile crap just so I can be a more productive human being, you will understand that I will smack you if you try to take away my multivitamins again.

Any word on the ginko biloba I'm also taking? =p

Yes, I see and agree what you mean about how a lot of people get scammed into buying something they don't need but I hope the above shows you that there are some benefits they possess for the non-pregnant, non-starving.
And Glucosamine info was particularly useful, thanks - I'll pass it on to someone who has probably already stopped taking it despite doctor's orders. X\

Cod liver oil pills delicious?? I hope you did mean pills (which I have no knowledge of) and not capsules cos I don't remember them being pleasant! The orange cod liver oil mix was yumz but seeing as I read the label and wasn't particularly impressed, KSW will probably tell you it's the scam of the seven seas. =p

nicoletta: sorry, yes, I did mean capsules, and I was being sarcastic =) I hate all cod liver oils, and I've experienced them in four forms (the orange gloop, the white, milky, extremely fishy gloop that makes me gag after each spoonful, the capsules, and the actual cod liver oil i.e. the really, excessively fishy, rancid oil) and I must say the capsules taste the best, because they have the least taste of all.

Always nice to have some professional medical opinions on this humble blog =)

k0k s3n w4i: Let me rephrase. When I asked you on what scientific basis are you recommending multivitamins, I meant "Do you know of any well-controlled, double-blinded studies which show that multivitamins actually help with fatigue/tiredness/oversleeping?"

And unfortunately, you haven't convinced me of anything. What you offered is your experience, an anecdote - and as statisticians like to say: "The plural of anecdote is not data." One only needs to read about placebo controlled trials to know that anyone can tell a good story of how treatment x, y or z helps even when they aren't actually getting any. Human cognition is a very poor arbiter of good science - which is why we have the scientific method to really tell us what's what.

And since you asked about Ginkgo biloba, check out this article on science-based medicine on it. I'll spare you the suspense - the title is "Ginkgo biloba - No Effect"

Incidentally, it was written by Dr Steven Novella, an Associate Professor of Neurology at Yale and host of The Skeptic's Guide to the Universe, one of my favourite podcasts.

From your description of your diet, I find some cause for concern, and it's not because I think you might be depriving yourself of micronutrients (you really need very, very little of those). You actually don't sound like you're getting enough macros, and no amount of supplements in the world is going to help with that. I'm certain that you do occasionally shop for bread and a head of lettuce for your rabbit sandwiches - so it isn't going to take a lot of extra time for you to also throw some cheese, chicken rolls or ham slices, tofu or a couple of apples into your basket while you're at it. It certainly isn't going to take more time than it requires to go to a pharmacy to refill your multivites. Just a friendly advice. You can totally bin it if you don't like the sound of it ;)

As for doctors prescribing glucosamine - well, med schools certainly don't prepare practitioners to think critically. And more often than not, most just don't bother if they think whatever new-agey crap their patients are into couldn't hurt. I defer to the Science-Based Medicine website for easy-to-read skinnies on edgy, kooky treatments and supplements. They trawl the journals so I don't have to. I highly recommend that you bookmark it as well :)

P.S. As it happens, I really have no opinion on cod liver oil and their derivatives - but I'll say this much. I have yet to read any convincing papers saying that the stuff helps to prevent infections or boost the immune system in any way.

c3rs3i: And hey.. the Gbloba study was for people aged 72 to 96 and they were testing for effects against Alzheimers or other forms of dementia.
This study is irrelevant and ineffectual for proving that it does not enhance cognitive abilities in those of other ages.

Aged 72 to 96!!! Imma whack you with my walking stick.

k0k s3n w4i: There is scant research done on Ginkgo for the more sprightly segment of humanity, but the research does show no positive effects on the population which we would expect the most dramatic improvements from. Neither was it efficacious in preventing cognitive deterioration in those who are most at risk for such impairments. On disciplines I have no expertise in, I listen to the actual experts. And in this case, the resident expert, an academic neurologist, did weigh in on the plausibility of the mechanism by which Ginkgo purportedly act through (thin) and the weight of the evidence thus far - which isn't heavy. I ask you in turn: On what objective evidence or proof are you claiming that G. biloba improves your cognitive functions? Should we just pop every root, berry and leaf which was claimed to be good for something into our mouths just because no studies have been done yet to disprove those claims for our specific biology? And after studies on G. biloba is performed on twenty-somethings, are you going to complain next that they weren't performed on Asians? I daresay you were engaging in special pleading or ad hoc reasoning there, pardner. The crux of the issue is this - at present, there's no good, reliable scientific reason to suppose that Ginkgo helps your brain work better.

