Of course, those who are alergic to bees... they're rather SOL

Atkins is of course Exhibit A in any modern endictment of persistent dismissal of this sort. I always think of the movie Sleeper, with Woody Allen where he wakes to find himself in a new century and all the conventions of "health" foods and practices are turned on their heads. Will these new conceptions likely be de-bunked in turn? Hmmm.

The hardest part of the research, the reason it wasn't undertaken until now, was breeding the non-venemous bees to use as placebo in the double-blind study.

Interesting article. For 4 years I studied small conductance calcium-activated potassium channels (SK channels). They are specifically blocked by apamin (from bee venom). SK channel blockade leads to greater frequncy of neuronal transmission -- demyelination slows down the electrical conductance along a neuronal pathway. It does make sense that blockade of SK channels can alleviate some MS symptoms! Cool! Too bad I work on retinal ischemia now.

I had a patient with MS and bee venom worked great for her. She had to undergo desensitization treatments prior as she was allergic to bees. She then could have more frequent bee venom treatments. It helped greatly with her large muscle, muscle spasms--which significantly improved her quality of life.

I agree with you Dean--if it works for someone, it works and should be made available. One person's poison is another's medicine. Chemo for example...

Great link.

I am not a stats guy, but it seems to me that each anecdote is a data point. Accumulate enough of them, and you will have a sample size large enough to be meaningful. You probably need to try and figure out more about the sample, but it's worth investigating...

Well, anecdotes are data points but unless you are extremely careful in how you compile them you don't have much. And even then, you don't have truly rigorous science unless you can double blind with a control group.

Of course, not everything in science or medical technology allows for that. To the best of my knowledge, for example, no one's ever done a double blind study to verify that appendectomies save lives. After all, to do one, you'd have to have a control group of people whose appendices you allowed to burst....

One of the reasons why "alternative" therapies are so often "dismissed" is that no one seems to be willing to do a good study on so many of them. And I don't buy that "that's 'cause there are no big bucks to be made on a non-patentable plant" argument. You can't patent bees, but you can patent your extraction method, etc.

And anyway, there's no such thing as alternative/conventional, eastern/western etc. There is only "works and is safe" vs "doesn't work/dangerous". The herbalist doesn't give you a vial and say "Here, take this herb. It doesn't work." He is implying that it DOES work, and if it does, then he should be able to show me. That has been done with saw palmetto for prostate disease, garlic for cholseterol, and, I believe, black cohosh for menopausal symptoms. For that reason I can, in good conscience, recommend them to my patients. If the guy pushing an "alternative" therapy can't show that it's been studied and it works and is safe,he's a quack in my book. Rant off.

Well Mike, I can respect what you're saying, but there's a catch, see. Some of us have long memories, and it kind of changes how we see these things.

Alternative medicine folks were saying for years that anabolic steroids helped build muscle mass easily--and doctors were saying (rightly) that there was no scientific proof that it was so. Meanwhile, professional bodybuilders and weightlifters were snickering at the stupid doctors. That was as late as the 1970s.

As late as the 1980s, doctors were still saying "you get all the vitamins you need from a balanced diet, all vitamin pills give you is expensive urine." They were saying that for decades. Then the studies started showing up demonstrating reduced cancer risk, improved cardiovascular health, better longevity, improved serum lipids, reduced birth defects, etc. from any number of vitamin and mineral supplements, and whups, certain doctors who once had big mouths all of a sudden got reeeeeal quiet-like.

Which is why I tell my phsyician pals (I've had a few) to be careful about shooting your mouth off about untested therapies. The phrase "That's untested and I'm skeptical" is a lot safer if you know what I mean. ;-)

Thanks, Dean. But I'm not aware of any reputable studies showing those things you stated. For example, fiber to reduce colon cancer risk. Turns out it ain't so, though fiber has other benefits. Vitamin supplements to decrease cholesterol? Show me. Increased longevity from supplements? Impossible to prove; so many factors contribute to lifespan that the confounding variable are legion.

Any yes, I still say that all you get is expensive urine/stool. But show me a good study, not an anecdote, and I will accept correction, as I did with black cohosh, saw palmetto, glucosamine (though the chondroitin does nada).

You're not aware of naicin treatment to improve serum lipids? Read the studies referenced here for a start. Of course there's danger of liver damage from such supplementation, but it's not like no other treatment has that danger.

