Do doctors treat pensioners with snake oil?

A cheering and optimistic story about dementia at HealthInsightUK.org.When Obhi Chatterjee’s dad was diagnosed, Obhi set about researching the most plausible supplements and diets to help him.

The piece tells you what they are and why they might work and also has useful advice for anyone wanting to follow his example. Two of the biggest obstacles are – shamefully – the Alzheimer’s charities and carers provided by agencies who view supplements and odd diets with suspicion. Obhi describes ways of getting round both of them.

It’s a heartening story because Obhi’s dad is now more alert than he was a year ago. That’s in striking contract to the more familiar story of sad and distressing decline. But it also raises a much wider issue about how do we treat people with chronic diseases when the drugs are either unavailable or don’t seem to work very well.

Just grin and bear it?

If you decide to try a range of non-drug treatments – supplements, a specific diet, alternative therapies – the response from self-styled skeptics is all too predictable. Any form of treatment not stamped with the approval of a pair of randomised controlled trials (RCTs) is dismissed as “woo” or quackery. So your only logical option is to grin and bear it. Or, in the case of Alzheimer’s, to watch a relentless decline. Obhi had already done that with one relative and didn’t fancy a repeat.

The skeptics seem unable to accept that this is not an irrational choice. People do it either because they have tried what is on offer from conventional medicine and it hasn’t worked or because there is nothing else.

If there is evidence for elements of the non-drug approach, it is likely to be variable, not least because the funding available is tiny. So is that the final word? If you want your treatment to come with added science it’s an RCT or nothing?

A revealing irony

That seems wrong for so many reasons, not least because of the many all too familiar failures of the RCT. One of the most important and hopeful elements in Obhi’s tale is that, as someone with a background in statistics, he is all too aware of the issue of evidence and the need to find a way of assessing the overall effect his father’s non-drug package. His report on the opportunities the internet offers to do this is very promising.

The revealing irony here is that the challenge facing Obhi attempting to assess the risks and benefits diet, supplements and the rest is exactly the same as that facing doctors following the official RCT approach to treating elderly people. In both cases there is no proper evidence that what they are doing works. Both are practicing “woo”.

This is because as we get older we are likely to be put on more drugs for prevention as our risk getting ill rises and on more drugs for actual disorders – arthritis, high blood pressure, diabetes and so on. Many people in their seventies are taking a dozen pills or more.

Snake oil in care homes?

But even though each of individual drug will have been tested in RCTs, the actual combination that you, I or anyone else gets won’t ever have been tested. There are no RCT guidelines to help doctors managing polypharmacy, just as there aren’t for non-drug therapists; both have to rely on clinical judgement, experience and a variety of different sorts of evidence.

So if the skeptics were to apply their own narrow principles consistently they would conclud that all the elderly people in care homes around the country were getting a mixture of woo and snake oil. Yet curiously we don’t see them campaigning for homes to be shut down.

Ageing baby boomers will increasingly be facing the challenge of avoiding or treating metabolic disorders such as Alzheimer’s, cancer and diabetes. Drugs have limited effectiveness but we haven’t developed effective ways of assessing the effectiveness of lifestyle diet and supplement packages. Obhi’s optimistic explorations seem greatly preferable to the sneers of the sceptics.

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Comments

  1. mikecawdery says:

    One of my interests is Alzheimer’s (AD). Dr Lorin wrote a book “Alzheimer’s: Solved”. He referenced some 3,000 refereed articles and found that low cholesterol was a feature as were statins.

    As an example of the “statins help AD publications: Dement Geriatr Cogn Disord 2009;28:75–80 DOI: 10.1159/000231980 Can be downloaded in full.
    Midlife Serum Cholesterol and Increased Risk of Alzheimer’s and Vascular Dementia Three Decades Later. Alina Solomon et al.

    In tables 2-4 change the row titles (cholesterol levels) to the US recommended treatment. This does not affect the numbers or statistics but certainly provides an alternative interpretation!. Incidentally, the patients treatment in the subsequent 2-3 decades is NOT GIVEN. Patient records without therapeutic details – UNBELIEVABLE. Clearly treatment details were redacted – an insurance company would not want to upset Big Pharma when they have to negotiate drug prices!