c3rs3i: Man, your life must be quite tiring/some, always having to verify that something works/exists through some scientific study before allowing yourself to believe that it really does. Look at you, turning your nose up at the power of the anecdote when generations ago or even just before the internet went massmarket, that is all people had to go by (nevermind that they got as many things wrong as they did right).

But despite the toxicity of your cynicism, I still appreciate your sharing of what you know, your perspective and concern.

You'll have to excuse a lot of people, me included, for not jumping on board immediately - for as many studies as there are saying nay, there're that many saying yay as well. Yay by Council for Responsible Nutrition, US of A!

And besides.. we heard yay first.
Anyway, statistics is one of the toys I play with for a living so I have an added dimension of skepticism in that I know you can get data to pretty much say anything you like, double sided, blind controlled or whatever.

No, my sandwiches come straight from the sandwich shop and my fave's bacon and chicken deep fill - So do I have your approval to hold off buying macronutrient supplements for the time being? =D
But yes, I think I will visit a grocery shop for the first time in a month, ignore all the studies negating the benefits of bananas and pop a bunch in my basket. 

k0k s3n w4i: Actually no - I just have a healthy respect for reality and mislike being taken for a ride by people out to make a buck. And you assumed that I obsessively look up every aspect of my life; which I don't. It's just that the nature of my profession requires me to keep abreast of the current scientific understanding on all things health related. If a patient asks me if Ginkgo biloba makes them smarter, I'd have to be able to tell them what science does know at the moment. And that answer is "There is no evidence for it." It's an answer that may sound ambivalent, but it's about the closest science will ever get to negating any claim. We are quite unlike the new age health gurus who will often tell you in no uncertain terms that their magic potion, pill or tincture will boost your IQ, cure the common cold and vacuum your house. Call it "toxic cynicism" if you like, but I prefer the term "scepticism" which I assure you, is not synonymous with the former. I was unaware that you consider caring about the truth to be such a negative quality for anyone to have.

And before there was the internet, there was the scientific method - a mighty useful tool which had been formalised by our species to offset our limitations in understanding the world. There were universities, academicians and journals. The net merely expedited our access to these resources, and I consider it criminal to not take full advantage of it.

In the medical field, we rarely rely on any one study for our practice. What we would (or should) consider in formulating health advice is usually based on a long-term look at the pattern of research (and if we can get it, a systematic review by an authoritive journal like the NEJM, JAMA or BMJ which is the closest thing to a last word on any healthcare subject).

On to the CRN report you just posted: it merely confirmed what I've been saying. Supplements are only useful in those who are pregnant, at-risk or deficient. We routinely prescribe pre-conceptional folic acid to women to prevent neural tube defects; that's true. Calcium and Vitamin D helps stave off osteoporosis in the elderly (strange that you're okay with the age-group here - cherry-picking much?); no one's denying that. No word on your miraculous brain herb, though. The rest is some iffy projections and over-optimistic claims. If you are aware, you'd also know that the anti-oxidant craze had been undergoing heavy scientific fire in recent years as well. However, the part of the report which interested me the most is this little tidbit at the bottom:

"The Council for Responsible Nutrition (CRN), founded in 1973, is a Washington, D.C.-based trade association representing ingredient suppliers and manufacturers in the dietary supplement industry."

I'd get my information from a source with a little less conflict of interest if I'm you. If you're interested, the CRN is mentioned in quite an unflattering light in this piece here. And macronutrient supplements? I usually call them "food".

k0k s3n w4i


c3rs3i said...

You missed out my pre walking stick comment. Should be in your email even if it's not on N's site (mayhaps we burst and busted her site's comment limit haha).

You should have asked me first - I'd have told you I want to be pink or if that is offensive to you, we can compromise for a pastel blue.

c3rs3i said...

