Friday, April 29, 2011

I support EU ban on non-evidence-based medicine is an international organization which mounts civil pressure for causes regarded by its leadership as good. Some of them are good indeed, such as the no-fly zone in Libya. However, as often happens with activists, they also advocate things that anyone of the meanest understanding would call foolish at best. See what I found in my Inbox today:

"EU: 3 days to save herbal medicine!
Dear friends,
In 3 days, a new EU directive will ban much of herbal medicine, denying us safe remedies and feeding the profits of big pharma. Let's raise a massive outcry to push the Commission to fix the Directive, and our national governments to refuse to implement it. Let's get to 1 million voices to save herbal medicine:
In 3 days, the EU will ban much of herbal medicine, pressing more of us to take pharmaceutical drugs that drive the profits of big Pharma.
The EU Directive erects high barriers to any herbal remedy that hasn't been on the market for 30 years -- including virtually all Chinese, Ayurvedic, and African traditional medicine. It's a draconian move that helps drug companies and ignores thousands of years of medical knowledge...

It's hard to believe, but if a child is sick, and there is a safe and natural herbal remedy for that illness, it may be impossible to find that remedy.
On May 1st the Directive will create major barriers to manufactured herbal remedies, requiring enormous costs, years of effort, and endless expert processes to get each and every product approved. Pharmaceutical companies have the resources to jump through these hoops but hundreds of small- and medium-sized herbal medicine businesses, across Europe and worldwide, will go bust...

There are arguments for better regulation of natural medicine, but this draconian directive harms the ability of Europeans to make safe and healthy choices. Let's stand up for our health, and our right to choose safe herbal medicine."

I am omitting the lines directing the reader to the online petition. If you want to sign it, you can easily find it by a Web search.
I have bashed the EU bureaucracy on numeral occasions on this blog and elsewhere, but I support it whole-heartedly in this case. It is high time to stand for evidence-based medicine and to ban all snake oils being sold us under the label of "traditional medicine" in pharmacies. There is no such thing as "thousands of years of medical knowledge" - the threshold when medical knowledge advanced enough to bring more good than harm is probably the turn of the 20th century, and it was passed only in the West. If someone thinks that a particular "traditional" remedy works for a certain condition, he has to prove his case to the appropriate drug administration, as with any other proposed remedy. I do not care that the "small and medium-sized herbal medicine businesses" may not have the resources for this, and I do not think their lack of resources is an excuse to let them sell whatever snake oil they wish without proving its efficacy and even safety. If they cannot do their business properly, let them file for bankruptcy, the sooner the better. And please, if you want me to hate Big Pharma which has saved my life more than once, give me at least one rational reason why Big Pharma must be hated, except that it works for profit (as if the snake oil salesmen work pro bono publico).
There is a myth among foolish people that traditional, "natural" and particularly herbal medicine is both effective and safe. To begin with, a remedy that is both effective and safe is a Holy Grail. There are a number of placebos that are safe but not effective, plus a number of effective drugs that are generally not quite safe but, if properly used, have benefits far exceeding the risk. Traditional medicine generally relies on placebos. However, we should not assume that it is always safe. Numerous plants contain potent toxins (take just the fact that Socrates was executed by herbal poison). Some of these toxins have found their application in evidence-based medicine and are being sold by Big Pharma; for the rest, you have only the toxic effect without any proven therapeutic effect. To make things worse, for many traditional Eastern remedies the natural toxicity of plants is not enough and they contain also well-known chemical toxins such as heavy metals (Orac and Skeptico have blogged about this).
Some hardline supporter of individual freedom may argue that consumers should have the right to make choices, even if they are not "safe and healthy". I disagree. A consumer should not be forced to be on a permanent alert in order to avoid buying useless and dangerous things - at least not in civilized Europe. Moreover, while responsible adults could at least in theory make their choices, there is no way to prevent parents from pushing placebos and poisons down the throats of their poor defenceless children. The Avaaz letter particularly stresses the need to keep "safe and natural herbal remedies" available for sick children. I even know parents who treat their own illnesses by effective evidence-based drugs but, when their children are ill, give them traditional medicine because of concern about the side-effects of drugs.
So let's hope that the ban will be enforced and EU pharmacies in the future will sell us only remedies that actually help, according to the best available knowledge.