    I therefore did a quick 2×2 Chi-square test using Table 2 of the paper using both the combined and separately the AD and VaD numbers using guidelines on therapy, i.e. cholesterol blood levels over 200 and over 239 mg/dl should be treated with statins while cholesterol levels less than 200 mg/dl would not usually be treated. The results are shown below in the table. As the results were significant (p = 0.0049) it is quite clear why the data on therapy was NOT available; Big Pharma would certainly not approve of results that implicated statins as a possible cause of Alzheimer’s and VaD.

    • Cooking in foil, very common in the past few decades, has also been linked to the rise in Alzheimer’s. Read up on it and it makes sense. Clearly in moderation no doubt it is not an issue but a lot of people use foil a lot in cooking.

      I was also horrified to see chefs boiling food in plastic wrap. Admittedly not so common but none of it good. And then there is the use of microwaves and foods cooked and reheated in plastic. Not to mention bottled water and food in plastics which may well provide even more toxins as they bleed when heated, which food often does during transport and storage in warm seasons.

      • mikecawdery says:

        Seneff S, et al, Nutrition and Alzheimer’s disease: The detrimental role of a high carbohydrate diet, Eur J Intern Med (2011), doi:10.1016/j.ejim.2010.12.017
        This lays some of the trouble on carbs, In turn carbs lead to diabetes, high insulin and Type 3 diabetes aka AD

        Dement Geriatr Cogn Disord 2009;28:75-80, DOI: 10.1159/000231980
        Mentioned above.
        !n 1960s the incidence of AD was circa 1 in 50 in the 85+ age group; it is now expected to be 1 in 2. Again, this ties in with cholesterol lowering and highcarb/lofat advice.

  2. Jane Priceman says:

    Well done Obhi and all the others out there who do not buy the usual line. There is masses that can be done.
    I would like to recommend Patrick Holford’s Brain Bio Clinic. This clinic provides an online 15 minute test that anyone can do to test there potential for dementia but crucially provides a tailored nutritional approach for anyone either already diagnosed or who would want to make sure they do there best not to develop it.
    Also as a practicing homeopath I would like to echo rosross’s comment about homeopathy.
    I wrote a while back about how my partner fully recovered from a lung infection using homeopathy when 4 months in hospital and antibiotics didn’t work and the same is true for demetia problems.
    People do not understand, even in the alternative field, the model and depth at which homeopathic medicines can work and there are many good remedies for brain function.
    It was observed over a hundred years ago, in homeopathy, of the relationship between heavy metals and dementia for example.
    I did many courses on nutrition for my own health before I became a homeopath and the combination of the two is very profound. I am 60 and have not had to visit a doctor in over 35 years.
    It is always worth trying.

    • There is no doubt that those who begin to use Homeopathy cannot but be impressed by its ability to deal with symptoms along the way and in the doing, to honour and work with the minor so it does not become major. There are no guarantees in life ever but there is also no doubt that ensuring a nutritious, natural diet as much as possible and utilising non-harmful, non-Allopathic medicine and reserving any recourse to conventional modern medicine for absolutely necessary circumstances, of which there are few, is more conducive to general good health.

      I believe the skills areas of modern medicine are limited to surgery and trauma although on both counts far less harm would be done if Homeopathy were used alongside such treatments, and/or acupuncture or herbal instead of pharmaceuticals.

      The first medicine is food. The best medicine is food. Beyond that qualified guidance is important and never more so than with supplements which are really a variation on the Allopathic theme of pop a pill. I believe that self-prescribing supplements and herbals does much harm although nothing does as much harm as pharmaceuticals.

  3. Let us also be reminded that “skeptics” for the very most part, have zero health experience and often make a good living out of branding natural therapies as ‘woo’. Some are decidedly dodgy. Brian Dunning was up until recently a key person in the fake grassroots ‘skeptic movement’ with his skeptoid podcast.
    As it turns out Dunning, who called alternative therapists frauds, turned out to be the real fraudster. Dunning was sentenced to serve fifteen months in prison for receiving between $200,000 and $400,000 in fraudulent commissions from eBay just this month. One has to wonder with the endless trolling they do and their affiliations with Amazon and other marketing and dodgy ‘consumer groups’-like Sense about Science, where the funding and GMO/pharma connections are questionable-are skeptics really ‘the concerned individuals’ they make themselves out to be?