In order of your question marks -

1. My proof that it works is that before taking it I got a 97% average in school. After, I got a 100% average. Whaddya know.. 3% improvement in cognitive abilities!!
In honesty, I have no proof. I don't feel whizzier with my calculator or anything.

2. Who am I to speak for the general we but I eat all sorts of things (chicken/cow/pig/rice/bread/etc) without looking up a study to see whether it's true what my mother's mother's mother's mother's mother said that it's good for me. Read any studies out there showing they're bad for us?
See.. I'm a creature of consistency; studies don't rule/out what I consume - This you can call ad-hoc reasoning, the next point, however...

3. That's putting words in my mouth, mate. No, I wouldn't insist on a study performed on asians or my specific DNA. I'm not adamant on being right but if you want to convince me that you are, you'll have to do better than that. A study in the right age group would lend a lot more credibility to your claim that it does horse shit for me. Firstly, it's more relevant to me, secondly we have differing views in that you see the geriatric as those for whom the supplements should have the most effects. I see them as those who already suffer from a myriad of other plagues meaning there could be a dozen other reasons why it hasn't worked clouding the objectivity of the study for the general population. But when I'm that age, if I remember, I won't bother taking them aight? But until then or further/conclusive proof, I shall continue in my faith/gullibility and believe that I'm getting smarter with every pill/penny.

nicoletta said...

Well, that was an interesting debate! It was all between you and c3rs3i though, since I didn't really make any assertions. Too little medical knowledge.

c3rs3i: Blogger automatically diverted all the later comments into my spam inbox, which explains why they didn't appear initially, until I logged in and cleared them all to be published.

c3rs3i said...

KSW and I could probably pick a tub of butter and have strong differing views over it.
And I think an opinion is more requisite for a discussion than anything. Don't be cowed you into thinking you need to support everything you want to say with scientific studies or cold hard facts - the world is not either black or white nor are we in a UNESCO forum here. Just point at something and ask a question or say a (polite) permutation of "Nonsense!!" and go from there. =)

Haha that's hilarious - we actually did spam your post! Good to know blogger's spam filter works =p

k0k s3n w4i said...

c3rs3i: fixed it. and i also added my latest answer to your arguments in the post above. and no, you can't have pink or pastel blue. i'll oblige if you pick a darker, more visible colour ;) and thanks for being a good sport so far :P

nicoletta: you can be the moderator, and keep score or something, haha. and perhaps you can let us know who got the better case at the end :)

c3rs3i said...

Don't be sad - I only called your cynicism toxic because if there were any (non-capitalistic) multivitamin fairies out there, you will have swatted almost all of them extinct from this one discussion alone.

It would be more correct to say "There is no evidence for or against it".

You're extrapolating again - I do not find caring about the truth to be a negative quality. Nor do I find you caring either. If anything, I'm more caring (of the truth) simply because I don't accept one wholeheartedly and quash the possibility of another completely - The probable truth is not the same as the truth even if that's the best science can do. Saying something has a 99.999999% chance of not happening is not the same as saying it has absolutely no chance of ever happening because it WILL happen 1 time in every 1,000,000.
And of course, even less 'truthful' is the average truth.

Multivitamins, like ginkgo supplements, are only useful to the people they are useful to (yes, I've somehow passed lots of exams - must be the gingko nut!). You don't see me buying saw palmetto (not a word, please) likewise you needn't buy multivitamins (I checked and discovered mine don't have v A - How clever is that? I'm sold, moreso now than ever). A clamp down on miss-selling and consumer education should sort out ignorant purchases/rs. Doctors should perhaps also be reeducated on antibiotics - All the times I've been diagnosed with a cold/flu, I've been given them. Apart from once when I pretty much waited an hour to get the grand prescription of "Go home and sleep" from the doctor.

I wasn't cherry picking - The report says multivitamins work. Especially for said groups. And in any case, I didn't link it to be the last word on the subject but merely to illustrate that for every study you can find stating the inefficacy of some pill, I could probably find one saying otherwise. But I looked up Harriet Hall too (sciencebasedmeds writer) and I could probably derive a conflict of interest if I liked.


Byzantine, thanks.