There are quite a number of studies showing the beneficial effects of antioxidents on immune system response and on aging and on reducing cancer risk; you can find a fairly good overview here.

At this point I'm not aware of anyone serious in the OB/GYN field who disputes that folic acid supplementation is beneficial.

There was a study released about four years ago that I'm having trouble locating at the moment which showed that people who took regular dietary vitamin and mineral supplements (no control for herbal remedies as I recall) tended to live 3-5 years longer than people who didn't, if you pester me I'll look harder for it. The debate it caused was basically over the question of whether it was the supploements themselves or the fact that people who spent time and money on vitamin pills didn't tend to be people who took better care of themselves in general....

There are several studies showing very good improvements to insulin response from regular chromium supplementation.

There's more, and it goes on a ways. What did you want to examine? There's been an explosion of research on these things in the last 10-15 years. But you can't demand that everything be double-blinded before you try it. As I think I said earlier, I'm not aware of any double-blind studies which demonstrate that emergency appendectomies save lives, and I'm not sure there are any which prove that cardiac bypass surgeries reduce mortality either, but I can assure you if I ever have either surgery recommended to me I probably won't call them quack medicine simply because they haven't been double-blinded.

Sorry, Dean. The article you cite does nothing of the kind. It A)**speculates** that antioxidant use **could** contribute to longevity **in a certain strain of mice**, but that is only speculation: the only results they actually got were that it did nothing for the animals they experimented on.
B)It notes that some studies have shown some changes in certain immune system processes in response to antioxidants, and in one case treated
**animal** subjects had lower than expected titers of virus in their lungs when infected. These findings in no way prove that antioxidants will make people live longer or have fewer diseases. Absolutely all they tell us is that they show possibilities which it would behoove us to explore further.

Now why do I make such a big deal about this? Two reasons:
A)misinterpretation of scientific studies is getting worse and worse, and frankly the quality of scientific studies is decreasing. It's almost as if today's scientists are a little scientifically illiterate. Studies are reported as demonstrating things they actually don't demonstrate, e.g. that antioxidants will make us live longer. They very well may, but so far I've not seen studies which prove it. The result of widespread acceptance of such poorly-supported conclusions is that
B)Dogmatic implications follow, such as "That doctor didn't even tell me to take plenty of vitamin E! He must not be any good. I'm finding another doctor." (to which sort of patient, by the way, I say please do so). Or, the "conspiracy" canard, that MDs are dismissing vitamin/antioxidant therapy for whatever economic/political/autoritarian/patriarchal dark motives move them.

Re: niacin. Not news to me; I wrote my first Rx for it about 1985. BUT hyperlipidemia is a disease, not a niacin deficiency, and to treat with niacin you must use supra-physiologic doses which produce-surprise!- side-effects like any other drug, as you correctly note.

Re: folate in OB/GYN. If you mean in pregnancy, you are talking about a condition which is well known to draw deeply on the woman's stores of nutrients, including iron and folate, so it's sort of a "physiologic" vitamin deficiency syndrome, if you will. So of course you treat it with vitamins. In neither of these cases are we talking about perfecly well patients taking vitamins/antioxidants to make themselves even more perfectly well, which is the implied benefit you allude to above.

I don't want to get in a peeing contest over this, Dean, but I would like to see that study that showed increased longevity. Because for it to show a difference in longevity--PROSPECTIVELY, not a retrospective study based on people's unreliable recollections of their dietary habits from years ago-- it would have to have begun about 60 years ago, no??

All I'm trying to say is that we must always keep in mind the limitations of scientific studies before we jump to conclusions--and, all too often, judgements. And we must remember our powerful tendency to BS ourselves, and to read into the data a conclusion we want to see.

Sorry, Dean. The article you cite does nothing of the kind. It A)**speculates** that antioxidant use **could** contribute to longevity **in a certain strain of mice**, but that is only speculation: the only results they actually got were that it did nothing for the animals they experimented on.
B)It notes that some studies have shown some changes in certain immune system processes in response to antioxidants, and in one case treated
**animal** subjects had lower than expected titers of virus in their lungs when infected. These findings in no way prove that antioxidants will make people live longer or have fewer diseases. Absolutely all they tell us is that they show possibilities which it would behoove us to explore further.