  4. One cannot be horrified to see the ‘little boxes full of ticky tacky’, i.e. drugs, which so many seem to begin to collect from the age of fifty and which, by seventies and beyond, is a regular magical pill ride through the rest of one’s life. How on earth can anyone believe that consuming up to a dozen medications can be good for anyone? How on earth can science/medicine justify such experimentation on the elderly who are more likely to do what they are told and certainly will be as the drugs keep adding up. The drug for this, the drug for that the drug for the side-effects and then another drug for the drug for the side-effects for its side-effects…. and so it goes, medical madness.

    What is truly criminal is that a nutritious diet, not the slop and swill most get fed in hospitals and aged-care facilities, along with non-Allopathic medicines like Homeopathy, Kinesiology, Acupuncture, Herbal and supportive methodologies like Reiki, Aromatherapy, Massage, Tai Chi, Yoga etc., could and would reduce those drugs to the absolutely necessary range – maybe one or two, and increase the health of people enormously.

    Chronic and serious disease is on the rise the more medicine medicates, vaccinates, interferes, tests, probes, prods so if Allopathic medicine is as good as it believes it is, why? Why too is iatrogenic, mostly from medication, now the third biggest killer in the US and rising everywhere?

    We are at the point where the safest thing you can do is stay away from doctors unless absolutely necessary – a last resort, not a first, because all they can do is wield the knife or prescribe the pill.

    This era of fear-based, pharma-driven, profit-driven maybe medicine will come to be seen as one of the worst eras in medical history and never more so than for the very old and the very young.

    • Bravo for that comment rosross! As a retired medical transcriptionist I can recall typing lists of prescribed drugs and indications for use to be included in patients’ charts. It was not unusual for a patient to be on 6 to 8 medications concurrently (often more) – each one to counter-act the ASEs of the others. Costly and harmful, especially for the elderly and ill. .

  5. ecologist says:

    As someone who has been researching Alzheimer’s disease for ten years as a non-scientist and who along with my sisters used aromatherapy to give our mother a better life with Alzheimer’s disease, I must give a profound thank you to Obhi and you. I think when people realize the truth they will put pressure to change the current system of funding and research on Alzheimer’s disease and other forms of dementia.

    My experience in the United States mirrors that of Obhi’s in Great Britain. I have contacted the Alzheimer’s Association with evidence that certain natural products can be used to effectively treat Alzheimer’s disease and their response is invariably the same: they will only accept evidence from phase three clinical trials and they do not want to give their clients false hope. My last visit to the local office involved a director politely listening to the evidence and then saying the science is not there and handing me a flier for the Walk to End Alzheimer’s Disease. Neither the Alzheimer’s Association nor the National Institute of Health will accept any “solution” other than a drug for the disease. And they will continue to support the use of drugs that have proven to be far less effective than various antioxidants.

    I recently exchanged emails with a researchers at one of the few U.S. labs studying natural products to treat Alzheimer’s disease. He said many natural compounds similar to the ones that I have suggested have been successful in mice, but that the lab cannot get the funding necessary to conduct large-scale clinical trials. And thus the sad fact that millions of people were going to die because the compounds could never be fully tested.

    So the Alzheimer’s Association will only accept phase three clinical trials, but it won’t spend any of its multiple-million dollar budget to support research into natural products that have worked in labs, in mice, and most importantly in human beings in both case studies and in human clinical trials. I will just briefly cite the results regarding the types of compounds that have successfully treated Alzheimer’s disease and other forms of dementia

    Eugenol in rosemary essential oil and geraniol in lemon essential oil (for cognition), linalool in orange and lavender essential oils (for relaxation)

    Psychogeriatrics. 2009 Dec;9(4):173-9. doi: 10.1111/j.1479-8301.2009.00299.x.
    Effect of aromatherapy on patients with Alzheimer’s disease.
    Jimbo D1, Kimura Y, Taniguchi M, Inoue M, Urakami K.

    RESULTS: All patients showed significant improvement in personal orientation related to cognitive function on both the GBSS-J and TDAS after therapy. In particular, patients with AD showed significant improvement in total TDAS scores. Result of routine laboratory tests showed no significant changes, suggesting that there were no side-effects associated with the use of aromatherapy. Results from Zarit’s score showed no significant changes, suggesting that caregivers had no effect on the improved patient scores seen in the other tests.

    CONCLUSIONS:
    In conclusion, we found aromatherapy an efficacious non-pharmacological therapy for dementia. Aromatherapy may have some potential for improving cognitive function, especially in AD patients.