Sure, I'm always up for a good discussion but you do realise no one else cares and you've as much as uploaded a thesis as your vacation filler?

k0k s3n w4i said...

c3rs3i: go ahead. try and derive a conflict of interest for harriet hall and every single one of the writers at science-based medicine which is even half as damning as being essentially a lobby group for businesspeople actually making money off of selling supplements. and like i already pointed out (and i'll reiterate), one can almost definitely find a paper anywhere to support any position but in this field, we look at the big picture; the history of research on any particular topic and then formulate our clinical decisions. and i am merely telling you the scientific consensus thus far.

and yes, it's correct to say that there is neither evidence against or for most supplements - but i fail to see how it negates any of my points or makes you any less credulous. if something is useless, we advice against it. if something is harmful, we advice against it more vigorously.

i also do not think you care more about the truth than i do. no sceptic will ever quash the possibility of anything 100% completely. if compelling research surfaces, i'd happily change my mind. scepticism is all about the science. there's a chance that through a quantum flux, you will turn into a puff of fresh air but the percentage of that is so vanishingly small that we assume it's zero. is there a possibility that ginkgo biloba can be good for you through some hitherto unknown mechanism or is beneficial in some unexpected way apart from boosting your brainpower? most assuredly. science is rife with possibilities, but is the plant useful for it's indication? can it prevent cognitive decline? can it improve dementia? can it boost memory and unimpaired cognitive ability? the answer is no - not that we know of and not in any measurable way we can think of.

Ginkgo doesn't work: Are there better ways to save your brain?

"Multivitamins, like ginkgo supplements, are only useful to the people they are useful to"

absolutely, absolutely wrong. that's false equivalence. while vitamins are useful for the deficient, ginkgo has time and time again been proven to be worthless for what it claims to help with. and "only useful to the people they are useful to?" recursive much? and besides, saw palmetto too is proven in a well-controlled, double-blinded study published by the nejm to be no better than a placebo. trust me, the medical fraternity has nothing against herbs. we are not part of a dogmatic priesthood with millennia-old unchanging, unchangeable doctrines. take aspirin for example, or quinine, or any of the countless plant-based, fungi-based drugs we actually do use in conventional medicine. if it works, we will adopt it. if not, we discard.

k0k s3n w4i said...

c3rs3i: next up: doctors have absolutely no illusions about the efficacy of antibiotics on viral infections, and i assure you that it's a particularly contentious topic within the medical fraternity. a lot doctors prescribe antibiotics indiscriminately because of patient expectations, and handwave their decision to do so by saying it prevents secondary infections by bacteria (which does occur). and more often than not, it's the patients themselves who request antibiotics when they get an ILI (influenza-like illness). you'll notice that most, if not all, physicians who do this work in the private sector - either in a franchise hospital or in their own clinics. you'll also notice that these physicians tend to also recommend and sell supplements and dabble in pre-scientific mumbo-jumbo like homeopathy and acupuncture. make no mistake about it; they want your money and selling mostly harmless, useless treatments is the best way to turn a profit (because the standard bed and rest recommendation for a cold/flu only gets them the consultation fee). walk into any government hospital in malaysia and you'll find that the doctors there are a lot more reticent when it comes to prescribing antibiotics.

"A clamp down on miss-selling and consumer education should sort out ignorant purchases/rs"

you'll never stop people from trying to sell you things. the entire science of homeopathy, for example, is essentially all water and sympathetic magic - but yet you find pharmacies everywhere hawking them alongside legitimate drugs. everyone tends to operate on a "what's the harm?" mindset on probably harmless, unscientific alternative medicine. funnily enough, there's a website called addressing that particular concern.

i don't believe i'm extrapolating, by the way. cynicism is quite a dirty word amongst sceptics because we are call that so often it's a cliche.

k0k s3n w4i said...

c3rs3i: aight, i just got back from langkawi and i've got more (gasp!) to add - i was hungover when i wrote my previous points and missed some. as you can probably tell, *this* is what i actually do for fun.

1) i trust CRN no more than i trust the council for tobacco research. they have basically the same goals - to help sell you more of their stuff. it's funny how you would trust (and defend) a flagrantly biased advocacy group over the advice of doctors.