Thursday, April 21, 2011

Questions to the "green" Libyans

On Apr. 14, published a post titled Video: State TV claims to show Gaddafi touring Tripoli this afternoon. A "green" Libyan (i.e. a Qaddafi supporter) joined the discussion to put his twopence. Here is a quote from his comments:

"KADDAFI IS A REAL LEADER! AND SIMPLE PEOPLE LOVE HIM! MILLIONS OF LIBYANS LIKE HIM!... I know that Kaddafi makes a lot of mistakes! Specially last years when his son Saif al Islam brought to him the list of reforms he was planning to make but Kaddafi canceled all of them! Also it was no free press. But you have to understand that he is a man of ideology and he was opposing USA! The most powerful country of the world..."

My own comments in that discussion aren't worth a copy-paste, because this guy pushed up my blood pressure and I called him names. This is not a good thing to do in any discussion, though he deserved it well. However, another commenter with the simple nick "a" (the same one who visited my previous post) made better contributions. I am giving a part of them below, advising all my readers - and especially the "green" Libyans - to have a look.

"You know what? I am from Germany. I know this kind of stupid babble from some of our delusional grandfathers, -mothers... In Gaddafi, we only recognize a very poor Mini-Hitler... The “simple people” you speak of, he just betrays them. They are human material for him, he will not shed one tear if you die... It's your own decision: Be part of a past that is despised, attach yourself to a murderer without honor. End up in history's dustbin together with him. Or be part of the future of Libya.
Gaddafi... claims he made a revolution in Libya, and brought direct democracy, and spread the wealth of the oil money. Sounds good. But it is not the truth:
What kind of revolution is this, where only one family rules for 40 years and every opposition voice is silenced? It's like a monarchy. 
What kind of “direct democracy” is this, where citizens cannot even express their demand that after 40 years they want another government?
Why is no free press and no critizism allowed? If Gaddafi's ideas were so good, he needn't be afraid of competition with other ideas.
What happened to all the money, where is it, why do the Gaddafis own billions and spend Libya's money as they please?
What kind of real revolutionary would buy mercenaries and have them shoot at his own people? Even Mubarak stepped aside, Ben Ali quickly took an airplane. Gaddafi chose to kill people who do not agree to him. This is unacceptable, no matter what ideology he claims behind this.
And I am sick of people putting ideology or religion over human lives and the self-determination of others. Saif had the chance of reforming things, he was weak and lazy, and chose to have lavish parties in Europe instead. He had his chance, now it's Game Over.
But. At least you try to argue, and I try to understand you. That's a good start, isn't it? Instead of hatred. You have already risen above your dictator by doing that.
If you think there is anything good in Gaddafi's ideas, you will always be able to stand up for such ideas and raise awareness for them in a real democracy. Found a party that supports direct democracy and spreading Libya's natural wealth – I have no problem with that. But stop supporting a dictator who will impose only his own ideas over 6 million people and kill anyone who does not agree. Can’t you see that this is fundamentally wrong?"

Thursday, April 07, 2011

Free world coming to rescue

My last post about the situation in Libya is dated March 17. So much has happened since then. On that same evening, the UN Security Council approved a resolution authorizing a no-fly zone and "all necessary measures to protect civilians". The draft was prepared by Lebanon, backed by France and Britain and approved by a total of 10 states. Five states abstained: China, Russia, Brazil, India and Germany. Bravo to Russia and China - they could impose a veto but they didn't. As for the other 3 - let me not call names but I don't want to hear a word about any of them becoming a permanent Security Council member in the foreseeable future, OK?