    Eugenol and ferulic acid (for behavior) in a tincture of lemon balm

    Melissa officinalis extract in the treatment of patients with mild to moderate Alzheimer’s disease: a double blind, randomised, placebo controlled trial
    S Akhondzadeh, M Noroozian, M Mohammadi, S Ohadinia, A Jamshidi, and M Khani

    Results: At four months, Melissa officinalis extract produced a significantly better outcome on cognitive function than placebo (ADAS-cog: df = 1, F = 6.93, p = 0.01; CDR: df = 1, F = 16.87, p < 0.0001). There were no significant differences in the two groups in terms of observed side effects except agitation, which was more common in the placebo group (p = 0.03).

    Conclusions: Melissa officinalis extract is of value in the management of mild to moderate Alzheimer's disease and has a positive effect on agitation in such patients.

    Ferulic acid in rice bran and Angelica archangelica (Feru-guard)

    Geriatr Gerontol Int. 2011 Jul;11(3):309-14. doi: 10.1111/j.1447-0594.2010.00687.x. Epub 2011 Jan 28.
    Effect of ferulic acid and Angelica archangelica extract on behavioral and psychological symptoms of dementia in frontotemporal lobar degeneration and dementia with Lewy bodies.
    Kimura T1, Hayashida H, Murata M, Takamatsu J.

    RESULTS: Treatment with Feru-guard led to decreased scores on the Neuropsychiatric Inventory in 19 of 20 patients and significantly decreased the score overall. The treatment also led to significantly reduced subscale scores on the Neuropsychiatric Inventory ("delusions", "hallucinations", "agitation/aggression", "anxiety", "apathy/indifference", "irritability/lability" and "aberrant behavior"). There were no adverse effects or significant changes in physical findings or laboratory data.

    CONCLUSION:

    Feru-guard may be effective and valuable for treating the behavioral and psychological symptoms of dementia in frontotemporal lobar degeneration and dementia with Lewy bodies.

    Ferulic acid, syringic acid, vanillic acid, p-coumaric acid, and maltol in panax ginseng

    Improvement of Cognitive Deficit in Alzheimer’s Disease Patients by Long Term Treatment with Korean Red Ginseng

    Jae-Hyeok Heo,1 Soon-Tae Lee,2,3 Min Jung Oh,2,3 Hyun-Jung Park,2,3 Ji-Young Shim,2,3 Kon Chu,2,3 and Manho Kim2,3,*

    Abstract
    A 24-week randomized open-label study with Korean red ginseng (KRG) showed cognitive benefits in patients with Alzheimer’s disease. To further determine long-term effect of KRG, the subjects were recruited to be followed up to 2 yr. Cognitive function was evaluated every 12 wk using the Alzheimer’s Disease Assessment Scale (ADAS) and the Korean version of the Mini Mental Status Examination (K-MMSE) with the maintaining dose of 4.5 g or 9.0 g KRG per d. At 24 wk, there had been a significant improvement in KRG-treated groups. In the long-term evaluation of the efficacy of KRG after 24 wk, the improved MMSE score remained without significant decline at the 48th and 96th wk. ADAS-cog showed similar findings. Maximum improvement was found around week 24. In conclusion, the effect of KRG on cognitive functions was sustained for 2 yr follow-up, indicating feasible efficacies of long-term follow-up for Alzheimer’s disease.

    Nutr Neurosci. 2012 Jul 9. [Epub ahead of print]
    Heat-processed ginseng enhances the cognitive function in patients with moderately severe Alzheimer's disease.
    Heo JH, Lee ST, Chu K, Oh MJ, Park HJ, Shim JY, Kim M.

    RESULTS: The treatment groups showed significant improvement on the MMSE and ADAS. Patients with higher dose group (4.5 g/day) showed improvements in ADAS cognitive, ADAS non-cognitive, and MMSE score as early as at 12 weeks, which sustained for 24-week follow-up.

    DISCUSSION:
    These results demonstrate the potential efficacy of a heat-processed form of ginseng on cognitive function and behavioral symptoms in patients with moderately severe AD.