2) science will never reduce the possibility of anything to absolute zero. and everything scientific relies on the balance of probabilities. it's how we decide what is worthy of our investment in and what isn't. why are you banking on ginkgo? why not use gotu kola, hawthorn, rosemary, pig brain soup, trepanation or the thousands of other questionable miracle brain boosters? they are all equally possible and improbable. while accusing me of ignoring the negligible possibilities, you make the mistake of elevating them to respectability.

3) "Apart from once when I pretty much waited an hour to get the grand prescription of "Go home and sleep" from the doctor."
and you can see why some doctors feel compelled to provide or administer some sort of treatment to make patients feel like it's worth their while to consult them. some take the trouble to explain how antibiotics will not help with viral infections, and then go right around to prescribing some vitamins because those are more harmless compared to antibiotics. arguably, the act of giving medication of any kind can help via the placebo effect which, in some circumstances, can be big. that is why treatments are always weighed against placebos in medical research - and ineffective treatments are usually described as "no better than a placebo" rather than "horsefeathers".

4) an aside: it's difficult but i've trained myself to be able to swallow my pride and change my mind when i'm confronted with evidence i cannot refute. i used to be a believer in the supernatural - no longer. i used to think that people were overreacting to the phenomenon of anthropogenic global warming - not anymore. i was convinced that vegetarians are talking out of their asses when they say that eating meat is very much detrimental to the environment - i no longer think that, but i am of the opinion that the world can end before i give up teh bacon.

5) I find it amusing that you consider yourself caring about the truth more than me when you said things like:
"Perhaps it was a placebo effect, but if all the money I have paid has just gone to tricking my mind into behaving better, then I still think it's money well spent..."
unlike you, i wouldn't.

6) I engage in such discussions/debates not to convince or convert the person(s) i'm conversing with. in fact, psychologists have found that confronting people's beliefs head on tend to make them more entrenched, more assured that they are right. research into human psychology had also shown that people who have made their opinions on a subject public are significantly less likely to change their minds compared to someone who had kept those opinions private. so, i probably contributed to the strength of your faith in supplements. i do what i do to show onlookers which side has the better arguments and evidence, and hopefully change some minds. i also do this because i enjoy the mental exercise - and i daresay it's probably much more helpful compared to ginkgo in boosting brainpower ;)

c3rs3i said...

8 hours in the library and I come home to find this
Haha =)

c3rs3i said...

1) I can see as clearly as you how suspect the integrity of that article is given it’s written by the CRN. What I have said has not been in their defence nor out of trust but merely because there are a dozen other articles out there (independence of CRN is debatable of course) saying pretty much the same thing so for the purpose of demonstrating that there isn’t a consensus, unlike what you’ve claimed, I’ve decided it will suffice. Now, I could trawl for an article with a more acceptable source to you but to the same effect or I could use that time more valuably elsewhere (responding to the rest of your … long reply, say) – guess which I’m going with?

Reading a left wing newspaper, you expect news biased such. Not saying ScienceBasedMeds is left wing but, likewise, when I read an article published within their site, I will factor their general stance on similar matters (which thus far has been negative) into the conclusions I draw from it. So yes, I believe the article may have some valid points but can it be the last word on the matter? No. I would certainly be more convinced if there were sources noted down and links to them. But as it is, all I see are claims and no proof so pardon me if I don’t take just take the writer’s word for it even if she has the letters MD after her name.

2) I’ve put in my order for all the mentioned, thanks for the professional recommendation.

If I asked a doctor if GBloba would make me smarter, I would want facts ie there is no evidence for or against it. If I then asked his opinion on the matter which is likely, he/she can advice me that it’s a waste of money. I would find any advocacy that I did not request presumptuous and a smidgen arrogant.

Who’s to say what’s a good success probability? We all have our own yardsticks – negligible to you, respectable to me.

I’m not banking on GBloba. I’m studying as well. And here, nitpicker, read this. It does say “There were no effects after 6 weeks” which may possibly explain why your old people who took them for 6 years experienced no change but that’s just fishing one shark out of the ocean. And guess what, before throwing away my empty GBloba box, I remember it telling me not to take it for too long either – my faith is reenforced! =p

Yes, there are failures/inefficiencies in the economy that permit the capitalisation of quackmeds but being in the country that I’m in, I have faith enough in the strong consumer protectionism carried out by the government/regulators to believe that stuff that has reason not to be on the shelves are not on the shelves.

c3rs3i said...