By the way, my Bulgaria also behaved in a shameful way. Our Prime Minister Borisov said that the intervention in Libya was a "reckless adventure" (avantyura) and he would never send Bulgarian military pilots to join it - as if anyone would want our Russian MiG planes that couldn't be reliably distinguished from Qaddafi's air force. Happily, Bulgaria is not in the Security Council now, so few people noticed; but we Bulgarians have to remember this next year when we go to the ballots.

Qaddafi declared a ceasefire almost immediately after the resolution, but it was only for external consumption. His troops, on the contrary, intensified fighting in an apparent attempt to win before anyone managed to implement the resolution. I remember how in the morning of March 19 I saw Benghazi shown in the Wikipedia map with the yellow colour of "ongoing fighting", and Al Jazeera reported that Qaddafi's tanks were entering the city.

Mohammed Nabbous was ready to meet them. This 28-yr-old blogger and citizen journalist had founded Libya Al-Hurra (Free Libya) TV in the early days of the protests. With his wife pregnant for first time, he had every justification to take shelter behind a thick wall. However, he decided to report what was going on in order to expose Qaddafi's lies to the world. As he was recording the attack with his cellular phone, he was shot in the head. Either Qaddafi's soldiers realized what he was doing, or - more likely - they simply regarded every human-shaped object as a target. Mohammed died several hours later.

Meanwhile, the coalition formed to implement the UN resolution finally stepped in. The first strike came from a French plane. Benghazi was saved, but in Musrata and some smaller towns the situation is still dire, people have ran out of everything and are being murdered by Qaddafi's mercenaries every day. I have no idea how this will end, I hoped for a swift and happy ending, but apparently things are not proceeding quite this way.

I am not going to describe the war in detail, let me just mention that I am disappointed both by the Coalition and by the rebel army. It seems, unfortunately, that the "Happy Arab" is right to call the operation "a mess" and "likely the most mismanaged operation in NATO's history". Indeed, this could be expected after the bitter experience of Kosovo, Afghanistan and Iraq made Western powers so reluctant to intervene in Muslim countries that now everyone is trying to hide behind his allies' backs. However, this is nothing compared to the armed forces of the Libyan opposition. Most of the foot soldiers are civilians turned into combatants overnight. They lack weapons, training and discipline. The commander, General Abdul (Abdel) Fatah Younis, was Qaddafi's interior minister until February. Let's leave aside his involvement with the regime - it is clear that you cannot begin anew and appoint 18-yr-olds to all positions. What is more worrying is his military experience and expertise, or the lack of it. Nobody says whether Gen. Younis prior to February 2011 had ever fought an enemy actually able to shoot back. We do not know anything about his military education and service, if any. He is not trying to build infrastructure of defence, so Qaddafi's tanks roll, roll, roll gently down the roads as they wish and advance hundreds of kilometers per day. Instead of thinking how to retake the lost territory, Gen. Younis is delivering press conferences, telling how NATO is a problem rather than an asset for not fighting all the Libyans' battles for them. He is apparently the sort of buraucrat who, instead of doing his job, will produce a brilliant explanation why it is your fault that his job has not been done. I hope somebody soon reappoints him to organize the traffic lights or do some other job where he would be less harmful.

The good news is that my blogger friends in Tripoli gave a sign that they are OK.

Let me finish with a quote from the post Libya and the International Moral Question by Libyan-British writer Ghazi Gheblawi: "Libya didn’t come into existence as a nation until after 1943 when the allied forces of WWII occupied the country, and with the help of many nations and the newly formed United Nations, declared its independence in 1951. It was through the help of the international community that Libya was liberated from the horrors of Italian colonialism, and as the Libyan representative to the UN said few weeks ago on the floor of the security council ‘Libya was established through a United Nations resolution, now once again it needs the United Nations help’." Let's hope this help will become more effective.