    Curcumin in turmeric

    Effects of turmeric on Alzheimer's disease with behavioral and psychological symptoms of dementia
    Nozomi Hishikawa, Yoriko Takahashi,1 Yoshinobu Amakusa,2 Yuhei Tanno,3 Yoshitake Tuji,4 Hisayoshi Niwa,5 Nobuyuki Murakami,6 and U. K. Krishna7

    Abstract
    We describe here three patients with the Alzheimer's Disease (AD) whose behavioral symptoms were improved remarkably as a result of the turmeric treatment, which is the traditional Indian medicine. Their cognitive decline and Behavioral and Psychological Symptoms of Dementia (BPSD) were very severe. All three patients exhibited irritability, agitation, anxiety, and apathy, two patients suffer from urinary incontinence and wonderings. They were prescribed turmeric powder capsules and started recovering from these symptoms without any adverse reaction in the clinical symptom and laboratory data. After 12 weeks of the treatment, total score of the Neuro-Psychiatric Inventory-brief questionnaire decreased significantly in both acuity of symptoms and burden of caregivers. In one case, the Mini-Mental State Examination (MMSE) score was up five points, from 12/30 to 17/30. In the other two cases, no significant change was seen in the MMSE; however, they came to recognize their family within 1 year treatment. All cases have been taking turmeric for more than 1 year, re-exacerbation of BPSD was not seen. The present cases suggest a significant improvement of the behavioral symptoms in the AD with the turmeric treatment, leading to probable benefit of the use of turmeric in individuals with the AD with BPSD.

    I have posted these studies several times on various websites and the supposed scientific minds and skeptics always have the same response: You are not a scientist, the studies are too small, some of them were not-double blinded, the results could have been by chance, it's the placebo effect. These scientists readily throw out insults (my favorite was Lane are you just an idiot or a complete imbecile) and one red herring after another. But here is the basic truth: the same type of compound has produced the same beneficial results time and time again. People with dementia may have better days and worse days, but they do not improve over a long period of time by chance. Look at the compounds and how they partially reverse oxidative stress in the brain and you understand how they work. To all the Alzheimer's charities and to most of the Alzheimer's research organization in the Western world: If you don't believe the results fund larger clinical trials. But you won't because you are afraid that they may actually work and then where would all the pharmaceutical companies who have backed you all these years be. And where would you be saying that all you wanted to do was to find a cure for Alzheimer's disease.

    • May I also suggest you explore Homeopathy as a treatment. There is some interesting research out there already and the good thing about Homeopathy is that it does no harm and it can still work even if medication is being taken because it operates on the material but at an energy or frequency level.

  6. Perhaps your best piece yet! Thanks for addressing the need for further use & study of alternative health care choices.

  7. Laurie Willberg says:

    Let us be reminded that “skeptics” are not healthcare providers and have no responsibility for patient outcomes. Let us also be reminded that the purpose of evidence-based medicine is to inform health care providers of treatment options, not to provide fodder for hobbyist armchair critics (most of whom have never even taken a first aid course) to supposedly “assess” the validity of medical treatments.

    • mikecawdery says:

      Evidence based medicine? Unfortunately, when Big Pharma is involved, the evidence is frequently highly selected and biased. Please read Dr Michel de Lorgeril’s book “Cholesterol and statins: Sham science and bad medicine”.

      To add to this, there is the work of Prof. R.L. Smith, who in books (Diet, blood cholesterol and coronary heart disease: a critical review of the literature. Vector Enterprises Inc., Vol 1, 1989; Vol 2, 1991. The Cholesterol Conspiracy: Warren H. Green Inc, St Louis 1991 and American Clinical Laboratory, Nov. 1989 pp.26-33) was highly critical of the work on cholesterol, to quote “It is virtually impossible not to recognize that many researchers routinely manipulate and/or interpret their data to fit preconceived hypotheses, rather than manipulate hypotheses to fit their data. Much of the literature, therefore, is nothing less than an affront to the discipline of science”. Dr John Ioannidis# has, some years later confirmed this view with his finding that many medical research reports are flawed through study design, selection of data, misuse or misinterpretation of statistics, or bias (JAMA. 2005;294:218-228; PLoS Med 2(8): e 124; Arch Gen Psychiatry. 2011 Apr 4.; J Clin Epidemiol. 2011 Mar 29). This is a serious indictment which is confirmed by some of the massive fines imposed by the FDA on Big Pharma companies (none by the MHRA or EMA). That these problems have been largely ignored by the medical establishment is, regrettably, even more serious in my opinion.

      In short while the concept of “evidence based medicine” is good, in practice it is severely marred by bias, selection, data manipulation etc., and pure MONEY and STATUS values, not scientific integrity.

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