3) I was at the clinic for a different reason but happened to have a terrible headache and delirious fever amongst other things so I thought I’d be given something for that at the very least but no, not even sympathy/empathy. Regardless, I thought it the most sensible prescription I’d ever had given my dislike for taking medicine and belief that doctors can’t do nuts for fluey ailments anyway.

4) Likewise, I place garnering knowledge above self-righteousness and would change my mind given a convincing argument. However, where I’ve made my mind up, it won’t have been lightly or without reason/support for my conviction. Thus, it is not easily changed.

And what...! How is eating meat killing momma earth now?

5) Ok, you are very caring. Perhaps moreso than I. I care about the truth. And in my spare time I will champion it. Otherwise, I care as much or even slightly more about results.

And in view of your hurt feelings, I take back what I said about you being a cynic. Still, I remain a sceptic about your skepticism.

6) Yes, that psychology sounds very plausible but citing that as the reason for my unfaltering believes does me the injustice of casting doubt on my ability to remain objective despite the ‘confrontational’ setting.

You possibly have too much faith in your readers (or I too little) - I would have given up on reading this post after the first skim of its length.

And I participate in discussions/debates because apart from discovering new things occasionally, I find understanding the psyche of the people I’m having the conversation with interesting too.
Unless I find a person’s allegations to be completely idiotic and so happen to be in the mood to do some community service, I don’t tend to engage in brainwashing – even so, I’d still be quite fascinated by how the person’s thought process got messed up like so.

So we’re both getting the same mental exercise out of this but I’m also taking GBloba. Looks like I’m one step ahead bro. =)

k0k s3n w4i said...

1) i think you misunderstood what a scientific consensus means. it means that there is a majority agreement amongst the real scientists - the people who actually do research - and that consensus is to be relied upon in making science-based decisions if unanimity cannot be reached. the words of advocacy groups, alternative medicine kooks and every keyboard warrior with a blog don't count. take the theory of evolution; there's a scientific consensus that it's the explanation for the diversity of life, but do a google search and you'll find creationists dissenting everywhere. look at anthropogenic global warming too while you're at it. when i speak of the scientific consensus on certain supplements, i'm referring to the majority opinion in the literature - in established, reliable medical journals. alternative medicine journals do not count because they were only started when good journals like nejm, jama, bjm, etc refused to publish biased, sub-par papers. if anything works, rest assured it will be assimilated into conventional medicine and be alternative no more. so no, you did not demonstrate that there isn't a consensus by showing me an article by an advocacy group representing supplement traders and manufacturers.

science based medicine was started with the goal of bringing the standard by which we appraise conventional treatments to the assessment of "alternative" medicine like exotic supplements, detox, chiropractic, reflexology and homeopathy - because while conventional treatments are required to undergo extensive testing (up to including human case-controlled studies) before they are unleashed on the unsuspecting public at large, alternative medicine happily and frequently bypass this vetting process.

i noticed you have a tendency to use false analogies/equivalences. a left-wing paper endorses an opinion, a worldview. you can draw a parallel between that and CRN. but science based medicine talks about the science, and they link to research papers and statements by official healthcare bodies which support their position (at least in the articles i've cited - so i'm puzzled by your patently untrue assertion that they did not link to their resources). you are doing - perhaps unconsciously - what creationists are doing in academic circles: trying to reduce the theory of evolution to "just an opinion".