Now why do I make such a big deal about this? Two reasons:
A)misinterpretation of scientific studies is getting worse and worse, and frankly the quality of scientific studies is decreasing. It's almost as if today's scientists are a little scientifically illiterate. Studies are reported as demonstrating things they actually don't demonstrate, e.g. that antioxidants will make us live longer. They very well may, but so far I've not seen studies which prove it. The result of widespread acceptance of such poorly-supported conclusions is that
B)Dogmatic implications follow, such as "That doctor didn't even tell me to take plenty of vitamin E! He must not be any good. I'm finding another doctor." (to which sort of patient, by the way, I say please do so). Or, the "conspiracy" canard, that MDs are dismissing vitamin/antioxidant therapy for whatever economic/political/autoritarian/patriarchal dark motives move them.

Re: niacin. Not news to me; I wrote my first Rx for it about 1985. BUT hyperlipidemia is a disease, not a niacin deficiency, and to treat with niacin you must use supra-physiologic doses which produce-surprise!- side-effects like any other drug, as you correctly note.

Re: folate in OB/GYN. If you mean in pregnancy, you are talking about a condition which is well known to draw deeply on the woman's stores of nutrients, including iron and folate, so it's sort of a "physiologic" vitamin deficiency syndrome, if you will. So of course you treat it with vitamins. In neither of these cases are we talking about perfecly well patients taking vitamins/antioxidants to make themselves even more perfectly well, which is the implied benefit you allude to above.

I don't want to get in a peeing contest over this, Dean, but I would like to see that study that showed increased longevity. Because for it to show a difference in longevity--PROSPECTIVELY, not a retrospective study based on people's unreliable recollections of their dietary habits from years ago-- it would have to have begun about 60 years ago, no??

All I'm trying to say is that we must always keep in mind the limitations of scientific studies before we jump to conclusions--and, all too often, judgements. And we must remember our powerful tendency to BS ourselves, and to read into the data a conclusion we want to see.

All very reasonable, Mike, and I actually agree with you on the state of many medical studies and, much worse, popular accounts of them.

But all I'm saying in return is that the amount we don't know exceeds the amount we do know. (And by the way, is there anyone working in women's health who doesn't believe now that calcium supplementation is useful for menopausal and post-menopausal women?)

;-)

I'll look for the longevity study, it was only a few years ago.

But also, I'll point out that while you may note that the study on antioxidant only concluded that supplementation *might* be beneficial, it is also true that until just a few months ago, not one single study had ever shown that use of statin drugs reduced mortality? THat they all merely concluded that they *might* reduce risk of myocardial incidents and they *should* extend lifespan for heart patients?

So, how long exactly were you writing prescriptions for statin drugs before you there was any actual proof that you were extending your patients' lives?

I'm not trying to trick you, but I'm trying to make what I think is an important point: why would you treat drug therapies different from non-drug therapies? We have substantial evidence that higher intake of antioxidents like vitamin E are beneficial, more studies are being done, so what does the intelligent, thoughtful person do?

Oh, by the way, my chronic leg cramps went away when I started putting potassium salt on my food. Turns out that's less of a threat to the blood pressure too. Hmm..... (Still ribbing you a little there, Mike.)

I know that I generally derive several minor but not-inconsiderable changes to my health when I'm taking my thrice-daily supplements. Are the benefits minor? Probably. But to assume that it's entirely in my head? With all due respect, you have no more way of determining that than I do.

My favorite doctor was a man named Emil Schnellbacher who graduated medical school around 1955. He liked to tell that at his graduation ceremony was a doctor in his 70s, who told the class that 50% of what he'd learned in medical school turned out to be wrong. He then told everyone present that 50% of what they'd learned would turn out to be wrong too--but they had no idea which 50% so they'd better remember 100% of it.

Seems that lesson probably applies to more areas than medicine to me...

Dean, they said the same thing to me at my med school graduation.

You are absolutely right that the most important thing for us to learn is how little we actually know. At least for me that has been the most important thing about science.

RE statins: the thing is that we knew (thought we knew?) that elevated lipids are a cause of MI, and that people die from MI, and that reducing morbidity is as useful as reducing mortality, and that if you can do so at acceptable risk and cost, you should try. We simply had a lot more data to support the idea, a much stronger "might", than we have as yet for antioxidants.

In any case, it appears to me that we actually are in agreement, just in different ways. I try to keep in mind how little I know; it bugs me when I'm confronted by certitude when it's unjustified, that's all.

Nice blog, BTW. Just found it today.