Saturday, April 02, 2011

ADHD quackery in scientific journal, again

I was not intending to blog on scientific themes these days, but sometimes duty calls. Carelessly browsing the Web, I suddenly found a link that switched all my alarms on. Briefly, it refers the reader to an article by Pelsser et al. titled Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial and published in the February issue of the Lancet. I have no access to the full text, but the abstract tells us that from 100 children with ADHD aged 4-8, a randomly chosen half were left as controls and the other half were put for 5 weeks on a restricted elimination diet. There is no mention what this diet was, and the results are described in such a messy way that it is impossible to understand exactly what is claimed. Happily, the same Web site directs the reader also to a LA Times article by Jill Adams discussing the study. It informs us that the restricted diet consisted of "short list of ingredients that included water, rice, turkey, lamb, lettuce, carrots, pears and other hypoallergenic foods". "At the end of the study, 64% of the kids on the limited diet showed significant improvement on a variety of standard rating scales. Though the initial scores for all of the kids in this group put their ADHD symptoms in the moderate-to-severe range, after the diet intervention their symptoms were classified as either mild or nonclinical."

Three years ago, I wrote a post titled I am skeptical about food additives - hyperactivity link. It questioned another publication in the Lancet claiming that "artificial food colous and additives" were causing ADHD symptoms. If you are interested in the subject, you can read that old post, too. In the present post, I will not try to keep the same line of composed argumentation. I am furious and not going to hide it.

Are you worried about the quality of the food you consume? Are you anxious to obtain healthy food and to give it also to your family members? And if so, what are you thinking of yourself? Perhaps you think you are a responsible person and everybody should be like you. Unfortunately, this has nothing to do with the truth. You are victim of a disorder which turns your life into hell and endangers your physical health - and that of any child with the poor luck to be under your care. The obsession with healthy foods is a disorder called orthorexia by some psychiatrists. It is not an official diagnosis but is easily accommodated under the umbrellas of eating disorders and obsessive-compulsive disorder. My observations show that many people with real or imagined health problems, and particularly parents of chronically ill and disabled children, develop orthorexia. They swear that their or their child's condition has been caused by unhealthy eating and is currently ameliorated by some particular "healthy" diet. Here, "healthy" diet typically means one that, if given to convicted felons, will lead to prison riots and charges with inhumane treatment. The list of publications of the first author of the study in question - Dr. Pelsser, is not too impressive but clearly shows that she has orthorexic obsession about ADHD.

People of science have a saying that extraordinary claims require extraordinary evidence. Any claims for successful treatment of a socially important condition are extraordinary, and so are any claims based on an insane working hypothesis. If you ask me what hypothesis I call insane, I'll answer that I cannot give a definition but the hypothesis of foods causing abnormal behaviour is a brilliant example.

I would ask again, as I did in my old post, why wasn't the study done first on animal models? And if someone thinks animal models of ADHD are not satisfactory (i.e. fail to produce the crazy results wanted and expected by the researcher), why wasn't the experiment done first on adult volunteers with ADHD? Maybe because no adult, except some patients with much more severe diagnoses than ADHD, would agree to participate in such a study; but parents eager to streamline their disabled or just different children easily fall into the trap of wanting the child "either cured or dead". In the LA Times article, Dr. Pelsser says, "The children said they felt so different, as if some mad thing in their head wasn't there anymore". Eh well, if your 5-yr-old experimental subject talks of "some mad thing in his head", you should bury your own head in your hands, then abort the study and pray that your institution's ethical committee never hears of this. Has the whole world gone crazy?

The Lancet is a top scientific journal with an impact factor of 30 (for lay people - this is sky high). Such a journal, especially if specialized in clinical medicine, is expected to have a take-no-prisoners peer review that would not let any crap sneak in. However, this journal 13 years ago published the disastrous (now retracted) study linking the MMR vaccine to autism, it published the mentioned article linking food additives to ADHD 4 years ago, and has now published another nonsense about ADHD. When will the respectable Lancet raise its bar for quacks and stop shouting "Fire!" in crowded theaters?