2) unlike homeopathy, supplements are not risk-free. i think have been overly generous in characterising them as having no evidence either for or against their use. i have personally clerked a few women with liver and kidney failure thanks to the injudicious use of poorly studied "traditional" supplements. ginkgo has a known adverse effect profile; the most worrysome of them is an increase in bleeding risk and thus haemorrhagic stroke due to its anticoagulant properties (almost negligible in a young person, yes, but for someone who respects vanishingly small percentages a lot, it's almost a certainty). so, known potential harm and no confirmed benefits... sounds like a piss-poor investment to me.

and methinks you have too much faith in the regulatory bodies in the countries you are in - and if that country is either the US, australia or the UK, i believe you are mistaken. they are practically undergoing a renaissance of quack medicine right now, hence the increased effort by physicians to take up the cause of public education.

also normally, i rarely criticise people's health decisions. but when a layperson, such as yourself (insofar as i can tell), is giving medical to others in a public forum, such as a comment box of a blog - i felt compelled to take up the case, unsolicited as my opinion may be.

k0k s3n w4i said...

3) i admit that the rising popularity of alternative medicine practitioners is due in part to doctors appearing callous and uncaring. and sometimes a flu is not just a flu because there's a myriad of far more dangerous viral infections which mimick it. and as you probably know, some influenzas are not benign. anyhow, if your temperature was high, the doctor should have at least given you a paracetamol/acetaminophen.

4) well, it's known that far more energy is required to produce meat than to grow plant based food - because livestocks occupy at least one trophic above them on the food chain. i understood that but was unconvinced by exactly how detrimental to the environment animal husbandry really is; that is until a vegetarian showed me some convincing data. if you are interested, ask a vegetarian (there's probably a handbook they have or something).

5) also, i care about the truth more in that i require a far higher index of evidence before i am convinced of anything - as our little exchange on what probabilities are acceptable to us demonstrated. as you admitted, you are more easily persuaded by smaller numbers. it's strange that you'd have such a low bar for evidence when it comes to accepting supplements but yet so high when your worldview is challenged by sceptical physicians who provide informed opinions on what the research says. this disparity in standards was what science-based medicine were established to combat. the bias appears in the media and the public at large as well - mostly due to the naturalistic fallacy.

i have no hurt feelings (cue the hurt feelings rap by the flight of the conchords). i was merely tired of encountering the same, unoriginal dismissal of skeptics as cynics over and over again. and luckily for me, no one made you an officer of the sceptic police. besides, my opinion on most things is very similar to the modern sceptical movement, which i follow avidly.

6) don't get me wrong. i am not suggesting that your conviction in your herbaceous supplements is caused by me. i merely explained that i am aware of these psychological phenomenons to demonstrate that my intent is not to convince you to reconsider your stance. but yes, i do consider you to be less than objective (read points #2 and especially #5).

i have faith that a lot of my readers uses supplements as well, and is following this discussion with great interest. at any rate, i personally know of two others who are.

k0k s3n w4i said...

7) I’m not banking on GBloba. I’m studying as well. And here, nitpicker, read this. It does say “There were no effects after 6 weeks” which may possibly explain why your old people who took them for 6 years experienced no change but that’s just fishing one shark out of the ocean. And guess what, before throwing away my empty GBloba box, I remember it telling me not to take it for too long either – my faith is reenforced! =p"

in the large 8-year study involving 3000 patients published in jama, the effects they are investigating are the chief claims of ginkgo, which is that it somehow prevent cognitive decline and improve cognitive function. it was large-scale, long-term and peer-reviewed in one of the best medical journals. the study you cited is quite small and preliminary, and at most, it warrants a closer second. i wonder how am i the nitpicker when i prefer to look at the big picture, but if you insist: the study you posted looked at the phenomenon of tolerance to the effects of ginkgo in 40 subjects, so one wonders if said tolerance would decrease if one stops taking it for any amount if time. and how often are you dosing yourself with ginkgo? it's found that boosters like caffeine, when taken for awhile, will actually depress the cognitive baseline to a lower level (and thus, people need caffeine just to return to normal functioning level every morning - and if you've ever met a caffeine junkie in the morning before his/her cuppa, you'd know what i mean), and i wonder if ginkgo shows a similar effect of dependence. and if its short term effect holds up in larger, better studies, can it still be meaningfully called a supplement? i won't hold my breath, ginkgo was shown to be effective for preventing and treating dementia in its earlier, smaller studies too but look at what happen when it's re-examined on a grander, more rigorous scale. nothing. that's typical of any unproven drug. personally, i'm more interested in research into ginkgo's anticoagulatory compounds. anticoagulants like warfarin has an incredibly wide application in medicine.